Tag Archives: health

Only a Test. (Whew!)

A couple of days ago I developed a cough and measured a fever. The cough has been very intermittent, and the fever went away after a couple of hours.

Still, I went for a Covid-19 test after measuring the fever, and we all went into lockdown mode just in case. No errands or walks. Just picking up the mail. Extra hand washing. Keeping physical distance at home. It could easily be a false alarm, but with cases surging, it seemed like a good idea to be certain.

All the drive-through centers in the area seem to be closed and I had to go to an urgent care. Instead of letting people in the waiting room, they were checking us in at the door, taking a phone number, and having us wait in our cars. An hour and a half later, they called me in. After checking vitals and symptoms, they actually had me swab my own nostrils with a q-tip and put it in a sample vial.

I got the results two days later through the network’s online portal: negative!

So with the cough and fever gone, and the coronavirus test negative, we can at least return to…well, whatever this is. It’s certainly not “normal.”

(This year has brought it home that “normal” doesn’t really exist – the world is in a constant state of flux, and what we consider “normal” are just local circumstances in time and space.)

But I can go back to daily walks (masked), drive-through and curbside pickup for errands (masked), and only having to keep my distance outside the house.

Flu in the time of Covid-19

Last weekend, after spending Saturday running errands and Sunday taking care of stuff around the house, I went out to de-stress with a photo-walk at the coast, taking pictures of shorebirds, waves, sailboats, sand patterns and a zillon tiny shells. On the way back I started feeling aches and chills, and by evening I had a 101-degree fever and felt kind of like Firestorm.

Everything has pointed to the flu, and it’s been manageable with home care, so I’ve been staying home all week, alternating sick days and remote work depending on how much I can handle each day.

Meanwhile, Covid-19 has continued to spread across the world. Literally the next day, Los Angeles County announced the first confirmed case of community spread. Events are being canceled left and right, schools and museums and even Disneyland are closing, whole countries have implemented quarantines, and it’s become blindingly obvious that it’s no longer possible to contain, we can only hope to flatten the curve and keep the pandemic from overwhelming the health system by hitting too many at the same time.

It’s been a really weird week to stay home sick with something else.

On one hand it’s been kind of a trial run, which is useful. Practicing the extra hand washing, distancing, trying not to get anyone else in the house sick, all that. But on the other hand there’s the understanding that I’m probably going to have to go through it again when one of us gets actual covid-19. There’s a part of me that wants to get it over with, like being sentenced to time served.

I’m not especially worried about us, since we’re reasonably young and healthy to start with, so we’re likely to recover if and when we get it. Probably without hospitalization. But I certainly don’t want to spread it to someone at greater risk, so I’m totally on board with remote working (post-flu) and avoiding crowds.

Still, I hope that there’s a gap between when I’m no longer wiped-out/contagious from the flu and any potential lockdowns in this area (general or just our house). I’d like to be able to do supply runs, though we’ve been building up a bit of a cushion on each grocery trip. I’d like to be able to pick up takeout from local restaurants while they’re open. I may need to pick up a new thermometer since the button on this one has gotten temperamental with all the times I’ve used it this week.

But mostly I want to be able to spend at least some time outside. I get cabin fever. Tuesday I was already pacing the living room between bouts of fatigue. Wednesday I was excited to walk to the mailbox. And that’s only after a few days. I don’t need to be around lots of people. I like outdoor solitude. Hiking nature preserves. Photo walks like the one I did right before the flu hit me. Even just walking circuits around the neighborhood. If I can keep doing that, this will be a lot easier to manage.

Yes, Adults Have Food Allergies Too — More Than Previously Thought

Discussion of food allergies tends to focus on children (for a lot of reasons), but a recent study found a much higher rate of food allergies among adults than expected. They found that 10.8 percent of American adults – that extrapolates to 26 million people! — reported a convincing food allergy (based on actual symptoms reported – another 9% reported allergies, but their symptoms didn’t match the diagnosis – presumably at least some of the rest are genuine intolerances). That’s actually higher than the rate among children found by another recent study, which came up with 7.6%.

Now, my first thought on reading this was: Of course! Kids with food allergies who were counted 10, 20, 30 years ago have grown up, and we’re adults now! But it’s more than that: There’s a lot more adult-onset allergies than anyone expected to find.

The JAMA article goes into the numbers. Of those who had a convincing allergy:

  • 48% developed at least one allergy as an adult
  • 26.9% developed allergies only as an adult.
  • 53.8% developed allergies only before turning 18

More than a quarter of adults with food allergies didn’t have them as children. That’s a surprise! And it raises questions: Is there a different mechanism that triggers childhood-onset allergies vs. adult-onset? (Other than tick bites, of course.) What about those of us who had allergies already and added more? Is there some sort of saturation threshold?

There are still a lot of unknowns about food allergies. But we do know that they can be deadly serious, and they affect a lot of people.

Food Allergy Shots Moving Forward

If you have environmental allergies to pollen, dust, animals, etc. you’ve long had the option of taking shots to desensitize yourself to the allergen. That hasn’t been the case for food allergies. But a pollen allergy is a lot less likely to kill you than a nut allergy. Some sort of treatment beyond “try not to eat it, and use epinephrine if you do” has been sought after for a long time.

Various forms of oral immunotherapy (OIT, SLIT) for desensitization have been under study for a few years…along with an injected medication that takes a different approach.

Around 10-15 years ago, my allergist at the time brought up the possibility of Xolair (omalizumab) for my asthma, suggesting it might also help with my food allergies. It’s an IgE inhibitor, which means it blocks the pathway through which food allergies operate. In theory, it would reduce my chances (or reduce the intensity) of a severe reaction to an accidental exposure.

It was an unproven, off-label use. Xolair had only been studied and approved for treating asthma, primarily asthma that other medication couldn’t control. And it would mean regular shots. And staying in the office after each one to make sure I didn’t have a reaction to the shot itself.

Ultimately I decided not to take her up on it. It seemed like more trouble than I wanted to go to for an uncertain gain. My experience wouldn’t have even helped clarify that gain. Any close calls I missed would have just been another anecdote, the medication’s impact unproven.

A decade and a bunch of clinical trials later (some alone, some in combination with OIT), the FDA has given Xolair a “breakthrough therapy designation” for treating food allergies. That means fast-tracking further reviews and development as a treatment. (more detailed article.)

There’s still risk/benefit analysis to do (in general and on a case by case basis), but things are starting to finally look up in terms of being able to treat the condition instead of trying to detour around it!

Wondering About Age and Food Allergy Deaths

OK, this is a bit morbid, but bear with me.

Most news stories about deaths from food allergies feature children or teenagers, maybe young adults in their twenties. You read about grieving parents. You rarely read about the 40-year-old who leaves behind a grieving spouse and kids.

Food allergies send a lot of people to the emergency room: 200,000 annually in the US alone according to FARE. Almost all are successfully treated. But people do die from anaphylaxis, roughly 63–99 each year in the US according to AAAAI.

So why are the fatalities we hear about so young?

Is it just demographics? Allergy prevalence has been increasing, after all, so kids are more likely to have food allergies than adults are.

Newsworthiness? A three-year-old dying at day care tugs at the heartstrings in a way that a 38-year-old dying from takeout doesn’t.

Is it onset age? A reaction is more likely to kill you if you don’t know about the allergy yet, don’t know you need to carry epinephrine, and don’t know that the warning signs mean “hospital now!” and not just “lie down and try to get through the asthma attack.” By the time you’re an adult, you’ve probably already encountered everything you might be allergic to, so you’re less likely to get that surprise first reaction. It happens – I’ve known people who developed shellfish allergies as adults, and I found my own nut and peanut allergies expanding their range in my early 20s – and there’s the Lone Star tick – but it’s less likely.

Are adults more careful? Teenagers take more risks. Children often have to rely on secondary caregivers who don’t always have the training or understanding that their parents do. And of course, the longer you deal with something, the more it becomes second nature. Is it that we’ve gotten better at avoiding triggers, keeping our medication on hand, and seeking treatment faster?

Are you more likely to have died of something else in the meantime? According to one NIH study, “Fatal food anaphylaxis for a food-allergic person is rarer than accidental death in the general population.” So the longer you live, as long as you’re taking precautions with the allergy, chances are that something else will kill you before the allergy can.

I suspect all of these are factors, but I do wonder how they balance.