A Little Bit Can Hurt (14 page)

Ten minutes later, as her class goes to the International Day assembly, Alicia develops hives and feels itchy all over. Her eyes begin to swell shut. Even worse, her throat is itchy and begins to close. Feeling ill, Alicia is excused to the school clinic. The nurse calls Alicia's mother to say her daughter isn't feeling well and is walking home. Alicia lives a block away from the school and
runs
home.

Her mother sees Alicia coming, hurries to meet her, brings her into the house and immediately phones the doctor. The doctor instructs Alicia's mother to give her daughter some Benadryl
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and place her in an oatmeal bath to soothe her itchy skin. After a dose of Benadryl
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, her allergic reaction subsides. Upset and confused about her daughter's allergic reaction, Alicia's mother phones the school to find out what happened. She speaks directly to the parent who brought in the African dish and discovers that the recipe contained two heaping teaspoons of peanut butter!

A child with a severe peanut allergy ate peanut butter in class and was then sent to walk home while she was suffering an allergic reaction! Shocking!

Alicia's allergic reaction took place in the 1970's when there were no epinephrine auto-injectors, no food allergy organizations and no food allergen labeling requirements. In addition, there was little awareness of food allergies of any kind. As a child, Alicia was on her own at school, navigating her peanut allergy by avoiding peanuts and peanut butter as best she could.

Over her lifetime, Alicia estimates that she's had approximately eight or nine allergic reactions which have become less severe as she has gotten older. She doesn't clearly remember her first allergic reaction but believes she was three or four years old. She vaguely recalls eating ice cream then developing a scratchy throat, swelling and hives. Her mother called the doctor who recommended Benadryl
^®
but nothing else. There were no further instructions or a recommendation to have Alicia allergy tested.

As a child, she experienced numerous allergic symptoms that progressed from itchy lips and tongue to hives to stomach cramps with vomiting and finally to a constricted throat. As an adult, her allergic reactions have been limited to stomach cramps. This is because Alicia is more careful about what she eats and more experienced at detecting and addressing her allergic symptoms in their early stages.

Unfortunately, in high school, Alicia was not adept at detecting the onset of a reaction and suffered her most severe reaction. She recalls eating lunch and not feeling well. Then she became itchy, especially around her eyes. Ignoring her symptoms, she went to gym class. About 40 minutes later while changing her clothes, she thought, "I have to go!" Realizing that she was in trouble, she ran out of the locker room and straight to the nurse's office. Alicia recalls that by the time she reached the nurse's office, she was collapsing. The nurse called 911 and Alicia's mother, both of whom arrived within minutes.

Alicia doesn't recall the nurse giving her any medicine. Once the paramedics arrived, they placed an IV line and, she assumes, gave her epinephrine. She recalls, "I could feel my whole face just becoming totally, completely puffy." Like a typical teenage girl, she was concerned about her physical appearance in the presence of the handsome paramedics and asked her mother to help her "look better."

Alicia clearly remembers the conversation between the doctor and her mother in the emergency room. "The doctor told my mother, 'It was close. She almost died. It was a good thing that they called the paramedic. I've never seen somebody so close before!'" To this day, Alicia is not sure what she ate that almost killed her.

After that horrific ordeal, Alicia was referred to an allergist for formal testing. Surprisingly, until her life-threatening reaction in high school, she had never been tested. She had simply assumed she was allergic to peanuts and tried to avoid them, though not always successfully. Allergy skin testing confirmed her severe peanut allergy but did not reveal any allergy to tree nuts such as almonds, walnuts and pecans. Her skin testing results also indicated she was sensitive to other foods such as pepper, something she routinely ate without difficulty or reaction. Fortunately, the allergist was able to correctly interpret the results in the context of her symptoms and eating experiences. He prescribed Alicia an epinephrine auto-injector for her peanut allergy.

Today, despite her severe peanut allergy, Alicia enjoys traveling and has accumulated many frequent flyer miles. While most airlines no longer serve peanuts, she recalls being on planes that did serve them and having nasal irritation when passengers opened the little bags of peanuts. Fortunately, she has never had a severe reaction while on a plane.

Whenever possible, Alicia removes herself from any area in which people are eating or handling peanuts. She explains, "I try to stay away from peanuts. I try to stay away from confined spaces where people are either baking peanut butter cookies or eating peanuts. I definitely don't touch them." Touching peanuts causes welts on her fingers.

While she reluctantly admits she doesn't always ask about appetizer and entrée ingredients, she does always inquire about dessert ingredients. Because peanuts are a common ingredient in many Asian dishes, Alicia is particularly cautious when dining in an Asian restaurant. She specifically asks, "Are there peanuts in it?" or "Is it made in the same pot as something else [with peanuts]?" Unlike Alicia, many peanut-allergic individuals avoid Asian restaurants and forgo desserts while dining out.

Cross contact in restaurant kitchens poses a risk to food-allergic customers. Alicia recalls being on the island of Anguilla, preparing to order a grilled lobster, a menu special. The restaurant alerted patrons that the lobster sauce contained peanut butter. She asked whether the sauce was applied to the lobster on the grill or after the delicacy was already plated. She was concerned that if the sauce was brushed on the lobster while being grilled, the grill itself would possibly become covered by peanut protein. This in turn would come into contact with all grilled food at the restaurant. Fortunately, the kitchen applied the sauce only after the lobster was plated so Alicia felt comfortable ordering the menu special without sauce. She enjoyed it without incident.

Alicia is not the only person in her family with a food allergy. As a young man, her father was allergic to fish, although not to shellfish. Unlike most people with fish allergy, he outgrew his allergy in his forties or fifties. Before that, he couldn't be in the house when fish was being cooked. Alicia recalls her mother waiting until he went out to cook meals with fish.

Alicia asserts the only thing that she cannot do because of her peanut allergy is eat peanuts! She is cautious about dessert tables, something she jokes is probably a blessing so she'll eat fewer sweets. The worst thing about having food allergies, she confides, is the need to be so careful about what she eats.

Alicia maintains that even as a child, she never felt deprived nor was she tempted to eat peanuts or foods containing them. She explains, "...I never missed it. I
never wanted it because I just knew it was something that I was not going to be pleased with anyway. I wasn't going to enjoy it."

What does Alicia say about being food allergic? "I think that everybody definitely handles their allergies a little bit differently, but I don't think that if you're allergic to something, it should be anything to be ashamed about, embarrassed about, stigmatized about." She encourages others with food allergies to be diligent about inquiring about food ingredients and to recognize that there are many other foods to eat.

POSSIBLE NEXT STEPS:

1. Do you inquire about ingredients even if a food appears "safe?" Are you teaching your child to do the same?
   
2. Do you consistently inquire about menu ingredients and cross-contact concerns with the restaurant chef or manager?
   
3. Have you inquired whether the restaurant in which you are dining offers an "allergen menu" which lists the food allergens contained in each menu option?
   
4. If your child's physician instructs you to give your child Benadryl
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   for an allergic reaction, do you understand when to administer epinephrine and call 911 if the Benadryl
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   fails to treat your child's reaction adequately?
   
5. Have you discussed with your physician the potential risk of suffering an allergic reaction from inhaling airborne food allergens, such as on a plane or via cooking vapors, or from merely touching the offending food?
   

16

LINDA

Beach Week Fiasco

Linda is a Jazzercise fanatic and an avid cook. Surprisingly, in light of her shellfish allergy, she makes a mouth-watering crab dip and seafood salad. In addition to dabbling in the kitchen, she cherishes spending time with her husband and children.

R
ather than happy memories of senior prom and graduation, Linda remembers having a frightening reaction to shellfish as a young adult. She had just graduated from high school and was celebrating with friends during Beach Week at a restaurant in Ocean City, Maryland. Approximately two-and-a-half hours after dining on crab imperial, Linda began to feel ill. She was light-headed and had difficulty swallowing. By eleven o'clock that evening, Linda's face was swollen and flush. Finding it hard to breathe, she felt as if she were being strangled.

Frightened, she had a friend drive her to the local emergency room where staff concluded she had eaten some spoiled seafood. Linda was given medication to induce vomiting and was kept overnight for observation. After her strange experience, she avoided seafood for about six months but later resumed eating it without difficulty. Although the cause of her symptoms was never determined, it is doubtful this first reaction was allergic in nature.

Ten years later, at age 28, Linda was invited to a crab feast. She ate heartily and developed allergic symptoms several hours later, which is atypical. She recalls, "I must have sneezed twenty to thirty times in a row. I got up and went to the bathroom, and my face was blood red and my nose was really swollen. I knew then I was having a reaction. It got harder for me to breathe and to swallow. I started vomiting. My girls were home but asleep. I called my mother-in-law and then 911."

Unlike her earlier experience, Linda understood what was happening. She was scared but didn't want to wake or frighten her young children. She went to wait for the ambulance on the front porch where she lost consciousness. The paramedics arrived in less than five minutes and treated her with epinephrine. She regained consciousness, and by the time the ambulance had reached the hospital, Linda's condition had improved significantly.

Linda followed up with her family physician who diagnosed her with a shellfish allergy, told her to avoid all shellfish including crab, lobster and shrimp and prescribed an epinephrine auto-injector. She didn't consult an allergist or undergo any specific testing for her newly diagnosed condition.

Unfortunately, Linda suffered a subsequent reaction at a work function. She recalls, "Someone brought clam dip to a bridal shower that we had at work...I had no idea it was clam dip. I put it on a cracker. It actually looked like tuna." Linda regularly eats fish such as tuna and flounder without incident and assumed that what she saw in the clam dip was tuna. She neglected to inquire about specific ingredients, and after eating the clam dip, began to feel "a little funny." She became light-headed, and her nose turned red. Linda took Benadryl
^®
and injected herself with her epinephrine auto-injector. This course of action quickly halted her allergic reaction.

Fortunately, Linda reacts only if she eats shellfish, not if she touches or smells it. She explains, "I make crab cakes and crab dip, and it doesn't bother me. I just can't
eat it." She is unlike some food-allergic individuals who suffer a contact reaction if the allergen simply touches their skin. Some experience a respiratory reaction from breathing in allergen particles that have been released into the air while the offending food is cooking. Although Linda is able to eat fish, she rarely orders fish at restaurants out of concern that it will come into contact with shellfish proteins on utensils, serving plates and cooking surfaces in the kitchen.

Linda advises others with food allergies to understand that, while they don't have a disease, they do have a serious condition that can be life threatening. She says, "...If you have a food allergy, just make sure you're aware of what causes it and educate yourself to prevent having a reaction."

Before becoming allergic to shellfish, Linda loved eating seafood. "I really miss...eating crabs. There's nothing like sitting outside on the water...eating a bushel of crabs." She and her family are still able to enjoy crab feasts with one twist. "I eat chicken tenders," Linda laughs.