The Nuts in Our Schools

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Crozet Annals of Medicine
by Dr. Robert Reiser

Anita, a longtime Crozet Annals reader, was asking me recently about my experience with fatal peanut allergies. Her children’s school, following a national trend, had banned all peanut-containing products. Tempers were running hot on both sides of the issue. Parents of allergic children were claiming protections under the Americans with Disabilities Act while parents of unaffected children were feeling bullied by overprotective parents and school officials. The list of products that have peanuts in them or may have come in contact with peanuts in the factories is quite extensive. And, after all, PB&J sandwiches practically define childhood for many of us. Put one in a Hot Wheels lunchbox and throw in a carton of milk and an apple and I would almost be willing to go back to elementary school.

The Kiss of Death

Peanut allergies are very rare but are the most potentially lethal of all food allergies. This lethality has led to all sorts of improbable reports in the global media. The most fantastical came out of Canada in 2005. A fifteen-year-old girl in Quebec who was allergic to peanuts died after her boyfriend kissed her. He had consumed peanut crackers several hours prior. In reporting this story, ABC News quoted a Michelle Risinger, who is allergic to peanuts. She once kissed a boy who had just eaten a cookie with trace amounts of peanut.

“My throat closed. It’s a tight, tingling sensation.”

Um Michele, that’s what’s supposed to happen. You’re doing it right.

Un Baiser Fatal (The Fatal Kiss)

Fifteen-year-old French Canadian Christina Desforges did not die as a result of the kiss. Her boyfriend had consumed the peanut butter nine hours before the kiss, leaving no trace on his lips or in her bloodstream. Christina suffered an unrelated fatal asthma attack. She called an ambulance at 3 a.m. after spending hours in a smoky room at a late night party. Nevertheless, the kiss of death story persists on internet peanut allergy forums.

The Facts

A growing number of schools have implemented bans. A recent survey of 1,174 districts by the Virginia-based School Nutrition Association found that 18 percent of schools had peanut bans in 2007, a 50 percent increase from two years earlier.

Food allergies are rapidly increasing. Maybe. According to the Centers for Disease Control, the prevalence of reported food allergies increased 18 percent between 1997 and 2007. This is what Americans are self reporting. A recent Danish study of an unselected population found discrepancies between the prevalence of allergy as reported by parents (15 percent) and the prevalence of food allergy on oral challenge, which was 2.3 percent in children younger than 3 years and 1 percent in older children. These data confirmed earlier studies in Sweden and Iceland.

We have an epidemic of parental reporting of food allergies.

Asthma is consistently associated with more severe reactions. This is true. Six foods (milk, egg, peanuts, tree nuts, fish, shellfish) cause 90 percent of all allergic reactions to foods. This is true. So we still have a lot of other foods to ban from the classrooms.

Food allergies kill 150 Americans a year, mostly children. Maybe. This is an estimate by the CDC with no actual mechanism to count.

In the UK where they actually count, eight children younger than 16 years died from food allergy between 1990 and 2000. Eight children in ten years. Milk caused four of the deaths and no child younger than 13 died from eating peanuts. One child with a mild food reaction died from over exuberant therapy: an overdose of adrenaline. Similar rates are reported in Sweden, with only six deaths between 1993 and 2003. No other large epidemiological studies of children exist, so we do not know how incidence varies between countries.

To put that in perspective, less than one in a million kids with true food allergies will die from them. Less than one in two million kids with reported food allergies will die from them.

Epipens (self-injected adrenaline shots) are lifesaving in cases of severe food allergy reactions. This is true. Epinephrine (adrenaline) is the treatment for life-threatening allergies of any sort. But you would have to give over two million kids with food allergies epipens to potentially save one life.

Peanut allergies stigmatize kids. One study found that children with peanut allergy report more fear of adverse health events, feel more threatened by potential hazards, restrict their physical activity more, and are more worried about being away from home than children with diabetes.

I explained most of this to Anita and closed with my most persuasive argument. In 20 years of full time Emergency Department practice I have never seen a problem related to peanuts, unless you count the kids who shove them up their noses.

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