Quinine

The Quinine Allergy Story

The story begins:

Back in November of 2006 I traveled to the Netherlands for business and on my first day there I remember having dinner and going to bed fine. The next morning, however, I awoke with a swollen lip and strange pains in certain points of my left hand. Odd, certainly, but beyond that my only thought was that it must had been something I ate (even though I had never experienced anything like it previously) and I took some Benadryl and continued my business trip as usual. By the time I got home I had around six red spots on my hands and some spots going on — shall we say, down south. It was all strange enough to go to a local dermatologist to find some answers. Being obviously puzzled they gave me an anti-viral medication and at the time I did not even take notice of the term “Erythema Multiforme” that the doctor made note of in the diagnosis. From there I got well and did not think much more of it until…

The Netherlands again?:

…I was on a mid flight back from the Netherlands in April of 2007. Yes, the next time I was in the Netherlands my way home was met with the now familiar pains in the very specific spots on my left hand that I had in November of the previous year. Thinking this was going to run a similar course as last time I debated even seeing a doctor, however, as the hours progressed this was obviously a much worse occurrence to the point where real worry was setting in. The spots were much worse (they were in the very same places as before) but this time they were also in my mouth (that made eating impossible) and in areas that made it painful to go to the bathroom. Going to a different doctor she immediately noted “Erythema Multiforme” later confirmed by a biopsy and thought, after making comment that she has not seen something like this since her residency — which was obviously a while ago, that it could be related to herpes. Cutting more details short I was now on Valtrex, off to another doctor for more blood tests, and in the mean time back to pretty much normal over a very long passage of two weeks. (The following photos show my left and right hands after about 2 days into this occurrence)

QASHand1SQASHand2S

The blood tests came back showing I did not have anything that they could come up with as ideas (including herpes) and while they were taking all of the blood I did fine out I was allergic to Brazil nuts which I kind of knew from a previous direct experience without medical confirmation. What the heck was going on during either the plane ride, or in the Netherlands, were the questions going on in my mind! This episode was really bad and if it happens again — and is worse, then I would probably need to be treated as a burn victim.

So, it is not the Netherlands:

The next time it happened I was home in New Jersey in July of 2007. I was now on Zantac (as an H2 blocker) and Claratyne (as an H1 blocker) as well as Prednisone. The symptoms played out their course as usual and this time it was much worse than the first occurrence but no where near as bad as the second one. Are the drugs helping? Who knows? About the only thing I do know at this point is that we seem to be eliminating a lot of possibilities that it is not and now it does not seem to be directly related to the Netherlands — however, from a statistical point of view I had only flown to the Netherlands twice in the past 9 months or so and how could it be that on those two trips this had been happening?

Again in New Jersey:

In October of 2007 it happened again in New Jersey. Unfortunately, at this point, the only actions left were to come up with other theories to try and now I am thinking about going to the Mayo Clinic for a complete observation the next time this happens. (As seen in the photo below the spots are just as bad as ever and always in the same place)

QASHand3S

The NL lottery hits for the 3rd Time in a Row:

The next month it happened again on the plane home from the Netherlands. Mentally, I am now focused on finding something my body is allergic to and thus making a massive change in all of the products I use (such as shampoo, deodorant, supplements, and so on…) In the mean time another theory has come up — maybe it is a parasite I picked up somewhere so off to a tropical medicine specialist. In January of 2008 I find out that I am negative for parasites and in attempt to reboot my body I go through a Master Cleanse.

I finally beat the odds in the Netherlands:

In April of 2008 I took my first trip to the Netherlands since this strangeness has started in 2006 and came home without any problems! Was in the cleanse or something else I eliminated? Time will probably tell…

…but, then again, it still is not over, or is it?:

Then comes May of 2008 with another episode in New Jersey. The frustration level is as high as ever and just when I think I am totally lost my wife saves me with the help of House, M.D.

House

My wife was watching House, M.D., Season 4, Episode 14 — “Living the Dream” and somehow connected an allergic reaction, that had none of the symptoms I had, with the source of the reaction being something she saw the other day as someone was preparing sangria. Looking back over all the notes I took in my personal journal we were finally able to connect the dots. Every time it happened in New Jersey I had some of the sangria that a friend of ours made with one special ingredient “Tonic Water”. In the Netherlands, I was introduced to something, by a colleague in November of 2006, that I had on nearly every trip back except for the last one — “Bitter Lemon”. Both of these drinks contain the one key ingredient that I now know I am highly allergic to: QUININE!

Looking back, as it usually is, it is easy to make the connections. The biopsy for diagnosing the Erythema Multiforme mentioned the term ‘drug eruption’. I now know the term ‘fixed drug eruption’ describes the fact that my ‘spots’ were always in the same places. There is no blood test for a quinine allergy that at least I know of. However, the scariest of all facts is that between tonic water and bitter lemon one sees dilutions of around 40 to 70 milligrams per liter of quinine. This is the literal drop in the bucket for what prophylaxis medication would be for malaria. Given the travel we have been doing I have passed on taking anything like this due to the low risk of, say the region we were visiting in Costa Rica, and thought that sometime in the future it would be needed if we were to go somewhere with a high risk. Now I am terrified to take anything for malaria given the rareness of the allergy and the sparseness of data around the subject.

If anyone could add further key insights on this subject I would love to hear about them!

-JR

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  • Tony Jiao

    Hi JR, I had the exact same experience like you. I was traveling to Germany and took Bitte Lemon last week. 3 hours after that,the red spots start to show up on my hands.They are really icht. 2 days later,my mouth start to be swelling and I can barely chewing or swallowing. This continued for a week…

  • AI

    JR – I have also suffered through eerily similar situations and have just come to realize tonic water may be the cause. Just curious whether you have had any recurrence and whether you’re off all medicines?

  • jraymonds

    This was as clear as you could possibly get. For the most part, unless it sneaks in somehow, it is easy (thank God) to avoid quinine. Thus, I have been careful to avoid obvious sources and asked if I ever ordered a cocktail that I was not 100% sure of. Since making this discovery I have NEVER had a reoccurrence and have NEVER had the need for any additional or ongoing medication. Please check back in if you manage to find the same! Good luck!

  • YE.Z

    AVOID TONIC WATER AND LIME

    USE FENISTIL (ANTIHISTAMINIC) to fight the symthoms of the allergy!