Conscious Choice: My Peanut Allergy

November 1999

My Peanut Allergy

by Laura Hoofnagle

My earliest peanut allergy experience involved a bird feeder I was making for my pre-school class by spreading peanut butter on a pine cone. I must have rubbed my eyes or unconsciously put a finger into my mouth or nose, because the next thing I remember, I was being whisked out of the classroom and the school by my surprisingly cool-headed mother. My entire face was swollen, and the other kids were nudging each other and pointing at me.

Since that incident, I have accidentally ingested peanuts, cashews, walnuts, or something else from the nut family approximately once a year — in Thai carry-out, in boxed candy assortments, in Christmas cookies. Each time the circumstances are different, and each time I say, "Wow, I’ll never eat that again." And I never do. But nuts sneak into the darnedest things.

My peanut allergy is quirky. For instance, peanut oil does not elicit a reaction, but a plain sugar cookie that has nestled against a peanut butter cookie will. Some reactions are short, mild, and forgettable; others are severe, debilitating, and scary. I am vigilant about reading labels (product ingredients change often, and peanuts in candy are not always visible — yes, plain M&Ms have them — ground up in the shell!) and I have been heartened lately to see on various candy labels: "This product has been manufactured by equipment that processes peanuts," or "May contain peanuts or peanut traces."

Basically, when I eat peanuts, I have an anaphylactic reaction. My immune system releases huge amounts of antibodies, other tissues release histamines, and everything swells and itches. People having acute anaphylaxis have died from a variety of complications, including low blood pressure (resulting from the increased histamines and dilated blood vessels), pulmonary edema (fluid in the lungs which backs up into the veins) and airway blockage (resulting from hives and swelling in the throat). Anaphylaxis can be triggered not only by foods (the most common offenders are shellfish and nuts) but by medications (e.g., penicillin), insect bites or stings, and even some vaccinations or allergy shots. The only treatment for anaphylaxis is an injection of epinephrine (adrenaline), which is available in single portable shots called Ana-Kits or Epi-Pens.

Wide as a wide-tipped magic marker, the Epi-Pen that I carry has a thick needle in its center that sticks out about a half inch. It is "sprung" just before use and punched into the outside of my thigh, through clothing if necessary. It arrests the reaction — and makes me shake and tremble a bit.

In my experience, the most dangerous part of anaphylaxis has been the reaction of my lungs. In one particularly severe allergic attack (I vaguely recall being starvin’-hungry and shoving an entire cookie into my mouth after being assured that it had no nuts). I remember being distinctly short of breath, racked by strangled, wheezing coughs. Thankfully, I was in the emergency room by the time this particular reaction began, and immediately given a Ventolin inhaler, which opened my lungs and triggered my most common peanut reaction — the expulsion of the offending food and everything that went down with or before it. (This is more painful than unusual because the digestive tract is swollen.)

I’ve become careful with food, simply by force of habit. At gourmet or experimental restaurants, I often have to stick to the house salad or another food item in which every ingredient is clearly visible. I always ask waitstaff, of course, and watch them carefully as they answer. Do they know this dish has no nuts or do they just think so? What does the cook say? Would they mind checking with him/her?

The most dangerous situations have been "pot-luck" events, holiday parties, receptions and the like, which feature tables of homemade or catered desserts. Why people feel compelled to add nuts to perfectly good cookies and cakes I will never understand.

If I am brave (some may say foolish) enough to try a particular dessert, I take small bites. If I have a reaction (and I usually know immediately, when my mouth starts to throb and swell) the first thing I do is fill my mouth with ice, crunch hard and spit. (If I’m able to get my hands on a toothbrush, I brush, too.) The ice is excruciating on my teeth, but it accomplishes two things — it stops the swelling and it flushes out any nut bits that are still in my mouth and could do more damage. If I know my Epi-Pen is present and working, I wait, paying special attention to my breathing (waiting for any tightness in my chest) and the texture of my skin (waiting for any bumpy red rash breakouts). If I detect either problem, out comes the Epi-Pen.

After the application, I am advised to seek medical attention anyway, as my body has had quite a series of shocks. I make sure I get a lot of rest that day and keep close watch on my heartbeat.

I am comforted, now, to hear at gatherings of family or friends, "Hey Laura! Is a pistachio a nut?" "Hey Laura! Can you eat almonds?" "Be sure to stay away from that Waldorf salad!" or "I’m sorry for buying Reese’s cups. I forgot!" Really, I’ve always accepted my allergy as an occasional, temporary, though scary setback rather than viewing it as crippling. I realize its dangers, take precautions, and am very grateful that peanuts are not in the majority of foods. In any case, it’s nice to have people looking out for me.

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