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The Allergy Prison (continued...) By SUSAN DOMINUS
Palin never buys baked goods, which might be contaminated with nuts; he almost never eats French fries outside his own venue. ("If you can't show me a can that doesn't say 'peanut oil,' I'm not eating your French fries.") He never eats on a plane, not one thing, and as he boards he asks the flight attendant to please "not shove almonds in my face." He rarely strays from a handful of packaged goods he knows are safe. Even at his own restaurant, where the kitchen has been nut-free for years, where every member of the wait staff is carefully trained on the subject of food allergies, he tends to order the same dish over and over rather than risk a bout of anxiety. And after he eats, he has been known to interrogate his own chef about the dish's contents, again. Palin presents his situation with a certain amount of humor and self-mocking bravado, but it's clear that he experiences the anxiety profoundly and on a daily basis. "I'm still nervous all the time," he says. "I think about it every time I sit down to eat. I feel a lack of confidence. Food is essential to making you feel good. You know, it's a sense that . . . you like yourself when you eat. The things that people reach for to comfort themselves -- I don't have that." As a restaurateur, Palin spends his day in the company of chefs, talking about menus, talking about presentation, talking about taste. He surrounds himself with food. He misses it terribly.
But for some, the line between anxiety and allergy blurs altogether. It is not uncommon, allergists say, for children and adults who have already lived through anaphylactic shock (around 30,000 people a year, hospitals estimate) to experience severe anxiety or a flat-out panic disorder for months or years following the incident. So many of the children whom Sampson treated were experiencing anxiety and eating disorders after undergoing a severe reaction that he recently initiated a study of post-traumatic stress among them. That mysteriously grim symptom of anaphylactic shock -- the sense of impending doom -- suggests that Palin's anxieties about food may not be exclusively emotional, but physiological or neurochemical as well. In one Pavlovian study Sampson described to me, two rats were repeatedly fed food that triggered an anaphylactic shock reaction while lights flashed and a loud noise went off simultaneously. Eventually, rats exposed to the lights and noise would respond with symptoms of an allergic attack even without ingesting the allergen. For someone who has experienced anaphylaxis, a restaurant setting might be, in some less dramatic way, the equivalent of those flashing lights and loud noise -- it's as if the body has learned in certain contexts to generate spontaneously the neurological component of the allergic reaction. "With this kind of thing, you're wasting your time with psychoanalysis," says Dr. Frederick Wamboldt, head of the department of psychosocial medicine at National Jewish Medical and Research Center in Denver. Panic, he explains, is not misplaced or exaggerated fear; it is something qualitatively different, distinguished by a shortness of breath. Psychiatrists believe increasingly that panic is the result of a misfiring in a suffocation alarm system at the base of the brain. In some cases, people are born with an oversensitivity to carbon dioxide that renders that alarm system hair-trigger sensitive, leading to spontaneous panic; in others, once that system has experienced a serious threat, it subsequently becomes hyperaware, with the same results. In people with food allergies, of course, the panic mimics the symptoms of the allergic reaction they fear -- shortness of breath, pounding heart -- so that the panic feeds on itself insidiously. "These anxieties aren't all in people's minds," Wamboldt says. "They're in their brains." None of this, of course, would appear to explain the elevated levels of anxiety of so many of the parents. But if their children are experiencing post-traumatic stress disorder, then perhaps some of their parents are experiencing secondary traumatic stress disorder, a phenomenon found in the family members of people who have suffered some life-threatening blow. The term is sometimes associated with the children of Vietnam veterans, some of whom mysteriously endure the same kinds of night terrors and flashbacks as the parent who returned from the war, even if that parent rarely discusses those dreams or has never acknowledged having them. It is the result of a kind of psychiatric contagion, with empathy serving as the vector for the disorder. In the months after she experienced the early stages of anaphylactic shock, Maia Pillot, then 7, developed all the classic symptoms of post-traumatic stress. She was terrified to eat, but she also became claustrophobic; her parents spent hours trying to coax her into cars or elevators. Her mother, Shawne Cooper, has no allergies herself; nonetheless, one afternoon at the peak of Maia's anxiety, Cooper suddenly felt itchy as she talked to a friend on the phone. She lifted her shirt and saw that red welts had broken out across her abdomen. Instants later, the hives were spreading all over her body and she was having trouble breathing. "I thought, This is where she gets the allergy," says Cooper. "She must have inherited it from me." Panicked, she called her doctor. He told her to take some Benadryl, but that her symptoms were most definitely psychosomatic. "I swear," Cooper tells me, "I used to be a laid-back mother."
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eople living with food allergies, even severe ones like Palin's, respond to the problem with a predictably wide range of levels of concern, including blithe disregard and adventurous dining. Most people with food allergies understand, and have managed to internalize, the reassuring truth that if they're carrying an adrenaline shot on their person, they should come to no lasting harm. They inform the waiters that they could die on the spot and bravely take their chances from there. 
n my way to Dean Palin's home one early evening, I stopped in my tracks. A few hours earlier, I remembered at that moment, I had eaten peanut butter on toast. I hadn't even paused to consider whether that might be a bad idea, but then, I'm not accustomed to questioning food -- I'm someone who eats steadily, unthinkingly, all day long, eating to calm myself, eating to focus, eating to be social. Now I felt alarmed by my carelessness. What if I were to play with Palin's 2-year-old daughter, Amanda, who shares his allergy? Could the tiniest trace of nut protein pass from me to her and endanger her health? I thought of the 2-year-old girl cited in one of Sampson's studies. She had eaten a sandwich made with a wiped knife that still had mere milligrams of peanut butter clinging to its blade. She went into shock, and she died. 
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