Myth: You either have a mild or severe food allergy
The truth: There are no mild or severe allergies, only mild or severe reactions. “Reactions are somewhat unpredictable,” explains Joshua Dorn, MD, allergy/immunology fellow at the Mayo Clinic in Rochester, MN. That means you can eat a food a few times and have nothing more than a couple of hives, then boom, you might have anaphylaxis—a severe systemic reaction that requires immediate medical treatment. “There have been many reports of people having severe reactions after mild ones,” Dr. Dorn confirms. And anaphylaxis is on the rise: Visits to the ER for a severe allergic reaction shot up a staggering 124 percent from 2005 to 2014, according to a 2017 study published in the Journal of Allergy and Clinical Immunology: In Practice.
Reactions are tricky to predict because other variables can be in play. Are you sick? Were you exercising? Overheated? Drinking alcohol? Do you have active asthma? Other allergies? They’re all considered “co-factors” that can contribute to a more extreme immune response.
The bottom line: “Any reaction can range from mild to severe so it’s best to be prepared for a severe one,” says Dr. Dorn. And when allergists say “be prepared,” they mean carry two EpiPens or other epinephrine auto-injectors.
Myth: You don’t need epinephrine if you’re not going to be eating
This is one of the most common mistakes allergists see. You think, “My child is just going to lacrosse practice. She won’t be eating—no need to bother with the EpiPen.”
You’re taking a serious risk, warns Dr. Dorn. What happens if your child’s coach hands out surprise snacks on the sidelines? Research shows that about half of fatal food allergy reactions happen away from home. Perhaps the bigger worry, though, is that reactions sometimes strike an hour or more after eating. If you don’t have epinephrine on hand, it could set in motion a terrible turn of events. “Most severe reactions happen when people don’t have their EpiPen with them,” notes Dr. Dorn. Deaths from food allergy often involve delayed epinephrine or not getting it at all, according to a 2017 review of research. “If you always carry it, it becomes a habit,” he says. This is some of the worst advice allergy doctors have heard.