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Monday, March 28, 2011

Peanut Butter and Food Allergies: What’s Reasonable?


Photo: George Doyle/Stockbyte

Parents at an elementary school in Florida have had enough. They’re protesting school rules implemented to protect a peanut-allergic first-grader from an accidental exposure. Students in his class are not only banned from bringing peanut products as part of their meals, but must also wash their hands twice each day and rinse out their mouths before entering the classroom (the school may be reconsidering the mouth-rinsing policy). One parent claimed that these procedures are using up half an hour of classroom time a day. Parents (and commenters on the news stories) claim that just a touch or smell of peanut could kill this child. Is all of this really necessary?

Peanut allergies probably occur in about 1% of children, and are the most common cause of life-threatening food reactions. Reactions to eating peanut in allergic individuals can range from hives and itchy skin to breathing problems, loss of consciousness, and death. However, deaths from an allergic reaction to food ingestion are rare, accounting for about 100-150 cases per year in the United States — that’s about as common as death from lightning strikes. The vast majority of peanut-allergic individuals will never experience a life-threatening reaction. Still, parents are understandably fearful, and reasonable steps to keep children safe are necessary to prevent unintended exposures.

So what’s reasonable? Ingesting — eating — peanuts or peanut products accounts for virtually all of the deaths and serious reactions reported among individuals with peanut allergies. Young children might share foods, so banning peanut products entirely in younger grades is reasonable if there is a severely peanut-allergic individual in the room. Food labels need to be complete and accurate, so it’s easy for parents to tell if an item contains peanut. Parents need to be sensitive when cooking treats for classrooms. Children should be discouraged from trading and sharing foods, especially with other kids with food allergies.

Though reactions after touching or smelling peanut can occur, these are not life-threatening — reported cases have only involved skin rashes or other passing symptoms. Parents do not need to be fearful of some kind of “touch of death” from peanut. Other kinds of indirect exposures have been hysterically reported by the media — such as a teenaged girl in Canada dying after a boyfriend’s kiss. It turns out that the peanut he ate nine hours prior had nothing to do with her collapse. Still, anxiety among parents of peanut-allergic children can be very strong, and may lead well-intentioned parents to demand herculean levels of anti-peanut purity that really aren’t necessary.

Ironically, our fears of peanut allergy may actually be contributing to its rising incidence. Delaying peanut exposures until past the toddler years may actually increase the risk of allergy, and early exposures have been shown to prevent allergy at least in some families. Also, preliminary studies show that in some peanut-allergic individuals, exposure to very small, controlled amounts of peanut over time can allow people to “outgrow” the allergy. Hopefully, future desensitization protocols will provide a safe and reliable way to really treat peanut allergy, and allow these families and children to breathe a little easier. In the meantime, parents of schoolchildren all have to help prevent peanut-allergic kids from experiencing a genuinely dangerous exposure.

- Roy Benaroch, MD

Editor’s Note: According to Associated Press reports, students will no longer have to rinse their mouths twice a day. Students must still wash their hands and face before entering the school, to remove potential nut residue.

Posted by: Roy Benaroch, MD, FAAP at 7:21 am

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