Walnut in Tomato Soup? My Allergy Complacency Led to the ER

My family went on a glorious hike, then hunger set in. I 'assumed' I'd be safe eating at a restaurant without my epi auto-injector. And then suddenly, a severe allergic reaction.

26 June 2023
By Summer Tan

My parents had flown all the way to Boston to help me move out of my first year college dorm, so we arrived home to Oregon late on Mother’s Day. To celebrate anyway, we decided on a hike the next day at the Columbia River Gorge. The gorgeous wildflowers were in bloom, so it promised to be a wonderful outing.

The Gorge is an hour and a half from my hometown, minutes away from the cozy town of Hood River. Three generations went on the hike – my grandmother, my mom, my Aunt Cindy, my cousin Aria, and me. 

We left at 9 a.m. and spent a few hours enjoying the last yellow blooms of Balsamroot. By noon, we were starving and headed into Hood River for lunch. I ordered a sandwich (which I was assured was made with sourdough bread, so no funny business there) and a simple tomato soup. The menu had no mention of nuts, except in some of the salads. There was no hint that this blissful day would soon go terribly wrong.

I was diagnosed with allergies to peanuts, walnuts and pecans as a baby. My family and I learned the lessons of managing food allergies. By the time I was 10, we knew that I would go into anaphylaxis if I ate nuts. At age 12, I knew what peanuts tasted like, and had overcome the barrier of my first self-administered epinephrine injection. 

By 15, I participated in a big clinical trial with the first peanut oral immunotherapy regimen that would get FDA approval. The OIT means that today, I’m far less reactive to accidentally eating peanut. 

But I still have to avoid peanuts, as well as all tree nuts. (Even with nuts I’m not allergic to, the concern is cross-contact risk during manufacturing.) I also let restaurants know about my nut allergies, and never, ever eat without having my epinephrine auto-injector with me – well, mostly. 

Neglected to Carry My Epi

As soon as I took a sip of the soup, I was met with a familiar sensation. My throat was swelling up, my face felt numb, and I began wheezing. I was going into anaphylaxis, and I had no auto-injector.

So what happened? 

I’d forgotten to pack my epinephrine injector (or rather, neglected – I hadn’t thought we’d be eating lunch). But when we did sit down to eat, I figured it couldn’t matter that much. After all, I’m always careful about ordering with my nut allergy, and most restaurants were pretty good about allergies. Simply put, I’d become careless. 

Lifelong allergy management had given me false complacency. In the months of living away from home, I’d lost touch with how important it is to be vigilant with nut allergies. 

As a college student, I had a stash of auto-injectors in every bag I owned, but they were often out of sight and out of mind. Furthermore, my successful oral immunotherapy for peanuts had made me more comfortable with eating, meaning that I’d become less wary of food overall. Of course, I realized the two mistakes – carelessness and the neglected auto-injector – as soon as my throat began to close up.

I kept calm and told my mom we needed to drive to the hospital. By then, I could barely breathe. She’d confirmed with a waitress that there was a pesto made with walnuts in my seemingly innocuous tomato soup. 

Recovery, Plus an Epi Lesson

I’ve always been told to call an ambulance, should I eat a nut. However in this case, my mom and I chose to drive to the hospital, which we knew was just four minutes away. In the car, I typed up a short message on my phone for the ER alongside my name and birthdate. “I need epinephrine, I have a nut allergy and just ate a walnut. I am having trouble breathing.” 

Walnut in Tomato Soup? My Allergy Complacency Led to the ER
Summer in the ER after her allergic reaction.

My mom sped to the emergency room, and I rushed inside while she parked the car, displaying my message to the receptionist. Within moments, I was swept into a bed and given saline flushes, epinephrine, Benadryl, and then steroids to prevent a delayed allergic reaction once the epinephrine wore off. At least seven medical workers rushed in to observe me for any signs of escalation. 

After two hours of observation and a nap induced by the Benadryl, I woke up feeling tired but safe. My amazing family drove me home. 

Although I recovered fine, this incident served as a stark reminder of the importance of always carrying my epinephrine auto-injector. This needs to be so, even when unexpected changes occur or food is not part of the plan. The cardinal rule of managing allergies is simple: always have your epinephrine with you and never eat without it.

It is easy to get busy, overlook rules or develop allergy complacency. But I have taken steps to ensure it never happens again.

I now keep my epinephrine with my essential items in a dedicated pouch that I transfer easily between bags. I simply never leave the house without it. Moving forward, I will always be prepared for my nut allergy, regardless of the situation.

Summer Tan is a rising junior at Harvard University student who is studying anthropology and history.  

Top photo: On the hike (l to r): Aunt Cindy, Mom (Jenni), Grandma Grace and Summer.

Related Reading:
I Didn’t Love My Heart-Shaped Pizza: The Italian Reaction
U.K. Trip: A Taste of Better Dining Out with Food Allergies
My First Trip as a Food-Allergic Teen Was an Eye-Opener