Type I Hypersensitivity

November 6, 2018

I had another allergic reaction, once again after specifically inquiring  about a dish’s peanut content. I noticed suspiciously peanut-like “macadamia nut” pieces that tasted an awful lot like peanuts to my companion, but after being assured they were not peanuts, the first bite determined that was a lie. Perhaps it was the sauce? I haven’t seen poke with peanut sauce before but hey, there’s always a first time.

One might think it would be obvious that someone asking about a a food ingredient due to a peanut allergy would be interested to know if some other component of the dish was, say, peanut. I’m beginning to wonder if restauranteurs in San Diego know what peanuts are.

Regardless, having been reassured that there were no peanuts, I took a big, delicious bite, telling my friend, “I would know by now if there was…” Which is precisely when I began noticing the reaction. It was fast and bad. I didn’t have my EpiPen with me because of style: my messenger bag is breaking down, starting with the zippers. Instead, I slammed two diphenhydramine and excused myself to the bathroom to throw up while we waited for the check.


Flashback: one month ago

I did an elective rotation in Allergy and Immunology, in part due to self-interested curiosity. One of the many fantastic attending physicians I worked with was Dr. Stephanie Leonard, who specializes in food allergies, and has a peanut allergy herself (one of the many cool things she’s involved in is a research study about de-sensitizing kids to peanuts). She was incredibly patient, giving me the chance to ask years’ worth of allergy questions. It turns out items like peanuts, peas, and lentils are more closely related in their antigenicity than their classification taxonomy, a factoid that finally explains my off-limits list

As allergy kindred spirits, we talked about some of our recent dining mishaps. I told her the story of my first week in San Diego, innocently admitting that I have never used my EpiPen, only diphenhydramine. Her subsequent scolding was swift and culminated in me getting four new EpiPens (actually a different type of epinephrine autoinjector, but same idea).


Back home and throwing up several more times in the bathroom, I heard Dr. Leonard scolding me in my mind. Already flushed with shame from ruining dinner (and, I suppose, that whole anaphylaxis thing), I found an EpiPen. Ever the scientist, I did use one that was three years expired. Jabbed it into my thigh…click…count ten seconds…withdraw. I noticed that somehow I had managed to bend the needle while it was in my leg. A drop of blood pooled from the injection site as I waited. It grew larger and began to run. And, miraculously, my symptoms started to subside: the constricting airway, vomiting, cramping, and prickling of early hives all faded away. 

About ninety minutes later, we got Wendy’s.


Note: Type 1 hypersensitivity is an immune system response that involves an immediate allergic reaction provoked by exposure to a specific antigen, such as a peanut. It’s also the process involved in milder allergies, like hay fever. 

Welcome to San Diego

July 29, 2018

Moving here has been less than smooth, but in my first week it really went off-script. It started well enough, with our friends Jon and John graciously helping us load the U-Haul late into the night. Jon even came with us the following morning to take a vanload of stuff down and unload said truck. With additional aid  from my new benevolent new child neuro colleague Adam, we were able to finish remarkably quickly.

Having worked up an appetite, Jon and I went  to Lucha Libre,  a highly-rated taco shop with multiple locations in San Diego that is fantastically committed to its theme. Instead of tacos, though, I was taken in by their enchiladas smothered in mole sauce. Mole sauce can be made a number of different ways, but some of them involve peanuts, which is an unequivocal dealbreaker. When I asked about this I was assured that no peanuts were involved in the making of this sauce, so when I got my food I began eating with a heartiness befitting someone who spent the morning hauling heavy objects from place to place. Two sizable bites in, however, the tingling sensation from my tongue went luchador on my brain, cluing it in that Something Was Very Wrong and activating subroutine What to Do Next. I excused myself to the bathroom, induced vomiting, cleaned myself up, and took three diphenhydramine from an emergency kit Rachel insists I keep on hand for some reason. What followed was an exercise in Trying to Act Normal while fighting the intense drowsiness brought on by 75 mg of H1 inverse agonist.

I made it home, said my goodbyes, vomited some more (spontaneously now), and fought back the haze, because  that evening was the first unofficial meetup of my intern class. Events like moving and starting a new job are seismic events that temporarily disrupt one’s social network, and the UCSD Pediatrics Interns of 2018 were keen to make as many new connections as possible before the dust settled. Thankfully my new child neuro colleague Adam offered to give me a ride as I was…indisposed to drive. I worked hard to project that Everything Was  Definitely Totally Normal despite the type I hypersensitivity reaction straining against the bonds of medication.  Nobody noticed, in part because we ended up waging an unspoken battle with the DJ, who over the next several hours struggled to drive 20-odd new resident physicians getting to know each other off his dance floor. He eventually won through a combination of increasing the volume to the point where we couldn’t hear each other and importing people who wanted to dance from other parts of the bar.

I got home, collapsed into bed, and slept well into the following morning. That night was the first official class meetup, where I was able to confirm with a clearer head that my soon-to-be-coworkers were as cool as I’d thought the previous night. I very carefully ate a bit of food without incident, happy to be putting the whole mishap behind me.

On Day Three I met up with our good friend Ashley, who has lived in San Diego for ages, for a dinner of tasty tamales. She was buying a car for her move to Guam that would take place mere weeks after my arrival–karmic retribution for what I did to another good friend back when I moved to California. As it turned out, additional negotiations were yet required, turning a brief trip in to a much longer ordeal. This made it all the more awkward when I noticed that my skin was gradually reddening with each passing minute. I tried convincing myself it was sunburn, but when the patches started swelling into wheals, I was forced to admit that it was the all-too-familiar urticarial rash.

I’ve had this damn allergy my entire life, and the symptoms always follow a specific sequential pattern that begins with an ominous tingling sensation in my tongue and oral structures and is the time where a precision strike with antihistamine can prevent some of the worst symptoms. By the time hives have started, though, all hope of a swift recovery is lost. Somehow, I had skipped past all the early warning signs and jumped directly to late stage, next stop anaphylaxis territory. Maybe it was some kind of hypersensitivity or IgE cross-reactivity from first event, or perhaps the allergenic compound was hidden especially well–although I’ve never heard of peanut anything being used in tamales. I vomited as quietly as possible in the dealership bathroom, took several DPH, and drove myself directly home, forgetting in my haze that I was driving Ashley’s car with her house keys. I stripped in front of the mirror to reveal a body more Red Skull than my own. After that night, it no longer mattered that I hadn’t purchased any food for the house: regurgitated gastric acid and hours of retching wrecked my esophagus and upper airway enough that I was disinclined to bother eating solids for the next several days.

One of the many fetch quests during orientation week involved collecting our newly-printed badges. As the others posted for a picture, our dear program coordinator informed me that, unfortunately, there had been a problem and mine wasn’t ready.