Mystery Reactions

[SilverLining]

When someone in your family has a mystery reaction, how do you deal with it after-the-fact.

To our knowledge, ds has no food allergies. Usually we assume a minor mystery reaction is either a bug bite or cat hair somehow got into his clothing.  But this one was different.

He says the reaction started before we went out shopping.  (We went out around noon.) He came and showed me the hives around five-ish. His back was covered and they were itchy. I gave him benedryl and he sat in the tub.  The back calmed down, but then his ankles and legs broke out in itchy hives. Gave him more benedryl.

For a little over 24 hours, hives moving back and forth between back, legs, hands, arms.

He's never had a moving reaction like that.....and when it happened to me it was a precursor to anaphylaxis.

So....we started thinking....what's new?

Same bath soap, shampoo, laundry soap, dishsoap.

Ate donuts he hasn't had in a long time......maybe?
Tried on a lot of coats. Bought one....wool.  That's new. 

He returned to school today, but I didn't let him wear new coat...and it bitter cold.  I feel like the grand winner of bad-mommy award. 

He swears reaction started first.  But he also didn't get up and look when he woke up itchy....so I'm not sure I trust him right now.

~~~~

So, with a mystery reaction, what do YOU do about anything new? How long before reintroducing?  Or do you just get rid of everything new?

[PurpleCat]

Have you considered having the coat cleaned?  Someone could have contaminated it when they tried it on or any of the other coats he tried on.  Anything new for DD gets cleaned or laundered before she wears it.

I don't automatically get rid of anything new.  Every situation is different.  Has he worn any wool in the past?  I love wool but it makes me itchy all over - not an allergy for me, just itchy.  I can wear a wool coat if it has a lining and I have a scarf on to keep it from touching my neck.

He could have come into contact with many things during the course of his day and the shopping trip.  Not to mention just being out in public with perfumes, airborne foods, etc....

Is this a continuation of his reaction that needed an EPI?  My DD has lingering and changing symptoms after anaphylaxis.  Prednisone usually keeps them benign but right when she gets off that her skin gets crazy with eczema often requiring a topical script to calm it down.  It takes her whole system 2 - 3 weeks to "relax" again.

I'd see how his hives are after school and take it from there.  Hopefully all symptoms are resolved.

[CMdeux]

When someone in your family has a mystery reaction, how do you deal with it after-the-fact.

--------------------

So, with a mystery reaction, what do YOU do about anything new? How long before reintroducing?  Or do you just get rid of everything new?



I haven't read the rest of your post, Silver, because I do get the sense that you'd like a check of what we actually do-- and sadly, I have some very recent experience to draw from.

I become Torquemada.  No, really.  I should insert a blushing emoticon here. 



What were you doing at the time?  No-- details.  Who was with you, where had they been, did so-and-so-wash his/her hands, was anything else happening around you, give me details of sensory inputs-- WALK.ME.THROUGH.IT.

I have never been so happy (well, okay-- um-- probably not the right term) as when DD's boyfriend proved to be someone with near-eidectic memory and sequencing this past three weeks.  He pays a TON of attention to his surroundings, and he operates nearly like a video recorder on replay.  It was awesome, and it allowed me to make some serious educated guesses as to the causation of that most recent reaction-- and making that educated guess, and talking to Dr. Awesome about it, to make changes in our pharmacology.


Anyway.  I digress.

After "walk me through it" I basically repeat that process going backwards in time step-by-step, about 30 minutes for each "step" until I get a list of suspect things.  GI reactions, always focus on food or sources of food residue and possible routes of consumption.  ALWAYS.

Reactions that present cutaneously or with asthmatic symptoms tend to be environmental exposures, though with DD's threshold, that includes food as well.

We do look at "what was new" but probably not as rigorously as we examine potential routes of food exposure-- locations, events, activities occurring in those venues, previous contact and transfer, people and where they have been, etc.  KWIM?  That is idiosyncratic, but it's based on what we know from DD's history. 



For example:

One recent mystery reaction started at the end of a play that we saw-- me, DD, and her boyfriend.   This was kind of vague/nonspecifically "allergic" initially, as it presented as lower-GI/pelvic PAIN.    So, in the hotel room, she, her boyfriend, and I walked it backwards-- when did the pain start?  Was it always this intense, or did it escalate?  Period pain?  (no) Mittelschmertz?  (no again-- timing all wrong for either).  Benadryl helped enormously-- heat and ibuprofen did NOT.  Those answers led me to begin walking backwards in time as I became convinced that it was allergy-related...

Did she touch anything leaving the theater?  No-- her hands were in her pockets, and she washed them upon returning to the hotel, and hadn't eaten in hours.
Did she touch anything IN the theater?  Perhaps-- arm-rests?  floor to pick up her program/epipens?
Did the production use fake smoke?  (meh... MAYbe?  but this reaction didn't present as asthmatic at all-- and that is almost beyond belief if that were the route of exposure)
When is the last time she ate or drank anything?-- intermission, bottled water, maybe a couple of Altoid mints from the (fresh!) tin in my purse
Where did that water come from?  Boyfriend went and got it from concession in theater lobby.... aha!!

What else do they sell?  Nuts?  (YES!  ding-ding-ding-ding-ding!!-- this is why we think that this one in particular was probably an ingestion of residue-- it was too 'big' a reaction to have been from the theater seat, or from me having contaminated the Altoid tin from a similar kind of residue pick-up on MY hands... so it was a more concentrated source-- and it probably wasn't one of the three of us, since we'd all been VERY conscientiously nut-free for the entire weekend and then some)



Does that help?

Now I'll go back and re-read your entire post to see if I'm on the right track here.

[CMdeux]

Okay-- the "what was new" issue.  Hmm.

Yes, we tend to reintroduce.  After DD's barforama reaction this past week, I let her make the call on that-- because immediately prior, she had eaten something from Trader joe's, and a bread product that should both have been safe, and which she has eaten previously, but-- the container from TJ's was new and she opened it.

So there were definitely different factors that were possible causative agents, and (like you) we didn't really want to 'reproduce' the chain of events, but DID want to eliminate things that seemed improbable.

So she tried the bread product the very next morning (her idea, not mine-- I'd have waited until she at least was benadryl-free!) and then the following day, the TJ's thing again-- out of the same container-- to absolutely zero ill effects.  She also rode in BF's Dad's car again about three days later--

so we truly don't know what was behind that reaction, and may never know.  It was pretty major.  I suspect that we know the allergen-- had to be pistachio, peanut, or cashew for the amount to be small enough that we can't find it, and still enough to have done what it did.  KWIM?




Sounds like this rxn is cutaneous, mostly-- I'd guess maybe some combination of viral/bug/hot water?  If he says it started before the coat, get it cleaned and put it back in play.  That's me, though. 

[SilverLining]

Have you considered having the coat cleaned?  Someone could have contaminated it when they tried it on or any of the other coats he tried on.  Anything new for DD gets cleaned or laundered before she wears it.

We wash all new clothes except coats.  And since he had tried on a lot, various fibres, if it started after shopping it could have been any.

I don't automatically get rid of anything new.  Every situation is different.  Has he worn any wool in the past?

I'm actually not sure.

Is this a continuation of his reaction that needed an EPI?  My DD has lingering and changing symptoms after anaphylaxis. 

It wasn't my son that needed epi.  I initially thought his reaction was mould in the leaves....and that is still a possibility.


Thank you for your input.

[SilverLining]

When someone in your family has a mystery reaction, how do you deal with it after-the-fact.

--------------------

So, with a mystery reaction, what do YOU do about anything new? How long before reintroducing?  Or do you just get rid of everything new?



I haven't read the rest of your post, Silver, because I do get the sense that you'd like a check of what we actually do-- and sadly, I have some very recent experience to draw from.

Yes, I do want what people actually do. Not just for me, but I think this topic could prove useful for others. So many of us at one time or another deal with the mystery reactions, I can't be the only one who second guesses myself and thinks I may have overlooked the obvious.

I have never been so happy (well, okay-- um-- probably not the right term) as when DD's boyfriend proved to be someone with near-eidectic memory and sequencing this past three weeks.  He pays a TON of attention to his surroundings, and he operates nearly like a video recorder on replay.

I'll just call him Sheldon from now on.

~~~~

Assuming ds was being completely honest ( and it's very unfair if me to doubt him) he was sitting in his room on the computer. He had eaten breakfast, but with no known fa's that shouldn't be an issue.  Showered, and played video games.

I did pull apart his room and found some spiders hiding. Not a lot, but could have bit through the night.  And of course, there is all those leaves that have fallen off the trees. There is always mould in them. Though, again, that shouldn't have affected him inside the house with no windows open.

[SilverLining]

Ok...just realized, there are two things different about this reaction.

The first was the moving hives.

The second is, his eyes were not affected.  Both cats and mould swell his eyes, and can cause some breathing issues.

So, that leads me to believe it was an insect, or something new.

[CMdeux]

Yeah-- I picked up on that.  It was that the reactivity pattern was different, and "off" for a known allergen.

The thing is, though, reactivity can really shift in teens.  I'm guessing leaf mold is playing a role, too.   We've certainly had that in play here as well.  It's ugly.

[GoingNuts]

Any viruses lately, SL?

[SilverLining]

No viruses.

No problems today at school.

[PurpleCat]

Oh shoot!  Wrong kid!  Sorry.  Too many FAS kiddos with reactions I'm getting confused.

How was your DS this morning?  Any more symptoms?

[SilverLining]

Oh shoot!  Wrong kid!  Sorry.  Too many FAS kiddos with reactions I'm getting confused.

How was your DS this morning?  Any more symptoms?

Honest mistake.  And possibly contributed to my anxiety.  (Also someone I know IRL had an anaphylactic reaction as well.)

He seems fine this morning.  He chose to give an extra day before trying the new coat again. I think I'll have him wear it a bit tonight, just to relieve myself.

[PurpleCat]

Good idea having a trial run with the coat.  Glad to hear he is doing well. 

[SilverLining]

So he wore the new coat to shovel the walk last night. No problems, so he wore it to school today.

[becca]

Dh had hives like that once and we presumed laundry soap.  Same old one, but new HE washer so maybe leaving more residue.  We never knew for sure bot did loads of rising and changed to a milder soap.  His was awful, for a couple of weeks, moving around but flaring badly where underwear rubbed, armpits, etc...  He ended up with a Rx. antihistamine.  Atarax?  dd had similar once, after a fragranced version of a lotion. I only had some on my hands, had not applied it to her.  It started as handprints where I touched her.  Seriously.  That was a few days on benadryl and kept blooming as the benadryl wore off. 

Sounds like he is better, though.