Allergen Awareness, Every Day

Article By KRISTEN HAMPSHIRE Published May 16, 2023
Article Source: Allergen Awareness, Every Day - Quality Assurance & Food Safety (qualityassurancemag.com)

When navigating food allergies becomes a comfortable habit, an unexpected severe reaction is a wake-up call.

We don’t obsess over my daughter’s allergy to peanuts and tree nuts.

It means we read the fine print on labels. We request the allergy scoop of ice cream at the local parlor that comes from a contained case using an unused spatula. We have an allergy action plan at school and avoid potluck dishes. We dump the Halloween candy on the counter and meticulously sort it.

These are simply habits now, and as my 10-year-old girl told me in a shrug-it-off way, “It’s just everyday life. It’s not a big deal.”

But revisting an experience that was anything but “everyday” is a reminder that you should never let your guard down.

Grace was 4. There we were, sitting together in a wheelchair, my arms wrapped around her like a momma bear. Blaring sirens rushed toward the double doors of the urgent care exit where we waited. Moments earlier, she was gasping for breath as her throat swelled and trapped air — her lips and arms, all of her inflamed and in a rash, her blue eyes watering. I imagined she felt like cotton was filling her mouth as an allergic reaction to peanuts swiftly advanced to anaphylactic shock.

“Deep breaths. Pretend like you are filling your belly up like a balloon,” I remember telling her, my voice even and quiet and calm.

Inside, I was pulsing with distress and fear.

The paramedics helped us on to the stretcher and strapped an oxygen mask on my girl, realizing the EpiPen was wearing off. Another shot of medicine was administered. More calming words. If she got worked up, it would make her dire situation even worse. “Everything will be OK,” I reassured her — and tried to convince myself.

An ambulance ride was definitely not on my bucket list, let alone holding my vulnerable preschool daughter, feeling completely helpless and afraid. I masked it.

We were minutes away from the hospital emergency department — all because of a dime-sized taste of a bakery cookie.

A SUDDEN, SERIOUS REACTION. The coffee shop up the road from our home is always stocked with pastries and other goodies. It was my son’s second day of kindergarten. Grace and I had just walked him to school, and the next stop was a caffeine fix — and that day, a treat. The Anytime Cookie, it was called, looked like oatmeal. There were no ingredients listed, and I didn’t give it a second thought.

Back at home, Grace was watching “Daniel Tiger’s Neighborhood” while I busied around the kitchen, dealing with breakfast dishes and scrolling through email. I had tucked the cookie into the fridge for later.

“Can I have some of that cookie, Mom?” I hadn’t planned on sharing it, actually. I hadn’t tasted it yet, either. “Sure, you can have a bit.”

I handed it to her, and she unwrapped the plastic, breaking off a piece. Right away, she started coughing and her eyes began to water. I thought maybe the oatmeal was stuck in her throat — but within seconds, I realized what was really going on. Hives formed by her mouth and she itched.

I grabbed the rest of the cookie and tasted it. Peanut butter.

Next, Benadryl — a dose immediately. I said to her, “Let’s go to the urgent care while we wait for the Benadryl to work. That way, if we need some extra help, we will already be there.”

I did not expect her reaction to escalate. But since peanut butter was used as a binding ingredient in the cookie and it wasn’t a “shared equipment” exposure, I had a bad gut feeling.

Grace had experienced two allergic reactions from exposure to peanuts before this. We were able to easily manage both with Benadryl. Since then, she had gone through a full allergy panel, and I keep an EpiPen on me at all times. That way, I can be prepared in case of accidental exposure and a severe allergic reaction. Aside from peanuts, we learned that Grace is also allergic to tree nuts and sesame.

What does that mean on an everyday basis? We read all the fine print on labels to find cross-contamination statements like “made on shared equipment” or “made in a facility that also processes nuts” or “may contain…” At parties or playdates, if there are homemade foods, we always double-check to be sure they are safe for her to eat, or we bring our own snacks. Grace, even in preschool, knew how to ask about foods.

But I never asked about the cookie from the coffee shop. Grace was content with the animal crackers she selected from the counter (with a label!) and the cookie wasn’t for her. My radar was on snooze. How could I have allowed this to happen?

We arrived at urgent care 10 minutes later, and in the waiting room, the allergic reaction was not dissipating as it had in past situations. I approached the check-in window again. “This is getting worse,” I told the nurse.

They took us back right away, and Grace laid on the exam table while the doctor gave her an epinephrin shot. We comforted Grace and monitored to see if the medicine would kick in. Next, a steroid shot. Then, Grace shot up from the table and vomited violently. She was in full-blown anaphylactic shock, and an ambulance was on the way to take us from urgent care to the hospital ER.

WHY AND WHAT IF? We spent the next few hours in the emergency department. Grace laid on me in the hospital bed, and nurses came in and out of the room, checking in and comforting my daughter. She was incredibly brave and stayed calm in spite of the chaos and uncertainty.

The reaction was a bold one, and it did eventually ease up. Symptoms lessened, and she rested as monitoring continued. Typically, a patient would be kept overnight, they told me. They discharged her, knowing she would be more comfortable at home.

By late afternoon, we were back home with a prescription for prednisone for the following several days to decrease inflammation and slow down Grace’s over-reactive immune system. It was possible she could have recurring or protracted anaphylaxis, which is when the reaction doesn’t completely clear up and returns within hours. Thankfully, that didn’t happen.

As a mother, the day’s events felt surreal. Were we in an ambulance? Was my daughter really wearing an oxygen mask riding on a gurney to the ER? What if we hadn’t gone straight to the urgent care after the Benadryl? Why did I buy that cookie — and why did I let my daughter taste it without sampling it first?

I beat myself up over that cookie. At the same time, I was so relieved and grateful for the fact that we were home and she was safe, healthy and, most of all, emotionally intact. She returned to her play kitchen and markers, followed by an early night to bed. This showed me how strong of a little person she was and would grow up to be.

I am glad that someone else didn’t give her a piece of cake, candy, snack or cookie that caused an incident like this. I can imagine the guilt and helplessness they would feel, and it was better that I, her mom, was right there in the moment and could react. What if she had a bite of something at a birthday party and it just looked like she had a cold? Or, in my daughter’s case, if she did not want to draw attention to herself and told an adult checking on her, “I’m fine.”

It wasn’t fine.

Grace says she does not remember being in the ambulance or how it felt. “I was a tiny child, Mom.”

THE KEY INGREDIENT: A HEALTHY MINDSET. At school, there’s an “allergy table” in the cafeteria where your child can sit to eat lunch. Grace never had any interest. At least so far, we have not had an incident where simply being in proximity to the enemy food will trigger a reaction. There are situations where a person is so sensitive that the peanut shells shucked into the stands at a baseball game cause a serious episode.

“I don’t think I’m missing out on anything,” she said when I asked how she felt about a food allergy. “Peanut butter isn’t appealing anyway. But I would like to have one of those chocolate bars with almonds.”

Interestingly, almond is the one tree nut we could food challenge in the doctor’s office to see if her body is OK with it. Her skin prick test and blood tests identifying allergens showed almond as a very slight tree nut trigger. Generally, you should have at least a 50% chance of passing the challenge before it is recommended. The process involves ingesting the food in small, increasing amounts while being monitored by her immunology specialist.

Grace’s take on this: No, thanks.

And I understand why. You spend about three hours in the clinic. You eat a food you’ve never tried but your body could reject. It’s like inviting a guest to the party that — well, you get the idea. She’s just not interested, and it’s her choice. She is the one who has to endure the process.

But back to those labels. When I see the “made on the same equipment that processes almonds,” I feel a lot less concerned than one that indicates a shared facility with peanuts. And so does she.

My daughter reads labels. She accepts when she can’t have a piece of cake at an event because the host or hostess does not know exactly what’s in it or what ingredients could have entered the equation. Sometimes, it’s frustrating. “Like, when I can’t have a piece of that beautiful and very appealing cake because they say, ‘We don’t know what’s in it,’” she related.

That doesn’t happen often, she adds.

What’s important to know is, as with anything, when we fall into autopilot and are swept into the business of an active school and activity schedule, that’s when slipups happen. But there is a balance — a mindset of awareness and education, not fear and “what if” anxiety.

Now, my daughter is at an age where she needs to “self-carry” her EpiPen. The school nurse has her covered, but there are sleepovers and get-togethers, Girl Scouts and time when she is with grandparents or away at her father’s. You can’t be there all the time to ask, “Does this contain peanuts?” But Grace owns the responsibility. She is careful and has gotten used to either avoiding a food she is not sure about or asking an adult.

It’s not always easy to speak up or bring attention to something that makes you stand out in a situation, especially as a 10-year-old girl. But Grace does not shy away from the food ingredient conversation. After all, “It’s just everyday life, Mom.”

I would like to thank QA magazine for this opportunity to share our experience. Every time I tell the story, it reignites my awareness and brings the conversation to surface at home, too — this time with Grace sharing her matter-of-fact perspective.