A teen girl dies after getting a kiss from her boyfriend, who was unaware she was deathly allergic to peanuts.
A little boy dies after eating a bologna sandwich prepared with a knife that had been wiped clean after being used for a peanut butter sandwich.
A university student dies after consuming chili that had been thickened with peanut butter.
They're media stories that sound surreal to families who don't have a child allergic to peanuts. But for many American families, they are a worst case scenario that could occur at any moment.
As it turns out, America's most dangerous nut isn't even a nut. The peanut is a legume, and an allergy to it can spell death by anaphylaxis, a sudden, severe, potentially fatal, systemic allergic reaction that can involve the skin, the respiratory tract, the gastrointestinal tract and the heart.
According to the Food Allergy & Anaphylaxis Network (FAAN) a food allergy is "an immune system response to a food that the body mistakenly believes is harmful. Once the immune system decides that a particular food is harmful, it creates specific antibodies to it. The next time the individual eats that food, the immune system releases massive amounts of chemicals, including histamine, in order to protect the body."
Fort Worth resident Lisa Hotchkiss has two daughters who are allergic to peanuts, allergies detected with one single bite of a peanut butter sandwich given unwittingly by grandparents when they were just a year old.
"Their eyes swelled shut, their ears turned bright red and they had trunk hives," says Hotchkiss.
Her second daughter had been tested with a skin test which gave a false negative. "We were cautious, but we thought it should be fine – unfortunately, it wasn't fine," she recalls.
More Common Than You Might Think
Scientists estimate that approximately 11 million Americans suffer from true food allergies. Reactions to peanuts send more of the 30,000 anaphylaxis victims to hospital than any other allergies, and it's a problem that's on the rise. By some estimates, sensitivity to peanuts has doubled in the last 10 to 20 years, and food allergy is increasingly present in the population as a whole in western society.
UT Southwestern allergy division professor Dr. Michael Ruff estimates that six percent of all children have a food allergy, and while many will lose their sensitivity to food as they get older, 20 percent or fewer with peanut and nut allergies may outgrow their allergies in five years, even with strict avoidance.
One hypothesis on the hike in anaphylaxis is that as hygiene standards have increased, allergic reactions have increased correspondingly. This theory is based on research that shows in Third World countries where exposure to pathogens is high, allergies among children are low. Children descended from farming stock in rural societies like Bavaria, where the barn was located under the living quarters, appear to be the most protected, Ruff said. Those who were exposed to more pathogens through daycare and older siblings and having multiple pets in the household may tend to develop immunities that protect them as they get older.
Many people don't realize there is a difference between the terms "food allergy" and "food intolerance." Food intolerance is a food-induced reaction that doesn't involve the immune system; lactose intolerance would be an example of this. People with lactose intolerance lack an enzyme needed to properly digest milk sugar, and may experience gas, bloating and abdominal pain after ingesting milk products.
Vigilance At Home and Away
Forth Worth allergist Dr. Susan Bailey said parents with peanut, tree nut and other allergies need to be vigilant; food allergy reactions trigger about 150 fatalities in this country per year, the majority of those are due to peanut allergy. "Food allergy can be fatal. It's very often trivialized – people just don't realize the seriousness."
Part of the problem is that peanuts, tree nuts and other allergens like egg whites and milk are common – and they tend to hide in all kinds of places -- pastries, candies, snack foods, breakfast cereals, ice cream parlors, restaurants. That's why parents should carry a supply of safe snack foods and Epipens with their child at all times, she says.
When it comes to being prepared at home, parents need to maintain that heightened state of awareness. A recent study showed that while common household cleaners removed peanut allergens, but in one in 12 cases, dishes washed with dishwashing liquid left traces of the notoriously sticky substance.
Peanut protein passes quickly into breast milk, so breastfeeding mothers are encouraged to avoid peanut products lest they sensitize their infant to it as an allergen. Children with allergies are susceptible to other allergies, so diagnoses should be backed up with the newer blood tests allergists give to get a more definitive answer.
Families should avoid unapproved therapies that purport to "cure" allergies. "I don't want them to go to anybody that injects or puts food under tongue – that can be dangerous," says Dr. Ruff.
Instead, the lifesaving device allergists recommend most for controlling a severe anaphylactic reaction is Epinephrine, also called "adrenaline." It's available by prescription as a self-injectable device (EpiPen® or Twinject™).
Caregivers need to be sure to take allergic reactions seriously, not just with a dose of Benadryl, an over-the-counter medicine often administered for quick relief of non-life-threatening allergic reaction. "If you have a rapidly progressive reaction, you need to get to the emergency room. But I would never fault a parent for doing the EpiPen – that's truly a lifesaving medicine," Ruff says.
Protecting Our Allergic Kids
Keller mom Marnie Freeman learned her daughter Madysen, 4, had the peanut allergy from one terrible phone call. "They called one day when she was in school – they said, ‘Something's wrong with her, can you come? We've called 911,'" she remembers. Freeman's husband sped to the school, arriving at the parking lot as the ambulance was pulling out. He rode to the hospital with her. "Her whole face was swollen like a little basketball and it affected her breathing. The EMT kept saying, ‘I don't know if she's going to make it, I don't know.'"
At the hospital, blood tests determined she had a peanut allergy – but she hadn't eaten a peanut product. The little boy next to her at the table had one, though. "She didn't ingest it, which is the scary part," Freeman says. "She could have touched her face and her eyes."
Now Freeman has her own peanut-free recipe for victory over peanut allergies with Madysen. "We take it day by day – you learn something new every day. and we rely on resources from FAAN (the Food Allergy & Anaphylaxis Network) and FAST of Texas."
The Freemans have encountered some skepticism from people who don't take their daughters allergies seriously -- "We've had to deal with some of the emotional issues with people who don't understand it," she says.
Madysen is aided in her own quest to stay healthy by her own determined little memory. "She remembers going to the hospital. She had eight epinephrine shots that day – her peanut allergy was off the chart," Freeman says.
FAST leader Kristie Serio's son, Nathan, 3, is allergic to peanut, tree nuts, egg, soy, fish, shellfish, paprika, watermelon, cantaloupe, peas and beans. She understands what it's like to be on guard. "For parents with food allergic children, it's constantly a fight-or-flight response. Every morsel of food the child puts in his mouth could potentially be fatal."
That's why groups like FAST and FAAN (the Food Allergy & Anaphylaxis Network, http://www.foodallergy.org/) are vital, Serio says. FAAN's website offers everything from allergen-free recipes and the latest research results to notices of food ingredient changes provided by manufacturers.
"The issues change over time and at different stages of the allergy. A lot of parents of teens deal with different issues – they have to worry about sons or daughters going out and kissing, and that's another issue," she says. "It's a life-changing, family-changing thing. We're trying to get everyone under the same umbrella so we can all share the same information," she says.
"One thing we have to be very, very careful with is not to give medical advice … We're not here to give medical advice .. we're here to share experiences and ‘what worked for me.' There are so many issues that we need to share, because there's a huge learning curve when you are first diagnosed with a food allergy."
For parents of children with allergies, the problem isn't going away any time soon.
"You have to strike a balance. I realize this is life and this is how it's going to be. It's not an issue when you learn how to manage it – it's the learning curve, it's the unknown that's difficult," Serio says. "You try to have a life that's as normal as possible."
Dr. Ruff agrees.
"I want these kids to lead a normal life, I don't want them to be hypochondriacs but I want them to be protected," he says.
Lisa Hotchkiss identifies one possible silver lining to the cloud of peanut allergies. "As my older daughter's approaching adolescence, she is able to say ‘No' to things a lot of people might not say no to. I'm hoping that will correspond to some of the temptations later on in life. It's a very neat character-promoting self discipline-building thing," she says.
"I have to think of the positives, otherwise it's a bummer."
J. Louise Larson is the managing editor of The Ennis Journal in Ennis, Texas. She is a Texas-based writer and speaker whose work has been published in magazines and newspapers, including Entrepreneur Magazine, AirTran's Go Magazine, Smart Business Magazine, Midwest Airlines' MyMidwest Magazine, DS News, the Dallas Morning News and others. Her work has been featured on thestreet.com, msnbc.com, entrepreneur.com, business.com and other sites. Her family blog can be seen at http://familyrootsandwings.blogspot.com/ and her writing blog at http://writingporch.blogspot.com/. She is the author of The FabJob Guide to Become A Party Planner (FabJob Publishing 2006) and a member of The Author's Guild and the Writers League of Texas.
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