Nuts About Nuts

Panic about food allergies rises with the frequency of their occurrence.

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Thursday, January 01, 2009

An article recently published in the British Medical Journal has received much attention from blogs and mainstream media alike. Written by Dr. Nicholas A. Christakis, a professor of medical sociology at Harvard Medical School, the article, titled "This Allergies Hysteria is Just Nuts," addresses the very present fear parents face in regard to food allergies their children have, or may have.

Christakis believes the measures some schools and parents have been taking to prevent allergic reactions—like banning nuts and peanuts altogether, or preventing children who have a mild skin test reaction to a food from eating it, thus increasing sensitization—have been Draconian.

He describes an instance in which a school bus full of 10-year-olds was evacuated and thoroughly cleaned when a peanut was found on the floor. Responses like these are not supported by scientific evidence and, he claims, "are making things worse." According to Christakis, these reactions "bear many of the hallmarks of mass psychological hysteria (MPI)& a social network phenomenon involving otherwise healthy people in a cascade of anxiety."

Hysteria, yes, but that doesn't mean it's unfounded, says Dr. Jonathan L. Bayuk, an allergist and immunologist at Hampden County Physicians Associates. Bayuk, who has written many articles on allergic diseases, started the Western Massachusetts Food Allergy Network (a non-profit currently producing a book for parents of food-allergic children that will serve as a guide to area tourist spots and restaurants).

Bayuk is the medical advisor for Pioneer Valley Food Allergy Support, a support group for parents of food-allergic children, and works as a food allergy consultant for many schools in the state. About 60 percent of his patients are children; many have one or more food allergies. To explain the anxiety surrounding food allergy, he pointed out that there are "not a lot of diseases like it, where you have an otherwise healthy person who suddenly becomes sick," sometimes fatally.

"I don't think it's mass hysteria—I wish it was hysteria," Bayuk says in response to the article, "but we spend a lot of time treating this disease." Bayuk describes the article as "pretty flippant," written by "someone who probably doesn't spend a lot of time working with parents, families and schools."

"There are opposing sides to [this issue]," he says. "Schools get subsidies for using peanuts. It's a cheap food, it's healthy, and they don't want to give up on that whole food unnecessarily, so that creates the problems that play out and have played out in a bunch of different school systems in Western Mass."

"Are there people who've become overly anxious and do become hysterical? Sure," says Bayuk. But he acknowledges that, for the most part, the responses come from parents who are doing their best to protect their children.

The panic surrounding food allergies has increased along with the frequency with which they occur. While it's true that parents weren't as concerned about food allergies 30 years ago as they are today, it's also true that food allergies were far less in evidence 30 years ago. According to the Division of Allergy and Immunology at Children's Memorial Hospital in Chicago, which is currently conducting an in-depth study of food allergies, 4.3 million children in the United States suffer from food allergies and "the number of children suffering with peanut allergy alone has doubled in five years (1997-2002)." The reason for the rise is unknown; one hypothesis, supported by findings that food allergies are most common in industrialized countries with ever-improving sanitation and personal care standards, is that less exposure to varied "dirt" and microbes in childhood makes people's systems less resistant to alien substances.

The number continues to grow. And while more adults are allergic to foods like nuts and seafood, more often you'll find children who are allergic to common, seemingly unavoidable foods like milk, wheat, soy, eggs or peanuts.

"Earlier in life," says Bayuk, "some children are allergic to wheat, soy and eggs [that have] conformational proteins, so they're easier to become tolerant to over time." On the other hand, the proteins in tree nuts, peanuts and seafood "have a straighter shape and they're more difficult to digest. & So those food allergies are less likely for your immune system to overcome because they stay intact." Peanuts fall into the latter category, so a child with that increasingly common peanut allergy will be less likely to overcome the allergy later in life.

The amount of contact to an allergen that will cause a reaction varies widely. Some need to ingest the food, but others can have a severe allergic reaction and even go into anaphylactic shock if they inhale the allergen or touch something that has come in contact with it. For parents of these children, knowing where and when their child may come in contact with an allergen and have a possibly fatal reaction is impossible, and that unpredictability is unnerving.

To these parents, the steps some schools are taking to accommodate food-allergic children are godsends. Many schools in the area have banned tree nuts or peanuts or both, like the Hartsbrook School in Hadley. One area mother, who wished to remain anonymous, has a food-allergic son who is still small enough that she can control what he eats, but because he is so little, "he still puts his fingers in his mouth [or] holds hands with friends who might have just eaten a peanut butter sandwich."

While it has become easier to tell which foods her son can eat, since food labels now include extensive lists of ingredients or possible cross-contaminants, many foods must still be avoided, like mass-produced candy and prepared baked goods. "We are basically on constant vigilance," she laments. "Things like big family dinners or birthday parties can be a nightmare as you hover to make sure your kid doesn't eat anything unsafe. And I've come to hate no word in the English language more than potluck."

This mother is dumbfounded that other parents grumble about restrictions on certain foods in schools. "I think part of the problem is that people don't understand how common these kinds of allergies have become, so they assume the risk is exaggerated or blown out of proportion," the mother says. "We didn't have peanut-free lunch tables at school when we were kids, so they don't understand why their kids' school has them." But, she points out, "there are a lot more kids with life-threatening food allergies than there were a generation ago... To me, when you're balancing one child's safety versus another's favorite sandwich, there's no contest." To those parents she's often wanted to say, "Believe me, we wouldn't require these restrictions in the school, or in our kid's life generally, if this wasn't a real life-or-death issue."

If you are a parent of a food-allergic child and want to join Pioneer Valley Food Allergy Support, you can find them on the last Wednesday of each month from 7 to 9 p.m. at the Pastoral Center at St. John the Baptist Church, 201 Hubbard Street, Ludlow. They are also listed on the national Food Allergy and Anaphylaxis Network at www.foodallergy.org.

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Excellent response by Dr. Bayuk.
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