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This Woman's Face And Throat Swelled After Eating A Nut Under A Doctor's Supervision

While undergoing a test to see if she was still allergic to nuts, this college student had an anaphylactic reaction.

Posted on June 23, 2018, at 11:31 a.m. ET

This is Nicole Hagel. She is a college student at the University of Nebraska–Lincoln, and she has a severe nut allergy.

Nicole Hagel

Hagel recently went to her allergist for a checkup to see how things were going with her nut allergy. Surprisingly, her blood test came up negative for nuts, suggesting that she might no longer be allergic to them.

"They were like come in and do this oral challenge and we’re going to see if you're allergic or not," she told BuzzFeed News. An oral challenge is when someone is given a nut (or another allergen) in the doctor's office to see if they react to the proteins.

Hagel was surprised because in high school she had been diagnosed with a severe nut allergy after she ate a piece of a cashew and ended up at the hospital. Other nuts are a problem too. "Cashews and pistachios are my top two worst, those will actually kill me," she said. "I’m not allergic to almonds and I’m not allergic to hazelnuts, but I stay away from all of them because it’s not worth it."

Allergies are basically an immune reaction to a normally harmless protein and they can range from mild to sometimes so severe it can be life-threatening. These very severe reactions are called anaphylaxis, or anaphylactic reactions, and can start with "feeling funny" and then quickly progress to face and throat swelling, trouble breathing, nausea, hives, vomiting, diarrhea, dizziness, and a drop in blood pressure.

The three biggest triggers of anaphylaxis are food, medication, and insect stings, and they can happen in people who haven't had a previous reaction to the allergen.

When Hagel was hospitalized the first time, she was treated with epinephrine, the same drug found in EpiPens, which are autoinjectors that can be self-administered by people with allergies to stop these dangerous reactions.

To see if she was indeed still allergic, Hagel had an oral challenge Monday, where she was given a cashew in the doctor's office to see if they were still a problem.

Nicole Hagel

An oral challenge is safe if it is performed in a doctor's office with medication on hand to stop the reaction if necessary. At first, Hagel had some cashew oil placed on her lip and sat for 15 minutes to see if there was any reaction.

"Nothing happened, and I thought 'maybe I’m fine,'" said Hagel, who lives in Overland Park, Kansas. "Then they gave me a whole cashew."

After she ate it, her tongue started to tingle but she thought it might be because she was nervous. “Then all of a sudden the back of my throat starts burning and I thought, well that’s probably not good," she said.

Then she had a burning feeling in her hands, then her feet, "and all of a sudden my eyelids are on fire and my eye starts swelling up," she said. "At that point you could see this ball coming out of my eye or eyelid, it was gross."

She needed two injections of an EpiPen and other medication. "It was a wreck," she said.

However, she was eventually able to go home from the doctor's office, and then, as one does, tweeted about it.

I did a blood test to see how allergic I am to tree nuts and it came back and said I wasn’t allergic to them anymore. Today I went into the allergist and tried a cashew for the first time!! Long story short, I’m still allergic and I almost died. They called me a “rare case” 🙃

Twitter

She wrote about her experience and ended with, "Long story short, I'm still allergic and I almost died. They called me a 'rare case.'"

Nicole's tweet went on to have more than 127,000 likes and 7,000 retweets. "I have no idea how this blew up, it was just kind of supposed to be funny for my friends," she said. "I tweet about my allergies a lot so I thought it would be a kind of a good laugh for people I know but obviously it went way farther than that."

A lot of people chimed in to share their own experiences with allergic reactions to food.

@nhagel77 Omg the same happened to me !! They took my blood saying I’m not allergic to peanuts but every time I eat them, I nearly die from pain!

Twitter

She said she's been getting a lot of replies from people who can relate and said they've had serious reactions too. She said not everyone seems to understand how dangerous allergic reactions can be.

"I make fun of myself all of the time for it, but know that it's very serious," she said.

Food allergies are tricky, and tests aren't always 100% accurate, an expert told us.

Nicole Hagel

"This case highlights a lot of components of why food allergy is so challenging for us these days," Dr. Stephen Tilles told BuzzFeed News. "The testing is not perfect, you can have false negatives, which is what this apparently was, and you can get false positives as well," said Tilles, who is the immediate past president of the American College of Allergy, Asthma and Immunology.

Because testing isn't perfect, doctors will usually take a careful history — meaning they will ask about any symptoms you get when eating a food — and make a diagnosis using a combination of multiple tests and symptoms. "It’s probably more complicated than most people in the public realize," said Tilles, who did not treat Hagel.

He said that some people do indeed outgrow severe allergies, although most don't. And even if they do go away, those can come back, he said, although regularly eating the food after getting the okay from your doctor can help stop it from coming back again.

For example, he said, someone with a previous cashew allergy who's been given an all-clear by an allergist after extensive testing, might try eating cashews a couple times a week or use cashew butter on their toast. "That makes it much more likely that it won’t come back," he said.

However, if you think you are allergic to a specific food, avoid it until you see an allergist, he cautioned. You can find an allergist in your area at the American College of Allergy, Asthma and Immunology.

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