Individual risk assessment is the old “new normal” for people with food allergies
How far you go to protect yourself and your family from Omicron boils down to your own risk tolerance levels. People with food allergies know this balance all too well.
As the experts regularly change their COVID guidance and debate the best course of action, one thing is becoming clear: each individual will have to make COVID safety decisions that align with their personal needs. If you’re a high risk individual or in regular contact with high risk individuals, if your mental health is suffering deeply, if you are the parent of a child under 5, if you are the parent of a school-aged child, if you are experiencing poverty, if you are otherwise healthy and carefree — whoever you are and whatever your individual circumstances are, only you can decide how much COVID risk you can bear. It’s exhausting, frustrating, and confusing.
For myself and the many other people with invisible illnesses, disabilities, and other chronic conditions, it’s a compounding of the ordinary. Coming to terms with our personal risk tolerance and constantly balancing decision fatigue is a core part of our lives. And while we can share the tools we’ve adopted to live with this push-and-pull of life, we ask that you don’t forget this experience when your relationship to risk management reverts to normal.
I have an unusually high number of food allergies (more than 35 foods trigger life-threatening anaphylactic reactions in my body) and my already-bad environmental allergies have only gotten worse amid the air pollution in LA, my home for the last 12 years. The protocol for living with food allergies is deceptively simple: avoid exposure to allergens, and you’ll be fine. Short of living in a bubble, though, there’s no true way to avoid exposure to allergens.
For instance: as I write this, I am sitting outside in a Starbucks. My drink is a perfectly customized recipe I’ve vetted through multiple inquiries to Starbucks and a food challenge at my doctor’s office. There is a chance the barista swapped my selected skim milk with one of the non-dairy milks, all of which contain at least one of my allergens (this has happened to me). I am seated at the only available table that isn’t covered in crumbs from a previous customer’s meal, which could also contain an allergen. Not that my table is clean; my laptop is socially distancing from a drink stopper left carelessly by the last occupant.
This is a level of risk I have decided is fine for me, at least right now. The benefits of getting my extroverted, pandemic-fatigued self out of the house, into the sunshine, with the deliciousness of white mocha syrup tickling my tastebuds as I l hear the chatter of the patrons around me is worth the risk of the distracted barista and dirty tables. My stash of Benadryl and my epinephrine autoinjectors are close by and my allergist is one of my iPhone emergency contacts.
Other people with allergies might think I’m being excessive. Why inspect the tables for their cleanliness? What are the odds the previous occupant ate something I’m allergic to anyway, and that these crumbs contain the allergen, and I’ll touch them, and react? Others might think I’m Evel Kneival, ordering a drink from a place with potential cross contamination and not wiping the tables down with gloved hands. None of us are wrong.
It’s not just grabbing a venti latte at Starbucks that’s a risk. Any time I ingest food, I run a risk. Ingredient labels aren’t perfect — indicating potential cross contact is a suggestion, not a requirement and temporary (read: as long as the pandemic and resulting supply chain constraints exist) FDA guidelines allow substitutions for minor ingredients outside the top 8 allergens. Since most of my allergens are uncommon (I am only allergic to 2 of the top contenders) and many fall under the umbrella of minor ingredients (stabilizer gums, oils, mushrooms), ingredient labels are only a starting point for me. Most of my allergens are fruits and vegetables, and I am so severely allergic to them that cross contact is an issue. I once went to the ER because I ate an apple that had been too close to my worst offender, horseradish. But I have to eat, and I have to engage with society like a normal, healthy person, because the nature of my disease is such that unless I am experiencing an actual reaction, I am not sick. Though my reactions are life-threatening, in order to live, I must not be afraid of fatal outcomes.
In the early days of COVID, the rules were clear, and I found that the sixth and seventh senses I gained from a life avoiding invisible poisons helped me adjust to the realities of pandemic life. The resilience muscles I built over the years prepared me for lockdowns. Now, as the rules become vague and personal, and the pandemic stretches well beyond the point of exhaustion, it’s simultaneously harder and easier. Harder, because like all of us, I’m emotionally spent, ready to return to normal life, and have been mired in fight-or-flight mode for so long I’m loathe to continue making these choices. Easier, because I know this extended fight-or-flight mode well, and I know it does eventually become second nature.
Things will settle. The world will spring back to normal. We’ll all get comfortable setting our risk boundaries with friends and relatives and we’ll soon know our safety protocols well. They’ll become instinctive.
But as our collective experience shifts to a bearable normal, and especially as COVID eventually wanes, let us not forget how exhausting this moment is. Let us be sympathetic to those among us who live without expert guidance, without clear rules, without certainty, with the weight of life-or-death hanging over their everyday choices. There is much we can do from a policy, inclusion, and social infrastructure standpoint to increase the daily comfort of people who face these struggles — food allergies or other concerns — and when we have the energy to focus on those concerns, let us not forget how vulnerable we feel right now.