Max Collins, now 8 and a second grader in Burlington, was a baby when a tiny taste of peanut butter nearly killed him.
No sooner had his mom, Lisa, now 32, spread a smidgeon on Max’s lips than he began vomiting and screaming. Huge hives sprouted on his skin. “It was almost simultaneous,” Lisa says. “I never knew foods could cause something life-threatening.”She rushed him to the nearest emergency room, where health workers, suspecting a potentially fatal allergy attack, pumped him full of epinephrine and Benadryl. Max survived, and hasn’t been near a peanut since – no small feat given that peanuts can lurk in any number of unsuspected places, from bakery-bought cakes to a restaurant meal cooked in a pan that has traces of peanut from a previous recipe.
Food allergies, once dismissed as rare or insignificant, are getting new respect. In response to requests from people with peanut allergies, the federal Department of Transportation told 10 major airlines in August that they must provide peanut-free “buffer zones” if a passenger with an allergy requests it. (Under pressure from peanut producers, however, the agency has been re-examining that policy.)
School systems, too, are grappling with ways to balance the needs of allergic kids with the rights of others to their p-b-and-j’s. Instead of bans – which can arouse antagonism without guaranteeing safety – many schools now offer peanut-free cafeteria tables, no-sharing policies for lunches or candy bars that may contain traces of peanuts, and instructions for teachers on handling allergy emergencies.
Still, food allergies – the big ones are to peanuts, tree nuts like walnuts and pecans, shellfish, fish, eggs, milk, wheat, and soy – pose a delicate problem.
On the one hand, the mere notion of killer food strikes some as ludicrous, though 100 to 125 people die every year from allergies to food – mainly peanuts – estimates Dr. Hugh Sampson, director of the Jaffe Food Allergy Institute at New York’s Mt. Sinai School of Medicine. He is also medical director for the Food Allergy Network in Fairfax, Va., a nonprofit education group.
Government statistics count only 88 deaths from food allergies between 1979 and 1995, but both sets of numbers are considered soft.
On the other hand, many people who think they have a food allergy – 25 percent of adults, according to one survey – do not, says Anne Munoz-Furlong, founder of the Food Allergy Network.
In reality, only 1 to 2 percent of people truly have a food allergy, she says. But that’s more than 5 million Americans and the number – hard data are scarce – appears to be growing, especially for allergies to peanuts, which are actually in the legume, not the nut family.
Despite the lack of solid data, many pediatricians and allergists believe peanut allergies are on the rise.
“The problem has doubled or tripled since I have been in practice for the last 15 years,” says Dr. John Saryan, an allergist at the Lahey Clinic in Burlington who thinks peanut consumption by nursing mothers may be partly to blame.
There’s no proof that the three proteins in peanuts that trigger allergies cross the placenta to the fetus during pregnancy. But there is evidence that peanut allergens are present in breast milk.
When a baby nurses, his immune system begins making a type of antibody called IgE to peanut allergens in breast milk. When an allergy-prone child is then exposed later in life to a larger dose of allergens – in a peanut butter sandwich, for instance – the allergens combine with his antibodies, triggering release of histamine and other chemicals from mast cells that line the respiratory and digestive tracts and the skin.
This leads to hives, vomiting, and swelling of the bronchial tubes as fluids seep out of blood vessels. The end result can be life-threatening anaphylactic shock – characterized by severe breathing problems and a drop in blood pressure.
Allergic reactions are especially dangerous in children who have asthma, says Dr. Dean Metcalfe, chief of the laboratory of allergic diseases at the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.
In most cases, it takes ingestion of a peanut product to produce a reaction, not merely touching it or inhaling peanut dust. (Peanut oils are considered safe, by the way, as long as they are made by acid extraction and heat distillation, as most commercial products are.)
But for some, even airborne exposure can be a problem, says Mike Hanson, a 43-year-old lawyer from Hingham whose son Dan, now 7, once reacted to the “airborne smell” of peanuts at a hotel. And that, he says, makes plane trips terrifying. “When 300 people open bags of peanuts at the same time, you can smell it. You are trapped. There’s no fresh air, no way out.”
Allergist Sampson agrees, saying some people have had such severe reactions after other passengers opened bags of peanuts that planes had to make emergency landings.
The allergens clearly linger in airplane ventilation systems, says Dr. John Yunginger, an allergist and pediatrician at the Mayo Clinic, whose data were used by the federal government. What’s not clear from his data, though, is whether enough peanut particles linger in the air to make people sick.
For some people, living with a food allergy is simply a nuisance. “Oh, I almost died several times,” says Paul Kelley, 63, a physicist and director of the electro-optics technology center at Tufts University who is severely allergic to peanuts.
When he visited China, where peanuts are used extensively in cooking, Kelley had a friend write him a sign to flash in restaurants saying, “Do not feed this white monkey peanuts.” But basically, he says, “I guess I’m oblivious.”
Not Lisa Collins. To protect her son, Max, she reads every label on every food product. She takes him only to restaurants with standardized menus, like McDonald’s. She talks to school staff to make sure other kids don’t give him peanut butter sandwiches or candy bars.
And when Max goes to birthday parties, he takes along something to eat rather than birthday cakes from a bakery, which could contain peanut allergens if mixing bowls and other utensils were previously used for foods containing peanuts.
Lisa also makes sure that wherever Max goes, there’s an adult with an EpiPen nearby, to give him an injection of epinephrine if he develops a reaction to unwittingly ingested peanuts.
“The threat is always with us,” she says, “but the more aware people are, the safer Max is.”
Some tips for averting perils in food allergies
Any food can potentially cause anaphylactic shock, a potentially life-threatening reaction. The most common culprits are peanuts, tree nuts, shellfish, fish, eggs, and milk.
-
Milk and eggs cause the most common food allergies in children, but unlike with many other allergies, people often outgrow them as they get older. Not so with peanut allergies.
-
Labels on food products are supposed to say whether the product contains allergy-triggering substances, but the labeling process is not foolproof. Labels do not have to say whether the food was processed in a vat also used for peanut products, which means cross-contamination is a slight possibility. In September, the Pillsbury Co. recalled some cookie dough products because the packages may have contained walnuts not listed on the label. Other companies have recalled products because labels failed to list peanuts, eggs, milk, pecans, hazelnuts or almonds.
-
If your school-age child has a food allergy, request a meeting with the principal, school nurse, cafeteria personnel, and teacher to make sure they know how to handle an emergency.
-
Use role-playing to teach your child ways to avoid contact with food allergens in the cafeteria or to resist peer pressure to try a new food.
-
Send a spoil-proof lunch to be kept at school in case your child loses or forgets his allergy-safe lunch one day. This can include a can of tuna, crackers, canned fruit, and fruit juice.
-
If you or your child has a severe food allergy, carry an EpiPen (pre-measured epinephrine) and a written emergency plan. School-age children and adults may also want to wear a bracelet describing the allergy.
-
If you have a family history of asthma, hay fever or eczema, avoid peanuts if you are pregnant or nursing, and don’t let your child eat peanut products before age 3. (After that, a child’s maturing immune system may be less sensitive to peanut allergens.)
-
Remember: As little as 1/20 of a peanut can cause a fatal reaction in someone who is highly allergic.
For more information on food allergies, call the Food Allergy Network, 1-800-929-4040 begin_of_the_skype_highlighting 1-800-929-4040 end_of_the_skype_highlighting or try the Net, at www.foodallergy.org.