For people with life-threatening allergies, safety is measured in minutes. Anaphylaxis is a rapid allergic reaction that can progress quickly to airway obstruction, circulatory collapse, and death if untreated. Although it is considered a medical emergency with a clear and effective treatment, anaphylaxis and its associated allergies are frequently misunderstood. In the United States, an estimated two to four percent of individuals will experience anaphylaxis in their lifetime, though true prevalence is likely higher due to under-recognition and inconsistent reporting.
These challenges are shaped not only by healthcare systems, but by cultural context. For instance, reported rates of food allergy in India have historically been lower than those in many Western countries, a pattern which is thought to reflect differences in early life environmental exposures as well as gaps in diagnosis and surveillance. When a condition is perceived as uncommon, it is less likely to be anticipated, recognized, or taken seriously, and as an Indian-American with life-threatening food allergies myself, I have often felt this gap acutely. Within South Asian communities, food allergies may be viewed as improbable or unfamiliar, even as my lived risk remains constant. This discrepancy between perceived rarity and lived reality has shaped my experience and informed my artistic choices.
Central to the management of anaphylaxis is epinephrine, the first-line and only effective treatment capable of reversing its symptoms when administered promptly. Yet access to epinephrine is far from guaranteed. Studies show that many individuals with diagnosed food allergies are not consistently prescribed epinephrine auto-injectors or do not carry them reliably, even when they are at risk. Globally, availability of epinephrine auto-injectors remains uneven, and cost poses a significant barrier even in high resource settings. When epinephrine is unavailable or delayed, outcomes worsen, transforming what could have been a manageable emergency into a life-threatening event.
These systemic realities shape the lived experience of many people with allergies, including my own. Epinephrine auto-injectors are prohibitively expensive, particularly without insurance, and as a child, I was required to provide a new, unexpired device to my school despite never needing to use one. At the time, this felt like a costly and burdensome requirement. That understanding shifted, however, after I experienced an allergic reaction in college. Carrying an epinephrine auto-injector no longer felt optional or imposed, but necessary.
I live with life-threatening allergies to peanuts and tree nuts, and for as long as I can remember, eating outside my home has required a constant state of vigilance. Every restaurant visit involves careful questioning, trust placed in strangers, and a quiet undercurrent of fear that one mistake could have irreversible consequences. Over time, I have come to recognize that much of this anxiety stems not only from my condition itself, but from a broader lack of public understanding surrounding food allergies. Life-threatening allergies are often conflated with intolerance or personal dietary preferences, and the risks of cross-contact are frequently underestimated.
It was within this landscape of medical risk and lived vulnerability that this dance, Dining with Danger, was created. Through movement, I sought to translate the severity of allergic reactions into a visual language that could foster greater awareness.
The piece unfolds in three parts. In the first, a girl enters a restaurant to dine. Despite clearly communicating her dietary restrictions, she is served food containing her allergen. Shortly after eating, she collapses. This opening scene reflects a reality many individuals with food allergies face. Even with precautions and communication, mistakes can occur, and the consequences can be severe.
The second section depicts the onset of anaphylaxis. Rather than presenting symptoms abstractly, I personified them as three raakshasas, or demons, each representing a hallmark feature of a severe allergic reaction: hives, shortness of breath, and dizziness or light-headedness. These figures surround and overpower the dancer, embodying the sudden loss of control that accompanies anaphylaxis. As the symptoms intensify, the dancer struggles toward her epinephrine auto-injector, eventually administering it for the recommended three to five seconds.
In the final section, epinephrine is personified as a powerful deity, such as Shiva or Devi, who enters the space and decisively destroys each of the demons introduced earlier. This imagery draws on Hindu iconography to convey epinephrine’s life-saving role with greater clarity and force.
Underlying this artistic narrative is a scientific framework that guided my choreographic choices. When an allergen enters the body, immunoglobulin E-mediated activation of mast cells triggers the release of histamine and other inflammatory mediators, leading to vasodilation, airway constriction, and cardiovascular instability. Epinephrine counteracts these effects by reversing airway constriction and circulatory collapse while slowing the chemical cascade that fuels anaphylaxis. Although I have lived with allergies my entire life, my understanding has largely been limited to their outward manifestations. Researching the internal physiology allowed me to create a depiction that was not only expressive, but also grounded in medical accuracy.
Costuming also played a deliberate role. I chose to wear the color teal, as teal is the recognized color of food allergy awareness. This choice served as a visual homage to advocacy efforts and reflected my own hope to contribute, through art, to greater recognition of food allergies as a serious medical condition.
Ultimately, this piece represents an intersection of lived experience, medical science, and classical dance. By translating anaphylaxis into embodied movement and mythological imagery, I aimed to create a work that is both informative and emotionally resonant. My hope is that audiences leave with a deeper understanding of the realities of allergies and a renewed sense of responsibility when accommodating them, because for those whose lives depend on careful awareness and preparation, understanding is not merely optional. It is lifesaving.
Image credit: courtesy of the author Dr. Shilpa Darivemula
Attending Physician Contributing Writer
UMass Chan School of Medicine/Memorial Hospital
Shilpa Darivemula, MD, MSCR is an Assistant Professor of Obstetrics and Gynecology at the University of Massachusetts T.H. Chan School of Medicine in Worcester, MA. She is a physician-scientist focused on menstrual health and mentrual equity research. She is also the Former Director of the Aseemkala Inititiative, an organization dedicated to using cultural arts to address social justice and equity in medicine. Please see their work at assemkala.org.
Undergraduate Guest Writer
Rice University
Srinidhi is a fourth-year student at Rice University and an aspiring physician who is passionate about exploring the intersection between arts and medicine. In her free time, she enjoys dancing, baking, and spending time with friends and family.