Tuesday, April 28, 2009

It's Peanuts

At a large gathering recently where the attendees where people in my general age bracket, I asked a question of as many people as I could, and asked others in attendance to ask as well. The question, actually questions, were simple: 1)How many of you have a peanut allergy? and 2)How many of your children have a peanut allergy? and 3)How many of you know of someone our age or our children's ages with a peanut allergy? The answers were awfully easy to record. Not one person there had a peanut allergy, had children with a peanut allergy or actually knew of anyone with a peanut allergy.

An awful lot of media time over the past few years has been spent on reporting that "large numbers of children suffer from peanut allergies." A number of school boards across the country have banned children from bringing peanut butter sandwiches for lunch or from bringing any peanut product to school because of the "danger" this poses for those massive numbers of kids with peanut allergies.

Now it just so happens that I do know someone whose child has a peanut allergy--along with an allergy to every other kind of nut, to wheat, to milk, to chocolate, to gluten, to perfumes and to at least half the substances that comprise the things we eat or use in daily living. Yes, this parent has a real problem. For years this child was basically housebound because just walking out the door could cause an allergic reaction. I am not pooh-poohing this child's medical condition. But this child is unique in her family and the only child in her yeshiva with this kind of a problem. Thanks to advances in medicine and doctors who are on top of things, they've gotten her to the point where she attends school and can go out in the world.

What I'm asking, as regards peanuts, is do we really have the widespread problem that the media have been telling us we have? If so, why? Why should the third generation from mine have developed this allergy? How? PBJ was a staple of school lunches when I was in school. Why did none of my classmates or schoolmates have a peanut allergy? Let me anticipate a comment here, that comment being "Just because you didn't know it didn't mean that some kid didn't have the allergy." Children can be such morbid little creatures sometimes. They may say "Oh gross!" if an action takes place that is less than wonderful, but they don't stop looking, and they remember the action well. Frankly, if a child allergic to peanuts had been present in my school lunchroom and had had an allergic reaction of the type the media describe as common today, we would all have remembered and reported it back to our parents. Someone turning blue in the lunchroom and requiring EMS to come? Kind of memorable wouldn't you say? It didn't happen back then.

The reason I bring this up is that peanut butter is an inexpensive but nutritious choice for school lunch sandwiches, one that is being banned right and left. Schools are faced with providing alternatives that cost a lot more. Are the numbers of children allergic to peanuts, who can't even be in the room with peanuts, so large that they justify removing this staple for everyone else? Is there a better way to handle the situation?

So what do you know about this, or what do you think?


mother in israel said...

I do follow the discussion to some extent. Israelis have very few peanut allergies, although I heard about one child recently.
The issue with peanuts is that many who are allergic are deathly ill. So even if the number is small, there is reason to be concerned for those children. But there has been talk about the rate of allergy being exaggerated. Many times parents report allergies without medical confirmation. Also, many fewer children die each year from allergies than from other preventable causes.
There are also new studies suggesting that early exposure to the allergen doesn't necessarily trigger it in genetically predisposed children as was previously thought.

AidelKnaidel said...

I actually know lots of people and children allergic to peanuts. I have a sibling highly allergic to peanuts, so much so that if someone near her eats it it causes her face to swell.

I know two young women around age 20-21 whom are also allergic. And I know of at least 6 other children who also have the allergy.

So while I dont know if removing peanuts for everyone is justifying... what about those children who can't breathe just by being around others who eat it? Or even worse, if someone touches them and may cause them to need hospitilization? I'm not sure.

Dave said...

The threat is unfortunately real, and as far as I know, no one knows why there seems to be a significant uptick in the rates of serious food allergies in recent years.

leahle said...

I have two siblings with two different allergies. They received allergy shots on first a weekly basis and then a monthly basis for a good few years. Today their allergies are almost gone and the most they might have to do is take an antihistamine tablet sometimes.

If peanuts are such a problem then why haven't the drug companies done something about developing an allergy serum like they did for other allergies? I'm not saying there aren't people with the peanut allergy but if it was as big a problem as the media is reporting then you would figure the drug companies would be right there, because there would be lots of money to be made.

Dave said...

There was just a study that finished (at Duke I believe) that found that in clinical trials, under extreme controlled conditions, they were able to reduce the threat of peanut allergies in a percentage of those suffering from them. But the dosage started at 1/10,000th of a peanut.

The problem is that for annoyance allergies (i.e. hay fever), there is a lot less risk with allergy shots. With potentially fatal allergies, they research is just getting to the point where they can even start testing in humans.

Anonymous said...

ProfK - I think I am of the same generation as you, and I have a friend my age who has a serious peanut allergy. She carries an epi pen. I agree that it seems more common in younger generations, but asthma, autism and other illnesses also are more common. The environment has changed a lot since we were young, and that could be a part of it.

BTW - there are alternatives to peanut butter, such as almond butter, soy butter, cashew butter, etc.

Anonymous said...

The environment has changed a lot since we were young, and that could be a part of it.[space]

This is probably the main reason. Kids a generation or two ago grew up spending time outside where all the allergens are floating around. They breathed in (or were exposed other ways to) those allergens and thus repeatedly built up their immunity. Other issues are more sealed up homes, with air conditioners filtering out everything before the kids are exposed to it. Finally, over 20-30 years, we've gone crazy with antibiotics with lots of pediatricians simply prescribing them for things that the body could generally heal itself from (seems to me, mostly to make the parents happy by "doing something"). Most likely (there is no direct proof yet) all these are responsible for a huge increase in asthma, autism, and the simple reduction of overall immunity, and less active (deficient) immune systems.

I also recall reading (unfortunately, I can't find a link) that some experiments with exposing people with peanut allergies to minuscule peanut dust, and then slowly increasing the level of exposure, seems to reduce (or perhaps even eliminate) the allergic reaction thereafter

Luckily my kids live in a home that isn't particularly tidy, is not cleaned nearly as often as most homes are, and is rarely dusted thoroughly. And we keep the windows and doors wide open as much as possible. We also don't go nuts if the little ones pick up some food that dropped on the floor and eat it. We also feed them all sorts of foods including nuts of all sorts.

It just goes to prove the rule that when mankind messes with something (the environment our kids grow up in in this case), there are always unintended side effects.

I don't know a single person from my generation that is allergic to peanuts. I do know one that is allergic to nightshades. And I have one friend with mild asthma.


Dave said...


"Excessive hygiene" is one of the many competing hypotheses out there, but the real answer is "we don't know". It could be lack of exposure, it could be some other environmental source, it could be something else entirely.

ProfK said...

Here's a link to an article reporting the Duke study. http://www.nlm.nih.gov/medlineplus/news/fullstory_81734.html

The source printing the article is our government, which makes me wonder about the following statement in the article: "About four million American have allergies to foods, and tree nut allergies, including peanut allergies, are the most common. For the highly allergic, exposure to even a trace amount of peanuts can provoke a life-threatening reaction. Nearly half of the 150 deaths attributed to food allergies each year are caused by peanut allergies, according to background information in the study."

If 4 million people in the country have food allergies, and tree nut allergies are the most common, then what is the number? If you can say "most common" then you must have data you are using to make that statement with. How many is "most common"? Is it 10% 50%?

And then there is this--peanuts are not a "tree nut." There is a bush above ground, but the peanuts grow under the ground--think things like potatoes. What brocha do you make on an almond or a walnut? A ha'etz. What is the correct brocha for a peanut? Ha'adama. Peanuts are a legume. Those who do not eat kitniyos on Pesach include peanuts in that prohibition. Those same people eat walnuts and almonds on Pesach because they are not kitniyos.

Now go to this article: http://www.huffingtonpost.com/meredith-broussard/food-allergy-deaths-less_b_151462.html According to information given in this article the number of deaths from food allergies has been grossly exagerated. According to government figures the real number of food allergy deaths is a much smaller number than that reported as background in the Duke study: only 11.

Lu said...

I'm not saying that there aren't people with an allergy to peanuts. Some commenters here know such people. But I'm not convinced that the allergy is all that common or widespread.

I did a little research and the US produced about 2.5 billion tons of peanuts last year, about half of it used in peanut butter. The rest is spread out over all kinds of other foods where it is added as an ingredient. We produce peanut oil. We sell peanuts in the shell. We use those shells ground up in compost material that is spread on lawns and is used by farms across the country.

Companies that produce products that don't have peanuts in them also produce products that do on the same machinery. Cereal companies aren't disinfecting their machinery between different cereal runs. Same for the candy and chocolate companies.

Peanuts are everywhere. If the number of allergy sufferers was that high we'd have lots more reporting being done.

Like I said, I'm not saying that there aren't people with a peanut allergy, but I don't think the numbers are anywhere near as high as we are sort of being told they are.

Dave said...

Here is the CDC page on food allergies: http://www.cdc.gov/healthyyouth/foodallergies/

To quote the National Institutes of Health paper listed on the CDC page: "Six foods (milk, egg, peanuts, tree nuts, fish, shellfish) cause 90% of all allergic reactions to foods; approximately 30,000 anaphylactic episodes and 150 deaths per year
are due to food allergy"

The NIH paper also answers the question of why there hasn't been the equivalent of allergy shots for food allergies thus far: "Conventional immunotherapy with food allergens is associated with an unacceptably high rate of systemic reactions."

Dave said...


People with the food allergies (or who are purchasing for people with food allergies) are extremely cautious on what they buy. There is a reason you have the warning labels on the foods; people who are severely allergic to peanuts don't buy foods which are produced in plants that also produce foods that include them.

The United States also produces vast quantities of treif, an analagous argument would be that no one could possibly keep kosher with all of that in the food supply.

Lu said...

Dave, I'm not arguing that there are no peanut allergy sufferers. My point was that with peanuts being all over and used in a huge number of products you would expect that there would be more more reported incidents of severe reactions and/or death no matter how careful these people are. My question is how many people with peanut allergies are there really in the country? How many with severe enough allergies to peanuts to have an anaphylactic reaction? Are there enough of people with a severe allergy to peanuts to justify banning peanut products in public places such as schools? Why stop there if there really are such large numbers? Why not place a ban on peanuts all together?

Re the treif argument, you're mixing apples with oranges. We have vaads of kashrut and kosher certification agencies that go in and check for treifus in our kosher food supply. This is a religious requirement, not a health requirement. I'm not sure I've ever heard of someone dying from eating something treif, unless maybe they have an allergy to a product that is treif, like shellfish.

Dave said...

Well, the CDC says 3.3 million Americans are allergic to peanuts or tree nuts; they don't give a breakdown as to a split.

The NIH says that an allergy to peanuts or tree nuts is a specific risk factor for fatal or near fatal anaphylaxis. In other words, of all the food allergies, nut allergies are the most likely to result in death.

The reason I pointed out the isue of Kashrus was that you were making a claim as to the scale of an industry as being evidence against an issue. There are 295+ million Americans who aren't allergic to peanuts or tree nuts, so the fact that we sell a lot of peanut butter is not evidence of a lack of allergies.

To put things bluntly, there is a real risk of fatal or near fatal anaphylaxis based on food allergies, depending on a number of factors (including heredity).

Dave said...

Incidentally, if you do the math, it comes down to one case of anaphylaxis for every 10,000 Americans, one hospitalization for every 150,000, and one death for every 2 million, per year.

RT said...

Peanut allergies are a problem because they work differently then a lot of other food allergies. One of my kids has a milk allergy. As long as he doesn't actually eat any dairy products he's just fine. He can be at the table where someone is eating dairy. He can pour milk into someone elses glass. He can get kissed on the cheek by someone who has just eaten dairy. He can use products on his skin that may have dairy derived ingredients.

But from what I understand, and I'm no expert, those people with the severe peanut allergies can get a reaction just by being in the same room with someone else who has eaten peanuts. They don't have to eat the peanuts to get the allergic reaction. That makes it a lot harder to control exposure to the peanuts. A kid riding on a subway car with some people in it who have eaten peanuts could get a severe reaction. Are we going to ban these peanut eating people from using the subways?

Dave said...

People with strong to severe peanut allergies make a number of changes in the way they live.

For example, if flying, they generally try to fly the first flight out in the morning, so that the plane has been cleaned, and can be "peanut free" for that flight, without worry of residue. If you've flown and heard the announcement that they are asking people to avoid all peanut products, you know why.

(No, I don't have any food allergies that I know of. I have family who do, and I should probably disclose at this point that that includes a case of fatal anaphylaxis).

JS said...

"But from what I understand, and I'm no expert, those people with the severe peanut allergies can get a reaction just by being in the same room with someone else who has eaten peanuts."

This is part of the problem/misunderstanding. I don't have specific numbers, but there are a number of people who are allergic to peanuts - meaning if they actually ingest peanuts they will have an allergic reaction. Of that number, a smaller number will have a reaction so severe they require emergency care.

However, the number of people with peanut allergies so severe that just being around a peanut product induces anaphylactic shock is exceedingly rare. I remember reading an article which spoke about how warning people about peanut allergies has produced widespread panic about peanuts to the extent that schools are banning peanuts without even knowing if anyone is so deathly allergic. The article also weighed the potential harm of an allergy against the harm of a ban for all. Finally, the article spoke about the theory that lack of exposure and hyper-sanitary conditions is leading to allergies and said under this theory the bans on peanuts would actually make the problem worse (again, just under this theory).

Rae said...

I am sorry to hear Dave that your family lost a member to a case of anaphylaxis.

However I think that RT made a valid point when he/she talked about the subways. Broaden that to include all forms of public transportation--buses and trains and cabs and planes. Broaden that to include all kinds of public places--movie theatres, libraries, shopping malls etc.

It's not practical if it would even be possible to tell those 295+ million people you mentioned above to avoid eating peanuts or using any peanut derived product before using any public facility. Unless peanuts are banned for any consumption or production by everyone, then the onus to protect themselves falls on the allergy sufferers. They are the ones that will have to curtail where they can go and what they can do.

I am not unsympathetic to their very real problems. If such a sufferer were a member of my immediate family I would do anything and everything I could inside my own home to protect that person. But I could not reasonably ask the rest of the world to change their entire way of living to accomodate me.

Dave said...


Even if the exposure theory is correct, that wouldn't make sense. After all, not having peanuts in the lunchroom does not preclude having them in the home.

Moreover, as I understand it, the hygiene theory isn't that there is a lack of exposure to food allergens, it is that there is enough of a lack exposure to other things that the immune system doesn't have enough to do.


I don't think anyone is advocating for a blanket ban. The only cases I am aware of (other than business practices by airplanes) involve young children in schools. Not only are such children not able to make risk determinations for themselves, they are at the highest risk for life threatening reactions.

To put it another way, if your child or grandchild gave their snack to a classmate, and that child died, how would you feel? How would your child or grandchild feel? It is unreasonable to ask a young child to read warning labels on foods. It is not unreasonable for adolescents or adults to be responsible for their own health.

Lissa said...

If JS is right that the number of people who can get a severe reaction just to being around peanuts or people who have eaten peanuts is rare then why all the public ranting and raving? One of my kids was allergic to tomatoes both in eating them and in contact on the skin. While she was little we closely monitored where she was allowed to go and checked if tomatoes would be there. We taught her all about the types of products that might contain tomatoes and to avoid them. When she got a little older she could monitor herself mostly. She knew to ask if tomatoes were in a dish. She knew to avoid ketchup.

If a kid can't eat peanuts then let the parents teach that kid how to avoid peanuts and products made with peanuts.

Just by the way, our allergist told us that lots of children with food allergies outgrow them as they get older. Our daughter is already a lot less allergic to tomatoes. If the juice gets on her skin she no longer gets an allergic reaction. She can even take a taste here and there of tomato products. Do peanut allergies remain the same for someones whole life or can the person outgrow the allergy like our daughter is doing with her tomato allergy?

Dave said...

Some people outgrow food allergies. Some people do not.

We still don't know why.

Rob said...

I'd just like to say that a lot of the allergies that people say they have aren't really allergies in a medical sense. A lot of people say they are allergic to milk when what they have is a lactose intolerance. Their system has a glitch and can't handle lactose. Some of those same people can eat processed cheese, where the lactose is less or where the processing has changed the form into something their systems handle better. Some people get gastric distress when they eat certain foods and that is reported as a food allergy by these people when it probably isn't. Some people's bodies just can't handle acidic foods or gassy foods well. And I know a lot of people who raise the word allergy when faced with eating a food they don't like the taste of or the look of. It's easier and gets less argument if you say you are allergic to broccoli then to say you don't like it.

Anonymous said...

I have a child who is allergic to peanuts. At age 1.5 he ate about 1/4 of a peanut and got very sick, although he did not have anaphylaxis. He was tested by an allergist and was found to be extremely allergic. I have been told by an allergy specialist that peanut allergies are unlikely to be outgrown. Also, I have been told that just because anaphylaxis didn't happen, it could happen another time.

My 85 year old father has lifelong nut allergies (although not including peanuts) and has never carried an EpiPen, and in my opinion he is lucky to have made it this far. I remember times he coughed and couldn't breathe after accidentally ingesting unexpected nuts. He has always had pulmonary problems that he ascribed to allergies, yet last year he was finally diagnosed with asthma and is being treated!

I'm sure that much of the increase in diagnosis of allergies & asthma & autism are due to recognition that didn't take place in previous generations. Does that mean that we shouldn't take precautions, or that people shouldn't be treated?

I try to avoid heimishe brands since their allergy labeling is not as good as national brands. I have found that even when American national brands say that there may be peanut traces, it's not enough that my kid is sensitive to it. I am very wary about Israeli and European chocolate since my son and even his siblings have shown some sensitivity. I would guess that these brands have some hazelnut traces.

There is a lot of common sense involved, but little kids are known for their lack of common sense, and their messiness. It's not unusual to find a little kid who ate a peanut butter sandwich with peanut butter on their hands, clothes, etc. An allergic preschooler could easily be exposed. With older children and adults, there's much less of a problem.

SubWife said...

I don't think that banning peanuts in schools is unreasonable. Many schools do so because they already have students with a history of severe allergic reactions. And children tend to have more severe reactions than adults. In addition, how can one put the burden of prevention on a little child when the reaction could occur simply by breathing in the particles from the food of others? And Epi shot (which has side effects, by the way) might not be administered quickly enough, and that severe reaction could become DEADLY. So while the inconvenience to other parents is obvious, the health and lives of allergic children are far more important in my mind.

Marjie said...

An interesting discussion goibng on but isn't there a point that is being talked around? How far does society have to go or should it go to accomodate members who are a minority in that society? The examples given about the public transportation is an area where I would say that inconveniencing many for the possible benefit of the few would be the wrong thing to do. With the schools I would say okay because little kids can't be counted on to rememb3er what they were told by their parents. But you know, it's really inconvenient that pbj is off the table to send for school lunches, and makes lunch way more expensive too. Maybe a better answer would be to have these highly allergic kids eat lunch in a separate area where it would be easier to monitor what they are eating or coming into contact with.

I'm not unsympathetic to the parents of allergic kids. I'm allergic to latex, and in the world we have now that's a lot harder to avoid then peanuts. But just how much adjusting does everyone have to do for what is a very small fraction of society?

Dave said...

If the school doesn't have any allergic children, I don't think they should need to restrict foods in the lunchroom.

If they do, however, restrictions seem reasonable. Even if we disregard the social implications of requiring a small number of children (possibly only one) to eat in isolation from all classmates, in the case of severe allergies, exposure after meals from classmates who have eaten peanut butter could be a danger.

As far as the cost implications, while I am certainly sympathetic to them, I should point out that treif food is much cheaper than kosher, but I doubt that observant Jews would consider that grounds for eating it.

little sheep said...

as someone who has been working in schools for the last five years, i have NEVER gone a school year or a summer without coming in contact with a child who has a severe allergy to peanuts.

i had a camper bring bamba to our peanut free camp one summer. when he took it out of his bag, i didn't look closely enough, and thought it was potato chips. i can't describe the pachad of realizing that there was bamba on a chair in my classroom. after grabbing the allergic kid and delivering him to another bunk, i had to take all 22 other boys to scrub their hands with water, get the cleaning crew in to wash the chair and the floor around it, plus all the toys out on the tables and floor around it, wash out the mouths of the kids who ate it, inform the director of the problem, dispose of the broom used to clean it up...

oh, and to the commenter who thinks that milk allergies can't get this bad...i know of a child who used to be so allergic to dairy that if she touched a cup that hadn't been washed well after use with milk, she blew up. any allergy can be this severe, just peanuts are USUALLY this severe.

Lion of Zion said...

i don't know how widespread allergies are, but they are definately.

the difference between the subway and a school is that the latter contains a high concentration of children

also, i'm sure one reason that many schools are peanut free is fear of liability and lawsuits.

"If a kid can't eat peanuts then let the parents teach that kid how to avoid peanuts and products made with peanuts."

sorry, but some of us have young children who are not as precocious as your kids.

miriamp said...

On Subways vs schools -- the school administration is responsible for the health and safety of all the students while they are on the grounds -- the conductor of the subway is not responsible for much other than making sure the trains run on time. Very different.

ProfG, I'm not your generation. I was born in the 70s. But I have three friends around my age who are peanut (and tree-nut) allergic, all of whom at one time lived in the same small out-of-town Orthodox community, although they were all "imports." Two of them (both also asthmatic) definitely have been known to have anaphalactic reactions, not sure about the third.

One of them was a preschool teacher, so naturally the classroom needed to be nut-free. Many parents raised a large fuss. "Why can't I send a PBJ sandwich?" Her response, (at least to me): Umm, because there are only two teachers in the classroom, and if you try to kill one of them, the other teacher will have to help her and no one will be watching your children?

In a scenario where the same people are together everyday in the same place (like an office or school) and one person has an actual issue, it does make sense to restrict nuts.

There's a peanut allergic child in my Kindergartner's class. The school is not nut-free, but the kindergarten is, and the children eat in the classroom instead of in the lunchroom. This child is also allergic to eggs, but the other children are allowed to have products containing eggs around her -- she just can't eat them. Her father explained that he was told by their allergist that peanut allergies are very different from other allergies, in that exposure to the peanut molecules can actually trigger an immune response, so they are trying to limit her exposure to those molecules all the time, in the hope that the immune response will die down and her body will hopefully forget how to react to peanuts -- and reactions to future exposure will be less severe. Will this work? Who knows? But the extent that they can protect their child's environment, they should have the right to try.

(As it happens, exactly 0 of my 8 children would actually agree to eat PB&J sandwiches, so I have a little bit of trouble understanding all the fuss about not having this as a possible food.)