Thailand & mild peanut allergy = ??

March 12, 2007 6:41 AM

I'm scheduled to work in Thailand for about 2 months in April, and I just found out Friday that I'm allergic to peanuts.

I'm 29 and would never have guessed I'm allergic to nuts, since I eat them fairly regularly and have never had even had a scratchy throat or a stomach ache from nuts.

BUT I've been tested for allergies Friday (bc of hay fever problems), and I reacted somewhat to peanuts and some other nuts. (I don't know if all allergy testing uses the same scale, but my reaction to nuts was about 3, whereas my hay fever reactions were 4+). The doctor told me that, even though I don't normally react to nuts, I should avoid eating them in the future because the reaction can be so extreme. I forgot to ask him whether that meant I should bag the Thailand trip, bc it seems impossible to avoid peanuts there, given that peanut oil is so prevalent and that pans where nuts have been in dishes are probably reused for non-nut dishes. (Is there such a thing in Thailand? Does this mean no pad thai?!!) I already carry an epi-pen (allergic to bees), but I hear (a) that only buys 1 hour before hospital needed and (b) they don't do well in extreme heat (e.g. Thailand in April). I'll be spending most of my time in a remote location about 7 hours from Bangkok.

So my questions are:
(1) Given a peanut allergy like I have - so mild I had no idea about it, but who knows for the future - should I skip Thailand? Or are there other ways of coping?
(2) If I have an anaphylactic reaction, is there anything I can do besides 1 hr of epi-pen adrenaline? E.g. Can other medicine help me if I'm too far from a hospital to get help? Is it possible my body would just calm down without medicine (after epi-pen)?
(3) Can you tell me how to write "no nuts please" or something like that in Thai? ไม่ ถั่วลิสง กรุณา - is this totally wrong?
(4) Am I ethically required to tell my employer about this development?

To head off the usual ask mefi responses:
YES - I am going to call the doctor back, but I figured I can't be the first person in this situation, so I might get some insight here. Plus, I don't want to be told 'no' bc he's worried about liability.
NO - I don't think I need to see a therapist about this. (I kid ask mefi.)

posted by Amizu to health & fitness (25 comments total)

Ok, there's got to be a good way to deal with this besides cancelling a trip to Thailand. I'm deathly allergic to insect bites and stings but I'm not about to stop going outside. Live your life. GO TO THAILAND. Definitely skip the pad thai. I'm sure you will get a lot of good specific advice in this thread about how to say things in Thai so I'll leave the others to that. I know from my mom's shellfish allergy that the trickiest part will probably be making sure your food wasn't prepared on the same table as anything with peanuts or peanut oil.

Dealing with a food allergy is a pain, but it can become routine after a while. I'm also allergic to certain preservatives & I often don't know which foods will have them so it's a little tricky. For example, I'm very allergic to the hash browns in 60% of restaurants -- depending on if they use frozen potatoes and how they're packaged (my throat closes up and I lose my voice). So I have to ask all sorts of questions about freshness before I order food & avoid things altogether if they seem sketchy. I have to do this when I travel as well. Sometimes I make a point to overplay the seriousness of it just so that people don't ignore me. I have gone so far to find the words for "allergy" and "death" in other languages. It works... if you use those words, people try very hard to understand what you are saying. From my experience, I can guarantee you that people do NOT want the American woman to die in their restaurant.
posted by miss lynnster at 7:13 AM on March 12, 2007

I wouldn't skip Thailand for that. There's tons of Thai food out there that has absolutely nothing to do with peanuts, especially the curries. In fact I can only remember having peanuts in pad thai at western oriented restaurants.
posted by furtive at 7:13 AM on March 12, 2007

Just noticed the tags. Are you going to see the Karen!? That's one of the coolest memories of my life! Trekking in Chang Mai/theGolden Triangle is a really, REALLY cool experience.
posted by miss lynnster at 7:16 AM on March 12, 2007

The world is a dangerous place. I think the least of your worries is dying because of a peanut. So stop obsessing over these small things and just go travel a bit.
posted by markesh at 7:17 AM on March 12, 2007

BTW, I do remember they served us an AWESOME cashew chicken dinner when I was trekking. Can you eat cashews?
posted by miss lynnster at 7:18 AM on March 12, 2007

Just make sure you know how to say, "I am allergic to peanuts. No peanuts." Surely there are people in Thailand who are allergic to peanuts. Surely there are Eskimos who are allergic to fish. Surely there are Maori who are allergic to kiwi. The people in the restaurant will understand what you mean. But be vigilant. Smell stuff. A lot. If you are not sure about something, take a small bite and wait. If you feel a strong reaction coming on, take your EpiPen. You'll be fine. That's what an EpiPen is for, to save your life in those scenarios. When your doctor says that you should avoid nuts/peanuts in the future, he is saying that every new contact will increase the degree of the next reaction. So, if you eat a peanut tomorrow, you're not going to die. If you eat a peanut tomorrow and then another one in a week, then the one you eat next week will be worse. It'll keep getting worse. It's your body telling you to knock it off. Luckily, your doctor has already told you that. Just be careful, be vigilant, and be wise. You'll be fine. Even in the middle of nowhere.
posted by billysumday at 7:24 AM on March 12, 2007 [2 favorites has favorites]

When I was in Bangkok, I ate at Hard Rock cafe (chicken fingers) and a lot of pizza joints... I'm weird, but there are plenty of options for you there.
posted by thilmony at 7:34 AM on March 12, 2007

I'm 29 and would never have guessed I'm allergic to nuts, since I eat them fairly regularly and have never had even had a scratchy throat or a stomach ache from nuts.

BUT I've been tested for allergies Friday (bc of hay fever problems), and I reacted somewhat to peanuts and some other nuts. (I don't know if all allergy testing uses the same scale, but my reaction to nuts was about 3, whereas my hay fever reactions were 4+). The doctor told me that, even though I don't normally react to nuts, I should avoid eating them in the future because the reaction can be so extreme.

Also, let me try to parse this for you a little bit. You're 29 and you eat nuts fairly regularly, without any bad side effects. Chances are, you actually AREN'T allergic to nuts, or won't be for quite some time. Allergists have a chart that shows them what allergies are cross referenced with other allergies. If you react to hay-fever allergens and grass, for example, then there is a strong likelihood that you are also allergic to peanuts. But it only means that you might be allergic to peanuts, or will become allergic to peanuts. It's like that SNL commercial where they are trying to sell the home-headache test. If you have to take a test to tell you if you have a headache, then you don't have a headache.

Your doctor/allergist is being very careful, as he should be. He's saying, "oh, look at this, I detect a small reaction to peanuts." Now, your allergist knows that this could potentially be very severe, as people with peanut allergies tend to have them in the extreme. He is covering his bases, telling you that it's just better to cut them out of your diet then risk keep eating them and possibly further compound any inherent allergies to peanuts that you may already have.

Also, when you return to your doctor/allergist, you should really have him check if you are allergic to peanuts, other nuts, are all nuts. For instance, I am allergic to peanuts but no other nuts. Other people are the opposite.

Still, what I said above is also important - even though it sounds to me that you do not have a serious, or even a mild, allergy to peanuts, your doctor sees something and wants you to scale back. Definitely nowhere near justification enough to cut your trip, but be vigilant nonetheless, and always always always have your epipen.
posted by billysumday at 7:34 AM on March 12, 2007

Here's a card you can show waiters in restaurants to let them know you're allergic to peanuts.
posted by amro at 7:36 AM on March 12, 2007 [4 favorites has favorites]

Argh...I completely forgot to answer your questions.

(1) Given a peanut allergy like I have - so mild I had no idea about it, but who knows for the future - should I skip Thailand? Or are there other ways of coping?

Don't skip Thailand.

(2) If I have an anaphylactic reaction, is there anything I can do besides 1 hr of epi-pen adrenaline? E.g. Can other medicine help me if I'm too far from a hospital to get help? Is it possible my body would just calm down without medicine (after epi-pen)?

You could ask your doctor for a prescription of steroids. If you start having allergic reactions to things you don't anticipate (like crazy Thai food or crazy Thai plants), or your hay fever gets out of control, then taking a course of steroids will help (has helped me, at least).

(3) Can you tell me how to write "no nuts please" or something like that in Thai? ไม่ ถั่วลิสง กรุณา - is this totally wrong?

Don't know.

(4) Am I ethically required to tell my employer about this development?

Ethically, it doesn't seem like it should matter. However, if your employer is in any way preparing food for you, it'd only be fair to give them a heads up, ie, here are my dietary restrictions. Plus, it's always good to let as many people as possible know about your allergy, in case anything goes wrong. Nobody cares if you have allergies, in fact some people think it's interesting. But you'd be sorry if you chose not to tell your co-worker that you had a peanut allergy because you thought it was "weird" or something and - god forbid - you go into anaphylactic shock in a restaurant somewhere and they have no idea what's wrong with you.
posted by billysumday at 7:40 AM on March 12, 2007

If it helps at all, I recall Alton Brown saying on an episode of Good Eats that generally people are allergic to the protein in peanuts, not the oil. Wiki confirms.
posted by donajo at 7:48 AM on March 12, 2007

Thanks for all the answers. I agree about living my life fully, but this is new to me and I don't want to moronically underestimate the risk, hence the question.

Re testing already done: I had skin tests for nuts, and reacted (3 - whatever that means) to peanuts, walnuts, sesame seeds, and a couple of others, but not to all nuts. Good to know that I probably won't go from feeling fine to anaphylactic shock in the next month or so - I'll probably just try to limit my nut exposure as much as possible but not go crazy with it. (Will check with doc on this when his office answers their phone.)

Good to know about peanut oil not being dangerous. I figure I can do a decent job of avoiding the nuts themselves, but avoiding peanut oil seems next to impossible, given how commonly it is supposedly used in thai cuisine, and re-use of pans in cooking. And supposedly 1/1000 of a peanut can cause a serious reaction, so I think I would be silly to expect others cooking for me to be that vigilent. But I'm hoping I'm not so allergic that so little peanut protein will cause me problems.

Re Thai ppl and peanut allergies: apparently peanut allergies are incredibly uncommon in Thailand, actually. Medical mystery. My experience with food prep in the developing world (not sure if Thailand even counts anymore) is that people tend to dismiss westerners' food concerns or don't realize ways that food can get contaminated (so vegetarians often get some sort of animal products in their food, e.g.)

Re Karen: Yes, the reason for the trip is to work with the Karen. I'm excited! I had typed something about them in the question, then deleted it, but forgot to delete the corresponding tags.
posted by Amizu at 8:22 AM on March 12, 2007

3 is moderate I believe. Not super serious. You will be fine. Even just taking benadryl with you is a good idea. If you have not ever experienced any reaction with peanuts yet, you are probably not going to have your first reaction be some crazy thing just because this allergy suddenly showed up on a test. I had 400 patch tests done last year & the doctors found that I was even allergic to the glycerine they used as the control patch. I had a 3 reaction to 70% of the trees in my neighborhood. But I'm surviving just fine. Didn't chop down a single tree, either. :)

The Karen are really interesting people. You will love it! I can GUARANTEE you that after you get on the plane, peanuts should be the last thing on your mind. (Well, unless they hand you a bag of peanuts on the plane.)
posted by miss lynnster at 8:36 AM on March 12, 2007

You can be a little allergic to nuts, without the dying part. For instance, I get an itchy mouth from walnuts, so I'm sure I would test positive for an allergy, but it has no practical effect on my life. If you don't have problems now, don't let the allergist invent them.
posted by smackfu at 8:37 AM on March 12, 2007

I think you should talk to your doctor - call up the office and get your doctor to call you back. You don't have a major allergy, but even minor ones can be a pain in the butt when traveling. Plus it's worth being careful - not so careful that you cancel your trip, but careful.

I've had more serious allergic reactions when traveling and my allergist said that there were things we could do that would have prevented those reactions. You want to enjoy your trip and eat the yummy Thai food, so talk to your doctor. That's what they're there for.

And enjoy!
posted by mulkey at 9:31 AM on March 12, 2007

Update: I just spoke with the doctor's office, and they said they're not going to tell me it's safe and that 3 is a strong reaction, and that I could go from zero reaction to anaphylactic reaction at any time, and that I should avoid peanuts altogether (ha - I really don't believe that's possible there), and that I should know which emergency number to call for an ambulance bc obviously they'll have those options where I'm going in Thailand since, think about it, otherwise people would be dying left and right (ha - those kind of health care options are not available where I'm going). And that there's nothing I can do but take 1 epi pen and then 15 minutes later take another epi pen and get to the hospital right away. (Aka not in 7-10 hours.) I'm a liiiittttle bit frustrated right now.
posted by Amizu at 10:40 AM on March 12, 2007

When my son was in HS he and his rifle drill team ordered pizza during a practice one day. One of his buddies (with no previous allergy afaik ) started getting symptoms-one guy had the sense to run get an adult who turned out to be a nurse...long story short he had a severe reaction that could have killed him.

Don't take our word for anything regarding this. Find a second opinion but NOT HERE. I have been to Thailand and you are absolutely right about lack of access to medicine (altho if you are near Chaing Mai I know an emergency room doc who runs a medical missions thing there for the hill tribe folks.)
posted by konolia at 11:19 AM on March 12, 2007

I'm sorry to hear about your news from the doctor. I can imagine your frustration. I am not surprised that your doctor was unwilling to give you an okay. I am friends with an allergist that told a patient that he was only mildly allergic to bee stings. He was stung a year later and suffered a reaction, but foolishly refused to use his epi pen because of the what the doctor had said. He went into cardiac arrest and suffered severe brain damage. The doctor ended up paying over $5 million. So it is unlikely any doctor will ever give you an okay after a positive test for peanut allergy, no matter how small the risk, because of the potential liability.

That said, you have to consider the risks youself. You have never had a serious reaction and may never. I have a friend I have traveled with who has a severe peanut allergy. We have been on extended wilderness trips in the U.S. and Alaska in which help could be days, not hours away. In our case we had pretty strict control over food, preparing our own, although you never know for sure when there are others in a large camping party. She carries several epi pens at all times. She has had life threatening reactions just from using a cooking spoon that had previously been used with peanut butter.

I disagree with the people here who so cavalierly dismiss the risks saying with authority "you will be fine." They can't possibly know. Allergies can get worse at any time.

But it would be a shame to let fear prevent you from enjoying adventures. There are many dangers in life and this just happens to be one you know about in advance. Most threats come about with no warning at all yet we still continue on with our lives. You will have to evaluate the risks for yourself considering you have never had a serious reaction. You can take what steps you can to avoid peanut exposure and always make sure you have lots of epi pens on hand, not just one or two if you are hours away from a hospital. Repeated doses of epinephrine is the same treatment they would give you in a hospital so even if you had a reaction, you may be able to successfully treat it yourself. In a hospital, however they would also be able to intubate you and supply oxygen if breathing became difficult.

Good luck and I wish you the best.
posted by JackFlash at 11:42 AM on March 12, 2007

Update: I just spoke with the doctor's office, and they said they're not going to tell me it's safe and that 3 is a strong reaction, and that I could go from zero reaction to anaphylactic reaction at any time

Glad to see they said this - I was going to post the same thing about the zero-to-anaphylactic. I was horrified at some of the answers saying that your mild reaction will likely stay that way - there's no way to tell with allergies, and I hate it when people who don't really know about it respond that way - it's terribly dangerous and probably why AskMe isn't a good reference for medical advice.

Allergies can develop at any time in your life (even when you weren't allergic to it before), increase or decrease in severity at any time as well, and sometimes compeletely disappear. Trust your doctor and do all you can to avoid peanuts and nuts on your Thailand trip and from now on.

Have fun, though! Thailand will be a great trip.
posted by agregoli at 12:02 PM on March 12, 2007

Find out as much as you can about treatment for an allergic reaction, ask a different doc if all yours will tell you is to hurry along to a hospital -- this is stuff you need to know even if you don't go to Thailand, but sometimes it can be difficult to find out.

Pad thai can also be made with walnuts, if you want to make your own. So you can eat it again, but you'll need some basic cooking skills.
posted by yohko at 2:26 PM on March 12, 2007

I broke 2 ribs in a scooter accident in Thailand... and I was terrified of going to the doctor so I backpacked that way for 3 weeks & waited to get care at home (with no clue I was actually endangering my life. I had no idea I also had a partially collapsed lung). Turns out people nowadays are actually GOING to Thailand for medical care. Bumrungrad Hospital in Bangkok is actually western owned & managed & most of the doctors were trained in the U.S. So really, if you have serious issue, worst comes to worst you are a quick plane ride away from great doctors. Getting to the plane from the hilltribe would be the most time consuming part.

The doctors will tell you things specifically so they are not held responsible for you. They are covering their asses, JIC. They have to. One of the preservatives I'm seriously allergic to is sulfites. ALL wines have sulfites. But only 1 in 5 wines affect me. I generally try to drink the same brands, but I still try new wines all the time. It's very simple... I ask for a taste. I take a small sip. I swallow. I wait. Within 5 minutes I KNOW if I'm allergic to that wine. I haven't drank enough to create any great harm to myself, but I've drank enough that if I would start coughing a tiny bit I know to step away from the wine and never order it again.

Be cautious. You can do this. Do not get frustrated. THIS WILL NOT RULE YOUR LIFE. You will learn to deal with it as a minor inconvenience. I promise you.
posted by miss lynnster at 3:20 PM on March 12, 2007

I'm sorry, Miss Lynnster, but you keep trivializing this issue. "You will be fine," you say. Just take some benadryl you say absurdly. You cannot possibly make such a statement with any authority. You cannot possibly know if someone who is known to be allergic to peanuts will have an anaphylactic reaction. A peanut allergy is not like sulfite allergies. A peanut allergy is not just some minor discomfort. It can kill you in minutes.

You can deal with this in remote locations with proper preparation. You should have written instructions and a colleague you can trust to execute them if you become incapacitated. Normally a doctor would administer epinephrine injections every 5 to 10 minutes while gaging the effects. A blood pressure cuff and stethoscope might be handy to have in your kit. The reaction should subside within 30 minutes although the epinephrine will make you feel like you stuck your hand in an electric socket, your heart trying to jump out of your chest and your hands shaking like jello. Your hands could be shaking so much that you need assistance for subsequent injections. You will feel terrified, but that is a side effect of the epinephrine, the same chemical secreted by your body in a scary fight or flight situation. Expect it so that you can calm yourself. Sometimes there will be a secondary reaction an hour or two later so be prepared with more epi-pens. If you have ever been treated for bee stings, you should already be familiar with this. I wouldn't expect you to need to limit your activities if you are properly prepared.

I would not have a card that says "no nuts, please." I would have a card that says "If I eat nuts, I will die." No ambiguity there. It isn't a suggestion.

I don't think you necessarily need to tell your employer. After all, it's your life. But you should inform a colleague that can assist in an emergency.
posted by JackFlash at 6:14 PM on March 12, 2007

Oh please. IANAD & I never said I was. I'm not trivializing, OBVIOUSLY precautions should be taken. But I also know how I felt when I first got diagnosed with major allergies. I have HAD anaphalactic shock & been surrounded by paramedics more than once. When I first was diagnosed with my allergies I WAS TERRIFIED and scared to do EVERYTHING. You cannot live that way forever, you have to learn how to deal with it and live around it. You MUST be very cautious but you cannot let yourself go through life terrified with every single meal. You HAVE to be smart & take care of yourself. Duh.

And if you read my first post, you will see that at 7:13 this morning I gave some of the EXACT same advice that you just said.
posted by miss lynnster at 7:52 PM on March 12, 2007

Miss Lynnster, you are absolutely right. You make a good point that you can't let fear take over. You just have to be a little more cautious and prepared when the paramedics are hours away.
posted by JackFlash at 9:12 PM on March 12, 2007

One more update. I just spoke with the doctor (not the nurse). The doctor said the fact that I have no reactions to peanuts and the nuts in question means that the cooking process and/or the digestive process is probably breaking down the protein enzymes enough for me, and that's why I'm not reacting. He said that it's extremely unlikely that I'll have a bad reaction at this point but that it's possible and that the more I eat that stuff, the more likely I am to have a bad reaction, so I shouldn't avoid nuts and peanuts, but I shouldn't start eating more of them either. He said I should always carry an epi pen, and that 2 of 3 times an epi pen injection does the trick, but 1 of 3 times the reaction comes back after the epinephrine injection, so that's why if I do need to use the epi pen at some point, I should go to a doctor or emergency room to be monitored for follow up treatment if necessary.
posted by Amizu at 8:17 AM on March 13, 2007