US student with peanut allergy dies after recipe change at restaurant; Here’s all you need to know about the condition

Alison Pickering

, a 23-year-old college student in the Texas state of the US, nearing graduation from Tarleton State University, died shortly after an undisclosed recipe change at a restaurant led to an allergic reaction. Alison, so far, had carefully navigated her

peanut allergy

for years. However, a first date in May 2023 turned into a heartbreaking ordeal when a trusted restaurant unknowingly became the source of her fatal reaction.
According to her family, Alison ordered her usual dish, Mahi-Mahi, at a restaurant she had frequented before. Alison’s father,

Grover Pickering

, told CBS News, “She would repeatedly go to the same restaurants and order the same dishes, you know. And that was a common thing.” However, her parents said that this time the dish was different from the previous times she ate there as the restaurant had changed the recipe to include peanut sauce. According to Allison’s obituary, this was not “disclosed” on the restaurant menu, additionally Grover told CBS News that the wait staff was also unaware of the change.
According to Grover, “She took a few bites, realised something was wrong. She did her

Epipen

. The ambulance came. She actually walked to the ambulance talking to them, but somewhere along the way things went downhill.” As per Alison’s obituary, she succumbed to severe

anaphylactic shock

, a life-threatening allergic reaction that escalates rapidly, impairing breathing and organ function.

What is peanut allergy?

A peanut allergy occurs when the immune system flags peanut proteins as harmful. When exposed to peanuts, the immune system releases symptom-causing chemicals into the bloodstream. These chemicals cause an allergic reaction.

What happens in peanut allergy?

The immune system mistakes peanut proteins as harmful and releases chemicals into the bloodstream that cause symptoms.
Direct and cross-contact with peanuts could cause a reaction:
Direct contact:

The most common cause of peanut allergy is eating peanuts or foods that contain peanuts.
Cross-contact: This happens when peanuts get into a product by mistake. It often happens when food is exposed to peanuts during processing or handling.
Inhalation: Breathing in dust or aerosols containing peanuts, such as peanut flour, may cause an allergic reaction.

Risk factors of peanut allergy:

It isn’t much clear why some people develop allergies while others don’t. However, people with certain risk factors have a greater chance of developing peanut allergy.
The peanut allergy risk factors include:
Age: Food allergies are most common in children, especially toddlers and infants. As a person grows, the digestive system matures. Then the body is less likely to react to food that triggers allergies.
Past allergy to peanuts: Some children with peanut allergy outgrow it, though it can recur. So be cautious even if you seem to have outgrown peanut allergy.
Other allergies: If you’re already allergic to one food, you have a higher risk of being allergic to another. Also, having another type of allergy, such as hay fever, raises your risk of having a food allergy.
Family members with allergies: Your risk of peanut allergy is higher if other allergies are common in your family, especially other food allergies.
Atopic dermatitis: Some people with the skin condition atopic dermatitis, also called eczema, have a food allergy as well.

Symptoms of peanut allergy:

From hives, vomiting, swelling, coughing,

wheezing

to having breathing troubles, symptoms of a peanut allergy can include:
Skin: Hives, redness, swelling, or itchy skin.
Mouth and throat: Itching, tingling, or tightness in the mouth or throat, or a hoarse voice.
Digestive issues: Stomach pain, cramps, diarrhea, nausea, or vomiting.
Breathing: Wheezing, shortness of breath, or difficulty breathing.
Eyes: Itchy, watery, or red eyes.
Nose: Runny nose, sneezing, or congestion.
Other symptoms include dizziness, fainting, anxiety, or a sudden change in behaviour or mood.

Anaphylaxis:

Anaphylaxis, also known as anaphylactic shock or allergic shock, is a severe, life-threatening allergic reaction that can occur within minutes of exposure to an allergen. A severe allergic reaction to peanuts can be life-threatening. Symptoms of anaphylaxis include, welling of the tongue or throat, Persistent cough or wheezing, Difficulty talking, and Persistent dizziness or collapse.

Diagnosis:

A peanut allergy can be diagnosed through a combination of medical history, physical exam, and tests, such as:
Medical history: An allergist will ask about your family’s medical history, diet, and any previous allergy symptoms.
Physical exam: An allergist will perform a physical exam.
Skin test: A small amount of peanut protein is pricked into the skin, usually on the forearm. If you’re allergic, a raised bump or hive will appear.
Blood test: A blood test measures the amount of immunoglobulin E (IgE) antibodies in your blood, which can indicate an allergy to peanuts.
Food challenge: You’ll eat small amounts of peanut or peanut-based products in increasing doses, while being monitored for a reaction. This test is performed in a hospital setting with emergency equipment and medication on hand.
Elimination diet: You may be asked to stop eating peanuts and other suspect foods for a week or two, then add them back into your diet one at a time. This can help identify which foods are causing your symptoms.
People with a peanut allergy may also be allergic to other tree nuts, soy, and legumes.

Treatments:

Peanut allergies are treated with a combination of avoiding peanuts, emergency medications, and sometimes immunotherapy.
Avoid peanuts: The best way to manage a peanut allergy is to avoid peanuts and foods that contain peanuts or peanut protein. You should read food labels carefully, as ingredients can change.
Emergency medications: Keep epinephrine, such as an EpiPen or Auvi-Q, on hand in case of an accidental exposure to peanuts.

Epinephrine

is a type of adrenaline that can treat a severe allergic reaction called anaphylaxis.
Immunotherapy: Immunotherapy, also known as desensitization, can reduce the risk of severe reactions to peanuts in the future. It involves slowly increasing doses of food with peanuts until the patient can tolerate the highest dose. One FDA-approved immunotherapy for peanut allergies is Palforzia, which is for children ages 4–17.