Unanswered Questions

[BethelAbba]

I'm not unfamiliar with allergies, I've been lactose intolerant for at least 14 years now.   It came on when I was 36-38 and, well, I just adapted.  No big deal.

But in the last 3 years I have also had something come upon me that I can't explain and can't find information on.   I seem to be growing allergic to Peanut butter.   When I eat it, I start getting bloaty, gassy and ultimately I wind up with horrid diarrhea.  Why? I don't know.... and there seems to be no question I ask "GOOGLE" which gives me answers for late-in-life peanut butter allergies.

Anyone out there know anything?  Is there such a thing as a late-in-life peanut butter allergy?

[BethelAbba]

I guess a bit of information might help...

I'm 50.  I'm an American living in Taiwan.  I haven't had any allergy tests, I'm simply going by what and how my body reacts to various things.

I can't say that I eat totally healthy, but it's not all that easy to eat UN-healthy in Taiwan.  (They don't use a lot of sugar or salt... and the main meal staples are rice & veggies.)   I don't exercise, but I am fit and not fat.   I don't drink coffee. (can't stand the stuff)  I don't drink alcohol in any form.  (Dad was alcoholic)  Don't smoke. (See previous parenthesis) I don't drink coke or cola all that much (maybe once a week... maybe less) and desserts are a rarity.... just never really cared.


I stopped eating red meat for about 5 years, and only went back to it after moving to Taiwan.  I didn't stop because I was against it or anything.... just decided It wasn't all that necessary ... and when I went back to eating it... no ill affects.

In America I had regular health check ups (Slightly high Cholesterol, and only 5-10 pounds overweight) but here in Taiwan I don't have health insurance, so I haven't had a "checkup" in probably 7 years now. 

What I do have that I know about:  IBS, Diverticulitis (or is it Diverticulosis... I always forget which leads to which) and early in life ADHD.  Other than that I've been pretty healthy all my life.

That's about it.... 

[ninjaroll]

Anything is possible, and while you could be sensitizing to peanut there's several reasons I'd think not.

First, most adults don't sensitize to nuts later in life.  They can, but shellfish or crustaceans are the usual culprits.  Peanut butter is the last thing I would suspect if you were truly sensitizing to peanuts.  Peanuts are pretty much everywhere in food across Taiwan.  Yes, I'm very familiar with Taiwan in particular.  Peanut butter is harder to find than ground peanuts or boiled peanuts that's in much of the food.  Even 沙茶醬 comes in a variety with peanut in it and 沙茶醬 is used in so many foods.

The medical system there is quite affordable without insurance, we've used it before for ourselves and for our child.  That said you have to know people who know the right people to get to a good doctor.  Taiwan is actually the center of a lot of solid IgE-mediated allergy research hosting the APCAACI conference in 2013. 

I can get the name of a well qualified allergist there if you want to get started.  Hong Kong would be another option if you're paying out of pocket anyhow and since you're an American my understanding of our responsibilities living expatriate is that we still owe taxes 'here' so you may be able to write that off partially as medical expenditure.

All the other items are of no significance if you are concerned about IgE-mediated allergy to peanut.  Asthma, however, is related as is the tendency to be atopic.  The rest are unrelated general health items.

For peanut what I would be concerned about are really nasty bacteria.  Even in the US the peanut industry here has caused horrific public health issue do to outrageous sanitary conditions that killed some, sickened many more.  Honestly, if you're eating like a local you're probably eating a lot of peanut all the time. 

I'm probably the only regular on FAS that has specific knowledge of where you currently reside, FYI. 

[BethelAbba]

Anything is possible, and while you could be sensitizing to peanut there's several reasons I'd think not.

First, most adults don't sensitize to nuts later in life.  They can, but shellfish or crustaceans are the usual culprits.  Peanut butter is the last thing I would suspect if you were truly sensitizing to peanuts.  Peanuts are pretty much everywhere in food across Taiwan.  Yes, I'm very familiar with Taiwan in particular.  Peanut butter is harder to find than ground peanuts or boiled peanuts that's in much of the food.  Even 沙茶醬 comes in a variety with peanut in it and 沙茶醬 is used in so many foods.

Even still -- It's specifically peanut butter (and sometimes just plain peanuts) that sends me running to the bathroom and likewise makes my stomach ultra bloated / gassy for hours.   I ate 2 peanut butter sandwhiches for lunch at 2 PM.  It is now 3 AM... and my stomach has been keeping me going since 9:30 PM.... and I'm still awake because of it.   Seafood I can eat.  No hives, no rashes, no problems.   But Jiffy... or just plain salted peanuts... and ouch.

The medical system there is quite affordable without insurance, we've used it before for ourselves and for our child.  That said you have to know people who know the right people to get to a good doctor.  Taiwan is actually the center of a lot of solid IgE-mediated allergy research hosting the APCAACI conference in 2013. 

I do know it's a good system... but my Taiwanese wife and I are living on a single income (hers) and that limits our options.  It took me 5 years to get my ARC.  (No kidding.... 5 years...  We had to actually go through a government elected official on a specific committee in order to to by-pass imigration.  No fooling.)  It cost us several thousand (US) of our savings just to get that done.   Because I don't have a college degree ---- no work for the last 5 years.  It's only been the last 8 months that I've been able to legally work.   Sooooooo.... we're only just now back to saving $$$$ and we're gonna be applying that first to long-term health care insurance.   Allergies are low on the priority list, hence why I'm net-searching for answers.

I can get the name of a well qualified allergist there if you want to get started.  Hong Kong would be another option if you're paying out of pocket anyhow and since you're an American my understanding of our responsibilities living expatriate is that we still owe taxes 'here' so you may be able to write that off partially as medical expenditure.

The wife is sensitive to this.  She's pure DPP blue... if you know what I mean.  To her, the KMT are devils who invaded Taiwan and should all be expelled.  Thus --- Hong Kong is not an option.   Mention China in her presence and she's libel to sit you down and grill you on your loyalty to her nation.   

But there's a point here that I can help you on....   The IRS does not require anyone living abroad to file taxes, so long as they are under $80,000 US (per person filing, so if jointly, $160,000) in earned income on foreign soil.   This is not myth or rumor --- you can find this information directly at the IRS.gov website.  I researched the matter myself.... and likewise inquired of several tax lawyers on the matter.   It's a little known fact and it's helped us to plan our finances better.  ----->> edited additional info ---->> the only requirement is that you live outside of the USA for a total of 305 days in a calendar year.   I haven't been back to US soil since 2010... so no real issue there.

For peanut what I would be concerned about are really nasty bacteria.  Even in the US the peanut industry here has caused horrific public health issue do to outrageous sanitary conditions that killed some, sickened many more.  Honestly, if you're eating like a local you're probably eating a lot of peanut all the time. 

Yea, aware of the adoration of the peanut in this culture.  I've made many a joke about it.  Nevertheless .... whether its Costco bought Jiffy PB .... or local store bought, Taiwan-grown peanuts in a shell.... it's the same reaction.   Diarrhea, bloating and gas. (and occasional belching.   forgot about that.)

I'm probably the only regular on FAS that has specific knowledge of where you currently reside, FYI.

I fell in love with Taiwan when I came here to ask my wife's father's blessing upon our marriage.  5 days after I got here, I made the decision to reverse my plans to move my wife to America.  I have not regretted that change of plans for a single day.   Amazing country.  Wonderful people & culture.  And a wealth of opportunities.   I tell folk all the time that it's like living in 1950's Mayberry.  (The Andy Griffith Show) ---- (some) People leave their keys in their scooters overnight.... I mean, seriously... it's just that polite.   But you know what I mean.

how long were you here?

[ninjaroll]

Let me know if you need the name of a qualified allergist with the appropriate specialization in IgE-mediated food allergy.  If you've lived in country long enough in contiguous time blocks and have the equivalent of permanent residency or citizenship you should be eligible for national healthcare.  The specialist I would find should speak English if language is a barrier to medical care for you.  Describing symptoms or medical terms are different set of vocabulary than domestic conversations.

I'm not a doctor but I'd avoid the PB sandwiches for right now.  Getting an EpiPen, should you need one, could be a challenge.

The expatriate items or lifestyle I can't help with.  I don't live or visit there as an expatriate.  Hong Kong is a typical commuter flight for many Taiwanese in case you're only getting limited information from a spouse.  With a USA passport as a foreigner you would be under very little scrutiny and would enjoy the privilege accorded to a US citizen.  There are plenty of resident Taiwanese in HK and many visit both there and on the actual Mainland.  But Singapore would be an option as well.  Dr. Hugo Von Bever in Singapore.  You could reach out to him via email, and they may have better access to medicines there for you as well (should you need it).

[Macabre]

There are a few members here who do have adult onset allergy to peanut, so while it might be less rare than shellfish (I'm adult onset allergic to shellfish and sesame and other stuff), it can certainly happen. 

I did have symptoms after eating peanuts and tested positive to it for a few years and now do not test positive.   One of my symptoms was just like what you described--D with gas and bloating. The gas and bloating by itself aren't normally considered allergy symptoms, but I'll say I do have that with shellfish and did have it with peanuts  With peanuts, it started 20 minutes after ingestion, but with shellfish, it is 2 hours (and that is unusual for an Ige mediated allergy).

Have you tried Benadryl (dyphenhydramine) to see if you get relief?  If you do, it doesn't necessarily mean it's an actual allergy.  Benadryl helps calm GI issues.


Know this:  if you experience two or more body system symptoms (like diarrhea AND hives or a nose running like a faucet, OR throat closing alone), you should seek emergency care.  That would be the reason for someone with a diagnosed life threatening food allergy to use their EpiPen and call for transport to a hospital. 

Benadryl can help a minor reaction, but it won't undo anaphylaxis. 

I would get tested for a peanut allergy with a blood test if I were in your position.

[ninjaroll]

Yes, but food and health care run so differently.  Eating PB sandwich would take some work.  Peanuts are all throughout the food on a regular basis.  Chances are he is eating it.  It's one of the reasons you'll hear of someone in a FARE newsletter talking of a successful trip to "Asia" with great labeling when really they went to Hong Kong or Singapore.  Taiwan is not like that, it does not have a sizable expat community compared to the other two. 

To get to a real health care professional you have to know people.  Even to exchange currency you have to know someone.  The theme is to know someone.  That's how things run there.

And honestly if the only people he knows are that hardcore DPP he's probably further south because north is KMT stronghold with a higher population born out of province.  That means his closest real hospital choice may be even further south towards Kaoshiung especially if he's near the Costco.

You can't just walk in somewhere there like you can in the US.  Plus it increases his chances of seeing someone who will grossly misdiagnose him with something else. So, he can't really do as he would if he were in the US.

I'll get the name by tonight. It will have resources in Chinese as well.  At the very least you can print it out and take it with you to let it do the talking before someone sends you to Snake Alley.

[ninjaroll]

Since I'm guessing by the political affiliation and Costco reference your physical geography is around Kaoshiung you should be in decent shape to get to Tainan.  There are a quite a few medical facilities in Kaoshiung, I know some of the people that run them.  For allergies I'd see if you can't get in touch with Dr. Wang Jiu-Yao in Tainan at National Cheng Kung University.  He's a pediatric allergist but he's the right type of allergist, the type that we're talking about and that Macabre mentions to see for blood and skin testing.  He's extremely well published so I'm guessing they follow the discipline's standard protocols including in office oral challenges.

http://ped.hosp.ncku.edu.tw/english/xoops2/modules/tinyd0/index.php?id=4

If not Tainan, then Dr. Hugo Van Bever in Singapore if you don't want the commuter flight to Hong Kong.  http://www.nuh.com.sg/scripts/WebFormShowProfile.aspx?id=13383

Academia Sinica is up north in Taipei but if I understand it correctly it's mainly a research facility.  Worst case scenario print out what resources you can about food allergy and anaphylaxis from the Nat'l Cheng Kung allergy page in Chinese and English to bring to a more local doctor.  They'll likely ignore it but that's Taiwan for you.  You live and die by the system there.  You either know someone who can get you in places, or you don't.

Van Bever might be a good resource to tap if he has a colleague or two he has a relationship with in Taiwan and could pave the way. If you do have a Costco membership and actually do live near the Costco it might be worthwhile to see if you can get a script for an EpiPen there.  I don't even know how you'd enact an emergency action plan there if you live out where I think you may live.

[BethelAbba]

Since I'm guessing by the political affiliation and Costco reference your physical geography is around Kaoshiung you should be in decent shape to get to Tainan.  There are a quite a few medical facilities in Kaoshiung, I know some of the people that run them.  For allergies I'd see if you can't get in touch with Dr. Wang Jiu-Yao in Tainan at National Cheng Kung University.  He's a pediatric allergist but he's the right type of allergist, the type that we're talking about and that Macabre mentions to see for blood and skin testing.  He's extremely well published so I'm guessing they follow the discipline's standard protocols including in office oral challenges.

How long HAS it been since you lived in Taiwan?  --- Kaoshiung is not the only city with a Costco.... there are something like 12 of them around the island, with 2 more coming later this year.   I actually live in Bali, across from Danshui.... outside of Taipei.    The KMT reference is mainly to infer that going to Hong Kong for "Help" wasn't really an option due to my wife's hatred for all things "CHINA".   I used to have a corporate level job with Best Buy.   I had the option to work in our Shang-Hai branch and actually fly back to Taiwan for weekends.  My wife said effectively: Pick sex with me or pick the job.....   it was kinda a persuasive argument to say the least.   She did that because she honestly despises China... and hates the fact that they "Assume" ownership over Taiwan.  So I kissed goodbye to a 13 year stint with one of the greatest companies in America to work for.

But enough of the history lesson....  Yeah, Tainan is an option, the in-laws live there.


But you are taking this in directions I had not considered and I'm curious why.

My allergy to peanuts affects my stomach and digestion primarily.   You're talking Epi-pens.... and making it sound like it could be something dangerous.   I'm not catching the logical flow here... what is danger of the allergy that I am not seeing?

I know that early-life peanut allergies can be life threatening even down to one peanut..... but would that be the same for late-in life onset allergies?   

I ate peanuts yesterday.  I am not dead today.   Is there a risk of that tomorrow?

You've got my curiousity piqued in directions I hadn't considered.

[ninjaroll]

Yeah.  I'm just gonna let Macabre take over from here.  He's all yours.

[BethelAbba]

Yeah.  I'm just gonna let Macabre take over from here.  He's all yours.

I got a good laugh out of this... not sure if you're referencing an actual member here or just dark thoughts in general... but good come-back.

You never did say what your knowledge of Taiwan stems from.   When were you here last?

[hezzier]

Macabre is a member here.

Here is a basic answer to your risk question...

http://allergicliving.com/2013/09/13/can-you-tell-if-a-food-allergy-is-life-threatening/

[GoingNuts]

BethelAbba, ninjaroll is referring to Epipens because it's impossible to know without testing whether your reactions are more of a digestive intolerance (a la lactose intolerance, which is not the same as an allergy) or a true  IgE mediated allergy.  If it is the latter, your reactions can change abruptly and without warning - meaning that just because you ingested peanuts yesterday and aren't dead today, doesn't mean that won't be the case tomorrow.  This can be dependent on an abundance of factors, such as amount ingested, what else is in your stomach at the time, and whether the month has a "r" in it.  (Just kidding on the last one, but it really can be that random!)

It really is something that you need to sort out, and yes, adult onset allergies can be just as life threatening as allergies that make themselves known early in life. 

[Macabre]

And it could take far less than one peanut. 

I'll repeat that adult onset allergies are just as dangerous and ones acquired as a child. Your mast cells don't get to use the "but I'm old" excuse.

I have had anaphylaxis from residue on tongs.  Now it involved shellfish, but my beef that was cooked in a clean pan that shrimp had not been in was turned with tongs that had been used with shrimp.

I had anaphylaxis. It started with a spaciness/disoriented feeling. Then I had stomach cramps and diarrhea.  Then nausea.  These were unabated by taking Benadryl for hours. After several hours--when I experienced chest pains and and had an impending sense of doom, I finally took the EpiPen. And I still ezpeirnced uterine cramping for days (anaphylaxis can affect smooth muscle tissue).

Symptoms can change over time--and not even long periods of time. There are soooooo many stories of parents and spouses saying, "His allergy was never bad before. Benadryl had always worked." And they are speaking in the past tense about their loved one.

So here is the thing:  if you are having symptoms after eating peanuts, you need to go to an allergist to determine if you are allergic. If you are, you need to carry epinephrine eith you at all times. Two injectors.  EpiPens are big, but most deaths result from not having epinephrine with them or not using it until it was too late. AuviQs are smaller--the size of an iPhone. 

You have to replace the auto injectors every year and they can't be exposed to extreme heat or cold. 

And you use them if you have two body systems respond or one system and its your throat. You use Epi and you get transport to the hospital. If symptoms don't improve in five minutes you use your second Epi.

There is an allergist with a peanut allergy, Dr Robert Wood. He had anaphylaxis because the spatula used to lift his otherwise safe cookies had been used on PB cookies earlier.   He had to have FIVE epis. That was from a little cross contamination. 

If you are allergic know that woks are rarely cleaned between uses in the US (and I assume elsewhere).  They will continue to have peanut protein.  And egg rolls are often pastes together with peanut Paste. Also most all treenuts are made on the same equipment as peanuts.

So--get this checked out and if you are allergic, take care of yourself properly or you could die. 

[Macabre]

And it could take far less than one peanut. 

I'll repeat that adult onset allergies are just as dangerous and ones acquired as a child. Your mast cells don't get to use the %2