Awareness Is Remarkable, But Protective Measures Are Extreme: Bob's Surprising Insight
This article was written exclusively for PeanutAllergy.com by Bob Ashley, a 61-year-old city manager with a lifelong anaphylactic allergy to peanuts and tree nuts. In this article, Bob reflects on how much things have changed for nut-allergy sufferers over the decades and offers surprising insight into living with life-threatening food allergies.
Back in the ‘50s, ‘60s, and ‘70s, all through primary and secondary school, I was the only kid I knew who had such a nutty affliction. Everyone thought I was just plain weird.
Things have changed dramatically, both in the number of people with this autoimmune disorder and our social awareness of it. When I was growing up, the disclaiming label, “May contain nuts or traces of nuts,” did not exist on food packaging. By convention, regular folks either did not believe anyone could actually be allergic to nuts, or, if they were, it was only as non-life-threatening as a run-of-the-mill allergy to cats or Golden Rod.
I’ve had a few near-death encounters with nuts. I have first-hand familiarity with that “light at the end of the tunnel” feeling as one crosses over into the Great Beyond. Short of those flirts with death, I’ve had plenty of incidents that were quite debilitating but somehow manageable.The relative rarity of my condition growing up necessarily demanded a self-educated approach to learning how best to protect myself.
Awareness Is Remarkable, But Protective Measures Are Extreme
My allergy is anaphylactic, and I’ve had a few decades of management practice. What I witness today in the management of the allergy by parents, the food industry and institutions like schools and some workplaces ranges from marvelous to maddening. Awareness-building has been a remarkable socio-cultural achievement, thanks to the efforts of caring parents, health organizations and government regulators. Sensitivity to the danger has risen from social ridicule to respect for the issues.
On the maddening side of things, some protective measures do have elements of “mass psychogenic illness, hysterical reactions grossly out of the proportion to the level of danger.” Some people seem to imagine the ingestion of a nut, traces of a nut, or sometimes even the mere proximity of a nut almost on par with a gunshot to the heart.
In my case, which I take to be pretty typical, onset of the various allergic reactions are not all instantaneous but progressively worsening, allowing plenty of time for treatment. Their severity and how long they linger appear to depend on the amount of poison taken in. So, yes, ingesting a few errant crumbs of walnut on a plain cake will make me feel quite sick. But please, folks, back up and give me room to breathe; I’m not going to die. The available emergency medications really do work, and they work fast. In my younger years, with minor exposures like this, I survived without medication. Yes, I had a few hospital trips too.
Preventing a Life-Threatening Reaction Is Possible
If there is one cool thing about a super-sensitivity to nuts, it’s that the hypersensitivity also means I can “rescue” myself 95 percent of the time before full-fledge ingestion. For example, if I bite and start to chew on an oatmeal cookie that someone has assured me “has no nuts, guaranteed!” (but has had a reckless brush with the peanut butter cookies), the rear and upper parts of my mouth will react instantaneously and quite violently with an unrelievable, intense, itchy sensation. It’s extremely uncomfortable.
But it’s also a saving alarm, so to speak, because I can react by immediately spitting out the offending poison. I can then brush my teeth (borrow one if you have to!), floss, gargle and re-gargle with a strong mouthwash, rinse, rinse, and rinse again with water. The sensation lingers, but within 15 minutes or so, maybe half an hour, the enraged palette calms down. Importantly, though, nothing got into my gut, where the poison would be free to wreak havoc, triggering a freak-out response from my entire immune system. This type of incident has happened to me quite a few times. As long as I haven’t swallowed, things eventually turn out just fine.
If I do swallow, Plan B is induced vomiting. As soon as I realize I’ve got a grenade in stomach, try to get it up and out before the whole mass has been dissolved by digestive acids to then enter the bloodstream. I couldn’t tell you if this is recommended or not. Frankly, I don’t care. That’s what I’m doing and have done, and I think it has helped keep me clear of the Grim Reaper.
Banning Nuts Is Not the Answer
So vigilance is a must. But measures like banning nuts or peanut butter in schools offer false comfort. In my opinion, it’s also an unfair imposition on everyone else. Exposure will happen. Fatal exposure is statistically very rare and isolated, and extenuating circumstances usually factor in. For example, a naive, allergic kid at a remote camp, a great distance from a hospital, no medication. That situation gives me the creeps, for sure. Nevertheless, life can be 99.9 percent normal with a severe nut allergy by learning and adhering to simple rules of avoidance. So here is my wife, sitting beside me, happily munching on her pistachios. And I’ve lived to tell the tale.
If my own child had the same all-nut allergy, what would I do? This might shock and appall some parents, but I’d systematically bring the kid into very close sensory contact with every combo of nutty threat I could imagine – without going so far as experimenting with actual ingestion. We would “practice” nut avoidance first hand, with drills and tests. I would put the kid through the paces, let her learn to detect those errant walnut crumbs with eyes, nose, and even touch. Yes, I can touch, even crumble a peanut between my fingers without dying. Short exposure and wash hands thoroughly afterwards. We’d find out what a walnut smells like.How about a caramelized peanut? Can you scope out the cake with almond slivers? What does almond extract smell like? What does a small mound of crushed pecans look like? What if the server at the restaurant doesn’t have a strong command of your native language? What do you do? Forget ordering anything remotely suspect even if supposedly nut-free, and even if you’ve delivered the message, “I’m allergic to nuts. Please be careful”.
Kids will be exposed. A nut-free life isn’t going to happen. Nuts are everywhere! Granted, I’ve learned the nuances of nut detection and nut detective work the hard way, one dumb anaphylactic shock lesson at a time. Better to teach kids systematically in preparation of the inevitable encounters. This boot camp training can be safe, I’m sure, in a tightly controlled setting, with mature supervisors and kids at least old enough to understand and comply with simple instructions and cautions.