Why did eating a cashew almost kill my 9 month-old baby boy?
My wife Anna knew what she had to do.
She grabbed the EpiPen. She raised it like a knife. Then she jammed it - hard - into the meat of our baby's thigh.She held it there for 10 long seconds. Our baby screamed and screamed.
It was a good sound.
It was the sound of a life being saved.
About fifteen minutes before all the screaming, my wife, and Arthur, who is my baby, had been in the playroom in the basement of our apartment building.
Anna noticed that Arthur was suddenly having a particularly bad rash. Arthur has eczema, and it's given him persistent rashes almost since he was born.But the rash Arthur had in the playroom that afternoon was worse than normal.
Anna decided she should take a closer look. She and Arthur headed upstairs.
In our apartment, Anna took off Arthur's onesie. Hives were suddenly blooming all over his little body.
In that moment, Anna realized she might have to use an EpiPen on Arthur.
An EpiPen is a drug-delivering needle. It looks like an extra-fat permanent marker. It's full of epinephrine, which is basically adrenaline. Parents of kids with food allergies have to carry them around in case their kid eats something that's starting to kill them. Because of a suspected allergic reaction to oats, a doctor gave us a one a couple months before. EpiPens are not pleasant to use. You have to jam them - hard - into the kid's leg, using a psycho stabbing motion.
Anna knew that the EpiPen would be painful and jarring for Arthur, so she had a moment of doubt.
Then she got over it.
She stabbed Arthur with the EpiPen and called 911.
When the paramedic came running down the hall minutes later, he shouted to Anna: "Is he still breathing?"
He was, because Anna had done the right thing and given him the EpiPen.
She saved his life.
I was in a meeting at work when I got the call. I rushed to the hospital.
When I got there, heaving and sweaty, a paramedic saw me and said: "You must be the father. Your wife did great. She saved your baby's life."
While we were checking in, Arthur started to swell up with hives again.
The ER doctors strapped him to hospital bed and gave him more epinephrine. They also gave him anti-histamines and steroids. All 20 pounds of him writhed with itchiness, pain, and adrenaline.They kept us for observation for another five or six hours.
I sat there and wondered: Why is this happening? Why is Arthur's body trying to kill him? What mistake of evolution led to this?
I asked a doctor, and he told me the answer to my questions is basically … worms.
Worms from thousands of years ago, to be exact.
Humans used to accidentally eat worms that would, once ingested, start to eat the bodies that ate them.
Through the process of evolution, humans developed a defense system against these worms and other parasites.
The doctor I spoke to, allergy expert David Stukus of Nationwide Children's hospital in Cincinatti, explained to me how this system worked.
Whenever a parasite ended up inside a human's body, a blood protein inside of that body called Immunoglobulin E (IGE) sent out an alarm to the rest of the body.Weaponized cells called mast cells responded to the alarm by releasing a chemical called histamine.
Histamine has different effects on different parts of the body. All of them are in service of one mission: expelling the enemy from the body. So in the stomach, histamine causes diarrhea and vomiting. In the nose, it causes sneezing. Histamine makes skin itchy so the human will scrape the parasite away. Histamine makes the airway swell so that they will cough.
The defense system worked, and over the last many thousands of years, it became standard issue for all new human bodies.
At some point along the way, however, this defense system grew defective in some humans - like my kid.
Instead of attacking parasites and other actually dangerous foreign elements, defective systems in some humans would start attacking mild-mannered items like eggs or cashews or ragweed.
Sometimes, these defective defense systems attack these foreign elements so viciously that something really bad happens. Too much histamine gets released in the lungs and they swell shut. Too much histamine gets dumped into the blood stream and it swells too thickly, slowing down the delivery of oxygen to the brain.Sometimes, the defense system actually kills the bodies they are trying to protect.
That's what was happening to Arthur.
Under doctor's orders, Anna was giving Arthur new foods to try. So earlier that day, she'd fed him part of a granola bar. It had cashew in it. Arthur's defense system mistook that cashew for a parasite and attacked. It attacked so hard he would have died if Anna hadn't stabbed him with a needle full of adrenaline.
This kind of malfunction is happening more and more lately. A study by the CDC says the number of children with food allergies increased 50% between 1997 and 2011. Now, about 15 million Americans have faulty defense systems. About 150 people die per year from allergic reactions.
Why has this started to happen?
Dr. Stukus doesn't know.
No one knows.
There are theories, however.One is called the Hygiene Hypothesis. Over the past thousand years - and the past few decades in particular - humans have developed ways to keep parasites and other dangerous organisms and viruses from ever entering their bodies in the first place. We have soap.
Maybe, goes the theory, we use soap too much. Our defense systems aren't getting exposed to small amounts of dangerous materials and learning a) what the bad stuff actually looks like and b) what to do about it.
One reason people believe the Hygiene Hypothesis is that kids who grow up on farms don't get nearly as many food allergies.
But it's just a theory. There are others. One is that doctors treated allergies wrong by telling parents to keep their kids from eating things they are allergic to at all, when in fact some exposure tends to help rather than hurt.
Another: allergy problems are genetic, and, over the past thousands of years, more people are surviving them long enough to meet other people with allergies and have kids, thus creating an exponential boom in kids who can't stomach a peanut.
Whatever the reason my kid almost died from eating a cashew earlier this year, there are a couple important messages Dr. Stukus would like me to relay.They are:
There are a few myths worth knocking down. One is that mom's should avoid certain foods during pregnancy or while breast feeding. Another is that giving moms and kids vitamin D will cure all allergies. Yet another is that pro-biotics are a cure-all.
Parents should not get an EpiPen to carry around just in case. "Definitively no. Parents should not be afraid to feed their children at all. Food allergies only affect 5% to 8% of all kids. That's just a general population. If you take someone who doesn't have an allergic family history, or any history of eczema as a baby, you really should have little to no concern at all that they are going to develop food allergies."
In fact, most parents should not bother having their kids tested for allergies at all. "If we use too much testing, there is a high rate of false positive results and we would over-diagnose people. Over-diagnosing will keep kids away from foods and then actually cause them to be allergic to those foods. "
If your kid has eczema, then maybe you should consider a test. "If your child has moderate to severe and persistent eczema, meaning that you need to use daily skin care in addition to topical steroids and other anti-inflammatory medicines for weeks on end, then you should discuss it with your doctor."
Parents should not be afraid to feed their kids. "Do not avoid giving these foods, especially for kids in high risk families. We want to introduce allergenic foods: milk, egg, wheat, soy, peanuts, tree nuts, and sea food before the first birthday because that's what we feel will give them the best chance to prevent developing the allergy. "