Peanut Afraid: Overcoming a Life-Threatening Food Allergy
by Chad Lange • February 7, 2018
This Thursday, the Exploratorium’s After Dark program Pairings: Cultivating a Taste for Science Through Food focuses on Peanuts. Dr. Sharon Chinthrajah—Clinical Assistant in the divisions of Allergy/Immunology and Pulmonary/Critical Care at Stanford and the Director of the Clinical Translational Research Unit at the Sean N. Parker Center for Allergy and Asthma Research—will discuss scientific discoveries in food allergies, including how to desensitize the body and prevent allergic reactions.
I am one of approximately three million people in the United States who have an allergy to peanuts or tree nuts. Many years ago I experienced a life-threatening reaction—from only half a teaspoon of peanut butter lurking inside an egg roll. Within five minutes I was gasping for air, but my airways were so constricted that nothing seemed to enter or leave my lungs. Growing up, Mr. Peanut—with his sinister monocle, pretentious top hat, and nonchalant stance—was akin to the image of the Grim Reaper. So when I heard about the POISED study, I felt a beacon of hope. Led by Dr. Kari Nadeau, Director of the Sean N. Parker Center for Allergy and Asthma at Stanford University, POISED is an immunology study that exposes patients to small amounts of the allergen—the peanut protein, in this case—and gradually increases the doses over a long period of time. By using this slow, steady approach, POISED hopes to “discover underlying immune mechanisms against the disease and develop a lasting cure.”
Admission into the study wasn’t easy. It involved myriad tests, including detailed medical screenings and pulmonary-function and scratch tests. During my first visit, a phlebotomist drew enough tubes of blood to fill a baptismal urn. The most bizarre and unpleasant test was called a “food challenge,” the point of which was to discover how many milligrams of peanuts it took before I showed a visible reaction. A medical assistant smeared peanut-laced applesauce all over my lips with a small wooden spoon. Feeling like a toddler, I licked all the applesauce off my face and then ate a plastic container filled with what was either a placebo or more applesauce with peanut flour.
It soon became apparent that I was not receiving a placebo. The reaction started after I had consumed a total of 240 mgs, about one peanut. The whites of my eyes turned red, my skin purpled. It felt as if I’d consumed poison, and it took two Epi-Pen injections, prednisone, and a cocktail of inhalers to control the reaction.
Two hours later the reaction subsided, and during this time it became apparent how much the allergists and assistants valued inquiry. I had numerous questions, and the staff addressed every single one. How long does the study last? Would every visit be this long? Most importantly: Should I expect such horrible reactions every time I visit? As much as I wanted to confront Mr. Peanut, I couldn’t endure bimonthly poisoning excursions.
Everyone assured me the food challenge was as bad as it got. Once I was admitted to the study, the doctors started me at extremely low doses. As time passed, the doses slowly increased. The plastic containers filled with more and more peanut flour, a crumbly, ashen substance that bore an unsettling resemblance to the cremated remains of a small, beloved family pet. Every day I consumed my own allergy. I mixed the flour with yogurt, chocolate pudding, and sometimes hummus. Occasionally I dump it into sparkling water or pomegranate juice and pretend I’m drinking a peanut-tini.
Retraining my immune system, at least in this case, was a mathematical process, and I became obsessed with numbers. Five mg. became 10; 10 jumped to 25, and after only a few months I was consuming well beyond the 240 mg. that had made me so violently ill that first visit.
The past year has been part Jonas Salk, part David Lynch. I learned how to desensitize my olfactory and gustatory senses; smells and tastes my body has historically recognized as dangerous slowly, over the period of a year, became innocuous. I practiced using an Epi-Pen with a precocious eight-year-old girl by “injecting” the practice kit into a plush rhinoceros. I watched as the compassionate staff comforted another young girl undergoing a reaction by singing songs from Frozen to her while they administered medical care. In this study I am both observer and subject, and I have become part of a community focused on improving the health of people everywhere—and fostering futures that are not filled with fear about silly names like “Jiffy,” “Skippy,” and “Planters.” In less than two weeks I reach the target goal of 4,000 mg, which is approximately a devilish 16.666 peanuts.
The second year of the study, I enter the maintenance phase. I must eat 4,000 mg. of peanut flour every day. After that? The study’s third and final year offers an unpredictable adventure, a time when inquiry is essential. The allergists will try to discover the answers to several questions. Do I need to eat 4,000 mg. of peanut flour every day for the rest of my life? What is the magic number? If I don’t expose myself to the allergen regularly, will the life-threatening reactions return? Together, we will explore the most intriguing query: Am I cured?
Chad Update: I wrote this piece more than a year ago. Since then, I successfully completed the maintenance year where every day I ate 4,000 mg. of either peanut or placebo. Now in my third and final year of the study, I have noticed significant changes in my life. Peanut enhancements, I like to call them. I no longer fear flying. Sitting next to someone eating Kung Pao chicken? Not a big deal. A few weeks back, I ate dim sum, and I later discovered it had been cooked in peanut oil. Nothing happened.
I still don’t know if I’m consuming peanut or placebo, and in a strange way I don’t really care. The ever-present fear of anaphylaxis, which used to constantly overpower my thoughts, has been diminished to a peripheral concern.
And just so you know: I wrote this update while eating Thai food. Take that, Mr. Peanut.
Stanford Medicine, the Sean N. Parker Center for Allergy & Asthma Research web page, accessed June 23, 2016, http://www.med.stanford.edu/allergyandasthma.html.