Anaphylaxis (Severe Allergy) Attack - Need some guidance

I got a very severe allergy attack yesterday around 10:30PM, where my throat and eyes were swollen and it was difficult to breathe. I called an ambulance and went to a nearby Emergency Room in Taipei where I was given epinephrine after an hour (I know, it took too long for them to find it). They injected the epinephrine directly into my arm muscle which hurt incredibly for an hour but I felt much better afterwards. Aren’t they supposed to do it in my thigh?

I need help trying to figure out what caused the allergy. I have been a vegetarian all my life and never had any food allergies. Here’s the timeline:

6PM: Ate a little bit of food at my workplace. Rice and green veggies.
9:30PM: Ate a veggie pasta that I ordered from TGI Fridays.
10PM: Allergies begin with my eyes becoming ref and itchy. But I think it might be the season and put some artificial tear drops and try to rest.
10:30PM: Can’t breathe now and throat feels weird, decide to call for an ambulance.

I am a little confused since I didn’t try any new dish yesterday. My best guess so far is that the TGIF food was probably cross contaminated with seafood, or maybe prepared in the same pots and pans. Their menu seems to have a lot of seafood. But as I said, I’ve never had meat and seafood before, so I can’t be sure if that’s the cause.

I do have some remaining pasta from TGIF which I could send for analysis, but not sure if that’s a good next step.

  1. What are the best steps I can take to find the root cause of the allergy?

  2. How can I be better prepared for this in the future? Google mentioned Epipens but they seem hard to get here.

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Get an allergy test. It’s you that needs to be tested, not the food, especially if you aren’t aware of any existing allergies

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Makes sense, I’m not sure how an allergy test works but I’m going to read more on that. I didn’t eat anything new yesterday, but it was the first (and last) time I will eat at TGIF in Taiwan.

Unless the restaurant is specifically vegan (look for the swastika), never assume it is.

If you are vegan all your life then you could be allergic to all kinds of stuff because you were never exposed to it.

You need to get tested.

They prick you with a variety of common allergens in a controlled environment to observe what you react to.

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Oh that’s interesting. I didn’t get any rashes yesterday though

And the treatment to make you tolerate the allergens better involves periodically injecting small amounts of allergens into your body in a controlled environment for a while.

By the way, in Taiwan you can just walk into any dermatology clinic and pay 2 to 3000 NTD to get an allergy test. I hear that in the US you will have to first get your family doctor to agree that you need one and refer you to a dermatologist. Then the test itself will cost you at least 300 USD.

is it really that expensive? I thought NHI paid for tests like these.

And I find allergy attacks like these tend to lessen over time if you are exposed to it over and over again.

So it’s important that you get that kind of treatment (where they introduce common allergens to you in a controlled setting). Because you really can’t control what you get exposed to. Like people have died from severe reactions from smelling fish. And that means just walking down the street could kill you here.

You need to get an Epipen or it’s Taiwan equivalent asap. Best to go to the hospital tomorrow first thing. You can probably get an allergy test as well but that’s secondary. Anaphylactic reactions tend to get worse over time not better. Sounds like you almost lost your airway. Once you lose your airway well…dont mean to frighten you but they might not get to you fast enough the next time. Don’t muck about. Go straight away to the hospital tomorrow and get some epinephrine and keep it on you at all times. And yes, it’s best to inject it into the thigh but not critical.

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Where can I buy an epipen in Taipei? I tried a few pharmacies and a couple of hospitals in Taipei, but none seemed to have it…

Those intradermal allergy tests are not scientifically backed though. There is a lack of accuracy and reproducibility. So if you have one done, I wouldn’t put much faith in the results at all.

They are especially not useful for food allergies which are often mediated by gut immune cells. Their only semi-sensible use is for environmental allergens.

OP’s best solution is to discuss with a doctor and carry their own EpiPen. If they are prone to full-blown anaphylactic shock from certain foods, then a doctor will happily prescribe a supply.

Do you have proof of that?

Skin pricks and blood tests are the go-to allergy tests.

@DunderMifflin, did you get a record at the hospital/clinic you got treated? If it is a big hospital, asking there about EpiPen or alternative may be the easiest. Did you already do?

I went to Heping Hospital today to see an allergy specialist. They did a blood allergy panel test for common allergens and the results will take a week to arrive. They said they do not have an epipen.

Taiwan doesn’t really do allergies like the US. As a teacher in the US, it was a nightmare because so many kids (supposedly) had severe allergies. I say supposedly because I know a lot of them went to a doctor to be tested once when they were three and their parents never took them to be tested, despite them then being teenagers. On the other hand, you don’t want to risk killing your students, because some of them were legitimately allergic to everything and you didn’t know who.

But I had a severe allergy attack (anaphylaxis) once in college. Wound up in the ER. Nothing I hadn’t eaten before. Went to a doctor the next day who was like “meh. be careful I guess?” Thankfully I never had any problems again. I didn’t think these things could be a one-off, but I guess they can.

Allergies in Asia are an excellent way to increase your chance of death. Just look at the sanitation of…any restaurant in this county ever.

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Fyi

https://www1.cgmh.org.tw/chldhos/intr/c4a80/medicine/11index-030.htm

This page says they are the only department that has epipen. I don’t know if the statement is still correct.

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From Mayo Clinic

Keep in mind, skin tests aren’t always accurate. They sometimes indicate an allergy when there isn’t one (false-positive), or skin testing may not trigger a reaction when you’re exposed to something that you are allergic to (false-negative). You may react differently to the same test performed on different occasions. Or you may react positively to a substance during a test but not react to it in everyday life.

Blood tests are mostly a scam too. IgG (which is what 99% of the ‘allergy tests’ you buy) tells you foods you have eaten. That’s why people end up reporting that they’re immune to all sorts. You need to look for IgE, which is more complex. And not allergies are IgE-mediated.

Basically, it’s not that easy to conclusively determine what exactly somebody is allergic to.

And yeah, to OP, allergies seem much less common here in Taiwan. Probably a mix of genetics (eg redheads are well known to have more eczema, asthma, hayfever etc) and environment. All that cooking in peanut oil and eating absolute everything probably helps!

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They don’t exist. I’m anaphylactic and have have several episodes here in Taiwan for the same reason. Cross contaminated food.
I always go to emergency and they give me the IV. I ask the doctors where I can get an Epipen. They have assured me every time it’s illegal to carry one. I asked what should I do next time. He said go to the nearest hospital.

I think the ingredients in the pen can be made into street drugs. This is the only logical reason.

Stay safe and cook at home!

Not in Taiwan.

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FYI

4 years ago, you could carry it by doctor’s prescription.

此藥屬自費用藥,在國內用量不大,通常是有過嚴重過敏反應如休克等患者,醫師會開立處方讓患者隨身攜帶,在野外過敏發作時可注射在大腿救命,近幾年的自費價約3500元,價格穩定。

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