Anaphylaxis and the Invisible Allergen

Today’s post is very real in my life; now, today, yesterday, tomorrow and perhaps until the day I die. White knuckles and EpiPens. This article explores Anaphylaxis and the Invisible Allergen. Cross reactivity can cause an allergic reaction due to protein commonalities. A seemingly invisible allergen. Cross reactivity. Be aware.

My Story

My daughter has life-threatening allergies. She was diagnosed with a peanut allergy one month ago. Everyone said if I was careful, I’d never have to use an EpiPen. Many people with allergies said they had never used theirs. I assumed that if the environment was allergen-free (peanut-free), she was safe.

Last week, she did not ingest any peanut. She nearly died twice, was rushed to emergency by ambulance, received an EpiPen injection and less than two days later, went back into anaphylaxis and back to emergency. In between was coughing, vomiting and fever. I naturally self-diagnosed my own condition as viral pneumonia, as my chest pain got worse and worse throughout the week. As my mind returned to it’s normal state for five minute periods of time, I learned that this was what they call a ‘panic attack’. Ah. Nailed it.

What happened here…

How does a child with a particular allergy go into severe anaphylaxis with seemingly no source? Although I have studied peanut allergies over the past month with more depth than I did for my entire university degree, no where did I read about a concept called cross-reactivity. Missed that critical portion of the whole allergy thing. I write this post today for all allergy parents.

Cross-reactivity is when an individual has a severe allergic reaction to either a similar allergen/protein or under conditions called co-factors. Peanut has similar proteins to pollen. Is it that simple? Did my daughter simply touch pollen on a very fluffy spring day? Perhaps, I thought. She wasn’t tested for environmental allergens.

Viral Infections as a Contributing Factor in Cross Reactivity

Two days after her severe reaction, I took her outside for fresh air. I saw pollen on the ground. I saw it in the trees and let her stand in it. She touched a flower. Then I took her inside, removed her clothing and began hive watch. Five minutes in, I saw hives. Things progressed slowly; then I noticed a second symptom. Medicine and off to the ER. Did only the minute of pollen contact send her into a reaction? Doubtful. An environmental allergen that severe was rare. Possible. But rare.

So what caused the reaction? Most likely, as hypothesized by three extremely experienced physicians, the trigger was a viral infection. She had a runny nose. She almost died. WTF…

Upon researching possible causes of spontaneous anaphylaxis, I came across an article published in the European Journal of Allergy and Clinical Immunology. The publication was about co-factors in anaphylaxis. It discussed why children in immuno-therapy for pollen had to be taken out of the program if they showed signs of a viral infection.

Findings from the Journal of Allergy and Clinical Immunology

“…the role of infections as co-factors of anaphylaxis is well documented in clinical trials with patients suffering from food allergy.”

“…bacterial or viral products can be sensed by receptors on mast cells and basophils and—under certain conditions—trigger or enhance mast cell degranulation. A model allowing to investigate how microbial factors act as co-factors of anaphylaxis is still lacking and research in this respect is ongoing”

Mast cells are the main players when in comes to anaphylactic reactions. Although it is clear this not a perfect theory, with many variables at hand, I believe it is worth acknowledging.

Awareness of symptoms is key

As a parent of a child with an allergy to a particular food, such as peanuts, there was an automatic assumption that allergen-free zones were safe zones. I was slightly less vigilant if I knew there was not a nut in sight. Nut free living for the win. I wrote this post because I believe to better care for our children, we need to watch for not only the allergen but symptoms, even in conditions that are deemed as safe. Co-factors, newly emerging allergens, cross-contamination, microbial factors and cross-reactivity are all worth taking into consideration when it comes to risk management. Ideally in risk management, a risk assessment will outline all risk factors.

I have learned the hard way that sometimes, the risk is unknown. Saying that, the symptoms are well known.

Instead of letting this story worry you, allow it to broaden your spectrum of risk management. Watch for not only an allergen, but symptoms. Be an attentive parent who can, perhaps, pick out symptoms of a reaction far before an allergen is identified. Shifting our perspective to symptom-watch, in addition to allergen-watch, could help save the life of your little one if the source of anaphylaxis is seemingly invisible.