Minutes after 18-year-old Karen* bit into her ham-and-cheese sandwich at school last week, her tongue swelled up and she started struggling to breathe. She realised at once her lunch contained traces of nuts.

She was taken to a health centre and given an injection to control the swelling. Her condition improved but the following day, the symptoms escalated and she was told to head to hospital where she was prescribed steroids.

“The doctor told me I must have come into contact with nuts again after eating the sandwich. Maybe it was when my friends were eating carrot cake... Without the treatment I could have died,” she said.

Her mother, who prepared the sandwich, said that day she happened to buy a different brand of sliced bread and did not realise it contained “traces of nuts” – three words that haunt the family.

When I tell staff at a restaurant I have a nut allergy and ask them to be careful they tell me I’m there at my own risk

“I feel like I’m becoming obsessed,” Karen’s mother says: “It takes me an hour to go shopping for a few items as I have to read all labels. Sometimes the ingredients and allergy information are not even in English and the print is tiny.”

She is angry because such allergies are not taken seriously. “It angers me when I’m at a grocer and I see them use the same knife to cut different types of hams, some of which contain nuts. It’s not fair,” she says.

She is determined that something must be done to increase awareness, the same way more attention is now placed on gluten-free products.

“When I tell staff at a restaurant I have a nut allergy and ask them to be careful they tell me I’m there at my own risk. People don’t realise how serious a nut allergy can be. When I insist on knowing if there are traces of nuts, they look at me like I’m trying to be fussy.”

Karen did not always suffer from the allergy. When she was about 10 the smell of nuts started bothering her. One day, she washed her hair and her scalp started itching  the shampoo contained almond oil.

Tests revealed she had a nut allergy which she thought was under control.

But when she was 13, she was at her sister’s house for lunch and ate a cracker. Suddenly her tongue swelled and she felt her airway blocking.

That was her first severe reaction. Since then she steers clear of anything – be it food or any product – that contains nuts. She carries an EpiPen (an auto-injector used for the emergency treatment) everywhere she goes, but sometimes matters are beyond her control.

For example, in December her lips swelled up when her boyfriend kissed her after eating a slice of Christmas log.

When she sees friends eating nuts at school she moves away. “I’m scared to go out with my friends. I have to check a million times and feel I’m bothering my friends. People don’t realise. Some people at school come near me with nuts as ‘a joke’...

*“This is why I don’t want to show my identity. I’m scared they play this sort of ‘joke’ on me... It’s difficult to live life like this,” she says.

Going nuts

The exact prevalence of food allergies in Malta still needs to be evaluated, however, studies in other European countries show they are increasing, consultant paediatrician Patrick Sammut said.

The most common allergies are allergies to milk, eggs, wheat, shellfish/fish and nuts.

There are two types of nut allergies – peanut and tree-nut allergies (such as walnuts and almonds). People suffering from such allergies react to a particular protein resulting in a cascade of reactions followed by release of inflammatory chemicals into the blood, said Dr Sammut who specialises in respiratory and allergic conditions. Reactions can be mild and include localised redness and swelling. The most severe reaction is known as anaphylaxis that results in lowered blood pressure and swelling of the airways or vocal chords with compromised breathing.

If anaphylactic shock is not treated immediately, it can be fatal. An immediate adrenaline shot is needed to counteract this swelling. For this reason it is very important to recognise symptoms early, he stressed.

“Due to the unpredictability and life threatening nature of these reactions, allergy sufferers may experience significant anxiety and even social limitations, with considerable impairment to quality of life.

“While awareness is increasing, a lot still needs to be done to improve the safety of these patients,” Dr Sammut said.

International ignorance

The lack of awareness about the severity of nut allergies made international headlines last month after a British boy who has a severe peanut allergy was told he could not board an American Airlines flight – because “Americans have a right to eat nuts”.

The parents of 11-year-old Daniel Levitan were at the gate at Florida’s Fort Myers airport – to return home from their winter break – when they asked for an announcement advising fellow fliers not to eat nuts. They explained to airline staff that Daniel could choke to death from a reaction to nuts.

But an American Airlines staff member refused to make the announcement and barred the boy from boarding the plane.