Read the label—someone's health could be in the balance

In August of 2020 my oldest grandson Maverick, then age 10, took a bite of a cookie and his life changed in an instant.

No, the macadamia nut cookie from Costco was not earth-shattering delicious; it was actually dangerous for Maverick.

“I only ate about half of a cookie and then spit some out because I didn’t like the taste,” Maverick shared later. “The cookie had macadamia nuts in it and the only kind of nuts I tried before were roasted peanuts. A half hour later my throat started hurting really bad.”

Maverick cycled through many symptoms within an hour but it took a while for the family to realize he was having an allergic reaction. “He started with a sore/scratchy throat,” Maverick’s mom, Danielle, explained. “Then he physically couldn’t drink water—it kept coming back up. He had extreme stomach pain and violent vomiting, then a very runny nose (like a faucet) and itch/puffy/red eyes.”

Danielle got a hold of the on-call nurse and was directed to take Maverick to the E.R. By the time they got there Maverick was already on the down swing of the reaction so he was given Benadryl but did not need to use an epi pen.

My daughter called the allergist the next week but it took about a month before he could be seen at Theda Clark Allergy Center in Neenah. In the meantime the family was careful to avoid baked goods and all types of nuts.

At Maverick’s appointment with the allergist, they used a tool to load several different allergens onto tiny prongs and pressed it all at once onto his back. Each allergen was numbered so they could tell which one might be causing a reaction. Danielle said after about an hour wait time Maverick had a strong reaction to cashews and pecans. He was not tested for all tree nuts, but they were told to err on the side of caution and avoid all tree nuts.

The visit to the allergist answered some questions about Maverick’s bad reaction that fateful August day. “We thought his initial reaction was to macadamia nuts, but it turns out there were cashews in those cookies and the allergist believes he reacted to those as his allergy to cashews is pretty severe,” Danielle said.

After a little research I found that Maverick is not alone in his challenge with tree nut allergy. Peanut and or tree nut allergy affects about 3 million Americans (or approximately 1.1 percent of the general population).

After my grandson was tested he found that while allergic to cashews and pecans, he can still safely consume peanuts and peanut butter. Peanuts grow underground and are part of a different plant family (the legumes) while tree nuts grow on trees. Still, it was prudent for Maverick to be tested since approximately 40 percent of kids with tree nut allergies are also allergic to peanuts.

So what causes a peanut or tree nut allergy? When a person with the allergy eats something with nuts in it the body releases chemicals like histamine. This can cause many symptoms including cough, sneeze, hoarse throat, trouble breathing, stomach ache, swollen eyes, hives, diarrhea, dizziness and anxiety.

Tree nut allergies can’t be cured and are generally considered to be lifelong. Approximately 10 percent of people can outgrow a tree nut allergy but when the allergy starts in childhood it is rarely outgrown. Danielle was told there’s only a very small chance Maverick will outgrow his tree nut allergy. He can go back the summer of 2022 (two years after the initial diagnosis) to be re-tested. The re-test would show if the severity of the allergy has changed and he could be tested for each specific tree nut so they have a better idea of the scope of his allergy.

These days Maverick and his family are doing their best to prevent another scary episode. Of course the best way to avoid a tree nut allergy reaction is to avoid products that might contain nuts. Believe me when I say that’s easier said than done. Since Maverick’s diagnosis he’s become an avid label reader and as Grandma I try my best to protect him by reading labels also.

Most baked goods are no brainers to avoid, but did you know there can be tree nuts in vanilla ice cream? I bought little ice cream cups for the Grandkids not thinking it would be an issue for Mav. Luckily he read the label and said, “Grandma, I can’t have this.” Sometimes it depends on the brand so now I’m trying to carefully check labels on ice cream, bread, cereal and snack foods when I know the grandkids are coming over.

I was surprised to learn that chili, soup, honey, pudding and hot chocolate can also contain tree nuts. Many items also have cross-contamination warnings such as, “Manufactured in a shared facility that processes tree nuts.” Maverick’s allergist concluded he can safely eat most items with that warning, but each case of tree nut allergy can be different. If Maverick sees a label stating “may contain tree nuts” or if tree nuts are listed as an allergen he definitely won’t eat it.

What else can you do to prevent an allergic episode? For some people eating out can be tricky since food without peanuts or tree nuts can still have contamination if made in the same place or with equipment that has nuts. Maverick has learned to research the restaurant ahead of time or ask the server if unsure. Our family has also learned to check the label each time before purchasing an item at the store since food makers sometimes change the recipe.

I’ve also learned to look outside the kitchen for allergy culprits. Did you know that nuts can be found in lotions, shampoos and pet food? Again, read the label before buying if you have a household member with food allergies.

While Maverick and the rest of the family is being careful to think before buying and eating tree nut products, everyone with a tree nut allergy must prepare for an allergic reaction. Danielle said they were able to get approval from the insurance company for three sets of epi-pens. He keeps one at school, one at my house, and one hangs on a hook (in a special case) in their laundry room. They grab the pen when they go out to eat as a family, go on vacation, or to sports practice or games.

Maverick also has a practice epi pen—it does not contain a needle or epinephrine but is basically a dummy prototype of the actual epi pen. “Every so often we pull it out and have him practice injecting himself so that he’s comfortable doing it or instructing someone else to use it on him,” Danielle explained. As a worried grandma I was relieved to learn that Maverick’s school, St. Mary in Hilbert, has gone over and above by instructing all of their staff in the use of an epi pen.

Symptoms of anaphylaxis often can occur within 15 to 30 minutes but anyone with a tree nut allergy should administer the epi pen as soon as symptoms or reaction occur.

While most food allergies start in childhood, it is possible to develop a tree nut allergy (or any type of food allergy) as an adult. It’s unknown why some adults develop an allergy to a food they previously ate with no problem. The important thing to remember is don’t ignore symptoms after reacting to a food and seek medical help if you have worsening symptoms or trouble breathing. Further testing with an allergist is always good advice.

Our family has learned a lot since Maverick’s scary experience with the macadamia nut cookie. In solidarity with him I haven’t had macadamia nuts since, but I’ve also become a more avid label reader. It only takes a minute to read the label—and it could just save a life.