Backpacking Thailand With A Peanut Allergy – Easy or Impossible?

(***I’m not a doctor and nothing in this post should be considered sound medical advice***)

*Updated Again March 27th, 2017*

It’s been almost 9 months since I updated this post, but I am reaffirming what I said in the last update. Vietnam has a much higher prevalence of peanuts than Thailand. In the time since I last updated (June, 2016 ) I have revisited Thailand for another month and have lived in Vietnam for 5 months. Some popular dishes to look out for with peanuts in Vietnam :

• Mi Quang
• Bun Bo Nam Do  

*I will continue to update this as I learn about more dishes with peanuts.*

*Updated June 19th, 2016*

So just a quick update about traveling through Southeast Asia with a peanut allergy. I have now been through Thailand, Cambodia, and I am one month in of my three months in Vietnam. Of all of these countries, Vietnam has a much higher prevalence of peanuts as the other two. I find this interesting, since as I mentioned in the original post the perception in the US is Thailand is the country full of peanuts, not Vietnam. In Thailand, you only have to worry about Pad Thai, and asking for no peanuts is easy. In Vietnam, I have seen many popular local dishes with peanuts, and knowing which ones have it and which don’t can be difficult if you either don’t speak Vietnamese or you’re trying the dishes for the first time. Just thought I would add this little tidbit for anyone with a peanut allergy considering Vietnam. Don’t let it stop you though! There are plenty of delicious dishes everywhere that don’t have a trace of peanuts.

When I was just a baby I was diagnosed with a peanut allergy. My mom gave me a little bit of peanut butter and within minutes my face was covered in hives and I was off to the ER. They did a blood test and it came back positive for peanuts, so the doctor naturally assumed the hives were from the peanut butter. Allergy testing, especially peanuts, is difficult because short of actually ingesting peanuts in a doctor’s office and measuring the reactions, there is no definitive test to determine just how allergic one is. Regardless, I was allergic and since then I’ve been very good about avoiding peanuts. 

Fast forward 25 years. I’m planning our trip around the world and we decided Southeast Asia, specifically Thailand, would be our first stop. As excited as I am, there’s one thought lingering in the back of my head : “they use peanuts in EVERYTHING!” At least, that’s what I thought at the time. I had never been to a Thai restaurant in the US because everyone I know kept telling me how everything on the menu had peanuts, including Pad Thai which everyone always loved to rave about.

I hadn’t been re-tested in about 15 years. Since that first time as a baby, I have never had an allergic reaction. I wasn’t sure if it was from constant vigilance or me outgrowing the allergy, but I at least had to know what to expect should I accidentally ingest peanuts. Everyone I know who had already been to Thailand always talked up the street food, which is my favorite kind of food. Unfortunately the sanitation standards of street food, even back home, aren’t exactly grade A. Between that and the language barrier, I was pretty confident that even taking extra precautions I would accidentally eat some food containing peanuts at some point and I wasn’t planning on traveling to the other side of the world to a country known for its food just to eat cheeseburgers and chicken fingers. No thanks.

I made an appointment with an allergist about a month before we left. I explained to him my situation and how I wanted to ingest some peanuts in the office to observe the reaction. I had to know what would happen : will I break out in hives or will I keel over and die? He wasn’t exactly thrilled with my request, and repeated to me about a dozen times how he thought it was a bad idea. I admit, it wasn’t the best idea I’ve ever come up with, but it’s better to find out what will happen while sitting in a hospital then some random village in the middle of nowhere. He agreed and eventually agreed to the food challenge only after I took another skin prick test and an ImmunoCAP test, which is a more definitive test that identifies how allergic you are to each individual protein within the peanut.

Allergy testing has come a long way since I was a baby. They still can’t determine with absolute certainty the severity of a reaction, but they have identified individual proteins within the peanut that are associated with different types of reactions. For example, proteins 1,2,3,9, are all associated with reactions, with 1,2, and 3 being the most severe. FUN FACT: protein #9 is genetically traced back to people with southern European, specifically Italian roots. Of course, I tested positive for this one. I just find it so interesting they know that! Medical science will always fascinate me.

Anyway, back to the story. We did the skin prick test and the results were pretty interesting. Long story short, it came back positive. The interesting part is there were a bunch of other things that I eat fairly regularly, almonds for example, that came back as being more sensitive than peanuts. The nurse taking the test, after telling him about my upcoming travels, pretty much told me I was crazy and should stay far away from Thailand. Thanks a lot buddy. He then took my blood for the ImmunoCAP and told me my results should be ready within a couple days.

After staring at my Yahoo inbox for what felt like forever, I finally got the results back and wasn’t really sure if I should be happy or not. While I tested negative for the 3 most severe proteins, I did test positive for one associated with mild reactions and protein 9, the “Italian protein”. The doctor called shortly after we arranged a time to do the creme de la creme of all tests : the peanut challenge ( sounds like some sort of Man vs. Food eating contest if you ask me ).

The food challenge was maybe the most boring thing I’ve ever done in my life. After signing a bunch of forms releasing the hospital from liability should I die, I more or less sat there for 6 hours while each hour I ate a little bit of peanut butter on a Ritz cracker increasing the dose each time. On a brighter note, despite the doctor’s wishes to not do the test, and the nurse who thought I was crazy, I had no reaction whatsoever! Everyone was pretty shocked, myself included. The doctor shook my hand and congratulated me as if I just climbed K2 and told me I must have built up a tolerance and to eat a little bit each week to keep it going, but to keep my Epi-Pen just in case.

I’m still weary when it comes to peanuts. I’ve been conditioned for 26 years to avoid eating them at all costs, and it’s going to take more than one doctor to change that. We’re in Thailand now and I’m still avoiding them, but the problem ( or lack thereof ) is there really aren’t a lot of dishes with peanuts in them! The only two things that I can say always have peanuts in them are satays and Pad Thai. Satays I just avoid altogether, but I learned peanuts are just a garnish on Pad Thai and not cooked into it so I just ask for no peanuts and voila! I can eat Pad Thai! I’ve come to learn that the art of putting peanuts in every dish is more of a Thai-American thing and less common here, which is a huge relief. Even still, everything for the most part is cooked to order here so if you just ask for no peanuts it’s not an issue.

While I’m happy I went through all the tests and found out I can eat peanuts ( I had my first ever Reese’s cup the week before we left! ) it was all for nothing in the sense that there really isn’t a big peanut issue here. I’d be worse off going to the local Texas Roadhouse than coming to Thailand. While I’m no doctor, and in no way should you take my advice as a medical opinion, if you have a mild reaction and can actually be around peanuts without having a reaction don’t let it stop you from coming to Thailand. There are dozens of great Thai dishes that don’t have any peanuts in them whatsoever, and should you want something like Pad Thai all you have to do is ask for no peanuts. Usually, the peanuts and other garnishes are off to the side anyway for you to put on yourself. And if you do have a severe allergy, there’s a surprising amount of western food here. In the cities there are plenty of fast food chains (Thais seem to love KFC, but that’s only because they haven’t experienced Popeye’s yet ) and in the touristy islands nearly every restaurant has a wide selection of western dishes. There is something for everyone, and with enough precautions traveling to Thailand with a peanut allergy can be just as easy as going to a restaurant back home.

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