DEAR DR. DONOHUE: My husband is 63 and in good health. He has never had food allergies, but a recent incident has us wondering. He ordered shrimp at a quality restaurant at about 5:30 p.m. He woke up at 1:30 a.m., gasping for breath. When he was finally able to breathe, he said his throat had completely closed up. We always thought food allergies happened immediately. Do you think he is allergic to shellfish? – M.L.

ANSWER: Symptoms typical of an allergic reaction include flushing, itching, sneezing, tearing, nasal dripping and more serious things like choking, wheezing, difficulty breathing and a racing heart. Most food allergies occur from minutes to two hours after eating the provoking food. However, sometimes food allergies occur in two cycles, one hitting early and the second cycle striking several hours later.

Some 2 percent to 3 percent of adults have a seafood allergy, and the allergy can develop later in life. In fact, children have only a 1 percent seafood allergy. That tells you people develop this as adults.

Like you, I’m not sure if your husband had an allergic reaction, but I wouldn’t tell him to order shrimp again – at least for the present. I have to leave this to an allergist. Skin tests, the kind where the allergen is put on the skin and then the skin is pricked, can help settle the question. Blood tests for allergies are another way of getting at the answer. There is also a “food challenge” test, where the patient is given the suspicious food. This isn’t a test to be done by people on their own. It’s something that’s occasionally done in the doctor’s office with equipment and medicines at hand to terminate a reaction if one occurs.

DEAR DR. DONOHUE: A friend has been diagnosed with sarcoidosis. What can you tell me about it? – N.T.

ANSWER: Sarcoidosis is a mysterious illness whose cause has evaded detection even though it has been pursued for decades upon decades. It’s an illness that can affect just about every body organ including liver, eye, skin, joints, lymph nodes, kidney, heart and digestive tract. However, the organ that bears the brunt of the sarcoidosis onslaught is the lung.

Lung involvement brings with it breathing troubles, cough, fever and fatigue. Lymph node sarcoidosis causes node enlargement, and the nodes most frequently targeted are the ones in the chest at the root of the lungs and the ones in the neck. Sarcoidosis of the eye can greatly affect vision and can lead to blindness. Painful, red skin bumps are a sarcoidosis sign. They often break out on the skin of the shins.

The picture I’ve painted sounds awful, and sarcoidosis can be a truly awful illness. However, some people have such mild symptoms they don’t know they have the illness.

The overall prognosis for patients is good. More than half get over the illness with no or mild organ disturbance. A significant number have to contend with an illness that stays active for a long time or that recurs time and again. For about 5 percent, it’s a lethal disease.

Treatment is with prednisone, one of the cortisone drugs. Since many have a spontaneous recovery, it’s often difficult to know when to treat or when to wait for it to leave on its own, as it can do. There are medicines other than prednisone that are used when prednisone doesn’t suppress the illness.

DEAR DR. DONOHUE: I am writing about the person whose 87-year-old father has an irregular heartbeat and has to take Coumadin. You said there is not a better medicine for dissolving blood clots. I took myself off Coumadin and started taking nattokinase. I don’t think you should publish this letter, because I don’t want anyone else to do the same. – C.Z.

ANSWER: I don’t want anyone else to substitute nattokinase for Coumadin either, and I think you ought to reconsider your stand. Coumadin doesn’t dissolve clots. It prevents them. Nattokinase is an enzyme extracted from natto – a Japanese dish made from boiled soybeans. It can dissolve clots. However, it’s effectiveness in preventing clots in humans isn’t known. Coumadin’s effectiveness has been demonstrated. Blood thinning is too serious an issue to fool around with anything but a medicine with proven results.

DEAR DR. DONOHUE: I am a teacher who is head of a children’s camp during the summer. Before I took this job, one of the campers had appendicitis, and it went unrecognized. I don’t want a repeat of that. How does one tell if someone has appendicitis? – B.M.

ANSWER: Appendicitis is the result of a blockage of the hollow core of the appendix. That structure hangs from the first part of the colon and looks like a slender worm, measuring, on average, 3.5 inches (9 cm) in length. The obstruction of the core can be caused by a hard piece of stool or an enlargement of an adjacent lymph node. Bacteria multiply in the blocked appendix, which then swells, and the swelling cuts off its blood supply. If action is not taken somewhat rapidly, the appendix can burst and spill bacteria into the abdominal cavity – a dangerous situation.

Pain in the area of the navel or in the part of the abdomen between the navel and the breastbone is the first symptom of an inflamed appendix. As the hours go by, the pain travels down to the lower right side of the abdomen. Coughing or sneezing increases the pain. The child or adult might vomit. Body temperature is slightly elevated. A trick that aids in diagnosis is to ask the person to raise his right leg while you apply counterforce to stop the upward motion. That maneuver temporarily magnifies the pain.

You shouldn’t try or be forced to try to make the diagnosis. Surgeons who have spent a lifetime examining possible appendicitis patients are often mistaken in their diagnosis. Appendicitis can present in a myriad of bewildering ways. Lab tests help a doctor reach the diagnosis and, if doubt remains, a CT scan can usually resolve the doubt.

It’s not good for a hospital or a doctor to be correct 100 percent of the time in making this diagnosis. If an institution is right every time, that’s an indication that some appendicitis cases are being missed. It’s much better to remove a few normal appendixes than to miss a few inflamed ones. If you suspect that one of your campers has appendicitis, get the child to a hospital as quickly as possible.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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