For as long as I can remember, I've been deathly allergic to peanuts. Through some miracle—which I attribute partly to my mother and partly to the blessing of inauthentic Chinese takeout in 1990s New Jersey—this never really affected my childhood. When curious classmates asked, "What will happen if you eat a Reese's?" I would reply, "My throat closes and I die," but I understood this fact in the abstract, as I understood sex and intoxication.
The peanut that sent me into crisis came less than two years ago, while I was visiting Berlin. It was an accidental peanut, a stowaway inside my boyfriend's sandwich on dark German bread studded with whole grains and seeds. After one bite, I knew something was terribly wrong with my throat and mouth. From there, the day blurred with urgency—the walk from the bridge to the U-Bahn station, where I sat for a minute, found it strange to swallow, and stabbed myself in the leg with an epinephrine shot—then the jolt of adrenaline, the confused phone call, the arrival of the paramedics, and at last the ambulance. I remember that I stayed calm and that everyone was kind.
Related: My Anxiety Is Slowly Killing Me
"The peanut," I was informed in accented English by the final doctor I saw that day, when the swelling had abated and they had carted off the nebulizer, "is still inside you." The precise medical sense of this statement was probably muddled in translation, but I took it at its most direct. Having imparted the comforting image of a peanut lodged somewhere in my body, the doctor prescribed me a week of corticosteroids—standard practice, I know now, to prevent a second wave of symptoms—and sent me blinking into the city to find a pharmacy.
An estimated 15 million people in the United States are allergic to at least one food, including as many as one in 13 children, according to Food Allergy Research & Education (FARE), an advocacy and awareness organization. The prevalence of food allergies among kids increased from 3.4 to 5.1 percent between 1997 and 2011, according to the Centers for Disease Control and Prevention; peanut allergies in particular have been reported to be on the rise. These trends have been attributed to causes that range from overly sanitized childhoods to the diets of pregnant women to pollution. In the 2000s, parents were widely advised to avoid feeding common allergens like peanuts to very young children because it was believed this increased the chances of developing a serious allergy, but now doctors saynot feeding infants peanuts makes them more likely to develop allergies.
Whatever their cause, peanut and nut allergies can often produce the most severe allergic reaction, anaphylaxis, the violence of which is difficult to mistake. In a normal allergic reaction, the body's immune system mistakenly identifies a substance as dangerous and attacks it by releasing chemicals like histamine into your blood. (Benadryl, used to fight allergic reactions, is an antihistamine.) Histamine is what causes itchiness, sneezing, wheezing, hives—symptoms that can be irritating but aren't fatal. But in anaphylaxis, the entire body is at war: Sufferers' systems are flooded with so many chemicals that they can stop breathing, lose consciousness, and die.
The telltale signs of anaphylaxis include difficulty breathing and swallowing, weak pulse, swelling of the face and tongue, stomach problems, and fainting. Doctors teach patients to be alert to the onset of these symptoms and, at the first suspicion, to self-administer an epinephrine shot (an auto-injection of adrenaline, usually known by its brand name, Epipen) before immediately calling 9-1-1. According to FARE, to delay the shot can result in death within 30 minutes.
"Do not obsess about the 'what ifs,'" advises FARE on its website. "Decide that if you're careful and stay prepared, everything is likely to work out for the best."
More than fear of what might happen while I was in a city and country and language that were not my own, it was the forced vigilance that strained me.
I did everything I was supposed to, but true to the doctor's word, the peanut was still inside me; I woke up every day for five days with a swollen throat and a muddy feeling in my chest. Berlin that March was beautiful. All around, spring was shivering open, buttering the sun, which cast a breathless light on the stone and concrete and bikes and trees and riversides of the city. But the Berlin of my memory was a lurching, terrifying comedy, and I see it now in bursts: hospital—waiting—cab—waiting—Nationalgalerie—waiting—Bauhaus-Archiv—cafe—Tiergarten—waiting—waiting to see if the feeling in my chest and throat meant I was again in danger.
I rode in two ambulances and two painfully law-abiding cabs, visited four different emergency rooms. I had the chance to meet two of Berlin's firefighters; a nurse who drew blood from behind my ear, offering no explanation, and cracked my back without asking; and a French doctor who threaded a thin tube up my nostril, around the bend, and down my throat in order to examine the swelling, a route that still seems indirect to me—but at least she let me know that I could drink as much wine with the corticosteroids as I wanted, mais bien sur, and for that I am grateful.
More than fear of what might happen while I was in a city and country and language that were not my own, it was the forced vigilance that strained me. It became imperative that I maintain absolute stillness in the service of self-observation. By then a feeling of being slightly strangled had become familiar, and I monitored it constantly, my hand at my neck, as if I could get a hold of the thick substance that seemed to cling there. Was this just uncomfortable, vestigial, or was it dangerous? When vigilance like that lasts for more than a day, it becomes difficult to remember how its absence feels.
Quietly, the need faded. I went back to New York City. I felt grateful, in a way, for the confirmation that my allergy was as serious as I had been told. Otherwise I did not feel changed.
Then, a few months later, I ate a sandwich that had been sliced with a peanut oil–slicked knife. I acted quickly, alerting a coworker who escorted me to an urgent care center where I was prescribed the requisite corticosteroids. This time, the pills made me paranoid and shaky for a week.
The days and months that followed were different. The feeling began to find me at unexpected times—first occasionally, then more often. I began taking Benadryl the way others pop Xanax. I knew exactly where and when the nut carts were parked in the 20-minute walking radius around my Midtown office. I rode the F train with eagle eyes, scanning for passengers eating peanuts or peanut oil–fried potato chips. The Grand Street stop in Chinatown, where many peanuts are sold, was a critical part of my commute.
That sort of intense worry is common among severely allergic people, especially those who have experienced anaphylaxis. A European survey of studies published this year in Chemical Immunology and Allergy found a "strong impact" of food allergies on "health-related quality of life" defined in terms of social, dietary, and psychological factors. Sufferers can grapple with anything from prolonged periods of worry to avoidance of social situations to depression to food phobias and disordered eating.
Every time I ate food I hadn't cooked myself, a strangling feeling surged in my throat.
One 24-year-old who is allergic to nuts and seafood described the psychological effects of his allergies to me as "broad and penetrating." As a child he was so worried that he might experience anaphylaxis that he restricted his eating, and he saw a cognitive therapist for several years. As he grew up and went to college, he said, "Anxiety stayed with me in waves and manifested in other ways, but it was always around issues of my health and wellbeing."
Such anxiety is echoed in a story I heard from a 52-year-old who is allergic to peanuts and fish and a few years ago had to fly on an airline that serves complimentary peanuts. Even after wiping down every surface around him with Clorox wipes, he told me, he felt surrounded by peanuts—peanuts on the seats, on the tray tables, everywhere. "I didn't talk, I didn't want to look at anybody. I buried my head in my book and wanted it to be over," he said.
Sloane Miller is a food allergy counselor, licensed social worker, and author of Allergic Girl: Adventures in Living Well with Food Allergies . In her view, one of the biggest challenges is that the fear of the risk is very rational. "As a mental health professional, most often we deal with irrational fears," she told me. "But in the case of food allergies, dying from a food is a possibility, a real risk, and thus the fears that surround it are complex, both irrational and rational."
To complicate matters, the physical warning signs of anaphylaxis are similar to symptoms of anxiety, including difficulty breathing and swallowing, tingling sensations in the extremities, lightheadedness, and a racing heartbeat. As a result, some patients may be incorrectly treated for anaphylactic reactions that are actually panic attacks. The effect of repeated over-treatment and misdiagnosis of anxiety as allergic response can create the perception that a patient has suffered more dangerous reactions than in reality—the makings of a stress spiral.
Anyone who struggles with allergy-related anxiety understands this at a gut level. Every time I ate food I hadn't cooked myself, a strangling feeling surged in my throat, no matter how clinically I reviewed the evidence, or how sure I had been that the kitchen was peanut-free. I learned that it's possible to sit in a New York ER waiting room for hours if you have no visible hemorrhages. While waiting, there are many horrible and sad things to see, especially at two o'clock in the morning. Nonetheless, I walked voluntarily to the ER three times in that vigilant year, just to find peace of mind. The sharp, flavorless hospital air was comforting to me.
My worst experience came on a nine-hour-and-30-minute flight from Honolulu to New York. My grandmother had passed away, and I was heading back to my hometown for her funeral. The anticipation of the flight's duration (and my difficulty communicating the seriousness of my allergy to crew members) brought me to tears at the airport gate. I managed to board, but for the first three hours of the flight to JFK I was convinced that it was happening, that I had been exposed through armrest or faucet or god knows what to peanut residue that I had accidentally ingested while unwrapping a hard candy, and there, above the Pacific, unable to articulate my distress to the flight crew, I would asphyxiate or die of a heart attack.
Somehow, the aloha-laced ukulele music that the airline pipes through the intercom before takeoff made dying midair seem all the more inevitable. I felt immobilized, separated by a membrane from the people around me. I started an emergency log in my phone: Deathly allergic to PEANUT!!! Anaphylaxis and asthma. Epipen must be administered IMMEDIATELY and 911 called. Possible reaction in Honolulu prescribed corticosteroid for airplane. 3PM Hawaii time took corticosteroid. 5 PM took 1/2 Benadryl feeling swelling in throat and asthma. 6PM took 1/2 Benadryl...
It was only after four hours had passed and I had taken two Benadryls, eaten a fair amount of candy, and watched half of Furious 7 that I realized I was breathing easily.
Not long after the flight from Hawaii, I went to see a new allergist. My emotional distress must have been palpable, because she asked if I was anxious. I was so taken aback by the question, and so grateful to be seen clearly after all those months, that I almost cried. In almost 30 years, no medical professional had ever mentioned the strain that a life-threatening food allergy might bring.
"Anxiety is very common for people with allergies like yours," she reassured me, "and it's not surprising, because the threat to you is real."
Living under a constant threat like this had changed me. I never had the luxury of taking my body for granted. In truth, the feeling in Berlin had been familiar—it took me back to my childhood as an allergic, asthmatic kid who worried that her lungs wouldn't be there for her when she needed them. I was primed to feel fully responsible for my body, as I certainly had to be, but in a way that, after Berlin, felt all the more isolating.
For someone with an allergic reaction, it is easy to feel alone in responsibility, in the least empowering way. In my experience, this has been especially true thanks to the contradictory tones of overly urgent or mistakenly simplistic advice, dismissal, and worry from doctors and nurses, waiters, friends, family, and flight attendants. By the time I was on the plane from Honolulu, my habit of self-observation had yanked me further and further from self-reliance.
I now thank that nine-hour flight for snapping the wire. I had no way out. I felt physical symptoms, but I also knew, below the pounding of worry, that in a true allergic reaction things would have gone south already. I knew that if I was going to be OK, I would have to will it. And so distracting myself was a kind of test of what would happen if I let my mind loosen its grip on the symptoms I was experiencing. This is the kind of behavior that keeps allergists up at night (the mantra is always better to be safe than sorry), but it allowed me to regain trust in my reality.
I landed in New York in the morning, and, with an awareness of life's many cyclical layers, I took the train to my hometown in New Jersey for my grandmother's funeral. All the other, non-allergic emotions I had suspended in flight out of false necessity now flooded me, but with them I also felt new calm.
The peanut is still inside you. In hindsight, the Germany doctor's statement has morphed into a weird bit of Zen wisdom. The work was not to excise my peanut problem, but to dislodge the fear that had come to footnote every experience. In that way the nerve that had always lain below, threatening to crack through the surface and knock me sideways, could be an unexpectedly clarifying gift. It would be a lie to say that I know exactly what to do with it. But I do know that I feel more tender toward my body and my mind than I ever have.
And then, when deep breathing and long walks fail, there is always wine.
Update: An earlier version of this article referred to the Food Allergy Research & Education (FARE) group by its previous name, Food Allergy and Anaphylaxis Network (FAAN).