Confirmed: I'm allergic to an ingredient (PEG) in the Covid vaccines

Hey party people--just like everyone else, I was so relieved and excited when we heard that we had several vaccine options when the announcements came out. However, I had a sneaking suspicion that my special talents as the Food Allergy Queen could mean a possible allergic reaction to the Covid vaccine. I got tested by my awesome allergist team last week, and it was confirmed I'm allergic to polyethyline glycol (PEG), which is a common stabilizing ingredient in these and many other vaccines. PEG is in both Pfizer and Moderna vaccines, and Johnson & Johnson contains polysorbate 80, which is chemically similar and would likely also cause a similar reaction.

Reactions so far from friends and loved ones have been mixed:

"Oh shit!"
"I'm so sorry"
"Will you still get it?/Can you skip the vaccine?"
"What a pain"
"I'm so glad you have a viable plan"

Personally, I'm on the "Grateful, and glad I have a viable plan" path! Yay science!

Today someone asked me, how did I know to get tested? Here was my thought process:

- For me, a person who is prone to allergies anyway (the medical term is atopic) it's always a possibility

 - I've had allergic reactions to a range of medical ingredients previously throughout my life--on top of the skin, as well as under it (rubbing alcohol, oral antibiotics, general anesthesia). So far, no medication allergies, surprisingly. Also I react to toiletries and some supplements, because of the filler ingredients (dairy, rice, mysterious chemicals)

 - But the biggest flag for me is that I had a reaction to a flu shot years ago (fatigue, brain fog, anxiety) for a full 30 days following it. In the old days flu shots included egg--they now have #eggfree versions. But I'm allergic to chicken, not egg (I know I'm a weirdo) and I never got tested for that reaction, even though I'm high risk for the flu due to my accompanying asthma. Despite that I just never went back for another flu vaccine.

[Note: the slow, delayed reaction is also sometimes labeled an "insensitivity"--medically it's an IgG reaction. The immediate anaphylaxis version is IgE. This article was helpful to clarify between the two. I have experienced both types of reactions. Woo.]

With those red flags in mind, and noting that the first cases of anaphylaxis were with people who already brought their epipens, I've been waiting for data to come in! I've kept up on the latest news about anaphylactic reactions globally (check through my Facebook page, that the likely allergen was identified as PEG, and the allergy community's preparation for reactions. (Thank you internet and the openness of the global medical community!) I did some research and found a cutting-edge allergist in the area, Columbia Asthma & Allergy. They not only knew about this already, but offered PEG testing. Yay! I submitted all my former allergy test results and connected them to my previous allergist for records and such, and skipped my daily antihistamine (Claritin) for four days prior to get a "true" reaction.

PEG Testing day

I was told to plan for the appointment to be a few hours, be hydrated, and have a light meal before. To bring my own snacks, and if I was working they could set me up with a desk. 

The room they brought me to had lots of cleaned surfaces, and best of all, an attached bathroom! (I'm neurotic that if I'm going to throw up or something I won't get to a bathroom in time.) They paid attention to my briefing notes that I am allergic to alcohol, so disinfected with a non-alcohol cleaner.

When I expressed deep thanks, the nurse smiled and said "WE'RE YOUR PEOPLE!" 

This is also known as a Miralax test or Miralax challenge, because PEG is not only in vaccines, it's a key ingredient in the laxative Miralax. The plan was to start with a baseline scratch test of the PEG, then over the course of the next few hours, challenge my tolerance levels to determine a good course of action. Ready? READY. 

I read this handy dandy little chart to learn some more tips while I worked some more and waited. 

I reacted to the first test within 15 minutes. 

I felt suddenly woozy, my skin started to itch all over and my visible arm skin started turning red. (I wore short sleeves on purpose!) They asked me to describe how I felt to document it. After about 10 more minutes, I started to get a specific sinus headache between the eyes that felt like the beginning of a migraine, and the doctor who came in said "yes, that's very common for a PEG allergy". He decided to quickly give me two quick dissolve Claritins and 600mg of ibuprofen for the headache. Then they stopped all the rest of the planned testing because I had clearly very low tolerance.

The doctor asked if I'd had a colonoscopy, which I had, and asked if I had had a similar reaction because PEG is prevalent in what's euphemistically called the prep materials. I had to think back on it a bit, but since my focus was bathroom related (Colon Blow jokes here), I don't really recall. I think I would've remembered this headache, though.

Sensitive to a PEG allergy. What next?

This allergy team is ON IT. To prepare me to get the vaccine, they will schedule me for a full 8-hour day of immunotherapy--the same concept as allergy shots. But instead, building my resistance in one day to PEG long enough for me to tolerate a shot, then I need to schedule my vaccine that day or the next morning. It CAN be done--they've already done this process successfully 4x!

Washington state just opened up the vaccinations to anyone 16+, so availability shouldn't be an issue by the time their team is ready for me in May. It takes a week for the custom medication to be compounded. Lots and lots of planning and backups involved. I had already updated my epipen (actually Auvi-Q) prescription as well. Note, that if you deploy an epi for life-threatening anaphylaxis, it only lasts for 20 minutes. Which is why they recommend you bring two, just in case it takes more than 20 minutes to get to a hospital. And you should always go to a hospital if you deploy your epi, because some reactions can happen later.

Take a buddy

As I thought this through, I realized I needed a vaccine buddy, just in case I needed help with my epi and to possibly drive me to the hospital afterwards. And then drive me home. If everything goes fine, then I have a pal there anyway to watch me, because some of the early indicators are things like surreptitious scratching (scratching without realizing it) or face swelling--and sometimes others notice before you do.

Whew. It's a lot of planning. But as I said at the top of this piece, I'm relieved I know what's going to happen. And grateful I have a plan of action, since with my mild asthma I am vulnerable to lung diseases in general, so skipping this is not an option,  Knowledge and planning is your friend. 

Depending on the severity of an allergic reaction, the CDC recommends only one shot
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/allergic-reaction.html

If you deploy an epi or go to the hospital, they don't recommend a second shot. If you have lesser reactions like hives, or wheezing, they don't recommend a second shot, and you and your doctor may need to evaluate the risk going forward.

Whew. This is a lot. Feel free to leave comments or questions. Facebook is better since I check it more often and people can see discussion threads.

More to come, thanks for listening. The FAQ

NOTE ON ALLERGIC REACTIONS TO VACCINES

NOTE ON ALLERGIC REACTIONS TO VACCINES--I personally have had an allergic reaction to the flu vaccine. I am allergic to chicken, not their eggs (I know, weird, it's why I'm the Queen). Although flu vaccines are based on chicken eggs, I had low-grade anaphylactic allergy symptoms for a MONTH. No flu, though, to be fair.

I sometimes also react to the "inert ingredients", including alcohol. So be aware of how each vaccine is composed. Based on some severe reactions to the first Brits who took the Pfizer covid vaccine, the FDA is advising that severely allergic people like us don't get the vaccine right away. (And if you do, be sure there are medical personnel around who can handle severe anaphylaxis, and make sure your Epi is up to date.) For the Pfizer Covid vaccine, here are the ingredients. https://www.fda.gov/media/144414/download Personally, I am going to wait until there are several vaccine choices to determine the one with the least amount of allergic reactions or have favorable ingredients. https://www.cnn.com/videos/health/2020/12/13/coronavirus-vaccine-fda-commissioner-stephen-hahn-sotu-tapper-vpx.cnn

Shoutout to shallots...my substitute for garlic allergy

Shallots, two ways 

Hello there, it's been a while. So much while, that for a year I neglected to notice that my website name had expired and someone tried to ransom and sell it back to me for....$3000. Not kidding. (They even thoughtfully offered to let me make payments! Um, no.) If you've followed me over the years and you've found me again, thank you for your patience. You'll see that I got a new domain name by just adding the "the" in and we're back in business.

Here's the short version of what I've been doing for five years if you care--pretend it's the movie montage section where time goes really fast! 

Got laid off, started a K-12 education technology startup for three years (investor pitches, competitions, Silicon Valley, the works) then ran out of money, nearly went bankrupt, my car broke down so I had none for six months, taught cooking classes for a year, sold my condo, and am now working at a global tech company. Whew. So managing my food allergies during this crazy time has been a back burner item and I basically kept eating/making the same faves over and over. So much so that my startup business partner knew how to order my Food Allergy Queen lunch order, complete with all my requests for condiments on the side for me to manage mystery ingredients. :)

So today's topic--shallots! Prior to my food allergy diagnosis, I LOVED LOVED LOVED garlic. I would happily eat those whole roasted bulbs of delicious garlic on toast and call it a meal. Order extra Lebanese white garlic paste from Zankou Chicken in Los Angeles. Garlic went into everything, so much so that I would usually double the amount called for in a recipe. Until I was diagnosed with a garlic allergy. GARLIC allergy. One of my true loves. It felt like such a betrayal. (Ok a little dramatic, but you get the idea of how much I loved it.)

For a while I went garlic-less. It was a sad time. I doubled the onions everywhere but it wasn't the same level of piqant and pungent flavor of garlic. Then I remembered that shallots have a flavor that's in between onions and garlic...and voila! It was similar enough from a flavor profile that it was a mild garlic-like flavor. Buttery and a little more delicate, but still can be robust enough rather than just using onions only.

Botanically, shallots are an offshoot of the onion family. 

Onion (and shallots): Allium cepa 

          Garlic: Allium staivum 

Interestingly, even though both garlic and onions are alliums, I am NOT allergic to onions. (And I know people who are the other way around--allergic to onions but not garlic--it's a mystery.) For me personally, I usually try to skip the botanical family of my allergen altogether--e.g. for salads I avoid all lettuces but eat arugula and spinach, which are a different family. But here I make the exception after some cautious trial periods.

Warning: if you have allergies for alliums, proceed with caution. Your experience may be vastly different from mine.

Uses: I use the dried versions from Penzeys when I need that garlicky "background" flavor. In soups, stews, etc. For fresh dishes like over fish or steak, I dice the fresh just like I did with garlic--saute and brown for carmelization. Because the taste is way milder than regular garlic, I usually sub 2x the amount of garlic requested as long as it doesn't impact the volume too much. 

As you can see from the nearly empty bag, I rely on them a lot. Hope you enjoy them as well. 

Giving thanks in 2015!

Unroasted pumpkin pie made with coco milk yogurt 

I just checked in and realized I hadn't posted in months...unfortunately my other job (running a startup) has been sucking up both my time and my brain, so that I can barely even think about cooking for my food allergies....but wait. It's Thanksgiving, the bestest cooking holiday of the year, yay!

Due to a nasty flu last time it was my turn to cook, it's been a while since I have had time to think deeply about a turkey day menu. And you know what? It's so RELAXING for me...all the preparation and planning makes me feel comfortable and safe knowing that I'll have a lovely meal that meets my needs for my food allergies. I know it's stressful for others, but for me, the kitchen is my happy place.

I'm having a pescatarian friend over this year, so she's bringing salmon and a veg. My first time seeing fish at the table for Thanksgiving! So I'll be adjusting my cornbread stuffing to be meat-free, and instead add more roasted nuts and fruit for flavor. And my Cranberry, shallot and cherry compote  recipe will go most excellently with both her fish and my turkey. She just doesn't know it yet!

The menu:

Salmon
Turkey
Brussel sprouts
Cranberry-cherry compote
Potatoes of some sort--players to be determined later
Roasted pumpkin pie

I haven't made turkey in a while, so I almost forgot that I need three days to dry brine the turkey ala the late, celebrated Judy Rodgers of the Zuni Cafe. Since it's just me for the turkey (and for all of the glorious leftovers), I'm buying a few legs instead of the whole bird since I like the dark meat best. And I get to feel like Henry the 8th, waving them around.

The main thing I feel grateful for is that mentally, emotionally and physically, I am feeling like all is right in the universe. In reality, I'm pinching every penny and stressed about money as my partner and I are getting our business rolling--but the weird thing is that I feel like the cosmic tumblers are clicking into the right place, regardless. Do you get that feeling? I hope so--and wish that for everyone this holiday. There is so much disgusting, and mind-numbing fear and hate going on right now that I sorta can't wait to hide out in the kitchen for a while and think only about pie. BTW, Ruth Reichl roasts her pumpkin first! Wouldn't that be lovely if everyone could take a break from being horrible for a while and be grateful for all the blessings and loved ones they have in their lives?

Hope yours is wonderful,

The Food Allergy Queen

Anaphylaxis Awareness Day

Sharing this photo from FARE: I've personally experienced the heart (pale, faint, dizzy) and the other (feeling of dread, anxiety) and went to the hospital thinking it was a heart attack. Be smart and be safe! Thanks Food Allergy Awareness and Education at foodallergy.org.

Learn the common symptoms of anaphylaxis and the steps for what to do in case of an anaphylactic emergency. Find more resources and facts for Anaphylaxis Awareness Day on our blog: http://blog.foodallergy.org/2015/05/12/anaphylaxis-awareness-day-is-513-facts-and-resources-to-help-you-educate-others/ 

Homemade cornflakes recipe

Got this recipe from Alisa at GoDairyFree.com, and it looked so easy I had to try it. Who knew you could make your own cornflakes? Just eyeballing them, they look at little thick. But I tasted one dry, and it was tasty. I'll let you know how they fare with milk when I have them for my midnight snack.

Needed to spread it thinner!

With the crumb topping.

Done!

Link to recipe here: http://www.alwaysorderdessert.com/2014/03/homemade-corn-flakes-cereal.html?spref=fb

Homemade Cornflakes Cereal

Recipe by Alejandra Ramos | AlwaysOrderDessert.com

A recipe for homemade cornflakes cereal made from scratch in the oven.

Prep time: 15 min
Cook time: 55 min
Total time: 1 hr 10 min
Yield: 2 cups

Ingredients

• 1 1/2 cups yellow cornmeal, divided
• 1 tablespoon granulated white sugar
• 1/2 teaspoon kosher salt
• 1 teaspoon vanilla extract
• 3/4 cups water

Directions

1. Preheat oven to 350 degrees. Line a baking sheet with parchment paper or foil and grease lightly with oil or baking spray. 
2. Whisk together 1 cup cornmeal, sugar, and salt. Add vanilla extract and water, a little at a time, stirring until batter is smooth and thin. If it's too dry, add additional water. You want something the consistency of pancake batter.
3. Pour batter onto prepared pan and spread out evenly. (It won't reach the edges, but that's OK. You want a nice thin layer, about 1/4 - 1/3" thick.)
4. Combine remaining cornmeal with 1 teaspoon of water and mix until the mixture resembles course breadcrumbs (add an additional teaspoon or 2 of water if too dry).
5. Sprinkle the top of the batter in the pan with the cornmeal crumbs (this will help give it a little extra crunchy texture).
6. Bake on the center rack for 10-15 minutes, keeping a close eye on it, until the dough has dried out and cracked. (You're looking for a cracked arid-desert landscape look to it).
7. Remove from oven and lower heat to 250. Let pan cool, then use your hands to tear and crack the dough into small flakes. Return to oven and let bake on the center rack for about 45 minutes or until pieces are toasted, crisp, and golden.
8. Let cool completely before serving with milk or as you would any cereal. Store leftovers in an air-tight container in a cool dry place.

In bread we trust: Maninis gluten-free mix

Maninis bread using Multiuso mix

You know how, in the movies, when the hero is about to die their life flashes before their eyes in a beautifully-shot montage of tender moments? Well, when I was first diagnosed with my gluten allergy, the montage that flashed through my mind was of all the bread I was going to be missing. Dramatic, I know, but hey--it happened. Bread is one of my fave things ever, and I never tire of it. It is always definitely be on the plate when I play the "last meal" game. Rustic breads, unleavened breads, quickbreads, dinner rolls, croissants, brie and butter sandwiches on rustic baguettes--you get the idea, I love 'em all. So ever since I was diagnosed in 2003, I've been on the hunt for a decent gluten-free bread that didn't taste heavy and fibrous like a doorstop, or the Washington Post.  Most ranged from disappointing to downright criminal so basically I stopped eating anything resembling bread for years.

Although the gluten-free revolution is in now officially "a thing", to quote Rachel Maddow, I still manage to miss out on my bread-love because most of the good commercial loaves out out there (I hear Udi's is great) are based on rice. To which I am also allergic. Which is also why I'm the Queen, of course. I've dipped into the bread recipes of several respected #gf cookbooks, but have not been thrilled. And I've used Bob's Red Mill gluten-free bread mix, based on garbanzo bean flour, which I like for texture, but don't love for the slight beany aftertaste. It was my go-to, until now.

Last summer, I moved to Seattle and discovered Maninis Gluten Free, which bases their gluten-free breads, muffins, cookies, etc. on ancient grains like millet, teff, amaranth and sorghum. Also tapioca flour. Their pre-made baked goods and pastas caused me to gain an *undisclosed* number of pounds that summer, since I finally had bread that both tasted good and had a fantastic texture! (In my defense, they made these insanely good chocolate, chocolate chip and fresh raspberry muffins. The stuff of legends.) Sadly, they no longer sell their pre-made breads at the farmers market in my 'hood, so I'm left with whatever Maninis products I can get at Whole Foods: dinner rolls, fresh pastas and dry mixes. So I tried out the Multiuso (basic baking) mix yesterday using a recipe from their website.

Multiuse flour. They also have bread mixes.

It didn't disappoint! My biggest failure was to not proof test the yeast before I put it into the batter, as a result it took forever to make it rise. Also, I forgot to calculate the temperature difference since it's colder here than my kitchen in California. And, full disclosure, I parked the batter on top of the stove as a warm place to rise, completely forgetting that I have an electric stove, not a gas one. D'oh.

Lovely texture, terrific taste, with no nasty "it's not real bread" aftertaste. I froze half of the loaf for later. Be sure, I will be having some fantastic toast along with my newfound love of vegan butter based on coconut oil that I now make in quantities. I am SO happy, and feel so much more NORMAL knowing and trusting that I have delicious bread (and other baked goods to come) back in my life! You can also order their mixes online. In bread we trust!

*Bonus for those concerned with cross-contamination, the package states that they work from a dedicated facility free of gluten, wheat, dairy, eggs, peanuts, tree nuts, fish, shellfish and soy.

Here's the recipe from their site:

Bread Recipe for Gluten-Free, Rice-Free Multiuso Multi-Purpose Mix

January 19, 2012 by Maninis Gluten Free Blog

 

 

 

 

 

 

34 Votes

Multiuso Multi-Purpose Flour Mix can also make a delicious rice-free gluten-free bread loaf! For your first loaf, please also refer to our Baking Tips to make a perfect loaf the first time!

Ingredients:

7/8 cup warm water
2 tsp active dry yeast
3 Tbsp oil
1 Tbsp apple cider vinegar
1 large egg + 1 egg white
2 cups (278 grams) Multiuso™ Multi-Purpose Flour Mix

Instructions:

Stir yeast into the 7/8 cup warm
water. Let stand until creamy (about
10 minutes). Add oil, vinegar, and
eggs.
Place the 2 cups Multiuso™ in a
mixing bowl. Using a paddle
attachment on the stir setting, slowly
add the wet ingredients. Increase
speed to low and mix for 3 minutes.
Spray an 8-1/2” x 4-1/2” loaf pan
with nonstick cooking spray. Place the
dough into the pan. Using a wet
rubber spatula, gently form the dough
into loaf shape.
Cover pan with a dish towel and let
the dough rise in a draft-free,
preferably warm area. It’ll take about
60 minutes but don’t rush
it—humidity, altitude, and room
temperature make a difference. The
dough will fill the pan and rise above
the top. Preheat oven to 375°F.
Place the pan on the middle oven
rack and bake for 45 minutes.
Take bread from oven, remove bread
from pan and place on a cooling rack.
Cover with a towel and cool before
slicing.