Sheila’s got me invited into the doctor’s office.
“I got a call from Dr. Curran at the hospital this morning,” Dr. Nikano said, sitting at a cluttered desk. Behind her was an image of lungs blossoming with bronchioles. “I feel terrible about Sheila. Made me wonder if I’d missed something at her last visit.”
“That’s just it. It’s so rare for this to happen, isn’t it?”
“Yes and no…” She hesitated. “A study was done a few yearsago that found elevated levels of mast cell tryptase in a significant number of unexplained deaths. It may happen more frequently than we think.”
“Well, I want to find out what caused such a severe reaction.”
“The spoiled epinephrine didn’t help. That surprised the jelly out of me. Sheila was as prepared as any patient I’ve known.”
“Could she really have been taken down by a little speck of shellfish?”
“The long answer is that a number of scenarios could have brought on the anaphylactic reaction. People have severe allergies to nuts, milk, eggs, latex, even sperm. There’s a disease called mastocytosis in which your body can induce the reaction on its own. But Sheila didn’t have it, nor any of these allergies. So the short answer is, yes. A little bit of crustacean could be responsible.”
I shook my head. “How can that happen?”
“Don’t underestimate the speck. It triggers the whole arsenal of the immune system, a powerful thing. With allergic rhinitis, the allergen is pollen or dust and the reaction localized to the nasal cavity. In food allergy, it’s usually a protein. The reaction is far more extreme when sensitivity has developed in the intestinal tract. There are several crustacean proteins people are allergic to, some of which allow the animal to survive in cold water. Sheila’s immune system mistook them for a barbarian horde. We don’t know why, exactly. Some doctors theorize our society has become too clean. Our immune system doesn’t have as many germs to fight, so it turns its weapons on innocent allergens—or our own cells, in the case of autoimmune disease. People in developing countries have a lower rate of allergy and asthma, presumably because their histamines and eosinophils are kept busy with other things.”
“How can we be sure it was a crustacean protein? We know she didn’t eat any that night.” I told her about the dinner party. “We’re also certain there was no shellfish residue in the kitchen.”
“Even if there was a bit of residue, it should only have made her sick. Not killed her.”
I waited a moment before going on. “Right. So we’re thinking about other sources. What about where she works—LifeScience?”
Dr. Nikano tilted her head. “You mean a biochemical hazard? I doubt it. They’re super careful in those companies. What Dr. Curran told me points to anaphylactic shock, not some other type of poisoning. The protein hits fast and it hits hard. If she got it at the lab, she wouldn’t have made it to your dinner party.”
“What about after she left the party, then? She only felt a little bit ill at dinner. Maybe someone gave her the allergen afterward.”
“Gave her?”
“It seems unlikely, I know—if someone wanted to kill her, why not just do it the old fashioned way?”
Dr. Nikano looked perplexed, almost hurt by the idea. She folded her hands. Lines runnelled her forehead.
“So this doesn’t make any more sense to you than it does to us,” I said.
“Nope.”
On the wall I saw that she had an MD from UCSF, one of the best research medical schools in the country. “Can you find out what happened? Do some more tests?”
“Oh, I intend to. This one’s got my neck hairs up. I’ll request samples from Dr. Curran. If an autopsy has been done, I’ll get the report.”
I took a leap. “Her parents are on their way, but it may take a day or two. They’ve asked that everything possible be done.”
“I’ll call the hospital right away.”
“Thank you, Dr. Nikano.
“I got a call from Dr. Curran at the hospital this morning,” Dr. Nikano said, sitting at a cluttered desk. Behind her was an image of lungs blossoming with bronchioles. “I feel terrible about Sheila. Made me wonder if I’d missed something at her last visit.”
“That’s just it. It’s so rare for this to happen, isn’t it?”
“Yes and no…” She hesitated. “A study was done a few yearsago that found elevated levels of mast cell tryptase in a significant number of unexplained deaths. It may happen more frequently than we think.”
“Well, I want to find out what caused such a severe reaction.”
“The spoiled epinephrine didn’t help. That surprised the jelly out of me. Sheila was as prepared as any patient I’ve known.”
“Could she really have been taken down by a little speck of shellfish?”
“The long answer is that a number of scenarios could have brought on the anaphylactic reaction. People have severe allergies to nuts, milk, eggs, latex, even sperm. There’s a disease called mastocytosis in which your body can induce the reaction on its own. But Sheila didn’t have it, nor any of these allergies. So the short answer is, yes. A little bit of crustacean could be responsible.”
I shook my head. “How can that happen?”
“Don’t underestimate the speck. It triggers the whole arsenal of the immune system, a powerful thing. With allergic rhinitis, the allergen is pollen or dust and the reaction localized to the nasal cavity. In food allergy, it’s usually a protein. The reaction is far more extreme when sensitivity has developed in the intestinal tract. There are several crustacean proteins people are allergic to, some of which allow the animal to survive in cold water. Sheila’s immune system mistook them for a barbarian horde. We don’t know why, exactly. Some doctors theorize our society has become too clean. Our immune system doesn’t have as many germs to fight, so it turns its weapons on innocent allergens—or our own cells, in the case of autoimmune disease. People in developing countries have a lower rate of allergy and asthma, presumably because their histamines and eosinophils are kept busy with other things.”
“How can we be sure it was a crustacean protein? We know she didn’t eat any that night.” I told her about the dinner party. “We’re also certain there was no shellfish residue in the kitchen.”
“Even if there was a bit of residue, it should only have made her sick. Not killed her.”
I waited a moment before going on. “Right. So we’re thinking about other sources. What about where she works—LifeScience?”
Dr. Nikano tilted her head. “You mean a biochemical hazard? I doubt it. They’re super careful in those companies. What Dr. Curran told me points to anaphylactic shock, not some other type of poisoning. The protein hits fast and it hits hard. If she got it at the lab, she wouldn’t have made it to your dinner party.”
“What about after she left the party, then? She only felt a little bit ill at dinner. Maybe someone gave her the allergen afterward.”
“Gave her?”
“It seems unlikely, I know—if someone wanted to kill her, why not just do it the old fashioned way?”
Dr. Nikano looked perplexed, almost hurt by the idea. She folded her hands. Lines runnelled her forehead.
“So this doesn’t make any more sense to you than it does to us,” I said.
“Nope.”
On the wall I saw that she had an MD from UCSF, one of the best research medical schools in the country. “Can you find out what happened? Do some more tests?”
“Oh, I intend to. This one’s got my neck hairs up. I’ll request samples from Dr. Curran. If an autopsy has been done, I’ll get the report.”
I took a leap. “Her parents are on their way, but it may take a day or two. They’ve asked that everything possible be done.”
“I’ll call the hospital right away.”
“Thank you, Dr. Nikano.
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