Allergy & Asthma Network Mothers of Asthmatics (AANMA)

By Sakina Bajowala, MD

This column is controversial, but I’m compelled to write it. I have seen too many terrified parents who have been led to believe that being in the same room, on a plane or at a birthday party as a peanut is going to kill their peanut-allergic child. Their children are fearful of classmates, friends and food…and now, in the name of good intentions, many schools and ballparks are advertising “peanut-free.”

ENOUGH IS ENOUGH!

If medical care providers with food-allergic families want the rest of the world to take us seriously, it’s time to get a grip on actual vs. perceived risk of peanut allergens.

I know the nightmare of being doubled over in pain, covered in hives, and feeling the inside of my throat swell to the point that I had difficulty speaking. I am also the mother of two allergic children. Parents whose children have experienced food-related anaphylaxis are understandably traumatized by the event, and would go to the ends of the earth to prevent a repeat reaction. I get this.

However, I’m saddened by the number of parents who have been made to feel as though the world is not safe for their children. Anaphylaxis sucks. But the vast majority of children with food allergy – even those who experience anaphylaxis with ingestion – are able to live safely in proximity to their food triggers, as long as common-sense measures are taken to prevent cross-contamination of ingested items.

Peanut protein in peanut butter, for example, is undetectable in the air. Research by Scott H. Sicherer, MD, at the Jaffe Food Allergy Institute at Mount Sinai School of Medicine, evaluated 30 highly peanut-allergic children by having them sniff a half-cup of peanut butter for 10 minutes. None of the children experienced a reaction.

In the same study, the children had a pea-sized amount of peanut butter pressed onto their backs. One-third developed skin redness, itching or a hive at the exact site of contact, but otherwise no generalized reactions occurred.

Although this study does not guarantee that some exquisitely sensitive children may not react more severely, the takeaway point is that MOST peanut-allergic children are not at significant risk of anaphylaxis from smelling peanut butter or even from touching it.

It is important to remember that symptoms at points of contact (eyes, nose, skin) can trigger reactions that resemble anaphylaxis. However, unless the offending food enters the bloodstream, cardiovascular and respiratory collapse – the major dangers in allergic reactions – are exceedingly unlikely to be triggered.

Do we need to ensure that our toddlers are kept away from potentially cross-contaminated sweets? Of course. Do we need to keep our older, mature, and food-allergy-aware children home from parties where the cake was baked in a facility that also processes peanuts and tree nuts? As long as they know not to eat the cake or any food that has come into contact with it, I don’t think so.

So, why are so many parents telling teachers, school administrators, restaurateurs and airlines the following: “Don’t you get it? My child could DIE!” The answer is simple: they believe it. And the medical community is partly to blame.

All too often, it seems easier and safer for a doctor to say, “Avoid peanuts at all costs. Here’s auto-injectable epinephrine – keep it close and don’t hesitate to call 911.” Why unnecessarily risk a severe reaction, right? But it doesn’t make things easier. It makes things harder. It FREAKS parents out.

The above statement, translated into parent-ese, is this: “Remember how your kid looked after eating that peanut butter cookie – all red and swollen and puking? If you’re not careful, it’ll happen again. Better be ready!” You think you’re being cautious, but at what cost to your patient’s quality of life?

No wonder parents are worrying over sleepovers, school lunches and class trips. No wonder we have a new generation of children so ardently protected from any chance peanut encounter, however minute, that they see the outside world as a danger zone!

This is counter to what we should be trying to accomplish as medical professionals. What is needed is a more nuanced discussion of risk, tailored to each peanut-allergic child.

Parents need to know what to protect their children from, to be sure. They need training in the use of emergency medicine. But they also need to know which situations are relatively safe, even if it goes counter to popularly held conceptions.

As physicians, the onus is on us to do better by these families. All it takes is a little time, thoughtfulness, and a willingness to break free from a cookie-cutter approach to treating food allergy.


Dr. Bajowala is board-certified in general pediatrics and adult and pediatric allergy and immunology. An AANMA professional member and Anaphylaxis Community Experts (ACEs) volunteer, she practices allergy and clinical immunology in suburban Chicago. She is the mother of two boys with allergies. Read more at http://allergistmommy.blogspot.com.


Reviewed by Andrea Holka