Dear Dr. Debbie,
Our oldest child is starting kindergarten in a public school, with the option to bring a bag lunch. I was kind of surprised not to get the prohibition about peanuts and tree nuts that came in the parent handbook each fall from the private preschool we used the last three years. We got used to it, though we eat plenty of peanut products and tree nuts at home.
Is this not an issue any more?
Peanut Butter Fan
Food allergies are still an issue when children eat together. A reaction may be so severe as to cause airway constriction. This is known as anaphylactic shock and must be treated immediately with an injection of epinephrine. However, ongoing research has schools trending toward “allergy awareness” as opposed to blanket restrictions.
History of the Peanut Allergy
An allergic reaction to peanuts and or tree nuts was a rare thing until the 1980’s. By 1997 cases were on the rise, doubling by 2002, tripling by 2008, and currently estimated at 2.5% of the children in the United States.
A new focus on the cause of peanut allergies came about through the surprise discovery by pediatric allergist, Dr. Gideon Lack. On a trip to Tel Aviv he noticed that Israeli babies were commonly eating a peanut product (namely Bamba – made of peanuts and corn) as an easily gummable first food. He also found out that Israeli children were very unlikely to have the allergy. His subsequent research involved 640 babies in the United Kingdom and Israel, all of whom might have been predisposed to a food allergy due to severe eczema or an existing egg allergy. He found that early exposure to eating peanuts reduced the risk of developing a food allergy by up to 80%. The results prompted new guidelines for families to follow – that is, to intentionally give babies regular doses of peanuts.
The country of Australia reacted with a public education campaign in 2016 which recommended introducing peanut butter and other common food allergens before a baby’s first birthday. The tactic was adopted by enough Australian families to result in a 16% decline in the prevalence of peanut allergies over the next four years.
Our country needs to catch up on using early exposure as the best approach for preventing the allergy in the first place. While we’re waiting for that, rest assured that school-wide bans aren’t necessary, or even recommended to safeguard exposure for the allergic child. A Canadian study found that 4.9% of allergic reactions to peanut products were in peanut-free schools, while only 3% were in schools without a ban. The researchers explain, “Schools and daycares that allow peanuts may be doing a good job of controlling risk due to heightened awareness of the dangers. Secondly, when peanuts are not allowed, the child may be lulled into a false sense of security, as peanut-foods may inadvertently be brought in and shared with the child.”
An allergic child is not at risk of anaphylactic shock from just being at a lunch table where another child is eating peanut butter. Dr. Chitra Dinakar, director of the Food Allergy Center at Children’s Mercy Hospital, Kansas City, promotes peace of mind by suggesting a Proximity Food Challenge test which is conducted in a doctor’s office. A jar of peanut butter is opened while the patient engages in casual conversation or a game. The jar is brought increasingly closer. If there is still not reaction, a small amount is dabbed on the child’s arm and left there for 5 minutes. None of the children studied with this tactic had an anaphylactic reaction. One had a hive where the peanut butter touched the skin. Dr. Dinaker hopes this challenge test will “teach patients that ingestion, rather than casual exposure through the skin or close proximity to an allergen, is almost the only route for triggering severe allergic/anaphylactic reactions”.
Incidentally, Anne Arundel County Public Schools does not include any foods containing peanuts in its cafeteria fare. Each school or classroom may have its own policies regarding food brought from home.
To be sure, the prevalence of peanut allergies is still an issue. Through sharing information about prevention and management, maybe someday we won’t be looking for the rules about peanuts when it’s time to go back to school.
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