For 4 weeks, a 32 year old woman has had daily attacks of hives all over her body (urticaria) sometimes associated with swelling of the lips and around the eyes.
Food triggers will be excluded by a careful and detailed history followed by allergy skin prick testing. Increased doses of antihistamines and other drugs will be considered if food allergy is not shown to be the trigger.
Whilst on holiday in France, a known peanut allergic child was eating an apple pastry. He developed an acute allergic reaction and there was no known peanut contamination.
Skin prick testing to lupin bean flour was strongly positive. Lupin bean flour is added to wheat flours used in making pastries in France. It is a member of the legume family, alongside peanut.
An 8 year old took two bites of a nut cereal bar and immediately had itching and tightness of his throat and became covered in a red rash on his body. He was appropriately treated by the emergency services.
He needs specialist advice including skin prick testing to a variety of nuts. Correct advice on avoidance of nuts and related foods is essential. An emergency plan would include an Adrenaline auto-injector and advice/training of its use.
50 year old man is stung on his hand by a bee or wasp. He rapidly develops local hand swelling and hives appear on his body and he feels faint. Emergency services are summoned.
Subsequently he needs specialist advice to confirm the origin of the sting and develop an emergency treatment plan including an Adrenaline auto-injector. He may be considered for desensitisation to wasp or bee venom.
A 31 year old with a long history of bloating after most meals and embarrassing excessive wind. Following eating a meal at a Chinese Restaurant she develops sweating, palpitations, lightheadedness and diarrhoea.
This is most likely to be due to food intolerance related to monosodium glutamate (E621). Specialist advice will confirm the condition and detailed advice on avoidance given to alleviate the problem.
A 35 year old finds that avoiding wheat in her diet improves her abdominal bloating and well being.
Problems with wheat include allergy, intolerance and coeliac disease. Specialist advice and investigations will help determine the underlying nature of the problem.
A 28 year old whilst eating a well-cooked tuna steak developed redness and burning over the whole body. Diarrhoea and vomiting rapidly followed.
This is scombroid fish poisoning rather than a tuna fish allergy. Skin prick testing to exclude allergy and a supervised oral challenge with tuna may be required.
62 year old male develops large swellings of his lips, face and tongue. He finds these episodes extremely frightening. They can appear at any time. He has a past history of high blood pressure.
This is most likely to be due to his blood pressure tablets (ACE inhibitors). This can occur several years after starting the treatment. The swellings tend to be more severe on each subsequent attack. An appropriate replacement drug to treat his raised blood pressure will need to be identified.