Ask the doc: Food poisoning, latex allergies and other road hazards

It was for me during college and medical school. I hit all of the continental United States in search of those undiscovered places offering the perfect breakfast, doughnut, coffee, ribs, and of course, beer. But also scotch. Most of the time The Diner, Betty’s Stop, and Suzy-Jo’s Donuts delivered just what I wanted. On occasion, they offered something more, none of which I wanted, and all of which my body quite readily rejected and ejected.

Food poisoning used to be the front-runner to blame for such episodes but is now accompanied by two other diagnoses: latex exposure and antibiotic exposure. While they may have similar symptoms, they all have different triggers.

Food poisoning has traditionally been due to overgrowth of bacteria in inappropriately refrigerated foods, especially coleslaw and other mayonnaise-based foods sitting out at the family picnic. Or the food prep person who did not wash their hands (despite the bathroom sign) before making your burger, thus sharing their Hepatitis A with you. The current spate of E. coli that has contaminated food, especially lettuce, has focused media attention on food poisoning. Most episodes are self-limited, but some strains of E. coli and other bacteria, can be especially lethal.

How do you know whether you have the relatively benign kind that will clear after a 12-to-24-hour stint in the bathroom or if you need to go to the hospital? There is no home diagnostic like a pregnancy test, so common sense prevails: If you have a fever, cannot keep liquids down, cannot walk steadily to get to the bathroom, your urine looks really dark — or you are not making very much at all — a trip to the Emergency Department is in order. If you are not that sick, then drinking liquids like Gatorade or chicken soup are great, since they replace both water and salt; you need salt to help you hold on to water. But what about other causes that might create abdominal pain, nausea, vomiting or diarrhea?

Other causes beyond food poisoning

Latex is a naturally occurring product of the rubber plant, poppies and spurges (little “s,” not related to Spurgeon) and some credit Christopher Columbus with “discovering” latex during a voyage that included Haiti. Latex sensitivity or allergy is increasingly common but was described as early as 1933 in the New England Journal of Medicine. You can easily find latex-free condoms, house paints, rubber bands, and erasers. While most hospitals have moved toward a latex-free environment, this is not the case in the food industry.

Latex gloves generally have a powder in and on them that makes them easier to don. Unfortunately, donning aerosolizes the powder and can leave it behind on a host of surfaces, as well. How do you know if you have a latex sensitivity? This may be hard to determine, as some react only mildly while for others it may be life-threatening.

Clues that you are latex-sensitive include not tolerating certain foods whose components (antigens) cross-react with your body’s receptors for latex. Those foods most notably include kiwi, avocado, banana, peach, and mango. Lip stinging, mouth soreness, cramping abdominal pain, nausea and later diarrhea are excellent clues. Some also develop a facial rash, watery eyes and a runny nose after eating those foods. These same kinds of things may happen after eating other foods that have been prepared by someone wearing latex gloves. Or maybe the dishes or glasses were washed by someone wearing latex gloves. Or the table was cleaned by someone… you get the idea.

If you do not have a true allergy, then most of this is self-limited but may be improved by oral diphenhydramine (Benadryl) to address the symptoms. No, do not get on your bike after taking Benadryl, as it is likely to make you sleepy, increasing the odds of crashing if you are driving, or falling off if you are the passenger.

If you are truly allergic, then you should carry an Epi-Pen for rescue, since your reaction includes trouble breathing and maintaining your blood pressure, which can lead to death. You should always ask about food handling and preparation before eating at a restaurant, inquiring specifically whether they use gloves at all, and if so, what kind. You should ask the same questions of your dentist, the dog groomers, and your automotive service shop, to minimize your exposure risk. Buyer beware.

Could it be antibiotics in my dish?

Like the increased prevalence of food allergy (think peanuts), antibiotic allergy or intolerance is also increasing. While there are naturally occurring antibiotics (penicillin from mold), most are engineered. Livestock are the prime source of inadvertent antibiotic exposure for us. Unless you are eating at a farm-to-table kind of place, it is almost impossible to know from where your food was sourced. And if you have antibiotic allergies (I have several), you run the risk (small but not zero) of getting some exposure in the food you eat. Hence, the rise in popularity and prevalence — at least in part — of organic foods of all types, from lettuce to milk to fish and beef. Immediate management for an antibiotic allergy reaction is just like that for latex exposure!

If you have allergies (food, latex, medication, environmental), please obtain and wear some kind of medical jewelry to alert first responders in case you cannot. Carry a card in your wallet or purse and put the information in your phone under the Medical ID (iPhone) or other app, since they are accessible, even if your phone is locked, under the Emergency feature.

If you get sick and are not sure if you should go to the ED, many health systems have a phone service that connects you with a nurse practitioner and may use videoconferencing to your device — a kind of telehealth — to help guide your decision-making and navigation of the system so you get the help you need at the right time and the right place. Even if you're on the road, in search of your next meal.