Allergy Manager

Common Allergen Categories with Examples

Food Allergens (Top 9 + common others):

• Peanuts, tree nuts (almond, walnut, cashew, pistachio, pecan, hazelnut, macadamia, Brazil nut)
• Milk (cow, goat, sheep), eggs, wheat, soy, fish, shellfish (shrimp, crab, lobster, clam, mussel)
• Sesame, mustard, celery, lupin, mollusks, corn, nightshades

Environmental Allergens:

• Tree pollen (birch, oak, cedar, maple, elm, ash, pine)
• Grass pollen (timothy, bermuda, ryegrass, bluegrass)
• Weed pollen (ragweed, sagebrush, pigweed, lamb's quarters)
• Mold spores (Alternaria, Aspergillus, Cladosporium, Penicillium)
• Dust mites (Dermatophagoides pteronyssinus, D. farinae)
• Pet dander (cat, dog, horse, rabbit, rodents)
• Cockroach particles, feathers

Drug Allergens:

• Penicillin and beta-lactam antibiotics (amoxicillin, ampicillin)
• Sulfonamides (sulfamethoxazole)
• NSAIDs (aspirin, ibuprofen, naproxen)
• Anticonvulsants (carbamazepine, phenytoin, lamotrigine)
• Opioids, local anesthetics, contrast dyes, biologics

Insect Allergens:

• Bee venom (honeybee, bumblebee)
• Wasp venom (yellowjacket, hornet, paper wasp)
• Fire ant venom
• Mosquito saliva (Skeeter syndrome)

Contact Allergens:

• Nickel, cobalt, chromium
• Latex (natural rubber)
• Fragrances (balsam of Peru, cinnamic aldehyde)
• Preservatives (formaldehyde, methylisothiazolinone)
• Hair dyes (paraphenylenediamine / PPD)
• Topical antibiotics (neomycin, bacitracin)

2. Reaction Logging

Record individual allergic reactions with detailed context for pattern analysis.

Symptom Categories

Skin Reactions:

• Hives (urticaria), angioedema (deep tissue swelling)
• Eczema flare (atopic dermatitis)
• Contact dermatitis (redness, blistering, itching)
• Flushing, pruritus (generalized itching)

Respiratory Reactions:

• Sneezing, rhinorrhea (runny nose), nasal congestion
• Wheezing, cough, shortness of breath
• Throat tightness, stridor, laryngeal edema
• Asthma exacerbation

Gastrointestinal Reactions:

• Nausea, vomiting
• Abdominal cramping, diarrhea
• Oral allergy syndrome (itching/tingling of lips, mouth, throat)

Ocular Reactions:

• Itchy, watery eyes (allergic conjunctivitis)
• Eyelid swelling

Cardiovascular / Systemic Reactions:

• Anaphylaxis (multi-system involvement)
• Hypotension, tachycardia, dizziness, syncope
• Sense of impending doom

Severity Scale Reference

3. Cross-Reactivity Database

When a user reports an allergy, check for known cross-reactivity risks and proactively warn them.

Latex-Fruit Syndrome

Latex allergy is associated with IgE cross-reactivity to certain fruit and vegetable proteins (hevein-like domains):

• High risk: Banana, avocado, chestnut, kiwi
• Moderate risk: Apple, carrot, celery, papaya, potato, tomato, melon
• Lower risk: Pear, mango, fig, pineapple, passion fruit

Oral Allergy Syndrome (OAS) / Pollen-Food Allergy Syndrome

Cross-reactivity between inhaled pollen proteins and structurally similar proteins in raw fruits, vegetables, and nuts:

Note: Cooking typically denatures the offending proteins and eliminates OAS symptoms. Allergy to the cooked form suggests a separate, potentially more serious, food allergy.

Shellfish Cross-Reactivity

Tropomyosin is the major allergen shared across crustaceans and some other invertebrates:

• Crustaceans: Shrimp, crab, lobster, crayfish, prawns (high cross-reactivity, ~75%)
• Mollusks: Clam, mussel, oyster, scallop, squid, octopus, snail (moderate cross-reactivity)
• Insects: Cockroach, dust mites (tropomyosin homology)
• Dust mite to shrimp: Individuals allergic to dust mites may react to shrimp and vice versa due to shared tropomyosin

Tree Nut Cross-Reactivity Patterns

• Walnut and pecan share high cross-reactivity (~90%)
• Cashew and pistachio share high cross-reactivity (~70%)
• Almond is botanically a stone fruit; lower cross-reactivity with other tree nuts
• Hazelnut cross-reacts with birch pollen (OAS) and other tree nuts
• Coconut is botanically not a tree nut; cross-reactivity is rare but possible
• Peanut is a legume, not a tree nut, but co-allergy is common (~25-40%)

Drug Cross-Reactivity

• Penicillin → Cephalosporins: ~2% cross-reactivity risk (historically overestimated). First-generation cephalosporins (cephalexin) carry higher risk than third-generation (ceftriaxone).
• Penicillin → Carbapenems: ~1% cross-reactivity risk.
• Sulfonamide antibiotics → Non-antibiotic sulfonamides: Cross-reactivity is NOT established. Sulfa antibiotic allergy does NOT contraindicate furosemide, thiazides, or celecoxib.
• NSAID cross-reactivity: Aspirin-sensitive patients may react to ibuprofen and naproxen. COX-2 inhibitors (celecoxib) are often tolerated.
• Local anesthetic cross-reactivity: Esters (procaine, benzocaine) may cross-react with each other. Amides (lidocaine, bupivacaine) rarely cross-react with esters.

Additional Cross-Reactivity Groups

• Red meat allergy (alpha-gal syndrome): Triggered by Lone Star tick bites; cross-reactivity with mammalian meat (beef, pork, lamb), gelatin, dairy (in some cases), and the drug cetuximab.
• Legume family: Peanut, soy, lentil, chickpea, pea. Clinical cross-reactivity is lower (~5%) than serological cross-reactivity.
• Seed cross-reactivity: Sesame, poppy, sunflower, and flaxseed may share some protein homology, but clinical cross-reactivity is uncommon.

4. Seasonal Allergy Calendar

Month-by-month guide to predominant airborne allergens in the Northern Hemisphere. Actual timing varies by latitude, climate, and local flora.

Tips by Season

• Spring: Monitor local pollen counts. Shower after outdoor activity. Keep windows closed on high-pollen days. Use HEPA filters.
• Summer: Minimize outdoor activity on high-humidity days. Watch for thunderstorm asthma (pollen grains burst in moisture).
• Fall: Rake leaves with a mask. Watch for mold in damp leaf piles. Start preventive antihistamines before ragweed season if historically affected.
• Winter: Use allergen-proof bedding encasements. Maintain humidity at 30-50% to reduce dust mites. Clean HVAC filters monthly.

5. Food Label Scanner Guidance

Many allergens appear under unfamiliar names on ingredient labels. Use this reference to identify hidden allergens.

Milk (Dairy)

Casein, caseinate (sodium/calcium/magnesium), whey, lactalbumin, lactoglobulin, lactulose, ghee, curds, hydrolysates, recaldent, rennet casein, tagatose. May be in: caramel color, chocolate, nougat, "natural flavoring," baked goods, deli meats, hot dogs.

Egg

Albumin (albumen), globulin, lysozyme, ovalbumin, ovomucin, ovomucoid, ovovitellin, meringue, surimi, lecithin (sometimes egg-derived). May be in: pasta, marshmallows, baked goods, foam toppings, vaccines (influenza, yellow fever).

Wheat

Durum, einkorn, emmer, kamut, semolina, spelt, triticale, bulgur, couscous, farro, seitan, fu (gluten). May be in: soy sauce, modified food starch, hydrolyzed vegetable protein, malt (sometimes), surimi.

Soy

Edamame, miso, natto, tempeh, tofu, soy protein isolate/concentrate, textured vegetable protein (TVP), soy lecithin, soybean oil (often tolerated). May be in: bouillon, vegetable broth, "natural flavoring."

Peanut

Arachis oil (peanut oil), beer nuts, ground nuts, mandelonas, monkey nuts, arachis hypogaea. May be in: chili, egg rolls, enchilada sauce, marzipan (sometimes), nougat, ice cream.

Tree Nuts

Specific nut flours, butters, oils, extracts, milks, pastes (e.g., praline, marzipan/almond paste, nougat, gianduja, mortadella). Coconut is classified as a tree nut by the FDA but is botanically a fruit.

Fish

Surimi, Worcestershire sauce, Caesar dressing, caponata, bouillabaisse, fish sauce (nam pla), fish gelatin, omega-3 supplements (fish-derived).

Shellfish

Surimi (may contain shellfish extract), glucosamine (often shrimp-derived), bouillabaisse, cuttlefish ink, shrimp paste.

Sesame

Tahini, halvah, hummus, za'atar, sesame oil, benne seeds, gingelly oil, til. May be in: bread, bagels, sushi, tempeh.

Major Allergen Lookup Table

6. Severity Assessment and Action Plans

Mild Reaction (Severity 1-2)

• Symptoms: Localized hives, mild itching, sneezing, watery eyes, mild oral tingling.
• Actions:
  1. Remove exposure to the allergen if identifiable.
  2. Take an oral antihistamine (e.g., cetirizine, loratadine, fexofenadine).
  3. Apply cool compresses for skin symptoms.
  4. Monitor for 1-2 hours for progression.
  5. Log the reaction.
• Follow-up: If reactions are recurring, consider allergy testing referral.

Moderate Reaction (Severity 3)

• Symptoms: Widespread hives, facial swelling (without airway compromise), moderate GI symptoms, multiple symptom categories.
• Actions:
  1. Remove allergen exposure immediately.
  2. Take an antihistamine. Consider a second-generation H1 blocker + H2 blocker (e.g., cetirizine + famotidine).
  3. If prescribed, consider oral corticosteroids per doctor's instructions.
  4. Monitor closely for 4-6 hours for progression to severe.
  5. Seek medical evaluation if symptoms do not improve within 1 hour.
  6. Log the reaction in detail.
• Follow-up: Schedule allergist appointment. Discuss whether an epinephrine auto-injector prescription is warranted.

Severe Reaction (Severity 4-5)

• Symptoms: Throat tightness, difficulty breathing, wheezing, significant swelling, hypotension, dizziness, loss of consciousness.
• Actions:
  1. USE EPINEPHRINE AUTO-INJECTOR IMMEDIATELY (if prescribed and available).
  2. CALL EMERGENCY SERVICES (911 / 112 / 999).
  3. Lie down with legs elevated (unless vomiting or having difficulty breathing).
  4. A second dose of epinephrine may be given after 5-15 minutes if no improvement.
  5. Do NOT rely on antihistamines alone for anaphylaxis.
  6. After ER treatment, monitor for biphasic reaction (second wave can occur 1-72 hours later).
• Follow-up: Allergist referral is mandatory. Obtain epinephrine prescription if not already on hand. Consider medical alert identification (bracelet/necklace).

Anaphylaxis Action Plan Template

╔══════════════════════════════════════════════════════════════╗
║              ANAPHYLAXIS EMERGENCY ACTION PLAN              ║
╠══════════════════════════════════════════════════════════════╣
║ Name: [User name]                                           ║
║ Known Allergens: [List]                                     ║
║ Epinephrine Location: [Where auto-injector is kept]         ║
║                                                             ║
║ SIGNS OF ANAPHYLAXIS (any ONE of these):                    ║
║  • Difficulty breathing, wheezing, stridor                  ║
║  • Swelling of tongue or throat                             ║
║  • Persistent dizziness or collapse                         ║
║  • Pale and floppy (in children)                            ║
║  • Abdominal pain with vomiting (after insect sting/drug)   ║
║                                                             ║
║ ACTION:                                                     ║
║  1. Give epinephrine auto-injector into outer mid-thigh     ║
║  2. Call emergency services (911 / 112 / 999)               ║
║  3. Lay person flat; elevate legs (if breathing permits)    ║
║  4. If no improvement in 5-15 min, give 2nd epinephrine     ║
║  5. Stay with person until paramedics arrive                ║
║                                                             ║
║ Emergency Contact: [Name, phone]                            ║
║ Allergist: [Name, phone]                                    ║
║ Hospital: [Preferred hospital]                              ║
╚══════════════════════════════════════════════════════════════╝

7. Pattern Analysis

When sufficient reaction data has been logged, perform the following analyses:

Seasonal Patterns

• Correlate reaction dates with pollen calendars and weather data.
• Identify months or seasons where reactions cluster.
• Flag likely seasonal allergies that may benefit from prophylactic treatment.

New Sensitivities

• Detect new allergens appearing in the reaction log that are not in the allergy profile.
• Prompt the user to add newly identified triggers to their profile.
• Check cross-reactivity database to see if the new trigger is related to a known allergy.

Improving or Worsening Trends

• Track severity scores over time for each allergen.
• Flag allergens where average severity is increasing (potential worsening sensitization).
• Note allergens where tolerance appears to be developing (decreasing severity, especially relevant for children outgrowing allergies).

Trigger Correlations

• Weather: High pollen days, humidity changes, temperature shifts, thunderstorms.
• Stress: Correlate reactions with reported stress levels or life events (stress can amplify allergic responses via mast cell activation).
• Food combinations: Some reactions may require co-factors (e.g., exercise-induced food allergy: wheat + exercise = anaphylaxis).
• Medication changes: Starting or stopping medications (e.g., beta-blockers can worsen anaphylaxis risk; ACE inhibitors increase angioedema risk).
• Hormonal cycles: Some individuals experience worsened allergies premenstrually or during pregnancy.

Analysis Output

When reporting patterns, provide:

• Summary of identified patterns with confidence level (strong, moderate, suggestive).
• Supporting data points (specific dates, reactions, severity scores).
• Actionable recommendations (prophylactic treatment, avoidance strategies, specialist referral).

Output Formats

Daily Log Entry

When recording a reaction in the daily log, use this format:

### Allergy Reaction - [Time]
- **Trigger:** [Allergen]
- **Symptoms:** [Comma-separated list]
- **Severity:** [1-5] ([label])
- **Onset:** [Duration from exposure]
- **Duration:** [How long symptoms lasted]
- **Treatment:** [What was taken/done]
- **Outcome:** [How it resolved]
- **Notes:** [Any additional context]

Profile Summary

When presenting the allergy profile, format as:

## Allergy Profile Summary

### Food Allergies
| Allergen | Severity | Diagnosed By | Date | Notes |
|---|---|---|---|---|
| [name] | [level] | [method] | [date] | [notes] |

### Environmental Allergies
| Allergen | Severity | Diagnosed By | Date | Notes |
|---|---|---|---|---|

### Drug Allergies
| Allergen | Severity | Diagnosed By | Date | Notes |
|---|---|---|---|---|

### Cross-Reactivity Alerts
- [Allergen] → Watch for: [cross-reactive items]

Alert Format

When a cross-reactivity or exposure risk is detected:

> ⚠️ **ALLERGY ALERT**
> [Description of the risk]
> **Known allergy:** [Allergen]
> **Risk factor:** [Cross-reactive substance or exposure scenario]
> **Recommended action:** [What to do]

For anaphylaxis-level warnings:

> 🚨 **ANAPHYLAXIS RISK**
> [Description]
> **Carry epinephrine at all times.**
> **If symptoms occur: Use epi-pen → Call emergency services → Do NOT delay.**

Data Persistence

Daily Log Files

Reaction events are recorded in the user's daily log file at the standard daily log path. Each reaction is appended under the appropriate date with full details.

Allergy Profile File

The master allergy profile is stored at:

items/allergies.md

This file contains:

• The complete allergy profile table (all known allergens, types, severities, diagnosis info).
• Active cross-reactivity alerts.
• Current action plan (including epinephrine status and emergency contacts).
• Last-updated timestamp.

When updating the allergy profile:

1. Read the existing items/allergies.md file.
2. Merge new information (do not duplicate entries; update existing entries if severity or notes change).
3. Regenerate cross-reactivity alerts based on the updated profile.
4. Write the updated file.

Alerts and Safety

Medical Emergency: Anaphylaxis

Anaphylaxis is a life-threatening medical emergency. If the user describes symptoms consistent with anaphylaxis (difficulty breathing, throat swelling, rapid drop in blood pressure, widespread hives with systemic symptoms), immediately advise:

1. Use epinephrine auto-injector NOW if available.
2. Call emergency services immediately (911 in the US, 112 in EU, 999 in UK).
3. Do not wait to see if symptoms improve on their own.
4. Do not substitute antihistamines for epinephrine in anaphylaxis.

Important Safety Reminders

• This tool is NOT a substitute for professional allergy testing. Skin prick tests, specific IgE blood tests, and oral food challenges conducted by a board-certified allergist are the gold standard for allergy diagnosis.
• Always carry prescribed epinephrine if you have a history of anaphylaxis or severe allergic reactions. Check expiration dates regularly (typically every 12-18 months).
• Wear medical alert identification (bracelet or necklace) listing severe allergies, especially for drug allergies and anaphylaxis history.
• Inform healthcare providers about all allergies before any medical procedure, new prescription, or vaccination.
• When in doubt, avoid the trigger and consult a healthcare professional.
• Cross-reactivity information represents population-level risk. Individual reactions vary. A negative cross-reaction for most people does not guarantee safety for a specific individual.

Medical Disclaimer

This allergy management tool provides informational guidance only and does not constitute medical advice, diagnosis, or treatment. Allergy management decisions, including medication use, allergen avoidance strategies, and emergency action plans, should be developed in partnership with a qualified healthcare provider such as a board-certified allergist/immunologist. Never delay seeking emergency medical care based on information from this tool. If you believe you are experiencing a severe allergic reaction, call emergency services immediately.