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"Oh, I'm allergic to [insert food here]. I can't have that or I'll get sick." How often these days we hear of people becoming sick on stuff like soy, peanuts, shellfish and the like. Well, this story is about those, but also the three hundred or so deaths in the United States each year due to food allergies. This piece hopes to explain the difference between food intolerance and a true allergy to a substance. Let's take a look at some case studies:

  • A healthy 40-year old man consumes a meal at his town's new trendy Asian-Fusion spot. An hour later, he feels a bit queasy and feverish. This is not the first time it's happened to him after dining at an Asian-themed restaurant. The culprit, he assumes, is Monosodium Glutamate, a common additive to all sorts of foodstuffs but used particularly heavily by the chefs of the Far East.
     
  • Rodney Hawkins, a strapping 35-year old man joins his family for dinner at Ruby Tuesday; an upscale-casual chain restaurant. He takes no more than two bites of his meal, turns blue and makes the choking motion. The ambulance arrives timely; yet the man is pronounced dead at a local hospital only half an hour later.
     
  • Our next case is a 16-year old boy who joins his family for a treat at the local Baskin Robbins. The boy enjoys a milkshake, as he has in the past. That night he's awakened by leg cramps. His bedclothes are saturated in sweat, and he'd suffered a bad dream.
     
  • Across town a woman who's snuck a few spoonfuls of her husband's ice cream is doubled over with cramps and couldn't stave her flatulence no matter how hard she tried.
     
  • Finally, there's the tragic case of Daniel Sargent of Everett, Washington. Sargent was at a party and took a bite from a chocolate chip cookie. In a minute and a half, he collapsed. A doctor, nurse and medic happened to be guests at the party. They administered CPR until the ambulance arrived. For an agonizing two days, doctors at Harborview Medical Center in Everett struggled to help Sargent overcome anaphylactic shock. Essentially anaphylactic shock occurs because of  extreme allergic reactions to foods. Typically, victims of this kind of shock suffer closure (due to swelling) of the trachea and bronchi, leading to multiple other complications including plummeting blood pressure, but the worst of which is oxygen deprivation in the brain. Despite their heroic efforts, the 30-year old man was pronounced brain dead.

Anaphylactic shock can be caused by ingestion of any food to which someone is deathly allergic (some examples: bush nuts, eggs and shellfish). What's so mysterious about these allergies is that although most begin in childhood, some (particularly to shellfish) fails to react dramatically upon first consumption. But then on the second or third time the offending food is eaten, a surprising and typically fatal reaction occurs.
 

The Difference Between Food Intolerance and Food Allergy

A true food allergy put's a person's immune system into "overdrive;" overwhelming the body with histamine and wreaking havoc with the health of the patient - immediately upon consumption of the offending food. Food intolerance takes two forms; a mild, nonetheless unpleasant reaction that has nothing to do with an immune reaction; and a true "psychological" food intolerance for one reason or another.

Persons with known food allergies typically carry an epinephrine delivery device in the form of an injection or a much more efficient automatic injection device called an Epi-pen which the patient need only stab into muscle (typically the thigh) when they feel a reaction coming on. Persons with intolerance can rely on products such as Lactaid (for lactose, or milk-intolerant persons). Beano is a compound touted to eliminate flatulence due to eating of vegetables, beans and salads.
 

The Food Allergy Keyword: Caution

The most interesting case is the one of Mr. Hawkins, noted hereinabove. The case, which occurred quite recently, is a matter of the restaurant's word against the statements of those who dined with Mr. Hawkins. The restaurant claims that the waitress heard Hawkins order "Chicken Oskar," not once but thrice. This came out after the restaurant claimed previously that due to a kitchen mix-up, Hawkins was served the "Chicken Oskar" despite having ordered a different chicken dish, "Chicken Fresco". The restaurant made it very clear that the crabmeat contained in the Chicken Oskar is quite obvious on the plate (as well as being described on the menu). Asparagus tips and crab legs, along with Hollandaise sauce, are used in the preparation of anything in the style of "Oskar," the most famous being Veal Oskar. Ruby Tuesday's says that the "Chicken Fresco" is topped with slices of tomato and minced fresh parsley.

Given the above, Mr. Hawkins (who, it was said by relatives, has been allergic to crab since he was a child) failed, somewhere, to practice due diligence. If he did order the "Chicken Oskar," his failure to read the ingredients listed on the menu is what killed him. If the restaurant made a mix-up, and placed the wrong dish in front of him, he obviously was (fatally) not paying attention. One of the signatures of Veal or Chicken "Oskar" are the lovely juxtaposition of the slender, pink crab legs served next to the asparagus tips. The crab legs would show beneath almost the most viscous Hollandaise sauce.

It's a pain in the neck but living free of allergic reactions becomes easier once one makes certain that one doesn't come in contact with the offending foodstuff. For instance, the astute restaurateur would be certain that a pan used to sautee something with cashew nuts be washed thoroughly (or substituted with a clean pan) before preparing a dish to someone with an allergy to cashews. Sadly, those who don't understand the seriousness of true food allergies may even, for example, pluck the shrimp out of a platter of spaghetti with shrimp which was made in error, add a little sauce and serve it so as not to waste good food. If this happens and the perpetrator is found out, the savings of a plate of food that cost him all of $4 could potentially cost him a multi-million dollar judgment in civil court.

The U.S. Food and Drug Administration has a comprehensive, easy-to-read webpage dealing with the difference between allergies and intolerance. It is located at: http://www.cfsan.fda.gov/~dms/wh-alrg1.html.

Mr. Sargent, whose one bite of what was touted as a "chocolate chip cookie," proved deadly. Now, most of us who're not allergic to peanuts would think "who'd put peanut butter in chocolate chip cookies — why not make peanut butter cookies instead? Sargent dropped his guard and failed to either read the label or question the baker of the cookies. It may sound dramatic but asking questions about one's foods, and being convinced the answers are correct, are as serious to a food allergy sufferer as, well, a world in which we all were compelled to investigate whether or not our foodstuffs contained cyanide.
 

Thank Goodness It's Usually Food Intolerance

The first bullet-point under "case studies" above describes a 40-year old man who's certain he's being made sick by Chinese restaurants because of Monosodium Glutamate. This particular individual had nothing but four cups of coffee for breakfast, a Pastrami Sandwich on rye and two beers for lunch, and accompanied his Asian fare with a very English drink; gin, in copious amounts. What's to blame? The exotic item of food he least often consumes. I mean, heck, good old American food can't make ya sick, can it?


WaldemarExkul made the extremely sensible suggestion that perhaps at a restaurant of dubious quality such as Ruby Tuesday, the crabmeat would've been all mashed up into bits; rendering it nearly invisible to the late Mr. Hawkins.
 

SOURCES:

http://www.wrongdiagnosis.com/news/food_allergies_often_confused_with_food_intolerance.htm

http://www.foodallergy.org/

http://drrobertwood.com/death-at-dinner.shtml

http://www.heraldnet.com/article/20080704/NEWS01/546172117/0/news01

http://www.cfsan.fda.gov/~dms/wh-alrg1.html

http://consumerist.com/tag/ruby-tuesday/?i=5022167&t=wrong-order-kills-customer-at-ruby-tuesday

http://www.ajc.com/metro/content/metro/stories/2008/07/07/shellfish_0708.html?cxntlid=homepage_tab_newstab

http://www.ajc.com/metro/content/printedition/2008/07/09/shellfish.html

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