A few weeks ago I had the pleasure of lunching with some
dear friends of mine in Kuta. We chose a pleasant looking
place, nothing special, just somewhere to grab a quick plate
of local fare before hitting the shopping trail again. The
waitress came to the table to take our food order and it was
immediately obvious that her language skills were definately
of Australian origin. Indeed the establishment was owned by
Aussies, which accounted for her accent and the spick and
span way in which the restaurant appeared to be run.
“ What you want Daaaahhling?” she asked, which
prompted smiles all around the table. My friends ordered nasi
goreng with prawns, and my partner and I ordered nasi goreng
with chicken, and absolutely NO PRAWNS, as my friend had an
allergy to them. I went on to explain to the waitress (in
her native tongue) that the meals should not be cooked in
the same pan, or mixed in any way. I also made it quite clear
what the out come would be if some one who is allergic to
a particular food would be if they were inadvertently served
that particular food. Despite my adequate language skills
she insisted on replying in her broken “strine”.
“Yes daaahhlinng, don’t worry ‘bout dat
daahhling, I fix for you daahhling”.
Great pains were taken on delivery of the meals to ensure
that every one got the correct plate of rice. I should have
listened to the little voices inside my head (for they are
often right!), as they warned me that some thing was not quite
kosher. Almost at the end of the meal I checked my morsels
again, only to see tiny lumps of pink flesh that could only
be, yes, you guessed it….PRAWN!!!. I looked at my friend
who seemed to be enjoying his meal with no ill affects so
far.
“ You see any prawn in your rice?” I queried.
“No, hmmm well maybe just a small piece”. “Do
you feel OK?”. “Yes I’m fine”. I suspect
he was being too polite to cause a fuss about any ill affect
he may have been feeling. As for myself, I could have committed
murder right there and then but thought better of it. Perhaps
my painstaking explanation had just been lost on the “Chinese
whispers” that tends to happen between table staff and
kitchen staff, or had the waitress chosen to just ignore my
request?
On leaving the restaurant my friend professed feeling a little
tired, so we took a rain check on the shopping, and headed
for home. At the first set of traffic lights he started to
scratch; at the second set of lights I demanded to see what
was going on beneath his shirt. There it was. Giant red wheals,
an angry red rash, he started to sweat and admitted to feeling
“maybe a bit dizzy”. I took the wheel and headed
for the first drug store and bought a bottle of Benadryl.
With a good dose of the syrup on board we continued our journey
home, where he immediately fell asleep. I watched like a hawk
knowing that this kind of reaction can result in swelling
of the airway (as I am equipped with the medication and knowledge
to treat this I need not go to an emergency room, any one
that does not should be treated at a medical facility for
this kind of reaction).
So there is a little (true) story to illustrate a mammoth
problem that can occur so easily, especially in a society
where many of those involved in food preparation are only
basically educated and may not understand the implications
of their actions.
Severe allergic reactions of this kind are the result of
sensitivity to a particular substance (usually a protein)
that is ingested (eaten) or injected (bee stings, antibiotics
etc) into the body. The most common substances involved include
the following:
Cows milk.
Eggs.
Nuts, especially peanuts (Note that people allergic to a certain
kind of nut are often allergic to other kinds of nuts. Peanuts
are not truly a “nut” but a legume).
Fish.
Shellfish.
Soy.
Wheat.
Bee stings.
Certain medications (antibiotics).
Latex rubber (this is one of the few substances that does
not have to be eaten or ingested to cause severe allergy.
It is a “touching” or tactile allergy).
How do you know if you or any of your family have an allergy?
Unfortunately the only way you will know this is by exposure
to the substance that causes a reaction. Some allergies seem
to be familial, which means that if one child (or parent)
has a peanut allergy, then another child in the same family
may also be at risk of having the same allergy. For this reason
a mother who has a child with a peanut allergy for example
should avoid eating this food while she is breast feeding
younger brothers or sisters.
Signs that a reaction is occurring might include the following:
Red itchy rash over the body.
Red itchy eyes, runny nose.
Abdominal cramps, diarrhea.
Wheezing, shortness of breath.
Dizziness or feeling light headed.
Feeling of anxiety, restlessness.
Most symptoms of an allergy occur 3 – 60 minutes after
being exposed to the allergen. The faster the onset of the
symptoms, the more severe the reaction will be. Important
to note also that in some cases, following an allergic reaction,
even if that reaction has been treated and appears to have
gone, a relapse can occur within 4 – 8 hours following
the initial reaction. The secondary reaction can be just as
severe as the first, and for this reason the affected person
needs to be kept under close observation for up to 8 hours
following an episode.
Any person that appears to be suffering from an allergic reaction
that complains of a lump in their throat, develops a “hoarse”
voice or has swelling around the mouth or tongue must be taken
to medical facility immediately. Blockage of the airway will
result in death very quickly. Note that most fatalities from
allergic reaction occur in the first half an hour of the reaction.
Fortunately many allergies are out grown, or become less severe
with age. Nut and medication allergies however rarely get
any better.
How are allergies diagnosed & treated?
If you suspect that any of your family suffer from allergies
you should consult your family doctor who may order a series
of skin tests that will demonstrate the allergy by causing
a local skin reaction. Naturally if you are aware of any existing
allergies then you should avoid that substance. If an accidental
exposure does occur it should be treated with fast acting
anti-histamine such as are found in many over-the-counter
cough mixtures (eg Benadryl). The ingredient that you need
to look for is diphenhydramine, and a dose of of 25 –
50 mg needs to be given ASAP after exposure. (it is wise to
keep this in your medicine cupboard or first aid kit. This
medication will cause drowsiness). Naturally you should follow
this by a visit to the doctors office or clinic just to make
sure that everything is fine. A skin cream such as phenergan
or caladryl may help if the skin is itchy.
For those that react severely an injection of adrenaline (epinephrine)
may be required. For those with known severe reactions, a
self-dosing kit sold as a pen injector may be recommended.
This kit is called an Epi-pen and is available in both adult
and child doses. Your doctor or nurse will instruct you on
how to use this, and should be kept on you at all times (most
allergy exposures are accidental and can happen at any time),
Parents should also make sure that an epi-pen is kept at their
child’s school and that the school staff are of aware
of how to use this in an emergency. Most accidental allergy
exposure in children does occur in schools.
That’s all for this week, until next edition…watch
out for that hidden prKim Patra is a qualified Registered
Nurse / Midwife, and mother of three, who has been living
and working in Bali for past 15 years. She has assisted many
traveller (... and others) either as a flying medical escort
or just a voice on the end of the phone! Kim is happy to discuss
any health concerns that your may have. Her e-mail contact
is info@chcbali.com
