Possible anaphylaxis in a Mexican restaurant
Question:
1/27/2016
On two separate occasions a patient was at a Mexican restaurant and developed itching, ears felt swollen, lip and tongue swelling and trouble speaking. Skin became red and hives appeared. He was treated in the ER with antihistamine and Epinephrine. The first occasion he had also just started using Lactaid- he was concerned it was a reaction to this new medication so he did avoid taking it again. The reactions were in two different Mexican Restaurants. Is there any research in this area which would be helpful in the treatment of this patient?
Answer:
The episodes are convincing to me for an acute systemic reaction consistent with anaphylaxis. Determining the cause of anaphylaxis requires extensive history so I cannot comment as to whether there is any research related to your patient, since the cause is unknown at this time.
I do not think there is any relationship with Lactaid since this was ingested prior to only one reaction and would not be expected to cause anaphylaxis unless he is milk allergic. My suggestions would be the following:
1. Determine if there are any ingestants common to both restaurant meals and try to test to potential allergens identified.
2. Consider a baseline tryptase to determine if your patient may be at heightened risk of anaphylaxis in general.
3. Provide epinephrine autoinjector since currently there is no identified cause and idiopathic anaphylaxis is a consideration.
I hope this information is of help to you and your patient.
All my best.
Dennis K. Ledford, MD, FAAAAI