By: Sahra Mohamed
For millions of people across North America, living with allergies is a relentless battle against daily threats. For those who have experienced anaphylactic shock, the traumatic aftermath isn’t just physical, it’s psychological too. Simple pleasures like dining out, attending social gatherings or even walking past a food truck, all carry calculated risks and a lingering sense of anxiety. The presence of certain foods like peanuts, shellfish, or sesame can trigger intense fear, as the body braces for potential exposure. In the United States alone, approximately 6.2% of adults report having food allergies, with higher rates among children, as reported in the CDC. This translates to millions navigating a world where over 170 foods have been identified as potential allergens, FARE revealed. Given the circumstances, the psychological toll is understandable. Studies indicate that people with life-threatening allergies often experience elevated anxiety and symptoms similar to PTSD. Avoiding allergens isn’t limited to food choices. Many cosmetics and personal care products contain ingredients derived from common allergens. For instance, almond oil, found in some blushes like Charlotte Tilbury’s Airbrush Flawless Finish and shampoos, poses a risk for those with nut allergies. In an article posted on Allergy Insider, those with tree nut allergies have a higher risk of being allergic to almonds as well.
Beyond typical food allergies, conditions like Mast Cell Activation Syndrome (MCAS) and celiac disease, add layers of complexity. MCAS involves the inappropriate release of mast cell mediators, leading to symptoms ranging from hives to anaphylaxis, without a clear trigger, as stated in the National Library of Medicine (NLM) and the Journal of Allergy and Clinical Immunology (JACI). MCAS remains underdiagnosed. In a significant development for patients with MCAS and food allergies, the FDA approved Xolair (omalizumab) in the U.S.A in February 2024 as the first medication to reduce allergic reactions to multiple foods after accidental exposure. Xolair works by targeting immunoglobulin E (IgE), a key antibody involved in allergic reactions. Clinical trials have shown that some patients could tolerate small amounts of previously dangerous allergens during medically supervised food challenges after receiving the treatment. However, Xolair carries a black box warning, the FDA’s most serious alert, due to the risk of anaphylaxis which can occur after any dose. This presents a challenging dilemma: while the medication offers hope for increased tolerance over time, it also introduces risks that must be carefully weighed by patients and healthcare providers.
Tragic deaths, like that of Dominique Brown, emphasize the deadly risks individuals with severe allergies face every day. Brown, a 34-year-old influencer, passed away after consuming food at a Disney event despite informing staff of her severe peanut allergy. After being assured that her food was safe, she began experiencing symptoms shortly after eating and tragically died before receiving the medical attention she needed. This incident illustrates the dangers of poor allergy management and communication in public spaces. Similarly, Dr. Kanokporn Tangsuan, a 42-year-old physician, tragically died after eating a meal at a Disney Springs restaurant in Florida. Despite informing staff of her severe nut and dairy allergies, she suffered anaphylactic shock. Although she used an epinephrine auto-injector (EpiPen), she collapsed shortly after leaving the restaurant. Her autopsy revealed elevated levels of nut and dairy allergens in her system. In Italy, 21-year-old American student Avarie Anne Tierney died after eating avocado toast at a vegan restaurant in Rome that contained cashews, despite clearly communicating her tree nut allergy to the staff. According to an article in Allergic Living, Avarie used her inhaler, took Benadryl, and administered two EpiPen injections during the reaction. Avarie had three auto-injectors with her that day, but the first reportedly malfunctioned. Emergency responders were not equipped with the proper medication upon arrival, and the restaurant has since been charged with negligent homicide.
Some allergists are now exploring the use of biologic medications like Dupixent (dupilumab) and Cibinqo (abrocitinib) to help manage patients with severe eczema and multiple food allergies. These treatments, originally approved for atopic dermatitis, are being considered for their potential to reduce overall allergic sensitivity by lowering IgE levels and regulating immune responses. A Vancouver-based allergist notes that, for some patients, these biologics may help lessen the severity of allergic reactions. However, the benefits are not guaranteed, and these drugs can come with side effects. As with any biologic, they require careful medical evaluation and monitoring. Yet even with treatment, what many people without allergies fail to grasp is the persistent psychological burden carried by those at risk of anaphylaxis. For some, the anxiety is so severe that it becomes difficult to distinguish between fear and an allergic reaction. A sudden tightness in the throat, dizziness, or a racing heart can cause panic but is it anxiety or the onset of an allergic reaction? This psychosomatic overlap, where the body mimics symptoms like shortness of breath or chest discomfort, creates a dangerous cycle of uncertainty. In the moment, telling the difference between a panic attack and a life-threatening anaphylaxis is nearly impossible, forcing individuals to remain constantly on high alert. The result is an exhausting and invisible struggle that goes beyond the physical risk of exposure. Every grocery trip is a calculated risk. Every birthday party or work event is potentially dangerous. Even holidays with family can lead to exposure if someone unknowingly brings a contaminated dish or fails to clean a shared cooking surface. Labeling isn’t always reliable, “may contain” warnings are inconsistently regulated in North America, and cross-contamination remains a widespread issue. Allergic individuals feel like burdens or outsiders by constantly asking questions, needing accommodations, and double-checking every ingredient list.
In Australia, it is more common for some restaurants and food establishments to carry EpiPens as part of their first aid kits, though it is not a legal requirement. Many places choose to do this voluntarily, especially those that serve allergy-sensitive populations, aligning with public health recommendations to prepare for allergic reactions. This practice is not as common in North America, but the increasing awareness of food allergies and anaphylaxis suggests that it’s time to implement these practices. As allergy rates rise globally, especially among children, it may be worth considering whether more restaurants should take on this responsibility to ensure the safety of their customers. Beyond safety measures in public places, living with allergies also comes with economic consequences. Specialty foods, allergen-free cosmetics, private consultations with allergists, emergency medications, and missed work due to reactions or hospitalizations, can all accumulate expenses quickly. For parents of allergic children, this burden is even heavier, accompanied by school advocacy, education plans, and constant worry. Although severe allergies are becoming more common, public understanding remains limited. Allergies are sometimes dismissed as “overreactions,” or worse, the allergic individual is made to feel like a nuisance. But for those living with the reality, it’s not an overreaction. it’s survival. It’s the choice between life and death, made every day, multiple times a day.
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