Acute gluten allergy?

[bigbaldguy]

Working on the plane and a call button goes off. I go out and find a guy wo looks like he's circling the drain. I ask him what's wrong he says he's having a hard time breathing and has nausea and dizziness. Says he might be having an allergic reaction which I can see considering his appearance which is pale, diaphoretic, a little wheezy. I ask him what the allergy is and if he's been exposed to the allergen. He says yes it's gluten and he had breakfast this morning that contained gluten.

Huh? :unsure:

White male in his 50s slightly over weight. Guys pulse rate was around 40ish, BP never went above 90/50 and was 70/? a few minutes after patient contact. Normal BP was 130/90ish per patient. His lungs were clear but he did seem to have a little wheezing in his upper airway. Put him on O2 and had him sip some apple juice and he perked up a little but still looked like hell and his BP was still in the 50s after maybe 20 minutes. Refused further treatment at gate so that's about all I have.

So anyone ever hear of sudden and acute onset of "Gluten allergy syndrome"

 

[EpiEMS]

Whenever I hear gluten allergy, I ask "Has a physician ever informed you that you are allergic to gluten?"

Usually, the answer is no.

I didn't think that a gluten allergy was an IgE-mediated reaction, but I guess I may be confusing the hip diet "gluten allergy" with an actual gluten allergy (not Celiac -- that's a different beast, as far as I know).

Never heard of such a thing. What was his pertinent history? Also, any meds (new meds, perhaps)?

 

[EpiEMS]

Did a couple literature searches.

Here's something that may be relevant: "Allergic responses to the ingestion of wheat can be divided into two types. WDEIA is a well-defined syndrome that is caused by a specific type of grain protein, ω5-gliadins. Other allergic responses include atopic dermatitis, urticaria and anaphylaxis and appear to be related to a range of wheat proteins."

So, maybe it's wheat + exercise? This sounds crazy, but it's quite real, if rare. The exercise could be the extra effort of breathing if the plane wasn't pressurized to as close to sea level as he's from, maybe?

 

[AnthonyTheEmt]

It's actually pretty common. I have some friends who've recently started being allergic to gluten. They've been eating it most their lives and now are allergic to it. So it does happen.

 

[EpiEMS]

It's actually pretty common. I have some friends who've recently started being allergic to gluten. They've been eating it most their lives and now are allergic to it. So it does happen.

But what sort of response do they have? Are we talking allergic like "I have a stomach ache" (like myself when I drink milk) or allergic like "Can't...breathe..."?

 

[Aidey]

There are are few different versions of the "allergy". There are people who think they have a gluten problem, but don't. There are people intolerant to it (same idea as lactose intolerance). There are people with celiacs and then there are some people who have a true IgE mediated allergy, like peanuts or shellfish. My understanding is that it isn't super common though.

If this guy had a true allergy and ate something he knew had gluten in it anyway he is an idiot.

 

[mycrofft]

In truth, not from some fanny-covering text peddler or institute clown, how soon does an ingestion anaphylactic reaction occur? The commons signs for that route? For that matter, the signs of true anaphylaxis at all?

Now, he might have some of his complaints & symptoms from a GI intolerance reaction (try watching a dumping syndrome patient after he easts sugar sometime), which is often accompanied by borborygumus, flatus, urgent stool evacuation trending to diarrhea, maybe nausea and vomiting.

OK throw out his self-diagnosis. What did you see objectively? Was his pulse regular, strong?

Be a damn shame to treat him with apple juice when an AED might have been more in order.



PS: Who wants to go have a talk with Dr Oz and the ladies on The View sometime?

 

[EpiEMS]

PS: Who wants to go have a talk with Dr Oz and the ladies on The View sometime?

Count me in!

 

[bigbaldguy]

In truth, not from some fanny-covering text peddler or institute clown, how soon does an ingestion anaphylactic reaction occur? The commons signs for that route? For that matter, the signs of true anaphylaxis at all?

Now, he might have some of his complaints & symptoms from a GI intolerance reaction (try watching a dumping syndrome patient after he easts sugar sometime), which is often accompanied by borborygumus, flatus, urgent stool evacuation trending to diarrhea, maybe nausea and vomiting.

OK throw out his self-diagnosis. What did you see objectively? Was his pulse regular, strong?

Be a damn shame to treat him with apple juice when an AED might have been more in order.



PS: Who wants to go have a talk with Dr Oz and the ladies on The View sometime?

Pulse was nearly non detectable at radial. Got a little stronger over the next 20 minutes or so but I'd still call it weak at best. Apical pulse seemed a little irregular but that's just my inexperienced opinion. I actually had coworker bring AED up when I saw his BP (discreetly of course) sadly he never went unconscious so I didn't get to try our new toy Medics met the plane but as I said he refused further care and they didn't seem very inclined to try and change his mind.

He mentioned having had a recent EKG done that was "fine".

I'm going to google dumping syndrome. Is that the one that has to do with ammonia levels after defecation?

 

[mycrofft]

No, dumping is different

Anything causing high sugar levels in the bowel (usually associated with malabsorption conditions like post-pgastrectomy or roux en Y surgery) causes dropping blood glucose with severe s/s of hypoglycemia usual short of coma, high osmotic attraction of water to the bowel causing cramps, diarrhea, and maybe vomiting.

I fell across a NIH article from Italy about non-celiac gluten sensitivity. It doesn't list s/s.
http://www.ncbi.nlm.nih.gov/pubmed/22351716

 

[abckidsmom]

Was there any diarrhea or bowel complaint?

I have seen people who felt that intense need to have a bowel movement look like that.

 

[bigbaldguy]

Was there any diarrhea or bowel complaint?

I have seen people who felt that intense need to have a bowel movement look like that.

No not that he mentioned just the nausea. Although it occurs to me that this could have been some kind of vagal thing brought on by a bowel issue maybe? Is that what you're thinking?