Sunday, February 22, 2009

Facts About Peanut Allergies

I find myself with lots to say about peanut allergies these days, partly because I've had so many people ask me questions about it. There are so many things I'd love to say to people who are curious about peanut allergies (or are doubters). I could write a book myself if I had the time or inclination. Instead, I'll attempt to briefly cover some main points, and give you lots of links.


When Ryan was 2 years old, we gave him peanut butter. Later that evening, I got to call 911 and he spent the rest of that night in the children's hospital getting breathing treatments and being closely monitored. The next day, I got rid of the peanut butter. I spent the next two months purging the rest of our house of peanut products because I quickly realized that maintaining a peanut-free home is a lot more work than just reading food labels.


Food allergens can produce serious allergic reactions that can result in death. Read that sentence again.

There is no cure. Treatments are being developed (yay), but at least in the US, are still in the early stages of clinical trials.

The only way to know for sure whether anyone is allergic to peanuts (or any food) is by eating it. There are a couple of blood tests (one called a CAPRAST) which can determine how "active" the allergy is. A higher score means that some kind of reaction is more likely occur. But the blood tests have high false positive rates. Used in conjunction with patient history and skin prick tests, the blood tests can be indicators of the presence of a food allergy.

It has been determined that CAPRAST levels greater than 15kIU/L indicate a 95% chance of some kind of reaction. (for peanuts only)

A reaction might be a mild case of hives, a runny nose, sneezing, coughing, vomiting, swelling of the tongue and airway, difficultly breathing, a drop in blood pressure, fainting, or death. The presence of more than one of these symptoms can indicate anaphylaxis, the definition of which is still being debated among some medical experts.

There is no way to predict how severe any given reaction may be. Read that sentence again. This is something that so many people don't understand. Just because an individual has a history of mild symptoms does NOT mean that they have a "mild" allergy, and that their symptoms will remain mild. This is particularly true for those allergic to peanuts, nuts, fish, and shellfish. A year ago, a little boy in Indiana died. His mother had previously treated minor reactions with Benadryl. (Please, no criticisms of this family--they've been through a lot. I'm using their case to illustrate how someone can go for years without a major reaction. It is not my intent to start a woulda-coulda-shoulda debate over this.)

The severity of any given reaction is affected by many factors, such as how much of the allergen was consumed, whether the allergen was ingested or touched or inhaled, whether the person is sick or has asthma.

It takes as little as 1/1000th of a peanut to cause a reaction in a peanut-allergic individual. Those "may contain traces of peanut" or "made in a factory that processes peanuts" labels mean something to those trying to avoid peanuts.

The peanut allergen is "hidden" in so many foods. If you have been trying to avoid peanuts due to the recent salmonella scare, you have experienced this difficulty firsthand. Some surprising places where you might find peanuts: chili, eggrolls, nuts and seeds processed in plants with peanuts, birdseed, dog food and treats, liquid fabric softener.


Epinephrine must be administered within MINUTES of an accidental exposure.
But Epi-pens are all you need, right? Wrong.

Injectable epinephrine (Epi-pen or Twinject) has been and will continue to save lives. We carry two wherever we go. In a situation where an allergic person has accidentally ingested an allergen, as I mentioned above, you must act quickly, within minutes. The epinephrine will work immediately to reverse the swelling and blood pressure drop.

However, after the injection of epinephrine, the person must then be transported immediately to a hospital, where they must often spend hours, or sometimes days, being treated until the allergen is out of their system.

The Epi-pen is only the first step. It should be used to keep the person alive until they can get to the hospital.


Ryan's CAPRAST scores are around 75-85. Remember: scores higher than 15 mean there is a 95% chance of a reaction. The higher the score, the greater the chance of a reaction.

There is about a 20% chance of a child outgrowing a peanut allergy. Factors that increase that likelihood include: low CAPRAST scores, no history of anaphylaxis, no asthma.

Ryan has had one anaphylactic episode.

He has super high CAPRAST scores.

He has had at least half a dozen bouts of "mystery hives," when he has been exposed to peanuts on his skin only, which resulted in localized hives.

He does not have asthma, which is about the only thing he has going for him.

Consider that you can pick up a cold virus from a door knob, and transfer it to your body by then touching your mouth. That is exactly the same way Ryan could accidentally ingest the peanut allergen.

Add this all up and you get a picture of Ryan's risk. It is unlikely that he will ever outgrow this allergy on his own. He will have to deal with this for the rest of his life, unless there is a successful treatment or cure.

Do you need to wonder why we are cautious?

Given the prevalence of peanuts in our country, I must do quite a bit of careful research about the food we bring into our home. Not to do so amounts to playing Russian Roulette with his life. Incidentally, this is why I'm not comforted by the allergen labeling laws. Apart from the fact that I'm morally opposed to using the power of government force in this manner, having such laws does not relieve me of my responsibility to do my own research and make decisions according to our risk tolerance and the results of my research.

Why is this happening?

I get this question all the time. I understand that people are confused and curious, but honestly, I don't know why. Dammit, Jim, I'm a parent, not a doctor or researcher! Here are things I do know:
  • All immune disorders, including asthma, type 1 diabetes, and allergies are on the rise.
  • We eat a lot of peanuts in this country, and we eat a lot of processed food. Processing lots of food where peanuts are present spreads the proteins around a lot.
  • My mom has bad allergies (including anaphylactic ones); I have bad allergies (including anaphylactic ones); my kid has an anaphylactic allergy. Hereditary component?

What about doctors who think this is way overblown?

This recent article at is but one of many such articles I have read. I've read too many to count, where doctor or other professional or someone else just thinks I'm just a crazy person. This post is already way too long for me to write everything I'd like to say about this particular article, but I will point out a couple of things.

This doctor paints a nice little portrait of FAAN (the Food Allergy & Anaphylaxis Network) as a group of people with an agenda to push, a group of people who have, in this doctor's view, successfully riled everyone up into a big old hissy about peanuts and other food allergies simply to justify their own existence. (Full disclosure, I'm a member of FAAN, get their newsletter and participate in their fundraising walks. I like their educational materials and dislike their support of food allergen labeling laws.)

This doc makes it sound like FAAN is making up its statistics. Okay, fine. You don't like FAAN's numbers? Then go to the American Academy of Allergy, Asthma, and Immunology (AAAAI) and read the same figures there.

This doc then says this (emphasis added):

For those who argue that heightened awareness about food allergies is more beneficial than underestimating them, consider the psyche of kids who fear they have an allergy. They often wear a bracelet or necklace identifying them as food allergic and carry injectable epinephrine wherever they go. While those measures are justified for truly allergic kids, what about those who may not be? Research has shown these children report feeling more anxious, restrict their activity and are more worried about being away from home than even children with Type 1 diabetes.

See what he did there? Kind of a bait-and-switch....he's painting a picture of lots of kids who carry Epis and wear MedicAlert bracelets--just like Ryan does. Only in his image, it's the majority of kids who aren't "truly allergic" rather than the minority.

I've heard of parents who keep their kids away from peanuts unnecessarily (IMO). I can't do a thing about them. But to cast a shadow of doubt on MY kid, on MY judgment, simply because there are such parents out there? No. This doctor ought to be perfectly aware that Epi-pens are only available by prescription in the US. Did he mention that FACT? No, he did not.

Any child you see with an Epi-pen got it by prescription from a doctor who thinks that kid has a life-threatening food (or bee sting) allergy. Case. Closed.

If you are interested, the doctors at FAAN address this article specifically. It's worth pointing out that the statistics that are in dispute came from peer-reviewed medical journal articles. I'm not saying such articles are always perfect in methodology, of course, but I find it interesting in the extreme that the doctor failed to mention this in his article.


The Peanut Allergy Answer Book: 2nd Edition by Michael C. Young, MD

I know this is a lot to read. This post pretty nearly represents the sum total of my knowledge about peanut allergy. No, I don't know why it's out there. Yes, I'm sorry your kid can't bring cupcakes to school--but not nearly as sorry as I am that my own kid could DIE from eating a peanut, or that my other kids can't ever eat what your kids can eat at home any old time they want. I know that sounds crabby--because I'm actually very crabby about this. :o)

I hope this post has provided some helpful information. While this post is geared toward peanut allergies, much of what I have written applies to other food allergies, too. I encourage you to follow the links if you're interested further.

And I mostly encourage you to be kind if you are ever asked not to eat peanuts on the airplane (as a woman SO kindly did for us last year) or if your kids are asked not to bring baked goods to school or if you are asked to help your kids wash up after eating peanuts.

It really is that important.


Elisheva Hannah Levin said...

Very interesting post.

Although there is no one with a food allergy in our household, I do not understand the reaction of some people to simple requests by those who have them.

Really, how hard is it to refrain from sending baked goods to school or washing after eating peanuts or not eating peanuts on the airplane in order to protect a human life?

This does not need to be a matter of law; it's simple a matter of common courtesy just like that extended to anyone else with a grave disability or a life-threatening illness.

Good luck to Ryan.
He is one of my favorite kid-type peopleguys to read about!

PS: There is some evidence that allergies are more common among highly intelligent people. I don't know is this a linked set of genes, or if there is some other explanation.

Kelly Elmore said...

Good post, Jenn. I had no idea that Ryan's peanut allergic scores were so high! How scary! Having his energetic and interesting personality around (and the loads of other kids like him that I wouldn't want to miss out on) is worth a couple fewer cupcake parties.

Stephanie Ozenne said...

Thanks for the post. I haven't had to deal with food allergies in our family, but I do understand how serious they are. It's nice to get a summary from someone in the trenches.

I think people resist accommodations because when *they* were a kid, no one was allergic to peanuts, so it can't be as serious as people make it out to be. No one knows why the allergies are on the rise, and it is strange, but that doesn't make it any less real. I think it's an extremely interesting and difficult scientific puzzle, and I look forward to someone figuring it out (I'm a science / bio geek when I'm not busy being a mom).

Jennifer B said...

Really great post, Jenn. Calm and accurate explanation of things. It is very difficult to understans food allergies (and a whole slew of other medical problems) when one does not encounter or face them regularly. Thanks for helping shed more light on this subject!

Mar said...

I haven't commented before but had to, to thank you for this. Last May I shared some walnuts with my then-21 month old, and then watched him scratch furiously at his neck while his eyes closed up and his lips swelled. Fortunately this reaction (probably his second or third exposure, but first reaction) was mild -- we got a referral to the allergist, and RAST numbers in the 5-6 range. Even with a "low" RAST(although still in the highly allergic range), we are on high alert and have completely changed the way we think about food and allergies. Until we were affected, I had NO IDEA what this was all about. Posts like yours are so helpful - any one who has kids or works with children should be aware of the basic mechanics; the only safe measures here are the extreme ones. we are not overreacting to want to protect these kids.

Jenny said...

Hi Jenn,

Love this post! It's so great and I'm glad you wrote it--you explained everything so well and revealed the frustration that many of us feel when dealing with this matter in our own lives.

I especially like your response to the recent peanut allergy backlash perpetrated by "doctors" who are inexplicably miffed that some children have life-threatening peanut allergies.

I like this post so much, in fact, I'm giving you a shout out and a link today on my own blog. ( I hope many read this and learn from it!

Keep up the good work.

Liese4 said...

My 3 y/o has peanut, milk, soy, tomato, corn allergies. She throws up or gets hives if she eats or touches the stuff. People think it's ok to give her 1 peanut or 1 chicken nugget (Mcd's = soy nuggets) because all that might happen is she will throw up or her skin will turn red. I fear the day that her body decides that 1 peanut will be enough for a breathing reaction. I don't have an epi-pen (but my other ER daughter means that I always know the closest ER!)

Our HS has ALOT of kids with peanut allergies worse than Hannah's. There are kids that can't touch you if you touched peanut products or they would go into shock.

It sucks, but it's better than a trip to the ER.

Ruth Smith said...

Jenn-thanks for the thoughtful, educational, and informational post. You articulated what I'm sure most of us food allergic moms and dads feel. I hope you don't mind that I've linked to this post from our site.

Gabrielle (Peanut Free Mama) said...

Well said!

Elaine said...

This was such a great post. It surely explained things very clearly. We battle with peanuts, tree nuts and eggs. We are also borderline Asthma, which does not give us much hope of outgrowing either. Your little guy is so cute.

brendan said...

Liese4, forgive my presumption here, but *please* get an Epi-pen for Hannah.

From what you said, she's allergic to a lot of things, and even if you're super-diligent about keeping her safe, she has had multiple reactions already, right?

There is one very salient point in this post: you cannot predict how severe her next reaction will be. Make an appointment tomorrow.

kelly said...

fantastic jenn! i had to laugh at your comment about your son not having asthma being the one thing goin for him...because my little guy john also has asthma along with the high scores, etc. i always say he gets the double whammy. anyway, loved it!

Anonymous said...

I just wanted to add that a CAP RAST score is not a predictor to the level of severity a reaction could be. A 5 CAP RAST score kid is fully capable of an anaphylactic reaction.

Principled Parent said...

Thank you for this post. In the last week my mom has had two reactions to two different foods that contained nuts (she stopped being able to swallow both times). She didn't quite listen to me after the first reaction, but after the second she took me seriously. Thanks to this post I was able to share with her the fact that you can have a moderate reaction and that it can get more severe. I told her all of the things I've learned from your blog over the last couple years and she listened. She has an appointment with her doctor next week.

I appreciate you sharing this part of your life. I've learned a lot from you about food allergies and I am thankful to have that knowledge!

Jane Anne said...

This post is very informative! I appreciate it. I can relate to everything you said. My son has a severe peanut allergy. He also has asthma. I just got done making cupcakes so he could take a safe cupcake to preschool tomorrow to celebrate another child's birthday with the rest of the class.

I am going to pass this on. My sister recently found out her daughter is allergic to peanuts. We don't have any knowledge of food allergies in our family and yet we both now have PA children.

Back in October of last year, I wrote an Allergy Post for Rocks in My Dryer. It explains some of my son's story. I don't think we can educate enough. I might want to partcipate in the next food allergy blog carnival.

katy said...

My daughter was just diagnosed a few days about with a peanut allergy. I'm still taking it all in . . .processing with it means to us, her our life. It is a lot to take in. Thanks -

Rational Jenn said...

Katy, thanks for stopping by. I'm sorry to have to welcome you to the club.

I know how scared and overwhelmed you feel, but I want to tell you that it will be okay. You will get used to this and it is manageable!

If you haven't found a copy of The Peanut Allergy Answer Book, get one soon. Lots of good advice. If you're "reseacrhy" like I am, check out the food allergy blogs on my sidebar and read the blog carnival too (next one's coming out in two days).

It's very overwhelming at first, but with a little knowledge, you will be able to manage this and protect your daughter.

Cindy said...

Thanks so much for you post. My 2.5 year old has been diagnosed with a peanut allergy and I'm trying to educate myself as much as possible about it.

Rational Jenn said...

Hi Cindy! Glad you stopped by, but sorry for the reason....

As I wrote to the commenter just before you--it's overwhelming at first, but take it one step at a time and you will find that this is manageable. Scary, definitely. But also manageable.

Every other Thursday, we have a food allergy blog carnival--check back here for the link to the current edition. Lots of great food allergy bloggers out there, with lots of experience and helpful advice. I've learned quite a bit from other moms in the same situation.



Anonymous said...

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laser resurfacing irvine said...

The allergic reaction occurs when a person's immune system mistakenly believes that something harmless like a nut or peanut, is actually harmful.

Julie Leicester said...

Hi Jenn,

I came across your blog in researching peanut allergies. My four children are allergy free. However, we have conflicting policies at the three different schools they attend and I am trying to figure out where my stance is.

I do have several points to make as a parent of non allergy kids. I do have compassion for your plight. I would not choose your predicament in any way, shape or form and most certainly on an airplane, I would refrain from eating peanuts if asked.

However, I have had the following experiences:

1.) During a lunch restricted to my eldest son's classroom, he and he alone was asked to go downstairs and eat in the hallway because there was a child in his class with a peanut allergy and he had a peanut butter and jelly sandwich (which is not a restriction at his school so he wasn't sneaking in food.) I was appalled. it was not a teacher who asked him to eat in a downstairs hall way. I need not say more. I believe a 7th grader is capable of eating a peanut butter and jelly sandwich in the same room as another child who has even a severe allergy if he washes his hands and surfaces. There is no evidence whatsoever out there that indicates that children can come to harm in that way.

2.) I have a friend who treats her daughter's peanut allergy as if the rest of the peanut eating world is out of line. She at one point, in my presence, went up to an innocent family eating peanut butter sandwiches at the park and told them not to either stop eating their sandwiches or not let their children play on the equipment. This same friend would wash my daughter's hands for her in the school setting to make sure that she was clean enough to be next to her daughter even though I did not allow my daughter to eat peanut butter out of respect for her.

I will always respect the peanut allergy and a parent's request to be considerate and refrain on behalf of their child and their peace of mind. However, there are lots of children out there with all sorts of medical problems that inhibit them from living normal lives. One of my friends child has alopeacia and has lost all of her hair. Another friend has two sons with hemophilia and one son is in the process of receiving radical medical treatment to keep his clotting factor up. He must refrain from almost all physical activity.

Ultimately children do have to learn to live with these allergies and to take care of themselves as they grow into adulthood. I don't think peanuts are going away and I don't think that my son should have been isolated for his food choice. There are other reasonable precautions out there.