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The party was hosted by a doctor, and another physician friend named Paul watched over him, and kept asking whether he wanted to go the hospital rather than toughing it out. Ahluwalia declined; “I hate hospitals.” He figured he was better off anyway being watched by Paul.
But one thing Paul insisted on was that he get to a specialist “to find out exactly what you’re allergic to.” A Calgary allergist diagnosed an allergy to nuts, related to his sensitivity to the birch tree family, and including nuts, apples, cherries and peaches. Ahluwalia was prescribed and bought an auto-injector.
So why doesn’t he carry it? “I try not to take it [the allergy] too seriously, otherwise it would drive me and everyone else crazy,” he says.
McGarr finds the tendency of allergic adults to minimize the risks of anaphylaxis is common, and often accompanied by statements such as “I won’t let this control my life.” Tied into control is the belief that you can simply avoid your allergens.
In the study conducted for EpiPen in Canada, fewer than 40 per cent of the “at risk” group agreed they might not be able to avoid their allergen in every situation. As an example of avoidance and control, these people would speak of their restaurant choices. Those with peanut allergy would steer clear of Chinese restaurants because they use peanuts in the food. With tree nut allergy, an individual might pass on Italian restaurants due to pine nuts in many dishes.
Once inside a restaurant of their choosing, the “at risk” adults had a strong sense of trust that the kitchen would safeguard their food. “The belief in being able to avoid is very, very strong,” says McGarr, calling it the biggest single factor in explaining why so many allergic adults don’t carry an auto-injector.
Another recurring belief was that reactions would stay the same in both severity and frequency. If they had been mild and infrequent, in this group’s minds, that would always be the case.
McGarr describes this as a difficult mental construct to tear down: “Believing it is a powerful impulse because as human beings we are pattern recognizers.” If we’ve seen what happens with one or more exposures to our allergens, we believe we know what will happen.
Humans are also known for a capacity to forget about pain once the pain is gone. McGarr, who specializes in health-care research across North America, notes that even in patients who’ve had serious cardiovascular events like strokes, the longer it has been since the experience, the less vigilant the patient may become with prescribed medications.
In anaphylaxis, this will surface in the chances people take around food and in getting increasingly less concerned about keeping an up-to-date auto-injector. For instance, that EpiPen that Ahluwalia couldn’t remember how to use? It’s five years old, while epinephrine loses its potency after one year.
In his case, there’s also a hefty dose of denial. While Ahluwalia is at a higher risk since he has asthma as well as allergies, he has even eaten an apple slice just to see if he still reacts. Nor does his family take the allergies seriously. His mother will hand him some kicharee, his favorite East Indian comfort food, made from lentils and rice. She stores its ingredients in used cashew jars.
Though he gently admonishes her, he’ll still cook and eat the food from the jars (so far to no ill effect). “I don’t believe I’ve ever been close to death,” says Ahluwalia. “I’ve been in severe pain, but not close to death.”
Next: Doctors’ advice crucial to awareness