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Paul Motter August 17th, 2010 06:35 PM

I just want to say thanks to everyone with special medical needs and experience with cruising for contributing your knowledge here. This is a very specialized but naturally important topic where more information can only help.

I think medical information is often taken for granted where cruising is concerned - as in people just saying "they have a medical center onboard and they can handle any diet."

The devil is in the details, and these are not matters to be glossed over.

I hope more people will share their medical experiences where cruising is concerned with us here.

maxima August 18th, 2010 12:12 PM

Yes, but...
Having been treated for *presumably* food-related anaphylactic episodes over the past 30 years, several of them so severe as to require multi-night hospital stays, let me add several points to all the good information here.

1: You will never have an anaphylactic response to an allergen until you have eaten or ingested it twice. The first exposure is required for your system to produce antibodies, the chemical "trigger" which, when activated by subsequent exposure, produces the allergic reaction. Hence it is entirely possible, particularly in situations like a shipboard buffet where many of the items offered may not be those one eats regularly, to unknowingly eat something that can potentially kill you.

2: While it is always advisable to carry an Epi-Pen (or two, as noted here: more can't hurt you; less can) if you have experienced episodes in the past, your physician may (and depending on your situation, probably should) advise you to carry IM (injectable) Benadryl - a fast acting antihistamine - and oral Prednisone, a steroid. The antihistamine quickly short-circuits the release of histamines which cause urticaria (hives) and lower blood pressure. Prednisone, usually prescribed for a brief (3-5-7 days) tapering dose, where one first takes a fairly substantial amount and lowers the dose each day, is a longer acting anti-inflammatory which protects against a recurrence of the allergic response. This is particularly important in situations like travelling, where immediate critical care is not always available.

3: While there are those of you here who know which foods cause you problems, some allergies can never be identified. I have been hospitalized (ER or inpatient) more than 40 times for allergic reactions. I had a heart attack at the age of 30 as a consequence of one, and I have been intubated for respiratory support several times. I have been unconscious as a consequence of these episodes despite having self-administered the meds listed above, and have, on at least two occasions, had no (or very low) measurable blood pressure for a brief period. I have been tested - repeatedly - for allergies and no meaningful antagonists (items thought to potentiate the response) have ever been ID'd. The condition, while not rare, is not that uncommon: it's estimated that 100,000 people in the U.S. suffer from what is called idiopathic anaphylaxis: allergic reactions of unknown etiology, i.e. they don't know what triggers the episode.

I have been told by several of the allergists I have seen (including one at the NIH in Bethesda, Maryland) that allergy testing, per se, is limited in its overall effectiveness so as to render many of the test results less than reliably diagnostic. The test results are guides in many cases, but not absolute predictors.

4: Some allergists believe that episodes can occur, or occur with greater severity, when exercise is combined with the ingestion of the trigger. By exercise, btw, they don't mean running a 10K; something as benign as walking, dancing, or moderate physical exercise can set off a response which might not otherwise have occurred had one simply remained at rest. Given the myriad activities offered on a ship and in close proximity to mealtime (which can be 24/7 if you want it to be: breakfast then a swim; lunch then a jog; dinner then the disco) it's surprising to me there are not more unfortunate episodes like the one discussed here.

I have twice been well-treated for these episodes on cruise ships, once on the CRYSTAL HARMONY for a very severe anaphylactic episode which was quickly and skillfully (hey, it happened after lunch and I was dancing with her that evening) treated by a nurse while the doc was ashore and once on the Celebrity INFINITY. I have required hospital treatment in places as different as Berlin, Honolulu, and Toronto, and I have, so far successfully, been able to treat myself on other occasions at home, on ships, in hotels and twice on aircraft in flight.

I'm not offering my own experience as one I'd wish on anyone, and I'm all the more grateful for the second and third and fortieth and fiftieth chances I've been given, but it's led me to several conclusions, the first of which I learned in the Boy Scouts: be prepared. When you don't the cause, you can hardly avoid exposure to it, but you can try to limit the downside by knowing the early warning signals (flushing, itching, etc.), knowing in advance where medical care can be found and having a plan to get there, and by making sure you have the meds with you all the time and either know how to use them yourself or that someone with you does. It goes without saying that if you do know the trigger(s) you should avoid them, but again, that's not always possible. Finally, this condition has an upside. I've been lucky (knock wood) to have received so much skilled medical care every time I needed it and have - as a consequence - met and come to know some terrific people: doctors and nurses who work hard to find answers which aren't always obvious. In addition, I owe my life, literally, to some hotel desk clerks, and flight attendants, and cops and EMT's too.

Most of all, though, this condition has motivated me to see and do more than perhaps I otherwise would. When any day could be my last - which, when you think about it, is true for all of us - I think I value all of them more.

It's always a tragedy to see someone die, more so when that person is (and so often they are) young. In all honesty, my opinion is that all the preparations one might take don't guarantee a good outcome. Sadly, some of the 125 deaths mentioned probably could not be avoided. Without knowing any of the facts in this case, it's pointless to speculate why this young man died but it's not pointless to urge anyone who's ever experienced even a mild allergic episode to get good medical advice before you travel, to avoid those items you have had problems with before, and to have a plan when and if something does happen.

Paul Motter August 18th, 2010 02:35 PM

Thank you Maxima. That is good advice. It is good to know that most cruise ships and even airlines have been prepared enough to help you.

It is also good to know that NCL was very likely not negligent in this case. As you said, in amy cases the person may not even realize they are allergic to anything, and they als might ingest things, such as at a buffet, where they do not even realize they are eating a food they are allergic to.

Since I have a VERY mild allergic reaction to shrimp (and only shrimp, I have certainly chowed down on lobster and crab in much bigger amounts than I could ever eat in shrimp) I do watch out for it. But I will even more in the future.

As someone said, in a gourmet kitchen nothing goes unused. I would not be surprised at all to learn they use the shells and heads of shrimp to make a soup base, for example.

I know I will probably stop eating shrimp all together now. I don't think I need to chance anything like this happening to me.

Cerj002 August 18th, 2010 08:30 PM

I'd first like to say that my thoughts and prayers are with the family of this young man.
I'm new to this site, in fact I found it by searching for more info on the tragedy. My 14yr old daughter is severely allergic to peanuts/tree nuts, lentils and legumes. We took her on her first cruise 7 yrs ago on Princess. She has been on Princess twice and Carnival 1 time. We purposely avoided Norweign because of the anytime dining. ( At one time, I called Norweign and was told that they basically couldn't accomadate her). I always inform the ship about her allergy and make sure that we have a set time in the main dining room. I guess I just feel more comfortable having the same waiter every evening. We also go to meet the maitre'd upon our arrival. On the first cruise the maitre'd sent back a meal that the waiter brought our daughter because it wasn't made specifically for her. Every other cruise was the same with staff members going out of their way to accomadate her needs. I have read ingredients list for soft serve ice cream and other items but, I usually bring my own frozen deserts from a nut free bakery on board with me. I have seen signs about peanuts on the desert buffet on several cruises. I travel with about 7 epi pens and will be looking into IM benadryl as suggested by the other poster. I appreciate the experiences of other posters with the same situation as it helps me to learn more about traveling and the specific cruise lines in general.

Shelby August 19th, 2010 04:51 PM

Any of us can be allergic to a food or substance and not be aware of it. Also, just because you're not allergic to a food or medication today doesn't mean it can't cause a reaction tomorrow.

I'm wondering...a lot of us eat certain foods for the first time when we're cruising. Could be the unfortunate Epic cruiser ate something he hadn't eaten before, therefore wouldn't know he was allergic to it.


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