NOT QUITE ANAPHYLACTIC SHOCK?

Starting about a year ago, intermittently my fiance would get these episodes
where his skin would get very warm, his heart would race, and it would typically
be at the same time he’d experience hypoglycemia. We THOUGHT maybe he was having
an allergic reaction to a food, like nuts, but then at a later date he’d eat
nuts, and would be ok.  He saw an allergist, and she didn’t think, based on his
symptoms that he was having an allergic reaction.  He hadn’t had another one of
those issues until this past Friday. He was at cheesecake factory, had a long
island, and some tableside guac w/ chips…w/in about 20 mins of eating, he again
experienced what seemed like an anaphylactic reaction.  His skin became warm/hot
skin, then his heart rate > too 100+ bpm, then he had nasal congestion, next
came the nausea, then he had to run to the bathroom and he was in there about
40mins or so vomiting, the last 20mins his nephew drove him home, and on the
drive home he started getting the chills. So he came home and took a shower…and
was so exhausted he fell asleep in the shower.  This all happened within about a
span of an hours time.  The symptoms started out similar to these episodes he’d
experienced like a year ago that I’d described to you…but were obviously worse
this time around.  Throughout all of this his blood sugars (he’s type I
diabetic) were normal. Any thoughts suggestions or insights? Or what type of
practitioner he should see?

[Dr Rajput]

Hi, welcome to the forum, he is having atypical set of symptoms and needs detailed evaluation. Flushing is sense of warmth and erythema on skin. Possibilities of flushing with increased heart rate are Carcinoid syndrome (presents with diarrhea, tremors etc.), Mastocytosis, Pheochromocytoma, hyperthyroidism and pancreatic tumor/VIPoma.

This is neither due to allergy nor due to anaphylactic shock. Certain foods like cheese and drink beverages contain tyramine which can raise the blood pressure as well as the heart rate in some individuals lacking MAO enzyme in intestines or when taken concurrent with MAO inhibitors (cheese reaction).

The tests like blood pressure monitoring, 24 hrs urine analysis for 5-HIAA, histamine, prostaglandin and catecholamine and other blood tests. I suggest you to consult physician. Take care and regards.

[52kat]

I have been to the allergist and nothing showed up there...they have just ordered a new blood test called alpha gal...I have also seen a gastro doctor who has ordered CT abd/pelvis and it was negative...lots of blood work but it all has come back negative as well.  No idea what is going on but still trying to find out...also had the 24 urine and it came back negative for carcinoid syndrome as well. What about a parasite..

[Dr Rajput]

Hi. parasite can also be a possibility for which you need to undergo serum IgE levels and absolute eosinophil counts. Regards.