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Monday, 26 November 2012

Nut allergies and Nutty Reactions

Someone should start collecting stories of the reaction that parents have when their young child develops a rash after eating peanut butter, and the next thing they are advised they must carry an epinephrine autoinjector and that the condition is life-threatening.  It would be enough to freak out the best of parents.

A recent story related to the mother who wanted oak trees removed from the school yard because her child had developed a “nut allergy”.   Stories that we’ve heard include parents who insist on the right to inspect other students lunches, or on staying with the child in the classroom, appeals for children to have education assistants with them as health challenged students with severe disabilities do. And the topper is the Texas company that trains “nut sniffing” dogs, with parents appealing that the animal is required to protect their child’s wellbeing and therefore required to stay with the child in the classroom.

Some might consider the above a bit of an overreaction.   Were it our children though, we would likely be just as concerned.  The question is what is a reasonable level of concern?  and from a public health perspective, what should we support parents and schools in ensuring a risk reduced environment?

1-1½ % of students at school start will have a positive skin test to peanut extract.  Only half of these will display any clinical symptoms.  Moreover almost all peanut allergic reactions require an adequate volume of consumption, often at least a full kernel, before any manifestations are expected.   That most peanut allergies are treated as if any antigen exposure in the air will elicit a reaction is inappropriate.

The existence of a peanut allergy also does not mean allergies to other tree nuts (and peanuts are not even be classified as a nut by biologists but more a legume as they grow underground).  Even having skin test reactions to certain tree nuts does not mean an allergy or any reaction to all tree nuts.   So, to have a peanut reaction and associate this with acorn associated reactions is a huge misinformed leap.  Another common misperception is that milk allergies are manifest in a similar fashion, and rarely do milk products result in anaphylaxis, nor is there a need to modify the classroom environment to become “milk-aware” in an effort to reduce exposures. 

Schools have become much more “nut-aware”, resulting in overall school based exposure reductions by some 90%.  However even in classrooms with known interventions to eliminate peanut exposures, careful examination will usually reveal some peanut containing materials – and this has not resulted in life-threatening situations. 

As a great resource, Anaphylaxis Canada has developed a common sense and reasoned approach to food allergies of a variety of natures.  Anaphylaxis Canada .   In the end, it is about education, the environment, and emergency response.   Education of the parents, child and classmates, reducing exposure through making the environment nut aware, and lastly parents and the school being prepared for managing the very uncommon emergency situation.  

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