Web Only ArticleJanuary 1, 2008

Your Child and the Peanut Allergy

Coping with an anaphylactic food allergy.

One thing you notice when you talk to parents about their peanut - allergic children is the fear. It may not be expressed aloud, but fear is there nonetheless in various forms - worry, stress, anxiety, relentless vigilance. Just read between the lines.

The stories about the onset of the peanut allergy sound remarkably similar. The first sign of trouble comes early in the child's life, usually before he is two, when he is given his first taste of peanut butter, the favorite staple of childhood. The allergic reaction often comes as a complete surprise.

Sue Shero fed her 18-month old son, Mike, his first nibble of peanut butter on a bagel. Immediately, his lip ballooned. Peggy McKillip offered her son, Graham, not yet two, a piece of a peanut butter sandwich. The next thing she knew, she was rushing him to the hospital. Linda Mosholder brought her two-year old daughter, Haley, home from day care. It was to be a routine evening except, unbeknownst to Mosholder, Haley had eaten a peanut butter snack before she left the center. Soon after arriving home, the little girl broke into hives and turned blue, choking for air. "After that night, our lives changed forever," Mosholder said, who remains shaken by the severity of Haley's first encounter with peanuts. "I sometimes catch myself thinking, she was 20 minutes from death. If someone messes up, she's just 20 minutes from death."

Love Affair with Peanuts

America loves its peanuts. The popular legume, related to soybeans, peas, beans, and licorice, is part of the national culture. Baseball and peanuts, kids and peanut butter sandwiches. The average American eats up to eight pounds of peanuts a year. But to the peanut allergic person, eating a peanut can mean a trip to the emergency room.

About 5 percent of children under the age of 3 and 1.5 percent of the general population suffer from food allergies, which is approximately 4 million Americans. The peanut allergy is one of the most common food allergies, and the most deadly. It is usually not outgrown. For some allergic people, ingesting even a trace amount (1/44,000 of a peanut kernel) can be life-threatening. The severity of the allergic reaction depends upon the sensitivity of the person. Some very sensitive children will develop hives or wheezing after being kissed by someone who has eaten a peanut or after touching a utensil or countertop that has been wiped clean of any physical evidence of peanut butter.

With a peanut allergy, as with any food allergy, the immune system misinterprets a food as a harmful invader and releases histamine and other chemicals to protect the body from harm. Reactions to peanuts are commonly anaphylactic, with symptoms that can include vomiting, diarrhea, cramps, hives, eczema, itching or swelling of the lips, tongue or mouth, scratchiness or tightness in the throat, difficulty breathing, wheezing, collapse, and sometimes death. Allergic response can begin within minutes to one hour after ingesting the food, and a second or delayed reaction can occur 4 to 6 hours later. Studies suggest that at least 950 food-induced anaphylactic reactions and about 100 food-allergy deaths occur in the United States each year, and peanuts are the culprit in most instances.

Avoiding peanuts may sound like a simple proposition, but it's not. In a recent study, 75 percent of the patients with a peanut allergy failed to avoid food products containing peanuts even though they carefully tried to do so. Peanuts can be a "hidden" ingredient in foods like candy, biscuits, pastries, chili, and egg rolls. In addition, manufacturers can unwittingly "cross contaminate" products by switching production in processing facilities from one food to another.

The peculiarity and doggedness of the peanut allergy is highlighted by a recent medical case. A 22-year old man collapsed and died from an allergic reaction to peanuts. His liver and one kidney were transplanted into a 35-year old man, who had no history of food allergies. Months later, the transplant recipient broke out in a rash after ingesting peanuts.

Peanuts in the Schools

After two children in Ontario died from severe reactions to peanuts during the summer of 1994, The Canadian Society for Allergy and Clinical Immunology joined with provincial affiliates and allergy organizations to issue recommendations on managing anaphylaxis in the public schools. The goal was to reduce children's exposure to allergenic foods in the classroom, particularly to peanuts. The group concentrated on education about allergies, focusing on the primary grades. The guidelines suggested no trading or sharing of foods, encouraged hand washing, and stated that food-allergic children should only eat lunches and snacks that had been prepared at home. The group saved its strongest statements for the youngest ages, recommending complete restriction of peanuts and peanut butter from nurseries, day care centers, and early elementary grades in Canadian schools to reduce the risk of accidental exposure.

"The school situation was extremely urgent, and the guidelines were designed to help schools develop policies to manage life-threatening allergies," said Susan Yip, president of the Anaphylaxis Network of Canada, a nonprofit, volunteer organization. "Although any food can be life threatening to an allergic child, the peanut was the most pressing because it is a more common allergen and it is a so frequently eaten by young children in schools."

The Anaphylaxis Network of Canada was founded in 1990 by Marilyn Allen, after her 15-year-old daughter, Robyn, died from anaphylactic shock after accidentally ingesting peanut butter. Playing volleyball at her high school, Robyn had used a knife that someone else had used earlier to spread peanut butter. The knife had been wiped, but a minute trace of peanut butter remained, enough to trigger a fatal reaction. Since its founding, the Anaphylaxis Network has been dedicated exclusively to enabling its members to live safely with life-threatening allergies.

The push to restrict peanut butter in the schools has gotten mixed reaction from educators, school administrators, and parents, but generally people come on board once they understand that a peanut allergy can be life-threatening. It takes some education to convince them, according to Yip. "There are always people who don't understand the seriousness of this allergy, and then it becomes the rights of few over the rights of many. I don't think we're ever going to get 100 percent of the people behind us," Yip said. "But eight years ago when we first started this awareness campaign, people didn't know what anaphylaxis was, much less how to pronounce it. It is a much more common expression now, and the awareness is out there."

Hidden Peanuts

The treatment for peanut allergy is avoidance, but that can be tricky because peanuts are widely used in the food industry and can take on various disguises. Common products that can contain peanuts include marsipan, chili, egg rolls, candy, baked goods, and Chinese and Thai dishes.

The FDA requires manufacturers to label the ingredients in all food products. Some companies, like Nestles and Mars, list peanuts as ingredients in candy that does not contain nuts. This candy is manufactured on the same equipment used to make peanut candy, and peanut dust may remain during the manufacturing process. To very sensitive individuals, this trace amount would be enough to cause an allergic reaction.

Watch out for Nu-nutsŪ, an artificial or imitation nut product. Nu-nutsŪ are actually peanuts which have been deflavored, reflavored, colored and pressed to look like tree nuts, such as almonds or pecans. Most people who are allergic to peanuts are not allergic to tree nuts. However, a peanut-allergic person who eats a peanut disguised as a tree nut may have a serious allergic reaction.

You can avoid most sources of hidden peanuts if you read labels carefully and stay away from restaurant-prepared foods when you're not absolutely certain of their ingredients.

Food Allergies in the School

Lunch is a time for your child to relax, re-energize and socialize with friends. It should be a pleasant experience. Your child needs to feel just like the other kids, despite food restrictions. As a parent, you can help your food-allergic child be independent and responsible for his food choices. It is up to you to establish guidelines for your child and set a foundation for an effective dietary regimen.

The following are steps you can take to support your child and help him gain control over his food allergies:

•Impress upon your child that it is essential that he follow his restricted diet in order to safeguard his health.

•Sit down with him and learn about his diet together. List potential allergens, read food labels, and construct sample menus based on his favorite foods.

•Make his diet a normal part of your household, and help the whole family participate in it.

•Give your child as much control over food choices as possible. This will depend upon his age and will broaden as he matures. The more choices your child has, the more cooperative he will be. Let him pack his own lunch, and always be sure to keep plenty of "allowable" foods on hand.

•Alert the personnel at your child's school about his food allergies and restrictions. Consider having your child wear a Medic-Alert bracelet that provides information regarding these restrictions. (For more information, call 800-ID-ALERT.)

•Stress the importance of eating only his food at school and that sharing a friend's lunch or snack is prohibited. However, encourage your child to share his food with siblings and friends, if allowed. In this way, his friends will become more supportive, and the concept of food restrictions will become second nature to him and his friends. If your child wants to purchase lunch at school, discuss options with the cafeteria supervisor, and help your child make appropriate selections.

•Send special treats for your child to school for parties and festivities that may be substituted for forbidden foods, and be sure to send enough for him to share with his friends.

•Keep a positive attitude when enforcing the importance of your child's diet. Praise him for his efforts, and remember that your child is a normal child who just has to eat a bit differently.