A Rational Response to Peanut Allergies and Children

Some parents of children with peanut allergies are not asking their school to ban peanuts. They consider it more important that teachers know which children are likely to have a reaction, and how to deal with it when it happens; i.e., how to use an Epipen.

This is a much more resilient response to the threat. It works even when the peanut ban fails. It works whether the child has an anaphylactic reaction to nuts, fruit, dairy, gluten, or whatever.

It's so rare to see rational risk management when it comes to children and safety; I just had to blog it.

Related blog post, including a very lively comments section.

Posted on January 27, 2009 at 2:10 PM • 55 Comments

Comments

HJohnJanuary 27, 2009 2:43 PM

@: "It's so rare to see rational risk management when it comes to children and safety; I just had to blog it."

I've long suspected that this logic of trying to protect children from any and all risks often fosters carelessness and lack of a reasonable response when something does go wrong.

On Christmas, my brother in law's step daughter (Amber) was at our house for the first time. When my wife set desert out, Amber asked "does that have nuts?" She may not have bothered asking if she was used to being in a (so-called) "zero risk" environment.

anonymousJanuary 27, 2009 3:33 PM

I'm allergic to most nuts (not peanuts though, weird). Growing up I knew to be careful, and by age 8 I knew how to stab myself with an Epi-pen. I am also lucky in that I've always been able to suppress a reaction with just Benadryl.

Most importantly, I know what the beginning of a reaction feels like, and I know how to react when I do accidentally eat a nut. I recently did, and my mom started freaking out (I'm 27 btw). I just calmly reached for a Benadryl, and when I realized I left it in the car, walked out and got it. Everyone else was panicked, I just settled in for feeling sick the rest of the day.

AnonymousJanuary 27, 2009 3:41 PM

HJohn: If you're serving desert to guests, allergies are the least of their worries, unless they're allergic to sand :)

That's how it should be, though: with any allergy, you will encounter it sooner or later, so you need to learn to check for it. One guy I work with happens to be allergic to oranges, which can occur in strange places (such as lemon cheesecake - there's some orange zest in the topping), so he checks anything potentially citrusy. No big deal, just something to check before eating.

Now, if only we could find a kid with a moronic policy allergy, forcing THOSE to be banned from schools and other public places...

HJohnJanuary 27, 2009 3:44 PM

@Anon 3:41: "If you're serving desert to guests, allergies are the least of their worries, unless they're allergic to sand :)"
____

LOL. Ironically, my wife is a magazine editor and prepares the cooking page. She would both prepare and spell desserts much better than I. :)

Ward S. DenkerJanuary 27, 2009 4:07 PM

You've got it all wrong, Bruce. We should ban school lunches altogether because there's some child somewhere who is allergic to something in them.

When it's discovered that bag lunches from students may contaminate allergic children's lunches (peanuts are like germs, you know, they fly through the air, land on everything and then KILL) we will have to ban lunch altogether. Then, discovering that children can be allergic to other things than just food we'll have to ban children with the genetics for allergies to cut that off. Realizing that genetics mutate naturally and new allergies can pop up at any time, we'll just have to BAN CHILDREN. That solves the problem because allergic children cannot be injured or die due to our criminally negligent school system if there are no children. Problem solved through root cause analysis!

Or, we could just do what you're saying and instead ban hysterics and alarmism...

lythanderJanuary 27, 2009 4:11 PM

I'm delighted to see this trend. My son has the full suite of potentially-anaphylactic nut allergies (peanut and tree nuts), and we don't ever ask for him to be at a separate table at lunch. He knows what he can eat and what he can't, and must take care of himself (he's 7). He also knows what to do if he feels the symptoms, and knows what the epi-pen feels like, so he takes some care.

We specifically have nuts around the house for his sister to eat out of a concern that having none in her diet might lead her to some sort of sensitivity to them. She and my wife already have a gluten allergy (a project all unto itself, but at least not anaphylactic), so she doesn't need more special needs.

We eat at home a lot, and take stuff with us when we go out.

PittCalebJanuary 27, 2009 4:52 PM

Funny you blog about this on my sons birthday - and the first time I sent cupcakes to school without the ingredient list attached. His teacher told me, "there are no allergies in class this year."

I have blogged extensively about Peanut allergies and over-reaction, sometimes referencing this blog, on my blog, Hail2Pitt.org. The latest posts were earlier this month:
http://www.hail2pitt.org/blogs/index.php/peanut;?...

Cheers,
PittCaleb

Ward S. DenkerJanuary 27, 2009 5:02 PM

"His teacher told me, 'there are no allergies in class this year.'"

It's pretty sad that our culture has become so risk averse that we've actually stopped seeing children as children and begun to see them as 'conditions' and vectors for law suits. A damned shame, that is.

GrahameJanuary 27, 2009 5:15 PM

This is not that unusual - at least not in this country. My daughter's school asks parents not to send peanut butter sandwiches to school - but that's all it is, a polite request. In the meantime, the teachers are all trained to use my daughter's epi-pen. And of course, we work hard with our daughter to recognise what she can and can't eat - but that's surprisingly difficult for an adult, let alone a child (she is allergic to tree nuts - but not peanut butter)

Joe in AustraliaJanuary 27, 2009 6:04 PM

This is a great example of a security issue that ends up hurting everyone because of perverse incentives. Almost every food product seems to say "may contain nuts". This is a useless warning which is only there to protect the manufacturer from lawsuits. The warning is so ubiquitous that it means nothing to allergic consumers. They can only rely on the ingredient lists - exactly the situation that they had before the manufacturers started warning them explicitly!

People with allergies are hurt by this standard precaution because their access to real information (warnings on products that really may contain nuts) is obscured by all the false warnings that appear out of an abundance of legal concern. But in a broader sense we all suffer when legal forms are used as substitutes for genuine solutions.

vedaalJanuary 27, 2009 6:09 PM

well,
the view from the other side is a little different ...

no one in my family has a peanut allergy,
but
allow me to present two episodes i witnessed myself:

[1] 1983
a group of anesthesiology residents were getting off a 36 hr. call from Bellevue,
and went to eat at a nearby chinese place,

one of the residents, an olympic tryout swimmer in great shape, had a nut allergy, and asked to make sure the food had no nuts,
the waiter understood,
but there must have been some 'trace' of nuts in one of the sauces, or dishes

he never made it back to Bellevue alive ...


[2] mid 1990's,
a neighbor had a pre-teen daughter with a peanut allergy,
and had several attacks, requiring epi-pen rx,

at a birthday party, where everyone knew she couldn't have anything with peanuts,
a mother's helper gave her a doughnut with some 'unknown' glaze, but which didn't smell or taste like peanuts

she never made it to the hospital alive

.....

so,
is it so unreasonable to insist on responsible and verifiable ingredient reporting,
for real life and death issues?


vedaal

jetJanuary 27, 2009 6:27 PM

A reminder for those not used to dealing with food allergies: peanuts are *not* nuts, they are legumes. many people with severe peanut allergies avoid some legumes as well.

Not dead yetJanuary 27, 2009 6:29 PM

@ Joe in Australia "Almost every food product seems to say "may contain nuts". ... They can only rely on the ingredient lists ..."

No, they can't.

Just because the ingredients don't list nuts does not mean there aren't traces of nuts, due to processing on machinery that also processes nuts. That's what "may contain nuts" really means: may contain TRACES of nuts, despite there being no nuts in the ingredients.

I see this "may contain nuts" on all kinds of things that don't contain nuts, like chocolate bars. I see it on whole-grain (or white) bread packaging, too, doubtless because the machinery that processes whole grains is also used to process nuts.

I've never seen "may contain nuts" on a bottle of wine, but their equally useless warning is "may contain sulfites". I don't have a reaction to nuts (yay), but I do have a reaction to sulfites (boo), although it's never been life-threatening. It just encourages me to avoid certain things, or to sample wines and see my reaction before committing to buying a case. One of the worst reactions I ever had was to Woodpecker brand hard cider. Yup, there it is on the label: contains sulfites.

KnylokJanuary 27, 2009 6:33 PM

Grahame, how old is the daughter in question? I ask because I have issues with Gluten which have been active (and diagnosed) since I was about 5. At 5, I wasn't completely "in the know" about things, but I knew enough to eat only what I got from home and if (for some reason) someone gave me food, I had to ask an adult if it was "safe". Children are capable of managing their own diet when they understand the severity.

Vedaal, the examples you gave were unfortunate, but all of society cannot suddenly come to a standstill for a few persons. In both of your examples, had the victim carried an epi and knew how to use it, they would've been fine. The girl in the 90s should've known not to trust food from "less than reliable sources". It's a sad case when it happens, but even with all the banning and eppies and medical staff in the world on High Alert, it will happen again. And again and again. The best and only viable option is to educate the potential victim.

Davi OttenheimerJanuary 27, 2009 6:38 PM

"we all suffer when legal forms are used as substitutes for genuine solutions"

this sounds alarmist to me. solutions and legal forms are complimentary, not mutually exclusive. in other words, solutions often hold only when enforcement is palpable.

so don't abandon legal forms, just ensure they are reasonable. reminds me of the old saying don't throw out the bag of nails just because one bent when you hit it.

xd0sJanuary 27, 2009 6:58 PM

So if terrorists kill people, and nuts kill people, then terrorists must be nuts.

At least I like to think so.

MalvolioJanuary 27, 2009 8:07 PM

> allow me to present two episodes i witnessed myself:

OK, I'm calling BS on this one. I've never seen an anaphalactic attack, despite living with someone with severe allergies for 15 years, and yet this commenter claims to have witnessed (not just heard about or known the victim) not just two attacks, but two fatal attack.

Robert Todd Lincoln was present for the assassinations of three presidents (which are much more common than fatal anaphalaxis as a fraction of the affected population) and he gave up going to public functions; maybe Vedaal should avoid eating with others.

vedaalJanuary 27, 2009 8:43 PM

@ht
@malvolio

am a medical first-responder,
so.
it's somewhat more common to witness in our group,

and, in fact,
am somewhat surprised that in my whole career, have only seen 2 ...

NigelJanuary 27, 2009 8:44 PM

My daughter who is now 16 has had a severe reaction to milk protein since the age 6 months. This led to me setting up the first web site about milk allergy and a support group in the local hospital for kids with allergies.
...And from day one we have always promoted the education approach as opposed to the (IMHO, stupid) 'just ban everything approach'.
As others have mentioned, we too have milk in our house and she has known from a very young age the simple facts of the matter. She knows that if she gets it wrong she could die and so she is very aware and thoughtful of where the dairy is and what it has been in contact with. She uses the anti-histamine for the odd 'trace amount' in badly labeled packages that causes problems and has an epipen for anything serious.
There is no way we would ever expect any place to ban dairy products on our daughters behalf. It is simply rude to expect all others to make a sacrifice when the same result can be obtained with simple education and good food hygiene. And as Bruce implies, people we educate about milk allergy are also educated about all other allergies.
A robust solution IMHO.

Kermit the BogJanuary 27, 2009 11:28 PM

There seems to be a huge surge in the number of people with allergies of all types.

In the past they would have just died, but advances in medicine treatment have meant that these people are being saved so that they can pass on their problems to future generations.

It seems we have distorted evolution by protecting these people and our society is unhealthier and more vulnerable as a result.

It's obviously to late to turn the clock back and deny people access to the drugs we have developed, but it shows the consequence of medical advances.

A similar issue has occured with the overprescribing of antibiotics, except in this case we are not only preventing our own evolution to fight disease, we are also causing the evolution of antibiotic-resistant superbugs.

I don't know what the best answer is, but certainly in the case of people with allergies, we can at least stop mollycoddling them. Those with the intelligence to self-medicate themselves will keep themselves alive and we can let natural selection take care of the rest.

GrahameJanuary 28, 2009 2:16 AM

> how old is the daughter in question?

She's now 11. She's allergic to nuts (not peanuts) Each year it gets a little easier for her to work out what she can and can't eat. The earlier points about packaging - there is no doubt that manufacturers are overly careful and put bland warnings on food where we have no information about what "may contain traces" really means. (or what "nuts" means either, since so few people can distinguish peanuts from nuts.) So she can and does eat some things that have "may contain traces of nuts" - things we have tried at home (where there's a hospital not far away). But even these might be lot dependent.

However the hardest is home made food - which is, after all, the best - does this contain nuts? Did the cook scrub their cooking gear and kitchen surfaces? Did someone cross-contaminate the food on the table using some utensil? How far to the nearest hospital?

This is a mighty big load for a young child to manage. Of course, they can ask the nearest adult, but the average adult has no idea about these things either - we ourselves learnt slowly, the hard way. So it's been hard to let go sometimes, to let her go eat elsewhere. But we have to do that.

As for this:

> we can let natural selection take care of the rest

I sure hope you don't parent on those grounds, idiot.

A nonny bunnyJanuary 28, 2009 3:24 AM

@Kermit the Bog
"There seems to be a huge surge in the number of people with allergies of all types.

In the past they would have just died, but advances in medicine treatment have meant that these people are being saved so that they can pass on their problems to future generations."


I'm not sure how familiar you are with Mendel's laws of genetics. But if there is neither selection for nor against, the gene frequencies in the genepool shouldn't change much on average. So an increased prevalence of allergies means that something other than a "lack of natural selection" must be going on.
Changes in our environment are a likely candidate. (Such as, possibly, fewer parasites to occupy our immune system, which then throws a fit at harmless antigens in our food to get over its boredom.)


As for food labeling, wouldn't it be more useful, if possible, to put quantitative information on it about allergens? Like, "may contain up to 10 ppm peanut allergens". Surely it must be measurable.

Colossal SquidJanuary 28, 2009 3:36 AM

"I'm allergic to most nuts (not peanuts though, weird)"

Peanuts are legumes, not true nuts (produced by the Fagales order.)

davidheathJanuary 28, 2009 4:40 AM

@Grahame: I sure hope you don't parent on those grounds, idiot.

I'm sorry, but you're MUCH too close to the problem to have any kind of objective opinion. A sample of one does not constitute any kind of generality.

JMJanuary 28, 2009 6:26 AM

@davidheath: that's the nice thing about opinions: nobody requires them to be objective. Even so, your rebuttal is an overly broad ad hominem: you could dismiss anything said with the claim that it can't possibly be objective because of personal involvement with the subject.

What's more, I think a parent of a child with allergies can provide a nice counterpoint to the objective but distinctly thoughtless argument mr. Kermit presented.

Food Allergy AssistantJanuary 28, 2009 7:19 AM

I am not an advocate of banning foods in our schools. It's not practical to ban milk and cheese and anything containing eggs and peanuts and tree nuts and fish sticks, etc..

We do need to teach children to keep their food and their hands to themselves. We need to educate teachers and staff about signs of an allergic reaction and what to do if a reaction occurs.

IainJanuary 28, 2009 8:42 AM

My kids attend school in London UK. At the primary school (up to 11) there are no bans on particular foodstuffs, other than a 'healthy eating' discouragement of chocolate / cake. Kids are though banned form sharing packed lunches with each other.

At the secondary school don't seem to be any bans or restrictions in place. Rightly I think assumed that kids are old enough to make there own judgments and / or it is impractical to try and control what kids of that age eat.

I agree in this case it is better to be prepared for an event than trying to ban its cause.

Thankfully neither of my daughters have severe allergies.

I have a nut allergy - no anaphylactic reaction - but severe stomach reaction. I have got used to judging the 'may contain nuts' warnings on almost all bakery & confectionery goods these days. It is home cooked food and eating at friends that often presents the biggest challenges of judgment.

BryanJanuary 28, 2009 8:42 AM

@vedaal
"am a medical first-responder,
so.
it's somewhat more common to witness in our group,

and, in fact,
am somewhat surprised that in my whole career, have only seen 2 ..."

I think your "surprise" that you have "only seen 2" speaks toward your skewed mental perception of how rare this is. The point everyone else is trying to make and you continue to miss.

You're admitting that the evidence that exists, AND your personal experience, are incompatible with your perceived risk. How logical is that?

A nonny bunnyJanuary 28, 2009 9:19 AM

o38bcfk8778rvgaaqwa8r:
"Many of you suggest banning children. To this I ask, who would build the pyramids then?"

Can't we get aliens to do that for us?!

VedaalJanuary 28, 2009 11:50 AM

@Bryan

am not advocating 'banning', or 'restricting'

only responsible labeling,

so that the 'rare' persons this might happen to,
can be reliably forewarned,
and save the only lives they have

WebsterJanuary 28, 2009 11:54 AM

Children who are allergic to peanuts have life threatening anaphalactic reactions when injesting the allergen.

With some allergens, airborne exposure can cause a range of "mild" reactions. Peanut is one of them. Those reactions are often enough to make it impossible to stay in that area.

Like many adults, I grew up on PB&J. My son has had five life threatening hospital trips because of food allergies.

@Malvolio: You've lived with someone for 15 years with severe allergies and never seen an anaphalactic attack? I call BS on that.

ChazJanuary 28, 2009 12:17 PM

Managing anaphylactic reactions reminds me of layered network security. Certainly there are layers here too--the ban, education, and various types of treatment.

In the second case Vedaal mentioned, not just the victim was affected. When analyzing the numbers it might be useful to take into account the fact that children and care providers might be adversely affected by seeing someone drop dead in front of them.

Clive RobinsonJanuary 28, 2009 1:03 PM

Just one thing about the "May Contain Nuts" warning.

If you run a factory or shop making comestables, you usually do not start with the "real raw" ingredients for your comestables.

Likewise your supplier of such things as flour and oil may not have actually processed the real raw ingredients.

Likewise even if the processor of the real raw ingredients had a nut free facility they cannot make claims about the supply chain where a warehouse may cause cross contamination simply by having others bring goods in vehicals etc that might have been contaminated by nuts etc.

Also with cross contamination sample testing is not a reliable way of detecting the abcense of contamination.

So realisticly it is a sensible warning in that it reflects the reality of the food production chain.

Further with regards ingredients such as colourings and artificial fats and dairy products the known list of ingredients may not help you in the slightest.

For instance a number of red colourings would be derived from the crimson-coloured dye "carmine" which is also often used in lipstick. Which to 99.99% of people would have little or no meaning.

Even the more familier food colourant name of "cochineal" would still have little or no meaning for probably 98% of people.

In fact they are derived from the Dactylopius coccus carapace (shell of a Mexican beetle). Do you know what the beetle might have eaten before it was dried and ground up?

GrahameJanuary 28, 2009 2:30 PM

I wrote about Kermit: I sure hope you don't parent on those grounds, idiot.

To which someone replied: I'm sorry, but you're MUCH too close to the problem to have any kind of objective opinion.

well, kermit got my goat. The context was children, and he says: "Those with the intelligence to self-medicate themselves will keep themselves alive and we can let natural selection take care of the rest". This is just a stupid statement to make about children. I think this would sound stupid in any context to do with children, irrespective of my own situation

A nonny bunnyJanuary 28, 2009 2:59 PM

@Clive
"Even the more familier food colourant name of "cochineal" would still have little or no meaning for probably 98% of people.

In fact they are derived from the Dactylopius coccus carapace (shell of a Mexican beetle). Do you know what the beetle might have eaten before it was dried and ground up?"

They're not beetles, they're "scale insects", and they are parasitic on cacti. So you don't have to worry about them having eaten peanuts, or anything other than cactus juice.

Clive RobinsonJanuary 28, 2009 5:24 PM

@ A nonny bunny,

"They're not beetles, they're "scale insects", and they are parasitic on cacti. So you don't have to worry about them having eaten peanuts..."

Yes they are "scale insects" but the suffer from the,

"If it walks like a duck and quack lickes a duck"

Problem, if you follow the link to some pictures you will see why they are commonly called "cochineal beetles"

http://images.google.com/images?...

And no I did not say they ate nuts, and I'm sorry if it came across that way it was unintentional.

They do however cause food alergies including potentially life-threatening anaphylactic reactions (as does the food they live off).

The FDA has only just this month after atleast ten years of being aware of the problems decided they must be correctly identified on food labling.

You can read more at,

http://cspinet.org/new/200901055.html

GrannyJanuary 28, 2009 5:56 PM

My granddaughter age 4 had an emergency last night forthe 1st time by eating a cashew nut. her lip blew up 3 times the size. Emergency hospital gave her an injection and also prescription for ammoxillin, and to give her bendryl and followup with her peditrication. We took her to an Allergist, and he could not give her a bloodtest due to she had bendryl in her system. He seems to thing it is a peanut alleregy. And also stated that she should not be near anyone that smokes, (bad habit) of course, but being around smokers will affect her allergies also. She also is a fraternal twin, does this affect the other twin also. should she be checked also.

Kermit the bogJanuary 28, 2009 7:14 PM

Sorry to all for my thoughtless and offensive comments earlier. It must be a terrible concern to have to care for a child with this problem.

I am amazed at how many people suffer from life threatening allergy problems these days. Why has there been such a dramatic increase? Are there really more allergies or just more foods with nuts? Is it caused by diet or environmental factors during infancy? Or were we just not hearing about it before?

NeighborcatJanuary 28, 2009 9:07 PM

Vedaal, Webster, and the "Better labeling" crowd:

Your cherished and utterly irreplaceable child has a potentially fatal allergy to X. X is a common and often undetectable ingredient in food.

Are you actually going to depend on the accuracy of labeling to protect your child, or are you more concerned about establishing blame after they have a reaction?

Of course you are concerned for your child, I phrased it that way to put the problem in the most stark terms: What happens when a label is wrong?

Fragile failure mode * extreme consequences * high probability of occurrence = find a different solution

As a process design engineer, I run into this frequently in error-proofing and equipment safety proposals.

It's usually phrased as "Well, we'll make the operator scan their ID to use this machine.", or "...not following the safe procedure will activate an alarm."

It's irresponsible design, and when employee safety is at stake it ticks me off so much I usually say "Why not just follow the blood, find the person who's missing a finger/arm/head, and fire them to prevent recurrence?"

(Actually, we *did* once trace an anonymous fork-truck accident to the person with broken ribs, and they were fired, but the only way to error-proof a fork truck is to not have them...)

Errors, omissions, and lack in labeling, over time, are a certainty. Traceability of the causal chain is not prevention. I'd work on a softer failure mode.

PaulJanuary 28, 2009 11:06 PM

@schneier: Will your next movie plot threat contest include making creative use of policies which ban certain items that could be useful in combating the terror situation? :-D

Clive RobinsonJanuary 29, 2009 4:03 AM

@ Neighborcat,

"Traceability of the causal chain is not prevention. I'd work on a softer failure mode."

And there is the problem...

As I noted above due to unpreventable and not realisticaly detectable contanimation prior to processing there is no way either labeling or previous experiance will tell you if the food you are about to eat will kill you or not.

There are realisticaly only two methods to deal with this.

1, Grow and process all your own food.

2, Always carry your emergancy meds and be with someone who knows where they are and how to administer them in time.

In this modern world we live in neither is exclusivly practical so you have to take risks.

Unpalatable as it is society implicitly practices triage due to the fact it is neither cost effective or practical to allow for those on the ends of the bell curve, so self help/awarness is the only solution.

However society does interfere with natural selection when it is deemed there is sufficient cause, and this does have harmfull side effects on society. An example of this is medicaly assisted births.

In the 1700's a Frenchman developed a simple mechanical device like a cross between a large pair of spoons and a large pair of scissors. This device enabled a baby to be brought through the birth cannal when the mother could for some reason not do it herself. If the reason was genetic then natural selection would have removed the mother, child or both from the gene pool. The medical profession has improved on this device (forceps) and principle in various ways and one such modern device is the ventouse, which is usually prefered to the forceps.

Other medical interventions including antiseptics and anesthetics giving rise to sucessfull cesarean section.

Cesarean section was known to the Romans who had a law requiring it (lex reiga) if the mother was presumed dead during child birth, but was not practiced by them on live mothers as it would kill them the law was in response to a rapidly declining birth rate (possibly due to the use of lead pots for cooking).

There is statistical eveidence to show that the number of women who have hips that are narrower than there shoulders has increased in nations where medical intervention in births has been carried out for a reasonable period of time.

Medical intervention in child birth is often cited as one of the probable causes as to why the US has some of the worst birth statistics in the world where as other parts of the world where medical intervention is rare have considerably better statistics.

Personaly I have an open mind on this as better nutrition might be an equaly probable explaination for the observed effects.

However whatever the cause the statistics clearly show that the mortality risk in child birth is significantly greater in the "First World" than in the majority of "third World" nations. Indicating that society has interfeared with the natural processess to the point that it is now decoming dependent on intervention.

A nonny bunnyJanuary 29, 2009 7:26 AM

@Clive
"Problem, if you follow the link to some pictures you will see why they are commonly called "cochineal beetles"

Hmm, yes, I see your point. Apparently somebody somewhere along the line thought it was a good idea to pass off a female rain beetle (whose picture they seem to have stolen from http://waynesword.palomar.edu/ww0502.htm ) as a cochineal insect. Whereas in reality they look nothing alike. (Perhaps the real thing looked a little bit too unappetizing)

vedaalJanuary 29, 2009 7:57 AM

@neighborcat

" What happens when a label is wrong? "


this is a very big issue with blood types

getting the wrong blood type is often fatal
(often, not always, as type AB can receive A, B and O, and there are other 'wrong typing's that can be gotten away with)

still,
there are redundant labeling requirements in hospitals,
where even if the blood is drawn in the ER, and labeled, it still needs to be re-drawn and checked when going to the OR

and if for whatever reason, the 'wrong' blood is inadvertently given, even if there is no untoward reaction,
(i.e. the right blood type, but intended for a different patient)
there is bureaucratic and disciplinary 'hell-to-pay'...

as a result,

incompatible blood transfusion fatalities are extremely, extremely rare in the US

'inconvenience' and the fact that 'some errors may get through' is just not a good enough reason to dispense with life-saving careful labeling

MsAnonJanuary 29, 2009 12:57 PM

@Clive

I would be very interested in reading those studies, if you have links or abstracts available.

Is this "mortality risk difference" between First and Third World countries only counting physical malformations? Because if "statistics clearly show that the mortality risk in child birth is significantly greater in the "First World" than in the majority of "third World" nations", then the WHO Report "Maternal Mortality in 2005" is really wrong...

I mean, these are the WHO estimates of MMR (Maternal Mortality per 100,000 live births:

Africa = 900
Americas = 99
SE Asia = 450
Europe = 27
East Mediterranian = 420
West Pacific = 82
World = 400

The WHO has them broken down by country too. The "majority of third world nations" have a MMR much greater than first world nations--*not* much smaller!

Since women have been having babies in the third world for centuries, without medical interventions, why haven't small pelvises been "bred out" of them yet? Shouldn't their death rates have dropped by now? How do you even separate physiological risk factors from sanitation and nutrition issues?

But I would definitely be interested in the hip/shoulder ratio study.

JRJanuary 29, 2009 1:15 PM

I have a child with a peanut allergy. I think one of the biggest problems I observe is the lack of accurate information that people use regarding allergies. This was a nice way to say that many people who have these allergies are just plain ignorant. I can't tell you how many people claim to have reactions based on smell, or even casual physical contact to something with peanuts in it. Every study I've read indicates that this just isn't true. People must ingest peanut proteins to have anaphylaxis. Skin contact COULD result in a small rash. Smell COULD result in some psychosomatic response. Neither are fatal.

I am glad to see some more common sense in these areas. Things are very age dependant. Your worries as a parent for a 3 year old are different than for an 8 year old. We spend a lot of time educating him on his allergy. Epipen training to caregivers is a good thing (and VERY easy to do).

The places that have irrational responses seem to be ones that listen to those ignorant allergy sufferers who want to make up rules based on faulty logic or information.

Clive RobinsonJanuary 29, 2009 6:48 PM

@ MsAnon,

The information is from a couple of years ago. It was shown to me by a medical student who was doing research for their course and I was helping them with graphics based on it for a presentation.

The figures that shocked me where from research carried out for the Melisa Gates foundation and Save The Children for their anual Mothers report.

It showed a mortality rate in African-American women and children of 9.5 per 1000 and was the worst figure by far when normalised against available medical resources per head of population.

I'll have a scan around and see if the stuff is online.

JessJanuary 29, 2009 7:32 PM

@A nonny bunny:

"But if there is neither selection for nor against, the gene frequencies in the genepool shouldn't change much on average."

In this case the hypothesis is that prior to the introduction of modern medicine, there was a selection against fatal allergies, a selection that is now less pronounced. This seems reasonable over many generations, but allergies have been studied systematically for what, 80 years? I doubt that's a long enough span to see any serious genetic changes in a human population.

Increased sensitivities would then have to be the result of _something_ environmental. This would not necessarily be anything easily apparent to our current level of physiological expertise, since the immune system is sort of complicated. I suspect that increased reporting and a self-interested medical specialty are also factors.

As for measuring ppm's in various foods, it wouldn't do us much good to measure anything once. If flour produced at a particular factory had 1 ppm of peanut protein this month and 50 ppm last month, what's to be done? Do we close the factory? Should flour cost twice as much in order to get the variance down? There are trade-offs, and as others have observed, the interested parties are more likely to effectively deal with allergies. If epipens are too difficult to use, they should demand more effective tools, rather than a complete overthrow of society.

a blog readerFebruary 9, 2009 12:04 AM

100% avoidance of food-borne allergens may not be easy. In particular, there have been cases where food products have contained undeclared allergens. For actual examples, please see http://www.foodallergy.org/alerts.html Given that cases of undeclared allergens have happened, it might seem that ingredients lists do not always provide total assurance that a product is free of allergens.

At the Food Allergy Survivors Together site, there is a page about eating out at http://www.angelfire.com/mi/FAST/restaurants.html Among other things, from some the information on the FAST page, totally assured avoidance of allergens may be difficult or close to impossible when eating out.

NicoletteAugust 5, 2009 12:18 PM

I just wanted to know if you are a pediatrication and the things or struggles you've been through to get to that point and if you could write me back that would be very great.

kathySeptember 9, 2009 9:48 AM

I have just been notified that there are 3 kids who are severly allergic to peanuts at my sons school and that if we continue to have peanut butter sandwiches and something should happen to one of those kids we could be held liable. These kids are so allergic that they can not be in a room with peanuts....so shouldn't all products containing peanuts and any bit of peanuts also be banned. I was told thogh that my children could eat in isolation if I had no other option...but wouldn't any risidual peanut oil also be an issue? I am confused as to how unpeanut I need to be in order not to be responsible for those other children.

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