Going Nuts

The holiday season is a time to indulge in sweet treats, many containing nuts. Before you drive yourself crazy with worry that your child may have a peanut allergy and eat a treat that may trigger a reaction, make sure the threat is real.

Peanut allergies are serious, so parents deserve to know the facts. Labelling your child as peanut allergic without the right information could cause him or her more harm than good. Parents of peanut allergic children are understandably concerned for the safety of their children—unfortunately, that concern can create additional problems.

Allergy anxiety

A British study found peanut allergic children reported poorer quality of life than children with insulin-dependent diabetes. The peanut allergic children worried more about having bad reactions than diabetic children, and they had greater anxiety about eating. Peanut allergic children were particularly worried about eating away from home.

Canadian research also showed that the parents of peanut allergic children believed their children had more impairment in daily life than the parents of children with juvenile arthritis. In other words, the act of labelling a child peanut allergic may have unintended effects such as making the child more anxious and less social.

Unnecessary worry?

Many parents fear their peanut allergic child will have an attack at a friend’s house, school, or restaurant. This is a realistic concern, but it is important to note that Ontario data from 1986 to 2000 showed that one-fifth of peanut allergy deaths occurred within the home.

Eating out with a peanut allergic child may seem risky but may be gradually becoming less so. The Canadian Restaurant and Foodservices Association, in conjunction with Anaphylaxis Canada, has developed training materials on food allergies for its members.

Anaphylaxis Canada, the national advocacy organization for food allergy sufferers, also dispels some peanut allergy myths. For example, they make it clear that just smelling peanut butter does not trigger an allergic reaction—direct contact with peanut products is a must.

There is also a lot of fuss in the media about the growing epidemic of peanut allergies. Unfortunately, most of the data on peanut allergy frequency is based on self-reporting, not on a medically proven diagnosis (see below). This makes it tough to get an accurate picture of the problem.

For example, reported rates of peanut allergy range from 1 in 2,500 persons in Israel to about 1 in 250 in Europe and 1 in 50 in the United States—dramatic differences that vary according to how food allergies are defined. Research has shown that confirmed food allergy numbers are significantly lower than self-reported food allergies.

In other words, confirming the diagnosis is important—not just for the peanut allergic child, but also to help researchers gather accurate information. Misdiagnosing a child as peanut allergic without verifying this with a specialist has consequences for the family, educators, and society in general.

What to do

For many parents of peanut allergic children, an outright ban on peanuts is very appealing. However, in Canada most schools oppose banning peanut products. Even the allergic community agrees that bans create a false sense of security.

Bans put an unrealistic burden on schools to monitor foods coming in and to consider banning other products. Rather than banning peanuts or other food allergens outright, the Canadian School Board Association recommends that schools designate one room as allergen-free.

In an interview with CBC’s Marketplace, the founder of Anaphylaxis Canada, Marilyn Allen, stated, “When you look at a ban ... you’re asking for a reduction in vigilance. Personally, I’d rather see everyone striving for safety.”

Diagnosis and awareness

Diagnosis is the first step: be sure your child really has a peanut allergy by checking with an allergist. Anaphylaxis Canada recommends even minor food reactions be investigated by an allergist.

Awareness of the hazards is the next step. The risk of death from peanut allergy is real, particularly for children with asthma. However, the fact remains that accidents and violence are still the greatest threats to child safety. In Britain a review of all child food allergy deaths found children are 500 times more likely to die from accidents than food allergies.

The message seems clear: we have a responsibility to promote safety in all aspects of a child’s life, not just in our kitchens.

Testing for peanut allergies

Skin prick test
The skin prick test is done in-office by an allergist. The child is injected with a small amount of peanut under the skin and observed carefully for a reaction.

Blood test
Blood tests measure the number of antibodies produced to peanut proteins. The child is not exposed to peanuts at the time of testing. The number of antibodies decreases with length of time from exposure, so results may not accurately reflect a child’s real reaction to peanut butter.

Food challenge
The child is fed both peanut and a placebo (nonreactive food) some time apart. The child is watched carefully for signs of a reaction. Food challenges must be done in a hospital environment.