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The Prevalence of Peanut Allergy

by Nancy Witting

First the airlines stopped offering in-flight peanuts. Then you started getting notices from your child's school, or phone calls from the parents of his friends, urging you to avoid sending along any foods containing even a smidgen of peanuts. Perhaps your own child has been diagnosed with a peanut allergy. If you think you're hearing more about peanut allergy in kids these days, you're not imagining it.

Incidence of Allergy on the Rise

According to the Centers for Disease Control, peanut allergy doubled in children over the five-year period from 1997-2002. In 2007, approximately four out of every hundred children were reported to have a food allergy, and about half of those, or 1,500,000 children, were allergic to peanuts.

The peanut is not truly a nut – it's a legume, like peas and lentils. But researchers at Allergy Resources International have found that there is about a 35% chance that you will also be allergic to tree nuts (e.g., almonds, walnuts, pecans, and cashews) if you are allergic to peanuts.

Peanut allergy should be taken seriously – it's the most common cause of food-related death, according to the Asthma and Allergy Foundation of America (AAFA). Even a slight exposure to the allergen can bring on a violent and life-threatening reaction in those who are severely allergic.

While peanut allergy can be a lifelong condition, recent studies have found that approximately 20% of children will outgrow it by age six. That means that it's worth repeating the allergy test as a young allergic child grows older.

What Could Be the Cause?

New numbers from the National Center for Health Statistics show that the number of children diagnosed with food allergies has gone up 18% in the past 10 years. In fact, all allergic diseases in children (food allergies, environmental allergies, asthma, and eczema) are on the increase.

Dr. Michael C. Young, a pediatric immunologist at Children's Hospital Boston and the author of The Peanut Allergy Answer Book, was asked by pbs.org about possible causes for the increase. One possible explanation, according to Dr. Young, is the "Hygiene Hypothesis," which posits that increased sanitation and cleaner lifestyles have reduced microbial exposure, facilitating the rise in asthma and allergic disease in the Western world. But Dr. Young acknowledges that there are other theories, as well. For example, a 2003 study published in the New England Journal of Medicine reported that there was a strong association between consumption of soy milk or soy formula in the first two years of life and the development of peanut allergy. Researchers also found that about 90% of allergic children had been exposed during the first six months of life to skin creams that contained peanut oil.

What Are the Symptoms of an Allergic Reaction?

The most common reaction with peanut sensitivity is a feeling of itchiness and a red rash, particularly around the mouth where the food comes in contact with the skin. If the rash and itchiness are limited and are the only symptoms, treatment with an antihistamine (such as Benadryl®) may be sufficient. The AAFA says that if the rash is widespread and other symptoms emerge, such as asthma and digestive symptoms, the reaction should be considered systemic or "anaphylactic." Swelling of the tongue and throat, difficulty breathing, abdominal pain, vomiting, and a change in the level of alertness are all signs of possible life-threatening anaphylaxis. Any child displaying these symptoms needs immediate medical attention.

If your child has been diagnosed with a peanut allergy, your doctor may prescribe an EpiPen®, a spring-loaded needle that you can shoot directly into the body to deliver the medication when an allergic reaction occurs. After treatment with an EpiPen, the child must be taken to the nearest medical facility for observation, since a delayed reaction may occur anywhere from four to six hours later, requiring additional treatment.

What Foods Should Be Avoided?

The American Academy of Allergy, Asthma & Immunology cautions that anyone who is allergic to peanuts should avoid the following ingredients:

• Artificial nuts, beer nuts, ground nuts, mixed nuts, monkey nuts, nut pieces
• Cold pressed, expelled, or extruded peanut oil or arachis oil
• Mandelonas
• Peanut butter, peanut flour
• Items that may include peanut protein: African, Chinese, Indonesian, Mexican, Thai and Vietnamese dishes; baked goods; candy; chili; egg rolls; enchilada sauce; flavoring; marzipan; nougat, and sunflower seeds

The AAFA adds these foods to the above list:

• Muesli and other cereals
• Ice creams
• Soups
• Natural flavoring
• "Health foods" - nutrition and energy bars and other sweets
• Sauces

It is important to read all labels with every purchase. Just because a product was safe the last time you purchased it doesn't mean the ingredients have stayed the same. When you eat out, never be shy about asking for the ingredients of a dish.

If your child has a severe peanut allergy, there are other precautions you should take to avoid problems. While smelling peanut butter won't cause a reaction, skin contact will. If there are any peanut butter eaters in your house or your friends' houses, any surfaces the allergic child is likely to touch should be washed with soap and water (e.g., tabletops and countertops, toys, doorknobs, etc.). Remember, too, that cross-contamination can easily occur if a knife that was used to spread peanut butter is then dipped into a jelly jar without first being washed. Inhaling peanut dust (which was a problem on airlines when planeloads of people ripped open bags of peanuts) can also cause a reaction.

What Can Schools Do to Keep Allergic Children Safe?

Dr. Young stresses that schools should approach this problem on a case-by-case basis. Every school should identify students with food allergies and have a written action plan in place for each child, signed by his or her doctor. If an allergic student has been prescribed an EpiPen®, he or she must have one easily accessible at the school, in case of a reaction. Depending on the age of the student, strategies to avoid peanut exposure may include the following:

• No peanut products in the classroom (not even for science and art projects)
• Peanut-free zones in the cafeteria
• No food sharing
• Hand washing before and after eating

Further guidelines for schools can be found on the Food Allergy & Anaphylaxis Network (www.foodallergy.org).