Let's All Get Apprehensive
What food allergies show about the value of anxiety
When I was about seven, I was at a neighbor’s birthday party when I made an egregious mistake. I picked up what looked like a normal M&M from a nearby bowl, and when I bit in, I was horrified to find a peanut lurking in the center.
This came after months of bringing soy butter and jelly sandwiches to school and watching my parents pick the Reese’s peanut butter cups out of my Halloween candy—by then, I was well-trained to see peanuts as an obvious hazard.
I hurried into the bathroom to spit out the peanut and rinsed my mouth out in the sink, hoping without any real certainty that this was the right thing to do. For some reason, I didn’t feel like I could tell an adult until something actually happened, and I felt nothing like the one reaction I’d had to a cashew, with that instant tingling invading my mouth after only a trace amount of the nut. Still, I scanned myself for pain, or numbness, or some vaguer symptom I didn’t know to expect yet. I got the sense that something was impending, though I couldn't say what.
All I remember about the rest of that party is pacing between the clock in the kitchen and the lawn outside, praying the motion would make time pass and get me closer to the time the invitation had said the party would be over. (Somehow, there were enough kids scattered around the house and yard that this went pretty much unnoticed).
When I think back on that party, I don’t know how to interpret my reaction. I know now that I was never allergic to peanuts at all—rather, the doctor had me stop eating them for a while after I was diagnosed with my other food allergies, a now-disproven method for preventing the onset of further allergies. But at the time, I was going by what little information I had, which was that swallowing a peanut could end my life, a fate I could only imagine in the vague, formidable abstract.
Should I remember that panicked afternoon as a symptom of childhood neuroticism, where I could not ease my own fear enough to enjoy a birthday party? Or was my worry rational, a natural reaction to what I knew as a very real threat?
This is what’s confounding about food allergies: they require a mindset and set of behaviors that would, under most other circumstances, come off as pathological. At times, managing my allergies feels like being obligated to have symptoms of an anxiety disorder.
In the grocery store, for example, I comb over the ingredient lists on every item I buy. Later, I examine each pan and utensil before using it to be certain that it’s clean, sometimes rewashing them if I make out the residue of some unknown substance. I look over the menus at home before going to restaurants, and then I ask the waiter questions about the ingredients in the salad dressing, or the bread. I can never be completely careless; I’m aware of every ingredient I put in my mouth.
This may sound taxing, but I actually think very little about doing it. As medical anthropologist Emma E. Cook suggests, people with food allergies and other dietary conditions have a unique mode of attention to their environment: a keen vigilance cultivated through years of close calls and harrowing reactions. I don’t have to think about it consciously to know exactly what the people in my nearby environment are eating, and what they have touched, and which of those things I’ve also touched, and where crumbs are spreading. (In a way, this is similar to how people got more conscious about their proximity to strangers at the peak of Covid).
The reason it’s easy for people with allergies to do this instinctively is because we have a visceral awareness of the threats allergens pose to us. As a 2022 paper by Desoucey and Waggoner proposes, people without food allergies tend to see them more abstractly—they may know another person can’t have shrimp or pecans, but they lack that person’s subconscious anticipation of a numb prickle in their mouth, the sudden constriction of their throat. Without real bodily harm constantly looming over you, it’s easy to escape awareness of an allergy’s tangible consequences and earnestly forget things like checking the ingredients on a package or washing your hands between touching different ingredients. Meanwhile, I find myself on edge whenever someone nearby pulls out a bag of trail mix, as I quietly determine what kind of nuts are included, tracing the other person’s motions almost against my own will.
It’s hard to say where the apprehension necessary for managing allergies verges into maladaptive levels of stress. While food allergies are linked with heightened anxiety in both adults and children, the aftershocks of a severe reaction can mirror PTSD—but is it fair to see these as psychological symptoms in need of treatment when they’re what protects someone from genuinely harmful substances?
Personally, I find it hard to tell when my anxieties are actually healthy. Are my recurring stress dreams about ordering at restaurants or searching for food I can eat at events a sign of needless worry, or am I just processing situations where my uneasiness is understandable?
A few years ago, I went with a friend to one of her favorite restaurants in Denver one night, something we’d been eagerly planning on for weeks. Once there, though, I found myself jittery, skimming the unfamiliar menu over and over and stressing about the possibility of danger in each dish. You need to get out of your comfort zone, I told myself. Stop being paranoid and order something. Finally, I ordered a pasta dish and tried my best to focus on chatting with my friend rather than my lingering fears.
The pasta was good, but I still picked at it, apprehensive about the number of ingredients mixed in, how hard it was to be fully cognizant of exactly what was on my fork—and then frustrated at the way my nonstop analysis disengaged me from the conversation.
After we finished, I followed my friend’s lead in ordering a vegan milkshake, which felt innocuous enough. We took them to go, sipping them as we walked to her car, and it was just as she unlocked the doors that I felt a familiar prickle in my mouth. I tried not to show that anything was off, slipping into the passenger’s seat and reminding myself of how often certain textures echo the itch of a reaction.
It wasn’t until the tingling arrived at my throat that I knew this wasn’t my imagination. It wasn’t a serious reaction, at least—nothing a Benadryl couldn’t solve—but it still served as a visceral reminder that trying to temper my anxiety wasn’t going to help, not when it really mattered, not when it’s there as a means of survival.
But the anxiety that comes with allergies isn’t just the urgent, life-saving kind. Often, my attitude towards my environment feels almost like contamination OCD, where people become overly preoccupied with potential contamination, leading to excessive cleaning behaviors. People who have OCD may be more likely to develop this subtype of the disorder if they also have food allergies or Celiac—but it’s hard to know where contamination worries stop being helpful and become counterproductive.
After all, cleanliness is closely intertwined with the entire experience of allergies. For example, one of the prevailing theories about the cause of allergies is the hygiene hypothesis, which suggests that allergies are a disease of modern civilization, provoked by historically high sanitation that prevent us from encountering, and therefore adapting to, pathogens that used to be unavoidable. Growing up in a cleaner household environment, then, is seen as a catalyst for eventual allergies.
However, I wonder if this theory gets it backwards—what if people with allergies really are more clean on average, but as a result of the condition rather than a cause?
Medical anthropologist Danya Glabau proposes that people with food allergies are expected to reach a “hygienic sublime”—an extreme purity exemplified in allergy-themed magazines by images of spotless kitchens with gleaming countertops. As Glabau points out, the hygienic sublime blames people with allergies for their own reactions, wrongly implying that it’s possible to fully control your environment down to a microscopic level.
While Glabau’s work is focused on food, the hygiene sublime also applies to environmental allergies. It just takes a quick Google search for “allergy cleaning” to find page after page of advice about what type of vacuum to use, what temperature to wash your pillowcases at, and which areas of your house to dust most often if you’re allergic to pollen or mold or roaches.
Personally, I lived with dogs for most of my childhood—and it was only because of a hyperawareness of which surfaces were contaminated by their hair that I was able to do this with little impact on my physical health. I didn’t even realize how attuned I was to my dogs until I stopped living with them. Even in my current apartment, I often close my bedroom door on instinct when I’m just grabbing something from the kitchen, because I’m used to doing this to keep my dogs out of my space. Similarly, I avoid touching blankets that have been anywhere outside my room, habitually on edge around anything dog hair could cling to.
It’s like there’s this subconscious tracker in my head that marks objects in my surroundings as clean or not clean, that always knows what I’ve touched since I last washed my hands, and whether I’ll need to toss my clothes in the wash instead of wearing them into my room, and if the people around me are safe to hug without wheezing. As obsessive as these habits may seem, it’s hard for me to see them as over-the-top when they rose out of necessity.
Plus, I genuinely can’t remember the last time I caught even a cold. I’ve heard anecdotally that people with allergies get sick less, though there’s a lot of controversy about this in actual research. While studies show that food allergies are linked with lower Covid risk, the reason for this is unknown, and I have to wonder if any of this is caused by nothing more than the natural avoidance of contamination that comes with having an allergy.
People without allergies may wonder why you would bother fretting so much over a minor chance of sneezing or an itchy mouth—but in truth, allergies aren’t nearly as clear-cut as most people probably think. For one, it can be hard to know how intense a reaction will be, since allergy testing isn’t particularly adept at detecting severity. Even having a reaction can’t tell you for sure how severe the next one will be, since allergic reactions vary wildly, even within the same person. A food that previously made your lips swell and tingle a bit might end up killing you on your next exposure—in fact, more than half of food allergy deaths occur in people who had only ever had mild reactions in the past.
If you actually have an allergy, especially if you’ve experienced anaphylaxis, the worst case scenario is always hovering over you. Even knowing allergy deaths are relatively rare doesn’t help a lot when you know most people are only eluding death because of their relentless scrutiny.
And less severe doesn’t always mean easier to manage. I know cashews have given me anaphylaxis in the past, so I avoid them at all costs, with no exceptions. But how do I know when my hypervigilance becomes disproportionate to the incessant but non-fatal ache of my pollen allergies? And what about EoE, an allergic condition I have that operates differently from classic allergies, making it hard to say what even affects it? I’m endlessly uncertain about which of my actions are overkill—do I need to be vigilant about flecks of cheese on the tabletop near me? Will I get sick if I use the same utensils and cutting boards as my family? Or should I just chill out and remember that this condition can’t even kill me?
In 2013, a diagnosis called somatic symptom disorder (SSD), which involves excessive thoughts and feelings of distress about real physical symptoms, was added to the DSM. When diagnosing SSD, clinicians are expected to somehow judge whether a patient’s reaction is disproportionate to the severity of their symptoms, as if there’s an objectively correct way to cope.
In this way, we tend to treat psychological upset as a problem on its own, forgetting that distress doesn’t usually just come out of nowhere. Targeting people’s responses to their symptoms instead of the symptoms themselves only distracts from the real problems at hand. For patients with an undiagnosed organic disease, being diagnosed with SSD implies that the patients’ issues are psychosomatic, diverting attention from the diagnostic testing that could lead to treatment. Meanwhile, I find it frustrating hearing that I should try to alleviate allergy-related anxiety, because this is what helps me avoid getting sick and having potentially fatal reactions.
It’s true that catastrophizing can make physical pain worse—and in the case of allergies, that there’s a point where anxiety stops being helpful—but the answer shouldn’t be to just tell people to go to therapy. Just as we should help patients by taking their undiagnosed complaints seriously, we should address allergy anxiety with broader changes like better labeling at restaurants or allergy training in workplaces, making vigilance less vital to managing allergies in the first place.
Loved this piece and your clear description of your experience. Don’t doubt your vigilance. You have to have it in a world that’s still pretty dismissive of food allergies.
hii!! I loved this essay, you’re like a protagonist in a literary fiction novel but it’s so much shorter, thank god. since reading lit fic, i’ve learned experiencing crisis everyday is different than numbness. if we could see our psychology, solutions would never be an afterthought.