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December 19, 2008
"Nut Allergy" Fear and Overreaction
Professor Nicolas Christakis, a professor of medical sociology at Harvard Medical School, told the BMJ there was "a gross over-reaction to the magnitude of the threat" posed by food allergies, and particularly nut allergies.
In the US, serious allergic reactions to foods cause just 2,000 of more than 30 million hospitalisations a year and comparatively few deaths -- 150 a year from all food allergies combined.
In the UK there are around 10 deaths each year from food allergies.
Professor Christakis said the issue was not whether nut allergies existed or whether they could occasionally be serious. Nor was the issue whether reasonable preventative steps should be made for the few children who had documented serious allergies, he argued.
"The issue is what accounts for the extreme responses to nut allergies."
He said the number of US schools declaring themselves to be entirely "nut free" -- banning staples like peanut butter, homemade baked goods and any foods without detailed ingredient labels -- was rising, despite clear evidence that such restrictions were unnecessary.
"School entrances have signs admonishing visitors to wash their hands before entry to avoid [nut] contamination."
He said these responses were extreme and had many of the hallmarks of mass psychogenic illness (MPI), previously known as epidemic hysteria.
Posted on December 19, 2008 at 6:56 AM
• 109 Comments
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Or - I bought a packet of nuts the other day and on the back it said: "May contain traces of nuts".
I should hope so...
Yesterday I saw two signs:
At an industrial facility:
NO VEHICLES THIS ENTRANCE
At an apartment complex:
RESIDENTS AND GUESTS WELCOME
Sound familiar? The Simpsons, Bart Simpson vs. Principal Skinner.
The similarity is indeed interesting. I've been struck by the overreaction to nut allergies every time I've taken a flight recently. (I did get a pack of peanuts on my last flight. Funny, by now I expect so little from airlines, that I was shocked it didn't require some sort of upcharge.)
Here, it's obvious who gains from this paranoia: companies making packaged, processed foods marketed to children. Without packages, how can you have an ingredients list? Only they can save our children from the risk of nut allergies. Home-cooked food is no longer safe or appropriate. Fresh food is verboten.
I suspect the long-term health risks from forcing even more children to eat processed snacks instead of homemade foods far exceeds any incremental risk from nut allergies. Perhaps even to the kids with the nut allergies (who are now forbidden from bringing whatever nut-free foods are prepared for them at home).
I have a kid with a severe peanut allergy, and honestly, I could not agree more with the majority of this article. There is a TOTAL lack of facts and science applied by organizations regarding this issue. This is compounded by the fact that SOME people who have peanut allergies are also grossly misinformed about their own ailment. You must ingest the peanut protein to have a severe allergic reaction. The last study I read on the subject said that no severe reactions were observed with inhalation or skin contact. Peanuts are not "kryptonite". Being around a peanut is not going to cause me to leave someplace with my kid or demand decontamination! Obviously, we like to minimize the risk of ingestion with a child, but we also carry Epi-Pens everywhere.
The article doesn't differentiate between people with a diagnosed allergy and those that are just nuts, pun intended. Our child can't eat most birthday cakes (with an unknown origin), but brings his own dessert to birthday parties. We always carry something sweet in the event the kid is in a situation where others are eating a dessert that they cannot have so that we can substitute. We feel it is up to us to adapt to the world, not the reverse.
Labeling, however, is a real blessing for us. Without the knowledge of where something is produced, it is very hard for us to make our own determinations as to what to allow our child to eat. It used to be very hard before they labeled products well. It was even harder for our "friends and relatives" who don't spend a significant portion of their time reading about peanut allergies and food. Restaurants are particularly difficult. (Although when they label a package of nuts with 'may contain nuts', that does make me laugh). One place that makes things very easy is Walt Disney World. I wish more places would follow their model of dealing with food allergies (which I do not believe significantly impacts other people), but makes the parents of allergic kids feel very comfortable.
There is only one relevant question for an administrator in a situation like this, "Can I, or the organization I represent, be held legally responsible for someone suffering an allergic reaction on the premises?" If the answer is yes, then measures to eliminate that risk will be put in place. The same reasoning applies to kids bringing broken pencil sharpeners to class.
I understand your point, but I also bet that you have never had to stab your child with an epi-pen because he was exposed to peanuts. The rules of safety and security for adults probably fall under a different set of standards that for children. Also, macro health stats don't mean a lot when you are dealing with a specific child with an allergy. What would you do if a school principal offered to make their cafeteria nut-free because your child has a peanut allergy? I doubt that you would turn the offer down because it would be an overreaction to the macro problem of nut allergies.
@Griskupar: while apparently examples of double-speak, those examples are actually not that far from reasonable.
#1: Some industrials installations do not refer to their internal maintenance fleet as "vehicles"; that word is used to describe cars that primarily carry people from outside the compound to the compound.
2. Guests and residents can not trespass; trespassers are not residents or their guests. Therefore, no contradiction. If you are not in the first group, you are not allowed entry.
Bruce, I'm guessing that you don't have a nut allergy? I'd also bet that Professor Christakis doesn't either.
The first thing I should say is that most of the time its peanuts that cause serious allergic reactions and its technically not a nut - its a legume. So peanuts, lentils, peas etc are the main culprets but nuts in general seem to have been given a bad-rep. For some reason peanuts seem particularly problematic compared with other allergens.
The other item worth mentioning is that there may only be 2,000 hospitalisations in the US, but that is the really really serious end of the spectrum. Most reactions are somewhat less serious but still very distressing or really uncomfortable. I don't think its a particularly big ask for people not to consume peanuts while on a plane for a few hours, or bring them into a school for example. If I can make a comparison - when I was at school the standard experiment of dropping a bit of animal liver into hydrogen peroxide was banned because of the hygene risk from the liver (yup, seriously); so in comparison not bringing in peanuts is a fairly reasonable request.
In Scotland, Ireland, England and Wales, it is illegal to smoke in public places because of the health risk to others... why should potentially very serious allergens be ok?
Finally, 150 deaths a year is still 150 people that are dead - per year. The conflict in Iraq has lasted for about five years with 4208 US soldiers dead, each soldier's death lamented, and rightly so. Over the same five years that would mean there would be roughly 600 dead from allergic reactions which although is smaller is in a similar level of magnitude.
I didn't like the inference that its ok to put people's lives at risk for what is in effect a small inconvenience. Would you be holding that view if you or someone in your family had a serious allergy?
The challenge is in the level of response to the problem. Everyone in my house is allergic to some food (which can make getting dinner ready a challenge).
The challenge with some allergies is that the substance can become invisibly airborne, and thus get into the patient's system without the patient actively eating the item. However, if this is followed to its logical conclusion, soon we won't be able to allow eating in a public area, because in a group of two hundred, someone is going to be allergic to just about everything: Wheat, soy, nuts, dairy, corn, seafood, ad infinitum. To ban them all would mean banning the cafeteria.
It's time for a "War on Nuts", complete with a Nut Czar, mass cavity searches at the entrances to major public facilities, a special prison where those suspected of carrying illegal legumes can be interrogated (I recommend it be located in the state of Ala*BAMA*), and a new Cabinet-level agency to coordinate our national response.
After all, if we save but one life, we must do everything possible... right?
Proportion. Apply your attitude to everything that could possibly harm anybody, and we would have to sit at home, wrapped up in cotton wool, for fear anything might happen. Compare your 600 dead to road death figures in the same period.
It's one thing to accomodate people's medical problems, quite another to insist that everyone else changes their lifestyle for your benefit.
I don't believe anyone is suggesting that if someone's child actually has a severe nut allergy, steps should not be taken at their school to prevent them from coming into contact with something that could potentially kill them, including a ban on nuts while that child is enrolled. The over-reaction is in banning them outright just because someone with a severe allergy might someday show up and manage to come into contact with them.
@DadwithNutAllergyKid:"You must ingest the peanut protein to have a severe allergic reaction.", eh, I'd have to disagree, I've got a comparatively mild allergy to peanuts and I'll get a reaction when its being used in cooking (although not just sitting open on a table or whatever). Don't know what the mechanism is but the proteins can become airbourne, given a day or so I should be able to cite references to back this up.
@Calum:"Compare your 600 dead to road death figures in the same period.". Good idea. Lets take Professor Christakis' figure of 10 deaths a year in the UK. According to http://news.bbc.co.uk/1/hi/uk/5387568.stm there were just over 3,200 road deaths in 2006 in the UK. So the number of road traffic deaths are approximately 300x the number of deaths due to serious allergic reactions. I'm guessing that the amount of money spent on drink driving campaigns, road traffic policing, stop checks on vehicle tires/other safety issues, road stops to check for drunk/drugged drivers far exceed this 300x times cost comparison. If that is the case, saving the life of someone with a severe allergy is "cheaper" than saving the life of someone in a road accident. Again, don't have the figures but could either find some or do a few Freedom of Information requests and we can compare it.
As the father of a 3 year-old who is allergic to tree nuts (not peanuts), I can say that I do enjoy seeing certain aspects of this 'hysteria' take place. I like the fact that food packaging has become much clearer about allergen information. I like the fact that there is a general awareness which has been raised in the public's eye regarding allergies.
However, I do agree that some of this seems like hysteria. It is probably driven by fear of getting sued as well. Just think what would happen if one child ate a cookie with nuts in it when the school had been informed about his/her allergy, and that child ended up dying? You can see why extreme measures are being taken.
As for my son, we have to carry an epinephrine pen everywhere we go. We have to check all the food he eats. There is a sign hanging outside his preschool classroom which reads, "There is a child with tree nut allergies in this class".
All of this came about because an allergist told us that he is allergic to tree nuts, and that he could die within 30 minutes if he ate them. And we had no choice but to believe him. We still wonder if it's true...
We should turn over nut allergy enforcement to the government agency with the most experience in this area.
"epidemic hysteria" is the only reason that the TSA exists, so they're the best qualified.
I'm not sure how this is supposed to lead to mass psychogenic illness when most everyone knows for sure that they are *not* allergic to peanuts. The only way I could see a peanut allergy triggering a mass hysteria is if someone with an allergy accidentally ingests peanut protein without realizing it, allowing everyone around them to come up with some other explanation that might affect them to.
Also, from the story:
"However, a recent study has suggested that early exposure to peanuts actually reduces, rather than increases the risk of allergy.
Mr Collard said this might well change the current advice to avoid eating nuts for the first years of life."
Studies have been showing this for some years now (along with similar results for other allergens, like pet dander), and I was under the impression that the advice (at least in the US) was already changing.
@will:"It is probably driven by fear of getting sued as well", I do agree there - the threat of litigation seems to eclipse any sense of sanity in the situation.
Definitly, early exposure to a wide spectrum of bacteria also seems to be correlated with a big reduction in allergies. Also the wide-spread use of anti-biotics seems to increase the risk of allergies (or intollerancies). However once a hypersensitivity has been established, it can be somewhat tricky to eliminate (there are some immunological desensitisation treatments available with varying success rates).
I just heard this story on NPR:
"We came across cans of olive oil that were for sale in Connecticut that had, after testing, these other oils in there — peanut oil, soy oil, hazelnut oil," Farrell says.
So on to my questions:
1. Has there been any documented case of a serious (life-threatening) allergic reaction to airborne nut exposure?
2. Has there been any report of a serious reaction to contaminated olive oil?
Accurate food labeling is one thing and should indicate every ingredient (and perhaps possible contaminants e.g. the "processed in a facility that also produces..." warning)
Banning foods from areas (school, airplane, whatever) prophylactically without any evidence of a threat is what makes this resemble hysteria.
I am not surprised. The US has cultivated fear as a major cultural feature in the last decade or so. Fear is still the mind-killer. These hysterics are just the tip of the ice-berg.
This trend needs to be reversed. Nobody wants a nation of paranoid cowards with nuclear weapons on their planet.
Incidentlially, for the case at hand, people with allergies need to learn to be careful. The best learning age is childhood. Protect them too much and they will have a good chance of seriously harming themselves once the protection is lifted. Same as with life's other dangers.
Overprotection harms and, IMO, is basically child abuse as you rob them of the chance to learn how to protect themselves when they can do it best. I am sure somebody will disagree and tell me this could harm a child. Sure, it could and it will. But overprotection will actually cause much, much more harm. Protect them from knifes and they will likely cut themselves once they get to handle one. Protect them from traffic, and they have a good chance to get run over, since they did not develop the right reflexes. Protect them from sex and they will get pregnant/cause pregnancies when they start doing it. And so on.
I am severly allergic to processed Jalapeno Peppers (the oil concentrates) or products that use Jalapeno Oil as a flavor/heat agent. I am also allergic to Sulfites. I haven't ever asked a school, restaurant, airline, winery, institution etc to adjust their menus or procedures to suit me. I have learned what might and might not contain such ingredients and avoid them. I also travel with medication for emergencies. I do not understand this truly weird public fear of nuts, or nut pieces.
One reason that schools and day-care centers are so vigilant, in addition to litigation paranoia, is that infants, toddlers and young children make Murphy look Paul Wolfowitz cheerleading on Iraq. Older kids share food. Younger kids get food on their hands and smear it on every available surface. Other younger kids don't wash their hands before eating. Infants and toddlers put everything they can reach in their mouths, and swallow whatever won't stick in their throats.
I'm not sure what simple measures, other than exclusion, could be safely followed in such venues.
@Gweihir, I agree in principal to your ideas of overprotection. I let my kids play with fire (with supervision), own a pocket knife, climb trees, etc., since I believe that experience is the best teacher. My problem is that I can't predict what reaction my son would have to exposure. We've taught him to be self sufficient in reading labels, avoiding contact, and asking about ingredients, but I have no idea what would happen if someone were to smear peanut butter on his forehead, and I don't think I want to find out: http://wenatcheeworld.com/apps/pbcs.dll/article?...
An EpiPen is not a panacea; it simply buys you time to get to an emergency room. I feel it is my duty to be an advocate for my kid and educate as many people as possible. The Food Allergy and Anaphylaxis Network ( http://www.foodallergy.org ) provides resources to help educate people about food allergies.
As a father to a kid with food allergies, I think that the current reaction to peanuts and other food allergens is still a little lacking. I don't want to ban every allergen there is; but I think a wider awareness of how serious anaphylaxis is would go a long way to keeping my kid alive.
OK the story and the comments have confused me.
If I DO or DO NOT eat nuts then the terrorists have won.
Which is it?
The peanut oil wouldn't make a blind bit of difference - the extraction process for the oil uses high heat levels and denatures the proteins... ironic, huh?
As far as I know soy on the other hand is slightly different, the lecithins can cause allergic reactions and are not dennatured by heat (I am open to corrections on this one).
The point of "May contain traces of nuts" on a nuts packet is that those nuts may be different nuts from the ones in the packet. E.g. I know someone who is not allergic to cashew nuts, but is very very alergic to other nuts.
This is normal because nut companies tend to have more than one product and cross contamination from one product to the other via the packing machinery is common and accepted.
Which just goes to show why nut security is much harder to crack than you would think.
Surely Nicolas Christakis has more important things to study than those that do not pose a serious threat.
Has kids having allergic reactions to nuts actually been a big problem in schools? When I was in elementary school in the past 15 years, the kids that had food allergies knew enough to not eat what they were allergic to. If asked if they'd like a particular food they were allergic to they'd simply say "No thanks, I'm allergic to _________." Have parents gotten so good at keeping their children from encountering harmful things by writ that they no longer feel the need to teach their children to have enough sense to avoid harm on their own? (I recognize that younger children need more protection, but surely a 6 year old should have enough sense to say, "I can't eat that.")
Davi: Surely Nicolas Christakis has more important things to study than those that do not pose a serious threat.
I guess you've never heard of the little concept of "opportunity costs", have you, young Davi?
Bruce & Nicolas: your cases are now proven by the response on this thread. We have people claiming such things as because they show allergic symptoms when nuts are being cooked, ergo they are actually having an allergic reaction to airborne peanut protein; the proper response to many of your commenters is "Science, you're doing it wrong!"
I would add that most of what passes as our culture (and others as well) could be thrown under the rubric of MPI -- when we lack awareness of the extent to which our reality is simply a poetic extension of ourselves, as opposed to the scientific, empirical, externally and globally verifiable reality, we have a mass mental illness.
I am fatally allergic to walnuts and on more than one occasion I have asked those who made a dish (eg: in a well respected Chicago steak house) 'Does this have nuts in it?' and had the reply 'No', only to discover it DOES have nuts and I could have died if I had eaten it (actually I ended up in a coma after one of these moments so forgive me if I take this whole topic rather seriously). Banning nut products in schools is a small price to pay for a child's life, but children must also be educated to manage their own condition as they can never wholly trust anything packaging states or individuals say.
I have not yet seen any comments on the larger public health issues related to nut consumption (particularly peanut consumption). Nuts are an excellent source of non-animal protein. Compared to animal protein, they are far lower in saturated fats and far higher in omega-3 fatty acids. Plus, because they are typically eaten raw, they avoid many of the carcinogenic byproducts created from charred proteins.
If Americans ate nuts more frequently, substituting them for animal fats and proteins in their diets, I am sure that we would see a noticeable decrease in heart disease and cancer rates, probably far in excess of the 150 annual death from nut allergies.
One could easily underestimate the role that allergists themselves play in this hysteria. As one of the few medical specialties in the U.S. the pay of which is actually increasing, one wonders, how are they doing it? Why is the compensation of allergists immune to the ravages of managed care? It occurs to me that they might be tempted to stimulate demand for their services a bit, by finding allergies where none exist, and advising parents to be vigilant in combating allergens, wherever they may be found. After all, who would argue with an expert, where "the children" are concerned?
Why does it always come back to climatology with me?
Anyone with a food allergy must learn how to cope with it. The coping skills needed depend in part on the food and the type and strength of the reaction. But no matter what, in the course of your life, you'll encounter foods you're allergic to and need to know what to do.
My allergy (dairy) doesn't have immediate danger effects like some peanut allergies, but I know that if I eat the wrong thing I'll feel bad. I know that if I eat it on a regular basis, my quality of life will suffer. I know the costs of my allergy and can make decisions about it: does the risk of eating the potluck dessert someone brought outweigh what will happen later? Kids with allergies absolutely need to understand how to deal with that situation. They need to learn how to ask people what's in food and they need to learn the self-restraint necessary to not eat food their friends offer them.
Unless the only food available is steak and apples or something, you can't create an environment free of all possible allergens. If a kid in an elementary school class is deathly allergic to peanuts, it make that class a peanut-free zone. Teachers should communicate with all parents for that class to make sure any snack food is safe and so forth. If a kid is mildly allergic to peanuts, milk, shrimp, corn, or air fresheners the teachers should be aware of the fact and adjust the environment as necessary and treat any encounters with the allergen as a learning experience.
@DC: Allergy awareness doesn't really benefit major food packagers. Buying food for allergic people means (a) lots of produce and other single-ingredient foods and (b) packaged foods with few ingredients. I'm very glad the U.S. has strong labeling requirements because I know just how many brands of cookies and crackers I can't buy. Fruit is a much easier snack to manage.
I'm allergic to lettuce. I have gotten increasingly sensitive over the years and now can't even eat an ordinary sandwich with lettuce. Lettuce must be removed from everything!! This should be no real hardship or difficulty since there is basically no nutritive value in lettuce.
I am also contact allergic to several dyes - most notably those used on blue denim. Denim should no longer be dyed blue!! , "natural" denim will be better for the environment anyway.
Let's also not underestimate the willingness of some people to sue for things they know good and well are their own fault and their own responsibility. There are big bucks to be made by it, and if they win, others may step forward for free money as well.
Most people aren't like that, but the handful that are can be quite expensive.
I recently read an article (http://www.babycenter.com/204_nut-bans-in-schools-may-be-causing-hysteria_10304110.bc) about how nut bans in schools may be leading to hysteria among students and parents. The perfect example: one Boston-area school district evacuated a bus full of 10-year-olds because a peanut was found on the floor of the bus.
No word on whether or not the bomb squad was called in to defuse the peanut.
i'm perfectly willing to agree not to offer your child peanut products. i am not willing to sacrifice my liberty to eat peanuts on the remote chance that a peanut molecule might fly through the air and land on your child. if you're that concerned, perhaps you should keep your child off the plane, because my liberty trumps your victimology.
I think you might have learned the wrong thing out of your experimental life lessons.
While I can certainly sympathize with your plight as an extreme allergy sufferer, the story that you offer actually demonstrates rather lucidly that certain types of health hazards cannot be mitigated by relying upon the community. Certain types of material (a particular food, in this case) are so commonly non-hazardous that it is simply not reasonable to assume that the general population will be diligent enough to provide you with a default state of reasonable security.
"Raising awareness" is a suitable campaign for mitigating a risk if and only if you can both (a) raise awareness through the campaign *and* (b) have that awareness remain at a suitable level in perpetuity.
The incidence of most food allergies is simply not high enough to keep awareness levels at an acceptable minimum without very high and (as argued in the link) therefore unreasonable cost.
In fact, in your particular case, the campaign to raise awareness of peanut allergy might be what caused your server to answer "no" to your question. I can easily imagine that your server was aware of peanut allergies, and thus mentally mapped your question, "Does this have nuts in it?" to "I'm allergic to peanuts, do I need to worry if I eat this?" People contextualize communication naturally; sometimes the question that you're asking is literally not the one that they hear.
Pat is right - if you have a specific nut allergy, you should not ask if a dish has nuts in it, but ask if the dish has the particular nut you are allergic to. Walnut allergies are much rarer than peanut allergies, and you really should always be specific. Peanut allergies are overblown, but because of it, that is the one nut allergy which is widely known. Since I'm allergic to cow's milk and many products of it, I always ask about whether something has cow's milk or products made from cow's milk. I don't expect anyone else to do this for me i.e. make their restaurant cow-free. We should take responsibility for ourselves as much as possible, and at as young an age as possible.
>> At an industrial facility:
>> NO VEHICLES THIS ENTRANCE
Several reasons for this. One might be that it's a dedicated entrance for trucks, service vehicles, power equipment, etc. Another (more likely) is that it must be maintained as an entrance for fire access, but has no facilities (or parking?) to receive visitors, guests, etc. A third might be to distinguish "vehicles" from "pedestrians."
>> At an apartment complex:
>> RESIDENTS AND GUESTS WELCOME
>> NO TRESPASSING
This is utterly normal. A trespasser is a person who has no lawful business to be present, who has been asked to leave and then fails to do so.
Public Service Announcement: there are several "Andrews" who post comments to Bruce's blog. All of us seem pretty smart ;)
Many people have allergies and have experienced allergic reactions. Most people have a friend or coworker who has had an allergic reaction.
Far fewer people in the OECD have experienced terrorist attacks, or have a coworker or friend who has experienced terrorist attacks.
You go with what you know.
Oh, I do know that far more 'extra' people die of heart attacks and other causes during an influenza epidemic than would be statistically expected. I don't know how many extra people die during hay fever season. That would give us a baseline on hidden allergy deaths.
Is prevention of terrorism or exposure to allergens cost effective? Probably not. Which is the thrust of the posting.
Why is this a big deal? Removing peanuts harms no one, but having them around could, isn't is just common courtesy to remove the peanuts? My children have had several classmates with nut allergies over the years, some with very severe allergies. It has cost us nothing to avoid sending peanuts or peanut butter to school with them, we also don't serve anything with nuts when we have them in our home. When we can do something that helps others at no cost to ourselves, why wouldn't we?
pcjohnson, there are people who are allergic to wheat, milk, beef, chicken, spices, fruits, vegetables, pork, . . .
So perhaps you should avoid sending anything resembling food with your children.
And sometimes, people are allergic to other people.
Lots of people have lots of allergies, we cannot accommodate every one. And senseless overreaction is not useful. But when we have kids with allergies that could kill them, and we can easily mitigate the risk why not?
Severe nut allergies are really pretty common. If I can prevent one kid at my kid's school from having to have an epi-pen injection and a trip to the hospital to save their life why wouldn't I??
Wow. Something like 7 to 10 people are attacked by sharks every year, if this compares to the number of people affected by peanut allergies, then we should close all salt-water beaches. What is the actual number of peanut-related deaths in the U.S every year?
And no, it is not just a minor inconvenience to remove peanuts from school cafeterias when a peanut butter sandwich provides an inexpensive high protein lunch for a child.
Better-off addressing this outspoken nut-job parents who over-exaggerate the allergies of their children since these parents lack the sense of adjusting themselves to the world preferring that the world be adjusted to suit them.
If your kid's best friend, who sits next to him at lunch every day, is very allergic to peanuts, then it's a good idea not to give your kid peanut butter sandwiches.
But if some random kid in the same school is allergic, do you know all the allergies of any of the kids? Why cater to some and not all?
I am severely allergic to peanuts.
Being a teen ( in the 1970ies), it only affected me during during school parties when peanut flips were
trampled upon on the floor, created dust, which I inhaled, and got a medium asthma attack.
This was not really life threatening, but made me feel
very very uncomfortable for the rest of the night.
(At the time, antiasthmatic medication for inhalation was not popular or well known to the medical professionals here in germany.)
Later on, I was some kind of aware that peanuts were potentially deadly for me, but did not give that much thought.
In my late twenties, I had a rather close encounter with death because of that allergy.
I stayed in a south east asian country for a while,
and by accident, I ingested a large amount of peanuts without realizing it; the meal was hotly spiced and deeply fried. Nothing happened right after it. After an hour, I had a heavy asthma attack and was suddenly unable to breathe anymore.
This came on so fast, that I was unable to realize what was going on, actually. I had only one thought:
get out of the room, get out of the house, get to the street, where other people might help me.
Which I managed to do, and people on the street were able to stop an emergency car, which took me to a hospital which was only a few hundred meters away. (At this stage I collapsed, blue in the face, unable to breathe anymore. I had only less than a few minutes before becoming permanently brain damaged or killed)(The quick response of the bystanders saved my life; i am aware that something like this is unlikely to happen in most of the western metropoles.)
I omit a description of my near death experience after my consciousness was gone, this is a topic on its own (actually, I like to share this story with everyone who wants to hear it.)
I was unconscious for more than six hours and in intensive care (for which I paid around $30, mostly for oxygen, afterwards). I learned later, that most people die of the therapy, in heart attacks, this involves heavy doses of adrenaline and cortisone.
Somehow I made it.
I have to make sure to never ingest peanuts anymore. I see that even exposure to airborne peanut proteins might be harmful. On the other hand, I know that e.g. products based on on peanut oil are harmless, since they dont't contain the proteins. (When I can look throught it, i.e. it is not milky, it is safe.)
What I really appreciate, is consistent labeling to enable me to take precautions and, in addition, a ban on peanuts (and other obvious allergens, for others) in crowded and enclosed places like aircraft, busses, ships, etc.
raj - I wouldn't want my seven year old swimming with sharks, or yours either. Little kids do silly things, so if it is easy just remove the risk.
Seth - if another child in my community that attends the same school as my son had a severe, life threatening allergy to some food product that I could easily not send to school, I would not send it. Again why wouldn't I do a little thing to prevent a big problem for someone else, why wouldn't you?
Aren't nuts relatively healthy to eat? Is it not reasonable to suppose that if nuts are not allowed then children might end up eating less healthy food as a substitute? If so, how many lives are being lost due to these nut bans?
I developed an allergy to peanuts 12 years ago, after college. I don't have the full blown reaction, but I do get extremely sick for 24 hours. Do I worry about my allergy getting worse - and become paranoid? No. I am careful, but I still eat something I thought was safe at a restaurant and it makes me sick (not a good thing during business trips). One day I may die, if my reaction gets worse, because I don't carry an epi-pen. But that's my problem.
Grade schools are a little different. For anyone who has kids - what would you do if you got a call from your school saying your child would not be coming home - ever, because they died at school over something that could have been prevented. There is a level of trust with sending your kid to school, and they have to maintain that trust. The kids can't be responsible for themselves. Once out of grade school, that person better be able to deal with it, because like me, even the best precautions and I still end up consuming peanuts (or peanut oil) and have to deal with it.
The recent case in Colorado Springs where my coworker's kid died because of a peanut reaction from a snack brought by another kid - is enough for me, a father of 3, to understand.
One reason the "warning contains nuts" tag is on many obviously nut-containing things is that non-fluent English speakers may not know all the English names of various nuts, but could recognize "contain nuts." At least that's what we were told when we laughed at "Cashew Chicken - Contains Nuts" in our college cafeteria.
@Mosspiglet: My wife has a similar allergy to a protein found in scallops. It's not a generic seafood allergy like a lot of folks have; it's entirely specific to scallops. And if she ingests as little as one molecule of this protein, she goes into anaphylactic shock.
The last time this happened to her, she ordered some stuffed mushrooms, and asked if they had any scallops. "Oh, no," said the server. Well, somebody had moistened the stuffing by sprinkling a little water from a scallop-boiling pot, and off my wife went in the ambulance.
But that was over twenty years ago. We don't avoid seafood restaurants at all - we love them! But we're very pointed about asking about scallops. And if we get what seems to be a glib answer from a server, my wife or I look the server in the eye and say, "If you are wrong, my wife will be be going out of here on a gurney." That usually elicits a trip by the server back to the kitchen to talk with the chef, and very careful meal preparation.
She also avoids anything that may have hidden scallops, like seafood soups in restaurants that might be pre-prepared elsewhere. And I never eat scallops unless I'm on a business trip and won't see her for a few days; I like her to swoon when I kiss her, but not that way.
So it is possible to cope with that level of food allergy; you just have to be both very careful and very assertive. And fortunately, my wife has to *eat* the scallops; just being in the vicinity is not a problem.
Speaking of which, I wonder... are there really people, especially kids, for whom peanuts are like Kryptonite, and a few molecules wafting through the air will cause them to keel over and die?
When I was in school in the 60s, I remember a few kids with allergies to chocolate and milk so on, and it just wasn't a big deal - we ate our stuff, and they ate something else. Are such allergies now more prevalent? Are they more severe? If not, were people ignorant back then, or are people overreacting now?
It may surprise the nut nuts, but there are people with serious allergies to things other than nuts. It really is a question of "where do you stop?" We can't possibly have a reasonable public life by eliminating everything that might harm someone, no matter how exotic their condition.
I think everyone has the right to know what's in the food they're served. But the focus should not be on a big warning label reading "MAY CONTAIN NUTS", but on accurate and informative ingredient lists. "Natural flavors", "Vegetable oils" and so forth are probably not enouh: require specific ingredient lists. That way whatever your dietary requirements and for whatever reason, you can read it and decide for yourself. If you aren't satisfied with the answers of a home cook or restaurant about what is in their dish, don't eat it.
It seems strange to me that a tiny minority of people with nut allergies can dictate the behavior of a whole school, while people with serious shellfish, wheat or dairy allergies are left high and dry. The fact is that if you have an unusual allergy it's your responsibility to do what's necessary to avoid contact, not others'.
If you have such an exotically dangerous allergy that you can't even be near a peanut, such as when another child is eating their PB&J, then the world of public life is not for you. I don't agree that a child in a school class with a peanut allergy should mean peanuts are banned, any more than if they have a shellfish allergy I should not be able to give my kid shrimp salad for lunch, or if they have a wheat allergy I should have to give him meals with rice bread. If you think you can't trust your child not to eat other people's food because it might be dangerous to him, then you need to keep him at home.
The "protect us from everything" over reaction reached new heights of idiocy a few years ago in Vancouver BC, where one woman started a campaign to ban certain common flowers in gardens because her daughter had severe hay-fever reactions. She was quite defensive when someone suggested she teach her daughter to stay away from these flowers instead...
I agree that some line has to be drawn.
There are several kinds of allergies, which affect more than one percent of the population in a given country.
So, specific warnings should be given on labels with respect to the most prevalent conditions, maybe even using standardized icons which are easy to recognize.
The most effective measure however would be a combination of health education (in schools) and
consequent, detailed labeling of foods (and maybe other products, such as cosmetics, clothing, etc).
"May contain traces of nuts" is certainly not detailed enough.
I am not a parent nor did I have a severe food allergy growing up. I'm lactose intolerant, but that requires me to ingest milk and then I get sick. Sometimes, I drink milk anyway, because I like it. I still get sick, but that's on me.
For the folks saying that "banning peanuts from all schools everywhere is a small price to pay to save just one child", consider this.
Being arbitrarily selected or completely denied access to your plane because your first or last name appears on a list that you can't see is a small price to pay.
Showing the back of your belt before you are allowed to fly is a small price to pay.
Taking your belt all the way off and sending it through the X-Ray before you are allowed to fly is a small price to pay.
Removing your shoes and sending them through X-Ray before you are allowed to fly is a small price to pay.
Banning liquids above certain amounts and making you throw them away before you are allowed to fly is a small price to pay.
Submitting to full body T-Ray scans which will show the screeners your naked body underneath your clothes before you are allowed to fly is a small price to pay.
All because 1 person out of millions might be planning to do something bad at 1 location out of thousands.
Is it uniquely American the attitude that to smaller the potential number of victims, the greater the level of response must be?
Offend an entire religion (You can't say Merry Christmas, that's intolerant!) and that's cool. But have an issue with a single person (Ouch! This coffee was hot. I need $70k now) and the entire legal system jumps in to rescue them.
20,000 kids a year diagnosed with life threatening, lifestyle altering diabetes? That's way too many to get worked up over. That'd be like work, or something.
A few kids might be allergic to something that could kill them within an hour? Do we have to actually do work? No? We can just tell other places to handle it or they will be sued? Awesome!
For some perspective: over one thousand children die each year in auto accidents in the US. Shall we ban cars?
I thought the point of sending my kids to school was to educate them, not feed them. Why does managing food brought into schools elicit such an argument? We aren't talking about banning items from the face of the earth? And any other extreme allergies that cause near instance death, should also be properly managed. Having mild discomfort, or even getting sick for 24 hours is not the same as dying.
Perhaps the right way to handle it is to educate the teachers on how to handle a reaction and make sure there is help available on a moment's notice. The Colorado Springs kid died within minutes - the parents didn't even know the kid was allergic to peanuts, and the folks at the school didn't recognize that the kid was in anaphylactic shock until they died. Heaven forbid, but your kid could be next... I loved to eat everything with peanuts in them until I became allergic out of the blue one day. It happens.
We're all security folks, right?? Risk Management 101... you can't eliminate risk, but you can manage it to an acceptable level. I don't think my 4 year old understands RM yet, so the people that are responsible for her when at school should. We need to separate allergens into different risk categories and manage them properly. Those that are proved to cause near instant death and those that don't. Washing your hands before you can come into a school does not reduce risk, because if you really are airborne allergic, there could be a drip of peanut butter on my kid's clothes when they ate breakfast. Whoever is setting up these policies needs a course in RM, because they are trying to reduce the risk to zero, not managing it.
> For anyone who has kids - what would you do if
> you got a call from your school saying your child
> would not be coming home - ever, because they
> died at school over something that could have
> been prevented.
I have kids. This is an entirely (and dishonestly) manufactured statement, as there is no real converse.
I will bet any sum of money you wish to call as the stakes right now that should it come to pass that my child dies at school, I will be able to quite easily characterize that death as something that could have been prevented.
Earthquake causes a ceiling tile to fall on Jack's head? That could have been prevented by a retrofit. Brand-new transformer explodes and kills Hannah? That could have been prevented with proper quality control at the factory. Building is hit by a meteor? If the Near-Earth observation project had "sufficient funding" for the last half-decade, it would have been foreseeable.
About the only things I can actually imagine as being utterly random and unpreventable are large scale events for which there is no predictive technology and no mitigation available. Giant unpredictable solar flare kills everyone on Earth? Okay... *that* was not preventable. Undiscovered supervolcano erupts and wipes out all life on earth bigger than a breadbox? Okay... *that* was not preventable. Gamma ray burst bathes our solar system in a 24,000 light year finger of God? Okay... got me on that one, too.
Everything aside from global destruction is preventable. It's a matter of what I can practically presume we ought to try and prevent.
This is obviously an emotional topic, so please be sure to keep comments respectful. For the most part they have been; thank you all for that.
@kangaroo:'We have people claiming such things as because they show allergic symptoms when nuts are being cooked, ergo they are actually having an allergic reaction to airborne peanut protein; the proper response to many of your commenters is "Science, you're doing it wrong!"'
That last part was a cracker... "science, you're doing it wrong"... where did you study out of interest? From what I can remember one of the main thrusts of empirical method was that of repeatability. This response is repeatable, if I enter the same room where something with peanuts are being cooked I'll have watery eyes, itchy nose, sneezing, etc, etc. This doesn't happen with other foods, and it dissipates a few hours after exposure.
I've also witnessed a lot of other people with allergies to cat dander start sneezing within minutes of entering a house with a cat. So it stands to reason that allergens can become airbourne, either in a similar manner to dust or in airbourne water droplets - which is co-incidently the same vector that a lot of infectious viruses use (I'll assume that you accept the common cold is indeed both infectious and contagious). If you have a reasoned argument as to why this cannot be possible I'd love to hear it.
If as you seem to be suggesting that it is not an allergic reaction, are you telling me that you think its a somatic reaction? I trust you'll be quite careful in your answer.
@another bruce:" if you're that concerned, perhaps you should keep your child off the plane, because my liberty trumps your victimology"
I don't recollect saying I had a child, did you read my posts fully? To me, peanut allergy is nowhere near life threatening but to a not insignificant proportion of the population it is. That is their liberty to be able to board a plane without the risk of someone killing them for want of a trivial snack. Their liberty trumps your short term food preference.
@Michael Ash:"For some perspective: over one thousand children die each year in auto accidents in the US. Shall we ban cars?"
The number of deaths in road traffic accidents warrents the very large expenditure of government on road safety. Be that in improved testing, regulation, safety campaigns, clamping down on drink/drug driving, road side stops to check cars are safe, and all the other inititives that are undertaken to reduce the death toll. You've really just proven the point I'd initially made - it costs a lot of money to reduce deaths on the road, but its worth it. It doesn't cost a lot to say don't bring peanuts on a plane or into a school because a fair number of people are hypersensitive. In cost/benefit analysis I bet the road traffic costs would actually come out more expensive per death or serious incident avoided.
There has also been an argument that peanuts should not be a special case and where do you draw the line. Well, to the best of my knowledge (correct me if I'm wrong here), there is a small number of allergens to which most people with severe hypersensitivities will react to - so it is not an all-encompassing list.
There is a severe shortage of evidence in this argument which I am also guitly of. I'm guessing a lot of the issues here can be removed with a few references so I'll look out some over the weekend.
Getting back to the original topic. I don't think Professor Christakis' suggestion that it is a manifestation of a 'mass psychogenic illness' is a responsible statement at all, and his motivation for the statement has not been questioned - cui bono?
Yes, road deaths warrant a lot of money for safety measures. But you'll note that the safety measures being undertaken do not interfere with the fundamental functioning of the highway system. I'm all for taking measures to make things safer for people with nut allergies. But wholesale bans of the stuff is simply taking things too far. I can drive my car right in front of my local elementary school, 100% legally. This is because, in the realm of highway transportation, we've come to accept safety measures other than "ban it!" We should try to apply this to other areas of our lives as well.
Will TSA ban all nuts on airlines?
The people who keep equating nut allergies with auto accidents and terrorism are making a fundamental mistake. We all suffer costs of extra screening to stop terrorist attacks and we all receive the same (presumed) benefit of additional safety. The same is true for car accidents.
But it is different for kids with peanut allergies. People who like their PB&J sandwiches get to reap the benefits (eating their sandwiches) and, in effect, externalize the cost of those sandwiches to bystanders (the kids with the allergies). That's not fair. How about this: you can bring your peanuts, or whatever to school, the plane or where ever. But you agree in advance to shoulder all medical bills if my child goes into anaphylactic shock and also to pay the airline the cost of re-routing the plane that we are both on because the kid needs immediate medical attention. And the cost of my plane tickets the next morning to get where I was going. And the tickets for the other passengers. Emotion distress, I bear for free. Deal?
i have the liberty to eat whatever i want, and you have the liberty to stay off the plane. i don't tell other people what to eat, and i don't tolerate other people, particularly total strangers, telling me what to eat. i'm willing to defend my liberty to eat whatever i want with as much force as it takes for me to prevail.
Your concept of externalities is deeply twisted. The cost of my PB&J sandwich does not get "externalized" because I'm near somebody with an allergy. That cost should rightfully be assigned to the *allergy*, not to the sandwich. Thus a kid with a nut allergy who gets nuts banned from his entire school is externalizing the cost of his allergy onto everybody who visits that school. How's that for unfair? Now, it may very well be reasonable and the community should be willing to bear some additional costs to help somebody who's disabled. But let's not go off talking about other people being unfair.
As a parent it is ultimately your responsibility to teach your child well and keep him from doing things to himself that could threaten his life. If other people in the community are willing to help you with that mission then that's wonderful, and you should count yourself lucky. But goodness, don't get into this bizarre position where you somehow think you deserve all the help and assistance in the world as a substitute for doing your job as a parent!
Like many other readers and responders to Bruce's list, I have to manage my own diet and tiptoe through life avoiding allergens that cause mild (very unpleasant for me and people around me) to severe (life threatening) responses in me.
Nuts are one of the few classes of foods I can safely eat.
Since it is routine to train dogs to not accept food from strangers - surely you could train your children? Or are you arguing that your children are not as trainable as dogs?
Remember, if the world is altered to suit people like me, you will only be able to buy nuts. (I'll spare you the list of foods that I need to avoid, it's depressing enough for me to keep track of...)
As to why these allergies are seemingly more common? I'd add a couple of things to the list:
1. In earlier times, I (or others like me) would have died within a few months of my birth. Like many people in the Western world, I'm only alive because of the investment in medical research and education.
2. Reporting makes small things seem much bigger. I'm in Australia, and hearing tales of children nearly dying in America is routine these days. I would imagine that news would have travelled much less in earlier times.
3. As adults we pay attention to things that were irrelevant to us as children, therefore many things seem to be "on the rise" as we start paying attention. This is probably another form of confirmation bias.
@another bruce:"i don't tell other people what to eat, and i don't tolerate other people, particularly total strangers, telling me what to eat. i'm willing to defend my liberty to eat whatever i want with as much force as it takes for me to prevail"
With as much force as it takes you to prevail, do you not think that is a tad extreme for not being able to eat peanuts on a plane for a few hours? So what is your stance on drink driving, should people that get absolutely leathered then sit behind the wheel be allowed to do so - after all its their 'liberty'? What about somebody randomly taking up residence in your home, its their liberty to sit wherever they want to sit, or would you have a problem with that?
We live in a society, as such we (in general) look after other people's interests a lot of the time. If someone is infirm, we give up a seat on a bus to let them sit; we give money to charity; we use common manners and curtiousy... you get the picture. What we don't usually do is threaten the use of force at the suggestion that it may be hazardous to others to eat peanuts on a plane.
@novaphile:"Since it is routine to train dogs to not accept food from strangers - surely you could train your children? Or are you arguing that your children are not as trainable as dogs?"
You train a dog, you teach a child. It is prudent to teach a child about what foods are likely to cause problems, and as I understand this is generally the case.
The reason peanuts are the 'hot-topic' is because they are a very common culpret. If however in the rarer situation that someone has a severe allergy to other foods, then of course that is not going to be possible to work around in advance. If I was however informed that someone in my workplace for example was in that situation, I would certainly alter my behaviour to accomodate them - wouldn't you?
The scenario you describe where there is a large number of potential allergens is usually described as atopic, and generally not serious unlike your allergies.
Refering to your points:
1) If you had type I hypersensities within a few months of your birth, then that is very rare (given the mechanism that mediates type I hypersensitivities). Did you really have allergies at such a young age?
2) I would argue that reporting does not make things much bigger. Personally, I think improper context and misinformation are generally the culprets.
3) So why did the adults 50 years ago not record the same level of allergy problems as are recorded today? That's removed the variable where you suggest there is bias.
There is a big difference between "we do not allow peanuts in this office because Bob has a severe peanut allergy" and "we do not allow peanuts in this building because there exist people in the world which have a severe peanut allergy". I believe most of the people in this discussion are talking past each other because they are unable to see this distinction. The people who are railing against banned substances are railing against blanket bans with no allergy sufferer to prompt it. The people who are coming out in defense of bans are talking about targeted bans in the case where specific known-allergic people are present. Please make sure that when you refute somebody's point, you refute a point they're actually making!
Comment: The question here isn't really about adults, who both know how to manage their diet and their environment and associations. It's about kids. My kid is allergic to cashew nuts. Managing this is an ongoing challenge. Fortunately she is not severely allergic - though ingestion of several nuts will kill her. Airborne is not a problem (there was a kid in her school who was put into hospital by airborne peanut contamination).
The problem is that kids are not capable of controlling their own diet to the degree required, and even more, they cannot control their environment or the mates in their class who delight in threatening to smear them with peanut butter or whatever. Nor can adults be in constant supervision, nor would I want that. And kids are messy, and food gets everywhere... it's hard enough to get your own kid to take the problem seriously, and impossible to ask other kids who don't have the allergy to understand that this food I can eat is genuinely capable of killing my friend (or my current enemy).
If the current focus on allergies - which is not a hysteria, though possible a little overweighted - only accomplishes creating an environment where other children do properly understand that we really are talking about genuine danger, then I will be happy.
"If as you seem to be suggesting that it is not an allergic reaction, are you telling me that you think its a somatic reaction?"
Have you been tested for peanut allergies? Other allergies?
To be fair we must ban all foods that give people allergies.
Unfortunately I'm allergic to starvation. Its takes over 3 weeks, but i evenly die i tell you.
I have make the assumption no one is allergic to water.
According to this study, http://www.ncbi.nlm.nih.gov/pubmed/10200001 , "Peanut and/or TN allergy affects approximately 1.1% of the general population, or about 3 million Americans, representing a significant health concern."
Read that however you wish.
I am on a school board which in my country is an elected and voluntary position which nevertheless makes me legally responsible for the safety of staff and students.
We have a child in school who doesn't get on with nuts (and plenty of other food products) and has severe reactions. The Bureaucrats in govt have decided he should get funding for a full time teacher aid because it's a life threatening condition.
We have another child who has severe epileptic fits, not often but every now and then. She gets no teacher aid funding.
Then there is the child who has the mental age of a 2 year old and cannot toilet herself. She also gets no teacher aid, because it's not life threatening.
@random:"Have you been tested for peanut allergies? Other allergies?"
Yes, and eh, yes. The peanut allergy has been confirmed by both a IgE RAST test and skin prick test - thankfully it isn't particularly serious. Other allergies, yes, but the number of things I'm actually allergic to is fairly small - although I do have issues with food intolerance which is a completely difference issue.
The reason I don't want to list the others is due to an experience with some folk in the workplace. They'd presented some food to me that they knew had peanuts in it, and they also knew I have an allergy to peanuts. Thankfully, a different collegue warned me.
Again, please be respectful of other commenters. Rude comments are being deleted.
To Moderator: not too sure how to email you so have just posted.
Can you please reply/email me on why my response to "another bruce" was removed - I don't think I was rude or offensive (I've kept a copy of my post). You also had left his comment up until I replied, and his comment was outwardly offensive. Which effectivenly means he had the right to insult me and I had no right of reply.
I've a very terse selection of information from the literature...
- "recent estimates suggest that IgE-mediated food allergies affect 3.5% to 4% of Americans"
- "The prevalence of food hypersensitivities is greatest in the first few years of life, affecting about 6% of infants less than 3 years of age5 and decreasing over the first decade"
- "Recent studies from the United Kingdom and the United States indicate that the prevalence of peanut allergy has doubled in young children during the past decade"
- "The diversity of the human diet is enormous, and yet relatively few foods account for the majority of food allergies around the world. Milk, egg, and peanut account for the vast majority of food-induced allergic reactions in American children, whereas peanut, tree nuts, fish, and shellfish account for most of the food-induced allergic reactions in American adults. The regional dietary habits and methods of food preparation clearly play a role in the prevalence of specific food allergies in various countries around the world."
- "PEANUT ALLERGY ACCOUNTS FOR THE MAJORITY of severe food-related allergic reactions."
- "Food allergies affect between 4% and 8% of children and between 1% and 2% of adults"
- "Eight foods are responsible for more than 90% of food allergies: cow's milk, eggs, soy, wheat, peanuts, tree nuts (walnuts, hazelnuts, almonds, cashews, pecans and pistachios), fish and shellfish."
- "The food allergies most commonly associated with anaphylaxis (those to peanuts, tree nuts, fish and shellfish) are the ones least likely to resolve."
- "The clinical expression of peanut allergy is fairly predictable, and it has a tendency to be severe, although the severity may vary with different episodes of ingestion.5,18,20,21 The first allergic reaction to peanuts develops in most children between 14 and 24 months of age, and the first reaction most commonly occurs at home"
- "In a study designed to determine the minimum dose of peanut protein capable of eliciting an allergic reaction in highly sensitized individuals, subjective symptoms were reported with doses as low as 100 µg, and objective signs were evident at 2 mg"
- "In more than 70% of children with peanut allergy, symptoms develop at their first known exposure."
(note this document is now at least 10 years old, some of the guidance has been superceeded, c.f. http://www.parliament.uk/...
- "Oils extracted from nuts can be defined as 'crude' or 'refined'. The crude oils, also known as “gourmet” oils within industry, are manufactured to retain the flavour of the nut. Such oils may contain sufficient quantities of protein to induce an allergic reaction whereas refined oils, which are neutralised, bleached and deodorised peanut oils, contain no protein detectable by immunoassay,10,11 nor do they possess allergenic activity."
- "It is clear that in peanut sensitive subjects, specific IgE is generated against particular peanut allergens. The range of allergens from peanuts recognized by allergic subjects differs between individuals. Many of these allergens are heat stable and their allergenicity is not diminished by heating or processing. Thus, an allergic response can be elicited following ingestion of either raw or heat-treated peanuts and peanut products."
- "Peanut sensitive individuals can undergo a variety of clinical reactions following exposure by skin, mouth contact, ingestion or inhalation of allergen"
- "Prevalence data on food allergy are limited but prevalence is reported to be in the range of 1-3% for the population"
- "The prevalence of peanut allergy varies among countries and cultures. Since the introduction of the peanut into the USAand countries such as France, peanut allergy has been estimated to be the commonest cause of food allergic reaction."
- "In common with other atopic allergic disease, the available evidence indicates that the prevalence of peanut allergy is increasing. It is of interest to note, that the general increase in atopic disease appears to be linked to the Western lifestyle."
- "For those allergic to peanuts the age of first reaction ranged from 7 to 30 months"
- "Collectively the reports demonstrate the benefits of administering adrenalin immediately after the onset of anaphylaxis. In one report, 97 seven such cases involving 5 males and 2 females aged 11 to 43 years were reported over a sixteen month period. All were atopic and had suffered non-fatal episodes prior to the fatal event. The foods incriminated were peanut (four individuals), pecan (one individual), crab (one individual) and cod (one individual). Importantly, in 6 cases, the adverse event occurred away from home."
- "There are no robust data on the prevalence of peanut allergy since peanuts were introduced into the UK approximately 50 years ago. However, the available evidence indicates that, in common with other atopic disease, the prevalence of peanut allergy is increasing"
- "In the main body of the report reference is made to ‘refined peanut oil’. As explained in Section 4 above this is neutralised bleached deodorised peanut oil which contains no protein detectable by immunoassay and has not produced any reaction in peanut allergic individuals"
So, some of what I've said is somewhat inaccurate but the salient points still stand. Perhaps we could limit our discussion to that at least loosly based on evidence.
Sorry about the timing on that. You posted your reply to his comment right after I deleted it, or at least so close that I didn't see the reply until after. You've been calm in the face of provocation and I appreciate that, but it wouldn't make sense to delete a comment for excessive rudeness and then leave a reply that quotes and responds to it.
Fair enough, thanks :-)
It really depresses me that the bulk of the American public have two speeds:
"Buy" and "Panic".
In my child's school of ~300 students, there are 13 kids with severe peanut allergies spread throughout all grades. I'm not advocating a world-wide ban on peanuts, but surely you can all agree that protecting 4% of the school's population from a potentially deadly threat warrants posting a "This is a nut-free school" sign on the front door.
I recommend "Everyone's Gone Nuts" from the January, 2008, Harper's. It's on the web (URL below). If I'm marketing epi-pens, the hysteria is good for business. The word "severe" is prevalent in the comments. Who says what a severe allergy is? Is there a clinical definition?
FAAN was mentioned above. The Harper's piece is quite critical of FAAN.
A brief excerpt:
"Ken Kochanek, a CDC statistician, says there are far too few recorded incidents of anaphylactic shock triggered by food allergies to draw any sound epidemiological conclusions: 'We can't find any hard data that supports the conclusions'."
Fact: In 2004, 2.4 million Americans died from various causes. Twelve of those deaths are known to have been related to food allergies. Twelve. More than 40,000 died in auto accidents. Do we ban driving? We take precautions. We have forced the manufacturers to make safer cars, we wear seat belts, we drive defensively, &c.
Poisoning, choking, falls, and drowning kill tens of thousands, too. It's a risky world out there. Good luck, and fasten your seat belt.
That's not fair. How about this: you can bring your peanuts, or whatever to school, the plane or where ever. But you agree in advance to shoulder all medical bills if my child goes into anaphylactic shock
First: Life's not fair.
Second: I asked earlier. Has there been a reported case of someone having a life-threatening reaction to airborne nuts
RE: Science, you're doing it wrong.
No one disputes that allergens can be airborne. In your initial comment you suggested that you have a reaction to something other than the nut protein. Since an allergic reaction is an immune system reaction, and since the immune system reacts to proteins this seems, on its face, to be incorrect. Secondly, without isolating the ingredients and investigating your physical responses, there seems to be no evidence that you are having an allergic reaction to airborne peanuts. (Not all skin reactions are allergic reactions) No one is disputing that you have had some sort of reaction while in a room in which peanuts were being cooked, what is being disputed is whether you can draw any meaningful conclusions from that fact.
The real issue is an emotional one.
Nobody wants to be the guy telling a parent that their child died when X could have been done to stop it.
X is anything and everything that could have prevented a misfortune, also known as "hindsight."
If only I hadn't been smoking while pregnant, she wouldn't have chronic bronchitis.
If only I had told her about sexually transmitted diseases, she wouldn't have AIDS.
If only I had been a better example, he wouldn't be binge drinking every weekend.
If only the landlord hadn't required me to sign that lead paint waiver, she wouldn't have died from eating paint chips.
If only the swimming pool had a life guard on staff, he would not have drowned.
If only auto manufacturers forced drivers and passengers to wear their seat belts, that accident would not have been fatal.
If only the school had banned peanuts, she wouldn't have gone into anaphylactic shock.
When you are emotionally invested in the problem, you cannot think objectively about solutions. Cannot.
I expect any parent reading this forum who has a child with severe food allergies to agree that schools should be doing more to protect their child. That is part of a parent's job, to make sure their child is safe.
If my child had a special need of any kind, I would expect the school to accommodate for it. After all, I pay taxes (or tuition if it is a private school), and a proper education through grade school and high school would be my child's right as a citizen.
Put in a wheel chair ramp and elevators, have braille and audio versions of text books, have kosher meals available, remove offensive mentions of my religion from text books, allow me to celebrate my holidays and display decorations, allow my child to carry Tylenol because he has frequent headaches. "My child is special and the world will acknowledge his (or her) uniqueness and make concessions."
Have metal detectors, on campus police officers, and padlocking emergency exits during school hours increased safety? Has eliminating corporal punishment increased safety? Has the development of nutritionally balanced school lunches helped?
Are our kids safer and healthier?
Foods simply contain too many (useless) ingredients these days, and chefs don't know what it contains. It is difficult to filter out specific ingredients, and restaurants are not obligated to specify their ingredients. Often, they cannot! (I know this because I happen to have an intolerance to some ingredients.)
Then there is the need to eat 'varied' versus 'what works', or other apparent dogma taught in schools although this varies from culture to culture.
What we're discussing is not even a 'nut' allergy.
A peanut is NOT a nut. It is a _type_ of pea. Its prepared in cuisine similar as [other] nuts, but that doesn't change its species. A raw peanut might contain aflatoxins which are very carcinogenic. Which is one of the reasons they're usually not sold raw although humans have some resistance to aflatoxins, and strong species won't contain this in large quantities. Aflatoxins also occur in grains, potatoes, and nuts. The peanut isn't the only widely misregarded ingredient seen as a nut. A cashew isn't a nut either. It is a seed. A tomato, believe it or not, is a fruit. Not a vegetable/legume.
Nuts, for _most_ people, are very healthy. Rich of oils (including good omega-3), protein, and have proven to be effective against diabetes mellitus type 2. Also, rich in anti-oxidants. More specific they each have their own properties of vitamins in which they're rich. To ban them because a vocal minority is allergic to _some_ species of nuts, some of which ARE NOT even nuts, is outragerous.
Instead, I propose parents have the responsibility that kids are allowed to make known those who serve them their allergies, and those who serve them have to serve them in a clean manner without zillions of unnecessary ingredients. This way, you shift the choice of privacy/authentication to the parents while minimizing the risk taken by the cuisine & servants due to hygiene.
@JimFive:"No one disputes that allergens can be airborne."
It was disputed very near the start of the thread, see [kangaroo at December 19, 2008 11:45 AM].
"In your initial comment you suggested that you have a reaction to something other than the nut protein."
No, I didn't (unless you're talking about other allergies). What I said was that I wasn't entire sure *how* the proteins became airborne from cooking as the proteins by themselves are too heavy (my best guess would be in water droplets from the cooking). Also, as already discussed, peanut dust can become airborne but that wasn't the scenario.
"Secondly, without isolating the ingredients and investigating your physical responses, there seems to be no evidence that you are having an allergic reaction to airborne peanuts"
Please read my other posts, I've had an IgE RAST which is an immunological confirmation of a type I hypersensitivity,
@Jason:"The real issue is an emotional one."
I'd admit there is an emotional element, that's why I posted some links with outline figures, etc - to try and rationalise the argument.
"X is anything and everything that could have prevented a misfortune, also known as 'hindsight.'"
This isn't hindsight as we're talking about it *before* it happens, its mitigation of risk. I agree that its not possible to eliminate all possible allergens everywhere, but if there's something standing out that can be easily solved then do it. Take the school situation: children have a higher prevelance of allergies, peanuts causes the most problems in US and UK, its only one food for a short period of time, the risk of cross-contamination is high. So why not remove the risk when its so easy?
"If only I hadn't been smoking while pregnant, she wouldn't have chronic bronchitis."
Well, yes, that is almost certain knowledge beforehand that smoking while pregnant will harm the baby.
"If only I had been a better example, he wouldn't be binge drinking every weekend."
Fair enough, not predictable. It is not however the same as mitigating a known risk.
"If only the swimming pool had a life guard on staff, he would not have drowned."
Again, it is a well accepted risk mitigation that in public swimming pools there should be life guards (or attendents in the UK).
"If only auto manufacturers forced drivers and passengers to wear their seat belts, that accident would not have been fatal."
Yup, people know this as well - there's currently an ad campaign running on TV in the UK about driving safety and seatbelts are one of the things that are covered. We know this beforehand.
"If only the school had banned peanuts, she wouldn't have gone into anaphylactic shock."
Possibly not, a child could have come in with peanut dust on their clothes. At least the chance of that happening is a lot smaller though if peanuts aren't brought into the building.
"and padlocking emergency exits during school hours increased safety?"
That's a really, really stupid thing to do (and as far as I know also illegal). If the door isn't secure, then the school should get a better door, not pad lock it.
"Has eliminating corporal punishment increased safety?"
By definition, yes; you don't have teachers physically assaulting children.
"Are our kids safer and healthier?"
Probably, would you like to present some evidence to the contrary?
@jh:"Foods simply contain too many (useless) ingredients these days, and chefs don't know what it contains"
I'll second that one.
"It is difficult to filter out specific ingredients, and restaurants are not obligated to specify their ingredients."
Yeah, I'd been to a restraunt and specifically asked if a dish had an ingredient in it, to which I was told, "no". To my own discredit, I though it smelt of that ingredient and ate a bit anyway. Spent the next three hours in pain. However, every other time when I've asked if a dish has X, Y or Z in it, I get an accurate response. Not entirely sure what point I was making there, maybe just a moan :-)
"A peanut is NOT a nut. It is a _type_ of pea."
Yeah, I'd said that further up. Technically, its a legume (Fabaceae ).
"Nuts, for _most_ people, are very healthy... o ban them because a vocal minority is allergic to _some_ species of nuts, some of which ARE NOT even nuts, is outragerous."
I would normally agree, but the issue is more complex. There are a lot of people allergic to nuts (i.e. proper classification), although it seems to be half the prevelance of peanut allergy. That could be part of the reason that nuts get lumped in with peanuts in the genral press.
There is also advice (not my own and I haven't verified it, so don't shoot the messenger on this one) that if someone has a peanut allergy then they are more likely to also have a true nut allergy - personally, I'm quite dubious over this one though as it doesn't seem particularly logical.
You really should check your sources before posting this sort of thing.
Here is a valid source. http://www.foodallergy.org/media/HotTopics/...
You are not a medical expert, and should not be posting pop culture articles about medicine unless they're based on and adequately represent peer-reviewed research. You wouldn't do that for computer science and security.
Your article, (although allergies are not your point, hysteria is) since it comes from a usually respected source (you) undermines my work trying to get my coworkers to understand the severity of MY reactions, and what needs to be done to accommodate them. I'm not trying to change the world, just the places I need to be.
Disbelief in food allergies has caused many of my reactions, and has sent me to the hospital on multiple occasions. Please don't add to it.
I'm gonna bring up my food allergies. When I was in grade school I was allergic to wheat, milk and some other pretty fundamental stuff (I outgrew them and cannot recall the whole list now). Pretty severely allergic, so I really could not have any of them at all.
No one CONSIDERED banning all wheat and milk products from the school. And, shockingly, I survived. Teachers were vaguely aware, and prevented me from exchanging stuff, or having birthday cake and so on.
And yes, I was just some dumb kid. Without those minimal precautions I would presumably have become ill by ignoring these guidelines. But extra precautions above that seem extremely un-necessary, and I would be embarassed as the child or the parent to ask everyone else to be inconvenienced.
I have also seen a creeping coddling in other areas. I object to nut banishment because it's only a matter of time before one of these kids who is used to his purported allergy being everyone else's problem comes to work at my office and I have to banish all nuts or talk to my lawyers.
I would not define Bruce's source as being inaccurate nor would I diminish it by calling it a pop culture article about medicine. The BBC article that was linked to accurately reports the details of the editorial written by Dr. Christakis who is a MD by education and a professor of Medical Sociology at Harvard.
A copy of the editorial is linked to from Dr. Christakis's web page at
I would tend to define the foodallergy.org site as being a source of hysteria about nut allergies which does not help your situation by raising unnecessary fears.
The ultimate biological weapon of the 21st century: a bag of peanuts ...
Can you already rob a bank with a handfull of nuts and a slingshot?
What will happen if you unload a sack of peanuts over a well-filled baseball stadium? Mass panic with hundreds of deaths?
I suppose the infamous "dirty bomb" may come in a form you'd never expected ...
What I find really interesting is this article from November: http://www.timesonline.co.uk/tol/life_and_style/...
Basically they look at (not concluded) research that seems to indicate that it is the actual advice to avoid nuts in childhood that may be the cause of nut allergies. (The NHS still says to wait and think...) Quote below:
Scientists have disagreed for some time over the causes of peanut allergy. Since 1998 the Department of Health has advised parents that if there's some allergic history in the family, they should avoid giving any peanuts to infants. Many researchers noted that since that advice lodged in the worrying public's mind, the incidence graph started to climb strikingly.
Now a fascinating piece of research has emerged; the results of a study of more than 8,000 children in Britain and Israel. Israelis are genetically similar to us, but almost all Israeli children eat a peanut paste as their first solid food. And in Israel the incidence of peanut allergy among children is less than two in 1,000. From eight months old the average Israeli child eats 7g of peanut a month. Most British children eat none.
The report, published in last month's Journal of Allergy and Clinical Immunology, concludes: “These findings raise the question of whether early introduction of peanut during infancy, rather than avoidance, will prevent the development of peanut allergy.”
@ David Fraser,
“These findings raise the question of whether early introduction of peanut during infancy, rather than avoidance, will prevent the development of peanut allergy.”
There may be some truth in this.
There is a growing body of evidence that sugests that a lot of alergies are due to deficient immune systems caused by "lack of environmental triggers" in early childhood.
The argument used is that a child starts of with a defficient immune system and partial inherits immunity from the mother through the first three days of breast feeding (which is why it is talked up as much as it is).
From that point forward the childs immune system needs to be trained over the next year by environmental factors.
After this time the argument indicates that the immune system is less able to learn.
Therefor putting children in clean bubles would appear to be detrimental to them. And this has been bourn out with studies about Sweedish Troops -v- British Troops in places like Bosnia.
I guess after another twenty years or so we will be advised differently (remember pregnant women where once encoraged to smoke...).
> Proportion... Compare your 600 dead to road death figures in the same period.
> It's one thing to accomodate people's medical problems, quite another to
> insist that everyone else changes their lifestyle for your benefit.
Yeah, I totally agree. Only 2974 people died in 9/11 -- a mere 0.001% of the US population -- and now all of us have to suffer airport delays, removing belts, shoes, jackets, laptops etc at airports.
Only 15,000 people died of AIDS in US in 2007 -- just 0.005% of the population. Now hospitals and blood banks have all these expensive and cumbersome blood screening and over $8 billion spending per year on AIDS research.
We should institute precautionary measures only after at least 51% of the population has died or been severely affected by a problem.
Calum - YOU ARE A GENIUS!
I have seen a kid get a rash by inhaling peanut oil fumes from Chinese food being cooked in a restaurant. So do not try to be so nonchalant esp., if your kid has nut allergy. Also it makes no difference whether peanut is "a nut" or not. Often people with peanut allergy also react to Walnuts and other nuts - even Apples! So you can classify it was LegumeWalnutFruit allergy or what ever you wish. But again, be careful dismissing the risk when you have a kid who is susceptible.
Poison is generally controlled and those who don’t control it are rightfully subject to liability. Poisons are often useful (e.g. as cleaners) or are byproducts of useful processes (e.g. internal combustion – driving). When the poison is common society decides at a macro level about the risk-benefit tradeoff.
Certain foods are poisonous to some and beneficial to others so a tradeoff needs to happen. What would be most effective in a school setting would be singling children out and using small, specific bans (e.g. a single school). Wider bans will provoke greater resentment and noncompliance while no ban at all would be negligently failing to control against a foreseeable event with a high impact (death) a more than remote probability and a small cost to control.
However, I can understand a school official who would take pains to not single children out or who for liability reasons would implement a blanket ban. I don’t think this would be responsible or correct.
@nutallergydad brought up the concept of externalizing the costs of eating peanuts amongst those with allergies to which there was significant disagreement.
Thought experiment time. There is a substance that causes death to 99% of people and does nothing to anybody else. It would not be too controversial to restrict it. Say the substance though is very tasty to the remaining 1%; the likely response would still be restrictions but maybe with exceptions for the 1%. On the other hand, if it is tasty (or tolerable) to 99.999999% and kills the remainder it would be unreasonable to have more than targeted restrictions.
“In economics, an externality is an impact on any party not directly involved in an economic decision.” – Wikipedia. For those who eat foods which produce airborne allergens that impact the allergic this is absolutely the correct use of the term. For those who restrict allergens the transaction is not economic it is political but the concept is roughly the same – a burden for you to keep others safe (which is why you also need a license to drive).
@another bruce would likely attract criminal liability if he was told that eating peanuts would likely kill the person beside him and he ate peanuts and it ended up killing the person beside him. Would argue that this is unfair?
A frightening / humorous story:
My co-worker Fred has a severe peanut allergy. When dining out, he always asks the server if an item has any nuts.
We were in downtown San Jose, CA, at an Italian restaurant.
He asked the waiter if a dish contains any nuts. Waiter said "No, I don't think so". Fred says, "you don't sound very certain". Waiter mumbles "No".
A few minutes later, a manager stopped by. Fred mentions his allergy again.
Manager says "we've been in business for 60 years and haven't killed anyone yet".
Needless to say, Fred was nonplussed.
As for myself, I'm mildly allergic to a few things, including solid-cooked egg yolk. Many times, I have asked servers if a dish contains eggs, told it doesn't, only to find pieces of eggs throughout the dish. This happens most often at Chinese restaurants, as they like to mix eggs into many dishes, and it varies from restaurant-to-restaurant as to which dishes will contain eggs (e.g. MuShu Pork/Beef/whatever).
I have also at least once accidentally eaten scrambled eggs chopped into cubes which then more resemble tofu than eggs.
Food allergies are nothing to laugh about
A recent column in The Times puts allergy sufferers at risk by laughing off their life-threatening conditions as Yuppie anxiety.
As a parent of a child with a severe peanut and tree nut allergy I feel the need to comment not just on this article which is fairly incorrect but on some of the comments as well. My son is 4 years old and has had well over 25 reactions to nuts. I have watched him turn blue and nearly die after giving him an epi-pen injection. Epi-pens are to help with a reaction but are by no means 100% effective. Not too mention that it is fairly painful when injected. Only a few of my son's allergic reactions have been from actually injesting a product that contained nuts. Despite what most of the commenters on this blog are saying you don't have to injest a nut product to have a reaction. My son has had several reactions from people eating a nut product and touching him or kissing him. My son's allergist says that he has one of the more severe alleriges he has seen in his career. I understand that only 150 food allergy deaths have been recorded a year which may seem like a small number but those 150 people were someone's child, spouse, relative or friend and their deaths should not be treated lightly. I am not generally an overprotective parent but when it comes to my son's life I take that responsibility very seriously and I will do whatever it takes to protect him. I understand that it is difficult to imagine that something as simple as a little nut can cause such an issue and until you deal with it on a daily basis you will never fully understand what people with this allergy go through but please try to be more understanding and respectful to those around you. I think you will live if you have to go through an entire flight without a little bag of nuts or your child has to eat a lunch that does not include a peanut butter sandwich. You can always eat this products at home or in restaurants.
I trust the CDC over FAAN any day of the week. And 12 deaths in a single year is a miniscule number -- many fewer than the number of people who die from spider bites (30-40), from lightning (40-50), or from bee and wasp stings (90-100).
Hey allergydad, do you think that means that farmers are externalizing the costs of using bees for pollination onto allergic people?
All this discussion shows mostly one thing: People directly affected by having an alergic child lose most of their rationality. Interestingly, the alergic children seem to not do so.
Fact is that people, even children, with strong alergic reactions to common things, can expect not a lot of accomodation from society. It is just far, far too expensive. A certain amount of death from non-natural causes is acceptable, as the numbers show, and that is were the car-deaths are relavant. The one difference between an alergy-death and a car-death is that in the car death, the dice on who gets to die is rolled close to the event. With the alergy there is a time delay and a chance to educate the affected ones to avoid risk. Some will still die and that is both rational and necessary. Ever saw people making an unsafe street crossing? Ever saw children doing it? I have.
With this observation, I am sorry to say, but the conclusion is that parants of alergic children have no business making demands on others, because they are not rational in this question, but rather on the extreme egoistic side. There are a number of good suggestions from the people affected in this discussion, things that are both reasonably priced in overall cost and actually can make a difference.
In England we would say 'Bruce is the dogs bollocks' which means 'a good thing(tm)'.
American's don't say bollocks, they say 'nuts'.
So, there we are. :)
This has been your tedious link for the day.
As someone who suffers from a good number of allergies, let me add a few points here:
* The death statistics are mostly irrelevant. You can cause me severe discomfort and massive skin troubles by exposing me to certain allergens. You probably won't be able to kill me.
* Allergens vary a lot. e.g. I'm both allergic to eggs and peanuts. I have no troubles with eggs in my vicinity. I can touch them, I can cook with them, others can eat them on the same table. Peanuts are different. Get them in the same room, and I'll flee.
* So for me the right comparison is smoking: Both can cause distress to others in the same room, thus in cases where the affected person cannot leave (e.g. planes), it should be forbidden.
The point in this is the nut allergies can be life threatening! Dairy, egg, fish, etc are not life threatening!
Look up what anaphalaxis means before you bash those with nut allergies for being too sensitive or too cautious!
@ Bruce / Moderator,
The four posts above are a statistical anomaly in terms of their posting times.
They also read like they've been written by the same person.
Further they were posted at a time of day when you often get link spam etc posted to avoid human moderators etc.
It all feels distinctly odd almost as though somebody is trying blog content with a political or marketing agenda...
Yeah, that was a really odd one. I half expected to find that the comments were lifted from a discussion of nut allergies somewhere else on the Web, and that it was another example of a spammer who failed to include a link -- but if there's a source for the comments, Google doesn't find it. I guess the peanut industry could be trying out astroturf, though if so they need to hire someone more competent. Anyway, whatever it is, it's obvious sockpuppetry, so out it goes.
Schneier.com is a personal website. Opinions expressed are not necessarily those of BT.