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Facts About Peanut Allergies

Posted Feb 23 2009 10:37pm
I find myself with lots to say about peanut allergies these days, partly because I've had so many people ask me questions about it. There are so many things I'd love to say to people who are curious about peanut allergies (or are doubters). I could write a book myself if I had the time or inclination. Instead, I'll attempt to briefly cover some main points, and give you lots of links.


WHY I KNOW SO MUCH ABOUT PEANUT ALLERGIES


When Ryan was 2 years old, we gave him peanut butter. Later that evening, I got to call 911 and he spent the rest of that night in the children's hospital getting breathing treatments and being closely monitored. The next day, I got rid of the peanut butter. I spent the next two months purging the rest of our house of peanut products because I quickly realized that maintaining a peanut-free home is a lot more work than just reading food labels.


SOME GENERAL INFORMATION

Food allergens can produce serious allergic reactions that can result in death. Read that sentence again.

There is no cure.Treatments are being developed (yay), but at least in the US, are still in the early stages of clinical trials.

The only way to know for sure whether anyone is allergic to peanuts (or any food) is by eating it. There are a couple of blood tests (one called a CAPRAST ) which can determine how "active" the allergy is. A higher score means that some kind of reaction is more likely occur. But the blood tests have high false positive rates. Used in conjunction with patient history and skin prick tests, the blood tests can be indicators of the presence of a food allergy.

It has been determined thatCAPRAST levels greater than 15kIU/L indicate a 95% chance of somekind of reaction. (for peanuts only)

A reaction might be a mild case of hives, a runny nose, sneezing, coughing, vomiting, swelling of the tongue and airway, difficultly breathing, a drop in blood pressure, fainting, or death. The presence of more than one of these symptoms can indicate anaphylaxis, the definition of which is still being debated among some medical experts.

There is no way to predict how severe any given reaction may be. Read that sentence again. This is something that so many people don't understand. Just because an individual has a history of mild symptoms does NOT mean that they have a "mild" allergy, and that their symptoms will remain mild. This is particularly true for those allergic to peanuts, nuts, fish, and shellfish. A year ago, a little boy in Indiana died. His mother had previously treated minor reactions with Benadryl. (Please, no criticisms of this family--they've been through a lot. I'm using their case to illustrate how someone can go for years without a major reaction. It is not my intent to start a woulda-coulda-shoulda debate over this.)

The severity of any given reaction is affected by many factors, such as how much of the allergen was consumed, whether the allergen was ingested or touched or inhaled, whether the person is sick or has asthma.

It takes as little as 1/1000th of a peanut to cause a reaction in a peanut-allergic individual. Those "may contain traces of peanut" or "made in a factory that processes peanuts" labels mean something to those trying to avoid peanuts.

The peanut allergen is "hidden" in so many foods. If you have been trying to avoid peanuts due to the recent salmonella scare, you have experienced this difficulty firsthand. Some surprising places where you might find peanuts: chili, eggrolls, nuts and seeds processed in plants with peanuts, birdseed, dog food and treats, liquid fabric softener.


EPI-PENS

Epinephrine must be administered within MINUTES of an accidental exposure.
But Epi-pens are all you need, right? Wrong.

Injectable epinephrine (Epi-penorTwinject) has been and will continue to save lives. We carry two wherever we go. In a situation where an allergic person has accidentally ingested an allergen, as I mentioned above, you must act quickly, within minutes. The epinephrine will work immediately to reverse the swelling and blood pressure drop.

However, after the injection of epinephrine, the person must then be transported immediately to a hospital, where they must often spend hours, or sometimes days, being treated until the allergen is out of their system.

The Epi-pen is only the first step. It should be used to keep the person alive until they can get to the hospital.


RYAN'S RISK

Ryan's CAPRAST scores are around 75-85. Remember: scores higher than 15 mean there is a 95% chance of a reaction. The higher the score, the greater the chance of a reaction.

There is about a 20% chance of a child outgrowing a peanut allergy. Factors that increase that likelihood include: low CAPRAST scores, no history of anaphylaxis, no asthma.

Ryan has had one anaphylactic episode.

He has super high CAPRAST scores.

He has had at least half a dozen bouts of "mystery hives," when he has been exposed to peanuts on his skin only, which resulted in localized hives.

He does not have asthma, which is about the only thing he has going for him.

Consider that you can pick up a cold virus from a door knob, and transfer it to your body by then touching your mouth. That is exactly the same way Ryan could accidentally ingest the peanut allergen.

Add this all up and you get a picture of Ryan's risk. It is unlikely that he will ever outgrow this allergy on his own. He will have to deal with this for the rest of his life, unless there is a successful treatment or cure.

Do you need to wonder why we are cautious?

Given the prevalence of peanuts in our country, I must do quite a bit of careful research about the food we bring into our home. Not to do so amounts to playing Russian Roulette with his life. Incidentally, this is why I'm not comforted by the allergen labeling laws. Apart from the fact that I'm morally opposed to using the power of government force in this manner, having such laws does not relieve me of my responsibility to do my own research and make decisions according to our risk tolerance and the results of my research.


Why is this happening?

I get this question all the time. I understand that people are confused and curious, but honestly, I don't know why. Dammit, Jim, I'm a parent, not a doctor or researcher! Here are things I do know:
  • All immune disorders, including asthma, type 1 diabetes, and allergies are on the rise.
  • We eat a lot of peanuts in this country, and we eat a lot of processed food. Processing lots of food where peanuts are present spreads the proteins around a lot.
  • My mom has bad allergies (including anaphylactic ones); I have bad allergies (including anaphylactic ones); my kid has an anaphylactic allergy. Hereditary component?


What about doctors who think this is way overblown?

This recent article at Salon.com is but one of many such articles I have read. I've read too many to count, where doctor or other professional or someone else just thinks I'm just a crazy person. This post is already way too long for me to write everything I'd like to say about this particular article, but I will point out a couple of things.

This doctor paints a nice little portrait of FAAN (the Food Allergy & Anaphylaxis Network) as a group of people with an agenda to push, a group of people who have, in this doctor's view, successfully riled everyone up into a big old hissy about peanuts and other food allergies simply to justify their own existence. (Full disclosure, I'm a member of FAAN, get their newsletter and participate in their fundraising walks. I like their educational materials and dislike their support of food allergen labeling laws.)

This doc makes it sound like FAAN is making up its statistics. Okay, fine. You don't like FAAN's numbers? Then go to the American Academy of Allergy, Asthma, and Immunology (AAAAI) and read the same figures there.

This doc then says this (emphasis added):

For those who argue that heightened awareness about food allergies is more beneficial than underestimating them, consider the psyche of kids who fear they have an allergy. They often wear a bracelet or necklace identifying them as food allergic and carry injectable epinephrine wherever they go. While those measures are justified for truly allergic kids, what about those who may not be? Research has shown these children report feeling more anxious, restrict their activity and are more worried about being away from home than even children with Type 1 diabetes.


See what he did there? Kind of a bait-and-switch....he's painting a picture of lots of kids who carry Epis and wear MedicAlert bracelets--just like Ryan does. Only in his image, it's the majority of kids who aren't "truly allergic" rather than the minority.

I've heard of parents who keep their kids away from peanuts unnecessarily (IMO). I can't do a thing about them. But to cast a shadow of doubt on MY kid, on MY judgment, simply because there are such parents out there? No. This doctor ought to be perfectly aware that Epi-pens are only available by prescription in the US. Did he mention that FACT? No, he did not.

Any child you see with an Epi-pen got it by prescription from a doctor who thinks that kid has a life-threatening food (or bee sting) allergy. Case. Closed.

If you are interested, the doctors at FAAN address this article specifically. It's worth pointing out that the statistics that are in dispute came from peer-reviewed medical journal articles. I'm not saying such articles are always perfect in methodology, of course, but I find it interesting in the extreme that the Salon.com doctor failed to mention this in his article.


OTHER RESOURCES

The Peanut Allergy Answer Book: 2nd Edition by Michael C. Young, MD


I know this is a lot to read. This post pretty nearly represents the sum total of my knowledge about peanut allergy. No, I don't know why it's out there. Yes, I'm sorry your kid can't bring cupcakes to school--but not nearly as sorry as I am that my own kid could DIE from eating a peanut, or that my other kids can't ever eat what your kids can eat at home any old time they want. I know that sounds crabby--because I'm actually very crabby about this. :o)

I hope this post has provided some helpful information. While this post is geared toward peanut allergies, much of what I have written applies to other food allergies, too. I encourage you to follow the links if you're interested further.

And I mostly encourage you to be kind if you are ever asked not to eat peanuts on the airplane (as a woman SO kindly did for us last year) or if your kids are asked not to bring baked goods to school or if you are asked to help your kids wash up after eating peanuts.

It really is that important.

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