Nut Case

Has Peanut Paranoia Gone Too Far?

By Dinah Clarkson
Published in Today's Parent December/January 2000 issue

Seven-year-old Elise rarely eats in restaurants, and brings her own cupcakes to birthday parties. On school pizza days, she brings pizza made at home. She has a separate keyboard to plug into school computers and she always washes her hands when she enters her second-grade classroom. Posters bearing her picture are plastered around the school-in the classroom, staff room, gym, library-and her class eats at a special table in the lunchroom every day.

Elise has an enemy lurking in her Vancouver public school, one she must avoid at all costs: peanuts. Injesting peanut protein can send Elise into anaphylactic shock, which, according to her mother and medical experts, is frighteningly swift, severe and potentially fatal. The problem is, her foe is often the best friend of her classmates-peanut butter is a staple in North American lunch boxes-and its presence in Canada's elementary schools has led to demands for change and, in some cases, tenacious debate.

In the fall of 1999, Hillside Park School in Sackville, Nova Scotia banned peanuts from school premises, a move prompted by the life-threatening allergy of six-year-old Leigan Stapleton. A series of heated letters followed in The Halifax Daily News: " It is ludicrous to punish an entire school for the problem of one child," wrote one reader. Another retorted: "It will not kill children to live without peanuts for six hours, while it would kill a child with the allergy in less than three minutes."

In late 1998, Calgarians were embroiled in a similar controversy: Melina Leduc Benson pulled her six-year-old daughter from grade one at Erin Woods school when she couldn't be guaranteed a nut-free environment.

That same fall, Omar Maldonado did the same. His three-year-old son, Max, was enrolled in junior kindergarten in the Toronto Separate School Board. Maldonado says the school's policies weren't efficient, and the administration "wasn't positive" about making changes to provide Max with a safe school. So Maldonado withdrew Max and enrolled him in a nut-free private school.

"It's led to a great expense, but we needed the peace of mind," says Maldonado."And it's there. He's looked after in a very positive way. You need to do your best to protect your child. If you don't do your best to prevent a reaction, youıre only going to feel miserable.

Banning peanuts may sound rash, but for a severely anaphylactic child like Elise, even tiny amounts can kill. (About one percent of the population is at risk of anaphylaxis.) Most anaphylactic reactions are a result of cross-contamination, where an allergic child accidentally ingests traces of peanut. At least two Canadian children have died this way-one from eating a cheese sandwich packaged with a peanut butter sandwich, and another from a jam sandwich made with a knife that someone else dipped in peanut butter. Unfortunately, as long as children love their M&M's, granola bars and even Ritz crackers-all of which can contain trace amounts of peanut-many schools donıt dare to call themselves completely nut-free.

Recognizing this impracticality, not all parents of allergic kids advocate an all-out ban. Calgary mother Nancy Wiebe, who found out about her daughter Lauraıs anaphylactic allergy to peanuts four years ago, feels strongly that telling parents what their child is permitted to eat can have a negative effect. "It hits them in the face when the school tells them what they can and canıt put in their kids' lunches. The peanut ban puts people's backs up. Youıre starting off with people feeling defensive, and itıs hard to move back to a co-operative position from there."

Itıs important to understand that not every peanut allergy is life- threatening, says Caroline Graham, a Toronto allergist. Symptoms vary enormously. Modest reactions include hives, swollen skin tissue, and flushed or itchy skin; these allergies aren' considered anaphylactic.

"Anaphylaxis usually includes a skin reaction plus one or more of the severe reactions- respiratory, gastrointestinal or cardiovascular," says Graham. Respiratory reactions can include throat swelling, asthma, coughing and wheezing; gastrointestinal complications produce vomiting, diarrhea and cramping; and cardiovascular reactions result in a drop in blood pressure, light-headedness and collapse.

Elise had two anaphylactic reactions to peanuts as a toddler- the second more severe than the first- before a paediatric allergist diagnosed her. " Her face and eyes swelled shut," remembers her mom. "The only comparison I can think of was that she looked like she'd been beaten. She couldn't communicate, she had trouble breathing and she was dazed and throwing up."

Since her diagnosis, Elise has worn a fanny pack containing an Epi-Pen, which can be lifesaving first aid. The injector, which resembles a fat marker, is filled with epinephrine (adrenaline) and is administered in an emergency by pushing its needle-like tip against the upper thigh. The drug then rapidly constricts blood vessels and relaxes muscles in the lungs to reverse swelling and improve breathing (until the child can get to emergency).

Anaphylactic children and adults carry the Epi-Pen, whether they are allergic to milk, seafood, or wasps. For the severely peanut-allergic, the device is a necessity. Graham says peanuts are undoubtedly a more potent allergen than other foods. Peanut butter has a nasty reputation, and for good reason. "We allergists put it on a bit of a pedestal, but I think we're justified," she explains. "A smaller amount of peanut is required to trigger a reaction than, for example, milk. Those with allergies to peanuts also tend to have more severe reactions-but why, we don't know."

There are a lot of unknowns. Reliable Canadian statistics are few, though recent data suggest that roughly three million Americans suffer from nut allergies and about 100 to 125 deaths from anaphylactic reactions occur each year in the U. S. Graham says these numbers can be divided by ten to provide a sketchy idea of the situation in Canada, but how many of these deaths occur from peanuts is not clear. Graham is a member of the Anaphylaxis Foundation of Canada, which is trying to establish a registry through Canadian allergists; this would provide a place where those with anaphylaxis could report their cases.

When her daughter was first diagnosed, Nancy Wiebe was dismayed by the lack of information. "It's scary when you first find out and you leave the doctor's office with almost no idea how to live with it," says the mother of two. "It's pretty intimidating." After researching the issue intensively, Wiebe co-founded the Calgary Allergy Network in early 1997. Today, her Web site (see resources) is getting visits from all over the world. "It started as an anaphylaxis support group, but itıs more of an info hub now. I put people in touch with resources and other parents."

Wiebe believes it is in Lauraıs best interest to be schooled in a realistic environment- one where peanuts are not altogether absent. "Itıs natural to want to protect your children," she says. "But for me itıs a training issue- my daughter needs to learn to live in a world with peanuts. By the time she gets into junior high, she'll need those living skills. My goal is to get her completely comfortable with the precautions she has to take so that she can handle her allergy at an older age. Banning doesnıt address that at all."

Eliseıs mother, Isabel Grant, agrees that bans are impractical, but she insists on limits. "I donıt buy into the Œfalse sense of securityı argument because when someoneıs life is at stake, you need to be very vigorous. Elise needs to learn how to live in the world, and as she grows up, she'll start exercising her own control. But I donıt think that because she needs to learn how to live in the world, we should relax and not have limits on nuts in schools."

Stewart Black, a Montreal father, says heıs not asking the parents of his allergic seven-year-oldıs classmates to stop feeding their kids peanut butter-just not to send it to school. "I do believe that we should make elementary schools peanut-free," he says. "Iım aware that it might not be 100 percent, but weıre talking about kids. As much as you drum it into them, accidents happen. When theyıre in the lower grades, they need help."

Despite the differences in opinion, each of these parents agrees that educating both adults and children is essential. Videos and books, says Wiebe, are among the best investments a school can make (see Resources). Not only do these resources lower risks, notes Wiebe, they teach children about respect.

Indeed, most parents of peanut-allergic kids say that their childrenıs most helpful supporters are their classmates. "The kids are great," says Black. "They seem to understand the allergy better than anyone, and theyıre so happy to co-operate."

Adds Grant: "The world would be a much simpler place if it were run by kids."

WHERE WAS THIS ALLERGY 20 YEARS AGO?

The nagging question amid all of the brouhaha is the increase in peanut allergies in recent years. Why is it so much more prevalent now?

Just as there is mystery surrounding the particular potency of peanuts as an allergen, it is also unclear why peanut allergies affect so many children than they once did. Caroline Graham, a Toronto allergist, says there are three closely related theories, and all are controversial within medical circles.

One possibility involves the large increase in peanut consumption among North Americans. Between the late 1980s and early 1990s, peanut butter consumption increased by billions of kilograms. "Peanuts are in more foods than ever," says Graham. "Therefore the exposure is greater." This means that an undiagnosed peanut-allergic child will almost inevitably come into contact with peanut protein at some point.

Another theory is supported by evidence that peanut butter is being introduced to North American children at an earlier age, quite often when they are under 12 months. "Instead of adapting to the substance, a sensitivity occurs because their life and immune systems are so immature," Graham explains.

The third theory relates closely to the second. Some experts believe the allergy may develop in utero: The fetus absorbs the protein of a peanut product consumed by its mother and becomes sensitive to it. Many allergists and allergy-information groups are now trying to let women know-particularly those with a family history of allergies- that eating peanuts during pregnancy may not be wise.

RESOURCES

Anaphylaxis: A Handbook for School Boards. Put together in 1996 by Health Canada and the Canadian School Boards Association, this booklet has been used as a guide to handling life-threatening allergies in schools across the country. For a copy, contact the CSBA in Ottawa at (613) 235-3724; fax (613) 238-8434; e-mail admin@cdnsba.org

Life Threatening Allergic Reactions: Understanding and Coping with Anaphylaxis, by Deryk Williams, Anna Williams and Laura Croker, General, 1998.

The Calgary Anaphylaxis Network (www.cadvision.com/allergy), created by Nancy Wiebe, has hundreds of links, articles and other resources.

"Anaphylaxis in Schools and Other Child Care Settings" is a report available online at www.oma.org:70/phealth/allergy.htm, or from the Allergy Asthma Immunology Society Of Ontario, 2 Demaris Ave., Downsview, Ont. M3N 1M1; phone (416) 633-2215; fax (416) 633-3108.