Food Allergies/Severe rosemary allergy
QUESTION: I had an anaphylactic reaction to rosemary a few months ago. Since then my world has been turned upside down. As i am so severely allergic to it, even its components in fragrances, lotions, soaps, shampoos, cleaning products, and foods cause me a lot of trouble. I have been seen at a top hospital, and they didn't know what to do with me, other than to tell me to continue to try to avoid it. They ruled-out underlying autoimmune disorders. I'm am going to seek care at another top hospital because I cannot except that there is nothing more to do.
Rosemary extract is added to drinks, ground turkey, processed meats like hot dogs and sausages, broths, etc. I believe I've even had severe reactions due to cross-contamination. As a result, I can hardly have anything I haven't made from scratch, and I have to be careful of what I touch. I also have somewhat disabling eczema as a result. My question is, do you know of anyone that has had an anaphylactic reaction to an herb, especially rosemary? How do I find out if there are others like me, and where do I go from here?
ANSWER: You poor devil. I would find life without Rosemary very difficult.
I most certainly believe your story. There are very few large molecular structures to which absolutely nobody will react. I have seen some very weird things.
BUT: There are just a couple of things that worry me. More to be a devils advocate if you like.
1. Did you really have anaphylaxis. I constantly see patients who are told by otherwise competent doctor that they have anaphylaxis when they have had something else. Most commonly the something else is angio-edema. Angioedema is acute severe selling. Can be localised, as around the face, mouth or in the throat, guts. Or it may be generalised. There is usually no sudden drop in blood pressure. IT responds very well to therapy that most non-hyperspecialists know about, because they always assume that it is due to allergy when it is not.
2. How do you know it was due to rosemary? Did you have skin prick testa, patch tests, or measurement of Rosemary-specific IgE? The reasons for asking is that the scent and flavour of Rosemary is due to it's essential oils. That has all sorts of ramifications that I wont go into here and now. But enough to question the current explanation.
More facts please. Mark answers private if you prefer.
I'm have answered this question before on the day it was received, but it has come up again. So forgive me if this is repetitious
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QUESTION: Thank you very much for your timely and knowledgeable response. I will try to answer your questions and am interested to hear what you think. Sorry for the long answer, but I'm not sure what details are most important.
I'll start with how sure I am that rosemary is the main culprit. I began to suspect I was allergic to rosemary during the spring or early summer of 2012. I added a new fish oil capsule to my vitamins. I noticed I was itchy and through several trials, discovered that it was the fish oil capsule with rosemary extract that was giving me hives. Stupidly, I trialed the fish oil a few more times, and sure enough, i'd get very itchy al over & see some hives. The reaction did seem to worsen with each episode.
Then in August 2012, while on a trip, I encountered rosemary-lemongrass soap. There were very few ingredients in it because it was supposed to be for very sensitive skin (rosemary, lemongrass, glycerin, olive oil). I used the soap several times before I realized it was affecting me differently than my husband. At first i felt a "cooling effect" (like Bengay or another similar muscle rub) on my hands, and then it changed to a burning sensation. Soon enough I was very itchy, my areas of chronic eczema began to burn so badly I couldn't sit still. I washed many times with other soap but it took about 4days until I didn't feel any of the "cooling effect" on my hands. My eczema flared up for ~1.5wks after that.
Then, again, stupid me- Mid-September I roasted a chicken with fresh rosemary from my garden. Only other ingredients were olive oil, salt, black pepper. After eating it, I became itchy, had some hives, and my eczema flared worse for ~2wks. So I was planning on avoiding rosemary after this...
10/15/12 I was outside and decided to pull my rosemary plant out of its pot. I almost went for gloves, but I was too lazy and thought I would only get a little itchy. I grabbed the plant by the stem, yanked it out, threw it on my lawn, and within one minute felt a very intense "cooling effect" on my hand that started to spread up my arm and I became itchy and noted hives. This was ~3pm. I ran and got diphenhydramine 25mg and after ~45mins I thought the reaction wasn't going any further (by this time, though, my whole body was itchy and my eczema sites all had an intense "cooling-effect," and I was dizzy and spacey-feeling.)At ~5pm, my throat began feeling scratchy and really weird. I took another 25mg of diphenhydramine. By 5:10 I called an ambulance because the middle of my throat felt like someone had tigthed a belt around it. When the ambulance came I was very dizzy, couldn't speak in full sentences, and had started to cough. They said my O2sat was down, and gave me O2. I felt briefly better, and then felt like things were tightening more and I couldn't stop a weak, dry cough. They gave me IV steroids and an H2blocker at the hospital, and my symptoms gradually lessened. I didn't feel well for several days.
Since then, I have had several more reactions to what I'm pretty sure is rosemary or similar components. Rosemary has many components that are shared with other plants (for example: limonene is in both rosemary and orange rinds, and is used in many fragrances and body products). I think cross-contamination affects me in foods and soaps...
Mass general tried to do a rosemary-specific IgE test, but I think they had to create one just for me. It was negative, but I'm certain I'm allergic to it. The doctor at Mass General told me they hadn't seen anyone severely allergic to an herb before, and that I should go to Mt. Sinai Hospital for another opinion.
Angioedema vs anaphylaxis: Mass General said my SPEP, complement levels, ESR, other immune system labs, TSH... were all normal. Would one or some of those be abnormal with angioedema? No part of me has been visibly swollen during any of my episodes.
I could write forever about all the things I've reacted to, but I've written plenty for now. Thank you so much for your input. Any other questions or suggestions please?
ANSWER: OK. We are getting somewhere.
Your reaction was NOT anaphylaxis. Phew, what a relief. It means your life is less at risk than it initially sounded! That's good.
Also the pattern of symptoms are not really those of IgE-mediated allergy. I thought they would not be.
IgE-mediated allergy to oils (For the smelly stuff in Rosemary is it's essential oil.)are theoretically impossible.
But delayed-type hypersensitivity is entirely possible. The time pattern of your reactions is also compatible with that. There is no treatment for these reactions except steroids and rigid exclusion/avoidance. What you need is skin patch testing. Most major hospitals have a dermatology department and one of the members of that team will probably run a clinic especially for performing those tests in other kinds of contact hypersensitivity. That is normally confined to the skin. But if you must choose to become sensitive to such agents and they are particularly volatile, then you can breath them in.
I can tell you more about patch testing etc if you wish, but I suspect that if you see the right person, they will explain it to you more easily than I can here.
Hope this helps, Regards.
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QUESTION: I didn't tell you about all of my reactions. I recently had a tiny sip of san Pellegrino blood orange soda. My throat instantly began to close along with similar sxs to the first reaction. This was my quickest & scariest reaction. I later found out it's "natural flavors" were essential oils of herbs (what company told me on phone) and that they also have aproduct called San Bitter made with herbs.
Actually another instant & scary reaction was about a week after my first reaction with pulling the plant. I put my chapstick on that I thought I checked & my throat started to feel like it was swelling immediately. I quickly washed my lips with dish soap & rubbing alcohol & took benadryl 25mg. I had to take another 25mg about 2hrs later when my throat sxs returned.
Thanks for suggesting patch testing. I already have that scheduled in Boston. I had "sensitive skin" before all this started and now it's much worse.
Do you still think I don't have anaphylaxis?
Thank you very much for all your time spent answering my questions!
I am absolutely certain you did not have anaphylaxis. Unfortunately, poorly educated doctors call the sort of thing you have had anaphylaxis totally incorrectly. It leads to problems in this area quite frequently. Don't blame the doctors, blame those who teach them. The general level of ignorance about allergic problems is staggering in view of how common they are. Enough prosletizing!
Anaphylaxis is a sudden and dramatic drop in blood pressure severe enough to immediately threaten life (Like death within 5 minutes). It is commonly allergic in origen, but sometimes attacks just come on for no reason. With food allergy, anaphylaxis may follow putting a food in your mouth causing local reactions in the mouth and/or throat. Similar reactions in the mouth without any systemic symptoms are vastly more more common, but without a serious drop in blood pressure are Not anaphylaxis. This is important for several reasons, but I'll not bore you with what and why now.
The comments you have made in your last email are interesting in that they make me think of several alternative explanations for your ptoblems. I will not go into those now, because I still think I would do nothing more until you have had patch testing.
So, go ahead with your patch testing. Once you have had the results and have had time to assess the the advice you have been given, if there are still problems, you are very welcome to get back to me.
Good Luck! Regards