Gunshy

A Reuters article caught my eye tonight. It talked about anaphylaxis in general and specifically mentioned that many parents are apprehensive in using an EpiPen. I have blogged about the fact that teachers and other care givers are frightened by the thought of using an EpiPen to save a child's life.

Parents too are frightened, and perhaps even to a great extent since it is their child's life that is hanging in the balance. I tend to be calm in the moment of an emergency and would not hesitate to use an EpiPen. The statistics say that there is a reasonable chance that we will have to do this. Am I ready? Yes. Would I use the term 'comfortable' to described how I feel about the thought of having to save our daughter's life with an EpiPen? No.

Be ready, but don't feel bad if the thought of using an EpiPen on your child makes you queasy. I think I would be more concerned if it didn't.

The bottom line however is that in the event of an emergency, you need to be able to put your fears aside and act quickly. There would be no time to waste. You would need to be strong!

I would be interested in comments from those who have had to do this.

Duke Immunotherapy Trials

For those of you who are not aware of the Duke immunotherapy trials, this is worth reading.

Dr. Scott Nash of Duke presented at the 2007 Annual Meeting of the American Academy of Allergy, Asthma and Immunology in San Diego this past Saturday.

I have covered the Duke trials before and I have actually interviewed Dr. Wesley Burks, who is leading the project. I am overdue in posting my interview to the blog - I'll get it done this week!

This trial holds significant promise for the peanut allergic ... there are many questions still to be answered but in my opinion this is the best hope there is for a 'cure' today.

Xolair

I posted in January about current peanut allergy research. I noted that Xolair, an asthma treatment that nets Genentech over $400M per year in revenue, could possibly be used in the treatment of anaphylactic food allergies. However, I did note that the cost of the annual treatment could be as high as $10k.

This week the FDA required a warning label for Xolair due to the drug apparently causing anaphylaxis in some patients (specifically it occurred in approximately 'one in a thousand cases').

I suspect that a drug that causes anaphylaxis in some patients, however remote the risk is, might not be useful in the treatment of anaphylaxis. Perhaps Genetech will now revisit research into TNX-901?

Air Peanut

Today I flew for the first time with our daughter since we learned of her severe peanut allergy. I was not really that concerned but certainly made sure I was prepared. Though I did forget the flannel crib sheet (to cover our seat) I had wipes, snacks, water and the usual assortment of snacks from home. Of course Benadryl and two EpiPens were in the bag as well.

My wife called Transport Canada and they noted that EpiPens were fine to bring through security in Canada but if we traveled to the US we would need to have a doctor’s note to bring them on board.

We also called ahead to West Jet. The woman on the phone was helpful but noted that they ‘couldn’t guarantee a peanut free flight’. West Jet does not serve peanuts but passengers could bring peanuts on board. She also said to make airline staff aware of the allergy at check-in time so that I could board early. In addition, she said that the inflight crew could make an announcement to other passengers letting them know that a peanut allergic child was on board and that it would be appreciated if people refrained from eating peanut snacks.

I was impressed that West Jet would be so accommodating … however, it seems that these policies did not make their way to the airport.
When I arrived at YVR I let the check-in staff know of our daughter's allergy. I was met with a look of ‘what would you like me to do?’ and the stock ‘we can’t guarantee a peanut free flight’ statement. I told her that I was just letting her know as customer service thought it would be a good idea.

I let it go and moved on.

After convincing my daughter that our baggage would return to us even though I sent it down the belt, we went through security. I found it ironic that security was more concerned with the bottle of Benadryl we had than the two EpiPens. Liquids are the concern of the day it seems.

We arrived at the gate just prior to boarding. I went up to the gate agent and explained to her that our daughter had a severe peanut allergy and I was told to let the staff know. She gave me the same look of ‘what would you like me to do?’ and the stock ‘we can’t guarantee a peanut free flight’ speech. With a note of condescension she added, ‘tell the flight crew; there’s nothing I can do’. Then she turned away and went back to work.

Again, I let it go and moved on.

We boarded early and I pulled out the wipes to clean the surfaces around our seats. During a stopover, cleaning crews pick up visible garbage and recycling but do not have time to clean surfaces. I am not sure what the cleaning schedule is but I was appalled today at the layer of grime that covered the windows, meal trays and the console buttons. Given that my daughter apparently needs to press her face to the window to see the mountains, this is a concern for all kids and especially those with allergies.

I also informed the flight staff of the allergy. The attendant noted the allergy and again started in on the 'we can't ensure a peanut free flight' speech ... I told her I knew and that I understood but I was told to let her know.After the first series of announcements did not include a mention of our peanut allergy, I motioned for the flight attendant as she walked past. I mentioned that customer service noted that she could make an announcement. Again I got the ‘we can’t guarantee a peanut free flight’ which was followed up by ‘if we announce anything about peanuts then we have legal exposure’.

So there it was. West Jet’s policy on accommodating a peanut allergy is to warn us four times that they cannot guarantee a peanut free flight and then do nothing else for fear of a lawsuit should an allergic reaction occur.

I was really disappointed with their service. I expected better from West Jet given that their brand is based on being friendly. When it comes to peanut allergy they really missed the mark. I was not really asking for anything special. The expectation of an announcement was due to our conversation with customer service, and frankly the announcement would be a good idea.

Instead, they did nothing to accommodate my daughter’s allergy and made me feel as though I was being a ridiculous ‘peanut parent’. Nothing could be further from the truth.

West Jet needs to do more than simply not serve peanuts.

I think that it would be great if they made sure that no peanuts were consumed in the three rows on either side of an allergic child. I also think that a simple announcement does not have to create supposed legal exposure … wouldn’t this work? … “Passengers are advised that there is a child on board who is severely allergic to peanuts. We ask that passengers in rows 22-28 refrain from eating peanuts and suggest that remaining passengers avoid peanut snacks as well in the interest of safety.” Nothing invasive there. Shouldn’t create any lawsuits.

As a condition of making the announcement, I would be willing to sign a waiver discharging the airline’s liability should a peanut brought on board by a passenger cause an anaphylactic reaction. I would trade my right to sue for a safer environment any day.

This doesn’t just apply to nuts. Though nuts pose a greater risk due to their ability to roll away, if a child is allergic to milk then the people sitting in the immediate seats around the child should perhaps avoid milk to prevent an accident. This just makes sense doesn’t it?

The peanut risk is this … kids play on the floor of the plane. If you drop a peanut it could easily roll 5+ rows away. Kids also play peek-a-boo with the people in the seats behind them. Today I was terrified that the kids behind us might pass a ‘peanut snack’ through the seats to my daughter and I had visions of her eating it before I could stop her. These are not unreasonable or imaginary risks.

Today West Jet made me feel like I was being ridiculous. Ridiculous would be if the people behind us rolled a peanut under our seat, my daughter ate it and the plane had to make an emergency landing due to an anaphylactic reaction.

6 - Love

This article is a great follow-up to my last post on whether peanuts should be banned.

I contended that a peanut ban would not necessarily help all children ... in this case I was (happily) wrong.

An Iowa school district banned peanut products to ensure the safety of peanut allergic children. While the peanut debate usually generates a degree of controversy, I was surprised to read that the school board voted 6-0, with some board members noting that they "hoped the procedures struck a balance between protecting children and sparing them the embarrassment of having an unusual condition." As a tennis player that is a score I am used to ... I never though I'd see it in this context.

The best part of this ruling however has, imho, nothing to do with peanuts.

The ruling is cryptically comprehensive in that it covers off several aspects of managing anaphylaxis, despite the fact that the ban was targeting peanuts.

In particular, I really like the fact that a network of school personnel are required to discuss the health needs and symptoms of children. There is a ban on homemade food items. Young children are essentially prohibited from preparing their own food.

Even better, there is a "mandatory review of emergency procedures before field trips" and "required notification of bus drivers carrying students with such allergies."

I like this policy. If your child is allergic to something other than peanut you benefit from the group discussion, the field trip preparation and the bus driver awareness. This is an anaphylaxis policy in peanut clothing.

It's all good!

To Ban, Or Not To Ban

I came across a question at ABCPeanuts that stirred up some debate. I thought I would add my two cents. The site posed the following question:

What Is Peanut Free?
Peanut free means peanut safe. Does that mean an entire lunchroom must eliminate peanuts to be safe, or is a peanut free section sufficient? What is your opinion?

As is commonly the case with online peanut debates, posted comments ranged from practical to extreme. Here are two of my favourites:

Lilly (CA): I do not agree that we need to cater to the few that have this allergy. I do understand that it can be severe but we need to educate not ban. We live in a democratic society. All this banning of various items is becoming more of a dictatorship.

Kirsten (NY): I agree that we cannot become a dictatorship. If parents are so worried about the allergies they should home school their children and not go out in public.

I actually agree that a peanut ban does not solve the issue of overall food-related anaphylaxis but to compare a ban to the country sliding toward dictatorship is over the top.

I posted the following comment, directed in part toward these two posts but trying to discuss the overall situation:

It does not make sense to take such an extreme stance against a peanut ban. Claiming that it encroaches upon your participation in a democracy or that a child should be home-schooled due to peanut allergy is sensational and just serves to fan the flames of the debate. I will make the assumption that you would not want that for your child? That being said, I do not think that an outright peanut ban is absolutely necessary for a number of reasons … there are more reasonable solutions.

My blog (www.nopeanutsplease.com) chronicles our journey in dealing with our daughter’s peanut allergy. I take a moderate approach and one of my core concepts is that ‘It Takes A Village’ to manage severe food allergies. Peanut parents need the support of many people to ensure that their child is safe during the day and we need to support and educate those who help. While a peanut ban indeed helps my daughter avoid an anaphylactic reaction, there are several severe food allergens and banning them all is not feasible. Furthermore, a ban creates a false sense of safety and while it is helpful it does not make the school 100% peanut free.

Schools should have an emergency plan in place. They should also ensure that the contents of cafeteria food are clearly identified and that food-related activities are restricted in settings where allergic kids are involved.

Parents of other children should make sure that their children know not to share their food with other kids due to the risk of allergic reaction. It is also helpful when other parents ensure that allergic children are not left out of activities such as birthday parties just because they have an allergy. Parents of allergic children are eager to help in these situations and it is important that their kids be able to have normal social lives with other children.

Our role as ‘peanut parents’ is to make sure that the school is aware of our child’s peanut allergy and that they have a plan in place to deal with anaphylactic reactions. We also have to make sure that our daughter is fully aware of the allergy and all of the precautions that entails. We understand that sometimes we will have to make an extra effort to manage the allergy and we accept that.

It truly takes a village to manage these allergies, especially where children are involved. We all have a role.

NP.

So Long Peanuts!

Before our daughter's anaphylaxis to peanut became apparent I was a huge peanut eater. I had just cracked a brand new jar of organic peanut butter and as always had a reserve jar of Adams downstairs. My brother was the beneficiary of the peanut purge.

In addition to the (delicious) peanut butter, I also threw in that one can of Planters mixed nuts that seems to be in everybody's pantry.

I thought it ironic that the label on the mixed nuts advertises the fact that the mixture is now with "BIGGER Peanuts". Great!

I have tried almond butter and cashew butter since we had a peanut ban in the house. I found cashew butter a little too sweet but almond butter is actually quite nice. Peanut butter is of course the best ... I'll miss it but it's hardly worth the risk to have it in the house.

I am open to any and all suggestions for a peanut butter replacement! =)

Catering To The Allergic

On the heels of the Cadbury labeling recall and Peter Pan peanut butter's salmonella recall, I was understandably concerned over who was ensuring quality and safety of our food.

Then I read this article.

Seems that 17% of catered food provided to (known) peanut-allergic government officers in Northern Ireland contained peanut protein. Furthermore, over half of the samples that tested positive for peanut protein had incorrect allergy warnings. On top of this, 10% of the serving staff showed no knowledge of peanut allergy at all. I guess the silver lining is that 90% of caterers had at least a basic or passing interest.

It is tougher to manage our daughter's anaphylaxis to peanut and egg when you realize that catering (and buffets) may be a source of hidden allergens and cross contamination.

Clearly the caterers above require education as to the risks associated with food allergies and what they should be doing to help manage those risks. When 17% of the people who declared a peanut allergy are getting peanut protein in their food, that's a problem. It is reasonable for a politician who is having food prepared on a very frequent basis by a single caterer to expect an allergy-free meal when declaring the allergy well in advance.

There should perhaps be a component to the health certification for restaurants and caterers that considers their management of the most serious allergies. That doesn't mean the whole menu is without wheat, egg, peanut, tree nut, shellfish, soy, sesame seeds and wine (sulphites), it just means that the restaurant is able to offer allergy-free meals when given advance notice and time to prepare. It would also consider whether restaurant used financially-feasible precautions such as the restaurateur I referenced in a post earlier this month (his name is Chris Woodyard of Australia).

The good news is that there seems to be a changing of the guard. While I am still concerned that the mislabeled Cadbury eggs made it through safety checks, I was impressed that they went public quickly once they found out. That is progress irrespective of whether the corporate giant did this altruistically or out of fear of reprisal.

I also think that over the next few years many more restaurants will publish their menus online just like Damon's Grill. I am going to start calling into some local restaurants in an attempt to spread this idea.

The Perfect Roommate

Each day I read a variety of articles from the mainstream media on food allergy and anaphylaxis. Today I stumbled across one article that was disappointing.

In an article entitled 'What To Look For In The Perfect Roommate', the author included the following item for a roommate screening checklist, under a section called 'Habits' no less:

Habits: Living with someone who loves rock and roll at midnight might not jive with a devotee of Mozart at noon. Food choices also play a vital role when sharing space. Whether you're a vegetarian or a fan of junk food, seek someone who shares or at least respects your food preferences. Food allergies should also be discussed and ruled out, especially if severe. Peanut butter in the pantry can be fatal for some people.

So apparently food allergy is a bad habit and those with such a trait should be avoided when choosing a roommate? Wow. Forget that this may exclude excellent candidates - it is much more important to keep that jar of peanut butter on the shelf!

Anaphylaxis is not a 'habit' and it is disappointing to see food allergy trivialized in this fashion.

My 22 month old daughter has a great little spirit and I am sure she'll make somebody a wonderful roommate some day! It would be the author's loss to avoid selecting her due only to her peanut allergy.

Furthermore, there is also minimal responsibility for the author in helping to manage a roommate's severe peanut allergy. Learn how to use an EpiPen. No peanuts in the home.

It is irresponsible to advise people to discriminate against the food allergic, especially when the one is without the facts. Though there are people with multiple severe allergies, and that might prove to be a challenge, I would hope that people would select roommates based on their merit and the personality fit, not based on their food allergy.

It takes a village to manage an allergy ... and the food allergic need roommates too!

It Takes A Village - Online Menus

This is cool. A restaurant chain called Damon's Grill has put its entire menu online in a manner that lets you identify possible allergens. Though they have the standard caveats noted about risks and the fact that you need to be careful relying on the data, the interactive menu shows you the possible allergens in the food.

This would be a good tool for anybody dealing with anaphylaxis to food allergens. It would be perfect for identifying unexpected danger foods for my daughter's allergy to peanut and egg.

Here is a sample menu for my daughter and I ... hmm, I am not sure how the list auto-sorted but it might not be a bad idea to start with the sweet apple cobbler ... ahh, but wait ... my daughter can't eat the eggs! I guess that leaves more for me =)

Item	Allergens
Sweet Apple Cobbler	Egg, Milk, Soy, Tree Nuts, Wheat
House Caesar Salad	Egg, Milk, Soy, Wheat
Buffalo Chicken Pasta	Egg, Milk, Soy, Wheat
Kids Ice Cream Sundae	Milk, Soy
Kids Mac and Cheese	Egg, Milk, Soy, Wheat
Lemonade	None
Ketchup (Serving Size: 1.50 fl oz)	None

Peter Pan On The Run

ConAgra announced a major recall of Peter Pan brand peanut butter today. How does salmonella get into peanut butter? On the heels of the Cadbury recall I am left scratching my head as to the attention to detail by those in charge of food safety. Who's at the wheel?

GMO & Allergy

Here is an interesting article on GMOs and allergy.

It seems to lie somewhere between fully objective and pro-GMO. It highlights the fact that we do not really know whether GMO foods increase the risk of food allergy or whether they might actually help prevent sensitization down the road.

I am cynical on GMO until the foods are proven to be safe. I am certainly not opposed to innovations but it feels as though we have moved quickly toward widespread adoption of these products without sufficient, conclusive research. As this article notes, "a major health concern is the potential of GMO foods to increase allergies and anaphylaxis in humans eating GMO foods."

The fact that the increasing prevalence of GMO foods seems to correlate with the significant increase in the number of people with food allergy is cause for concern. There is little research to prove or disprove a linkage between GMOs and allergy, but the industry practice seems to err on the side of assuming that GMO products are safe.

Something is causing the significant increase in food allergy across the board and GMO is widely considered a lead candidate.

Overall, the article provides a reasonable overview of the GMO issue as it pertains to allergy.

Here is an excerpt:

"GMOs have the potential to directly affect people with food allergies for either their benefit or to their detriment. Foods that when grown organically may be tolerated by people with allergies, such as a potato, may not be tolerated once they have been genetically modified. For instance, potatoes have been modified by adding a fish protein gene and these potatoes could trigger an allergic reaction in people with seafood allergies. On the other hand, a food may be altered to allow a sensitized person to eat it. There are two main concerns with genetically modified foods and food allergies:

• "New allergies. GMOs may contain new proteins. Since most known food allergies involve proteins, GMO proteins could become new allergens. However, advocates of genetic modification dismiss those fears by pointing out that genetically modified crops undergo extensive testing.
  
  
• "Unknown ingredients. Food labeling guidelines, especially in the United States, make it difficult for people with allergies to known that they are eating genetically modified foods. Even when a food is marketed as containing GMOs, packages will not indicate which genes have been inserted into those foods. Therefore people who experience an allergic reaction to a food may not be able to determine whether it was the original food protein, a GMO protein or other substance that triggered the reaction. There are many opinions from scientists, industry advocates, non-GMO food activists, and government regulators on the pros and cons of GMO foods and it can be difficult to identify what concerns are being addressed through testing.

"In theory, any gene could be inserted into a GMO food. Known genes that have been inserted to improve a crop plant include brazil nut genes into soybeans and cod proteins into potatoes. Testing of the soybean-brazil nut crop revealed the presence of a known allergen and that particular GMO soybean has not been produced commercially. People with nut or fish allergies would require knowledge of these modifications prior to being exposed to these foods."

The jury is out ... my research continues.

It Takes A Village - Food Manufacturing

As noted before, It Takes A Village to manage an allergy and food manufactures bear significant responsibility.

This week Cadbury stunned the allergy community with a significant recall of thousands of Cadbury Mini Creme Eggs and Easter Chicks due to missing allergy labeling. This is particularly scary since these products are typically directed at young children.

In response to the Cadbury announcement, (incidentally their second recall within the last few months), Loraine Heller wrote an excellent piece entitled "Allergens: no room for mistakes".

Lorraine urges manufactures to prioritize allergens ahead of other food related concerns such as unfounded health claims on products or products that have hidden hazards such as contributing to obesity.

The link between allergen and anaphylaxis is a direct and well-documented risk. Lorraine notes that "allergens sit one notch up on the priority ladder – because when we're talking about the risk of people dying after a single nutritional slip, or even suffering a seriously compromised quality of life, there really is no room for debate."

Given that I have a child with anaphylaxis to peanut and egg I obviously concur, and am concerned.

She also notes progress that has been made ...
"New labeling regulations implemented last year in the US require the labeling in simple language of eight major food allergens - milk, egg, peanut, tree nut, fish, shellfish, wheat and soy."

and some things that are troubling ...
"Europe has gone one step further, essentially abolishing an outrageous '25%' rule – which meant that a compound ingredient comprising less than 25 percent of the finished product (such as salami on pizza) did not have to have its individual ingredients listed. But since 2005 products for sale in Europe must label 12 allergens, with an additional two shortly due to be added to the list."

It is not surprising that Europe has again taken the lead in erring on the side of caution in food related matters. Europe typically takes a more precautionary approach to food manufacturing rules, as evidenced by their tougher stance on GMOs vis a vis North America.

The other trend that everybody has noticed is that many products now feature 'may contain' labeling. The USDA requires this labeling whenever a manufacturer cannot be sure that the product is allergen free. The problem though is that many feel these labels are primarily for legal protection and as a result there is something of a 'Boy Who Cried Wolf' effect in the marketplace.

Says Lorraine, "Manufacturers feel they are being responsible, while consumers feel they are opting for a legal cop-out. As a result, the labels are mistrusted and often ignored."

The bottom line is that as parents of an anaphylactic child we have learned much about how to read labels, though it is confusing at times. It is very helpful when plain English is used and dangerous when allergens are buried. It is not helpful, for example, when a label includes 'vegetable oil' instead of calling out the exact oil. This happens when oils are a composite or if the ingredients are subject to variation.

I need the manufacturer to tell me whether there is peanut in the product. People allergic to the other primary allergens need the same level of clarity. Though progress has been made, there more work needed on the food manufacturing and labeling front.

My favourite quote in the Cadbury article comes from Tony Bilsborough, who said that the incorrect allergy labeling was discovered "through our regular due diligence report". Perhaps that process needs to be tightened before the product actually hits the shelves!

It is true ... there is no margin for error.

It Takes A Village - Peanut Industry

Before the events of Boxing Day I was a regular peanut eater. Though the sacrifice is obviously worthwhile, I dearly miss slathering my toast with Adam's peanut butter each morning … I'm salivating just at the thought!

By now readers are familiar with my 'It Takes A Village' series. The series follows the theme that 'It Takes A Village to Avoid A Peanut'. This time I focus on the Peanut Industry. If you make a product that is nutritious, safe (and tasty!) for 98% of the population, should you be made to worry about the very tiny minority that has a peanut allergy? Should you feel obligated to help find ways to treat or prevent a peanut allergy?

In short, is anaphylaxis due to peanut allergy your problem?

I ask this not on a personal level, (obviously a basic level of humanity encourages people help one another), but is it reasonable to expect the industry to contribute their limited research budget to peanut allergy research for the 2%, at the expense of funding research into production or agriculture innovations that would improve the product for the 98%?

It is a fair question – think about it.

This week I called Patrick Archer, President of the American Peanut Council. This organization represents peanut producers, growers, shellers and manufacturers in the United States. You could easily assume that he has a bias toward that portion of the population is forced to live in fear of his products. That could not be farther from the truth.

I assured Patrick that NoPeanuts was not anti-peanut and was not the work of an anarchist 'peanut parent'. I was sure to bring up my aforementioned love of peanuts and my inability to replace peanut butter … cashew butter is okay but it is just not the same.

Patrick and the peanut industry are empathetic toward those who cannot eat their products due to peanut allergy. When I told him that our daughter recently had a terrifying anaphylactic reaction after possibly not even eating a peanut he seemed genuine in his concern.

The challenge in representing the diverse and numerous participants in any industry is that you have to be well-versed on many topics. Given that peanut allergy only affects 2% of his market, I was impressed by his depth of his knowledge of peanut allergy and the patience with which he discussed peanut allergy with me.

For example, in my naivety I mentioned that our daughter had a skin reaction to (we think) a graham wafer and the only ingredient I could see that might trigger a food allergy was vegetable shortening (full ingredient list here ). I told him I suspected this might be due to the shortening including peanuts. He patiently explained that peanut oil would not likely be in shortening due to its higher cost versus other oils, and even if it was included, refined peanut oil is free of the proteins that make peanuts allergic.

"Oh, sure", you say. Of course he is patient when he explains to you that peanuts did not likely cause this reaction. He has a vested interest in that perspective. That was not my take. I found Patrick to be balanced and sincere in our discussion and he did not just default to a pro-peanut defense.

Patrick and his industry truly seem to care about those who have peanut allergy, food allergy in general or anaphylaxis. This is evident in its research funding program. Patrick cited several research projects over the past decade that were funded at least in part by the Peanut Council. He was up to date on the most current research and discussed some of the findings of promising projects with an air of optimism, as if he truly hoped that there was a solution whether or not it helped the bottom line of his constituents.

I think this is commendable. There are many other industries that could learn from this. I personally think that companies should be aware of, and held accountable for, the downstream impact on the environment or the populace at large.

Do I think that the peanut industry bears a responsibility to understand why some people go into anaphylaxis after eating their products? Yes, I do.

Do I think that, the peanut industry should play a leadership role in making their products safe for as many people as possible? Absolutely.

Thankfully Patrick and his industry agree. The peanut industry has been a good 'Villager', contributing over $4M to peanut allergy research in the past decade. The dollars fund research projects in multiple areas including: understanding the rising incidence of peanut allergy; developing allergic tests that gauge severity in addition to incidence; developing treatment or prevention options that could reduce the risk for those with anaphylaxis.

Though I was a little disappointed to learn that the research funding has not increased in the past few years to match the rising incidence of peanut allergy, I am still impressed with the funding that is in place and am left hopeful that this program will continue.

I also asked Patrick to confirm or dispel several 'peanut legends' that I have come across in my research.

**The caveat here is that this was a discussion between two non-medical people and is only for discussion purposes and should not be taken as medical advice – please discuss things with your allergist before relying on any of this information!**

NoPeanuts:
I have read that increased prevalence in roasting of peanuts vs boiling has corresponded to an increased prevalence of severe peanut allergy.

Patrick:
Many consumers prefer roasted peanuts to boiled. This is nothing new. The techniques for roasting have not changed in 20 years, nor has the prevalence of roasting itself.

NoPeanuts:
I have read conflicting things about whether bringing my daughter to a hockey game would be too great a risk.

Patrick:
You often hear of people being allergic to inhaled peanut particles or even the odor of peanuts. There is no research that demonstrates that the odor itself causes the allergy though it is possible for people to have a psychosomatic response that resembles an actual allergic reaction. These reactions would not result in anaphylaxis. As for inhaled peanut particles, research does indicate that this can cause an allergic reaction in some cases. Patrick noted that professional opinion on the subject is that airborne particles could not cause anaphylaxis.

NoPeanuts:
So you would not be concerned about the hockey game scenario?

Patrick:
I am not a doctor so you would have to check with your allergist, but no, I would not personally be concerned about that. You would want to bring your Epi-Pen to be safe but the risk of anaphylaxis would likely be low.

(Incidentally, I am writing this on an airplane and of course the person behind me started his day by tearing into a bag of Planters at 7am. I learned today that as a result of our daughter's anaphylaxis the smell of peanuts is now sickening to me.)

NoPeanuts:
What is your response to people who want to ban peanuts from schools and other places?

Patrick:
Education and awareness is a better strategy. You cannot completely ban peanuts and therefore a ban is actually risky since it can create a false sense of security. Controlling a day care environment is perhaps possible, and given that young children cannot manage their own allergy this makes more sense than trying to do the same for an entire school. The other issue is that peanuts are just one allergen and it would be virtually impossible to ban all food allergens.

Overall I enjoyed my conversation with Patrick and I look forward to chatting with him again in the future. The American Peanut Council is actively involved in research and also supports the good work of organizations such as Anaphylaxis Canada.

It Takes A Village to avoid a peanut and the Peanut Industry is making a meaningful contribution. In the future it would be great to see an increase in research funding and charitable work commensurate with the overall increase in peanut allergy prevalence. Current funding has been steady the past few years while the prevalence of peanut allergy and anaphylaxis are on the rise.

That being said, I am impressed overall by the work that the American Peanut Council has done so far for food allergy and anaphylaxis.

Desert Peanut 'War' - part 3

The Phoenix Allergy Network responded to the esteemed editor of the East Valley Tribune.

It Takes A Village - GMO Labeling

Tonight I read an open letter from AllergyKids founder Robyn O'Brien. Suffice to say that after reading this letter, 'GMO' will be a new area of focus for NoPeanuts!

Genetically modified infant formula - is nothing sacred?

A 50% increase in peanut allergy within 5 years of the the release of genetically modified soy bean? Makes one think.

Thankfully the fact that there is hay fever and asthma in my wife's family makes our daughter's allergy less than 'random' but the thought that this could be due to GMO food in her diet as a baby is tough to fathom.

If GMO is indeed causing increased prevalence of food allergy, it would not be a stretch to hypothesize that kids who are predisposed to allergy already might be even more susceptible to developing GMO-related allergies?

The rest of the developed world is labeling for GMO ... it's time for North America to follow suit. How is it possible that this was not regulated?

Here is a link to the full text of the letter, as posted on the AllergyWare.

It Takes A Village - Restaurants

Each day I review the various news search feed that I get. Typically there is at least an article or two of interest each day. Today I found a great article from the Sydney Morning Herald about the challenges that restaurants face in accommodating their allergic patrons.

The article opens with the sort of scenario that those with anaphylaxis are terrified of:

"Richelle Townsend informed the waiters at a Thai restaurant in Newtown of her allergy, ordered dishes unlikely to have peanut in them and was reassured repeatedly that there were no nuts in her meal. Nonetheless there was peanut in her food and her allergic reaction was so severe she was left with permanent brain damage. Townsend was 32 at the time and a mother of two young children. In 2000, the restaurant paid an undisclosed sum, out of court, for her ongoing medical care.

"Dr Robert Loblay, an immunologist and director of the Royal Prince Alfred Hospital's allergy unit, who is familiar with the case, says it was probably a case of micro-contamination. With severe allergies, even a minute amount of the allergen on a knife or a chopping board can
trigger a full-scale reaction, so food handling procedures in restaurants are of grave importance".

This scenario underscores the importance of restaurants and restaurant staff paying attention when taking orders and taking care in the kitchen. It also calls into question why you would eat in a Thai restaurant if you had a peanut allergy. They must have cases and cases of peanuts in the kitchen!

One young woman had some practical grounds rules for eating out ...

"If she's invited out for a restaurant meal, (Jade) Batty tries to call ahead to check the menu. If it has "heaps of seafood or satay or nuts, I just don't go in there. There is no point, because there is going to be a lot of seafood and nuts in the kitchen, and the chances of contamination are really high.

"When in a restaurant, Batty reads the staff as closely as the menu. She recalls a night when she
encountered a very young, very tired waitress who didn't seem to be listening. "I thought, 'Well, I'm not going to risk this ...' so I just had garlic bread and when I got home I had something to eat."

Though straightforward and practical, these ground rules are worth following. I have to admit that I would not have thought of the tired waiter scenario though I suspect that in the moment you would be concerned when your daughter's life may hang in the balance.

The article also outlines in some detail the pains to which restaurants have to go through to ensure that there is no cross-contamination of food. These are important measures but you are truly at the mercy of the kitchen and floor staff in any restaurant environment.

The thing that really bothered me in this article though is that there are some people out there who pretend to be allergic. That is just wrong ... have a look at this passage:

"Thompson has also been frustrated by pretenders. "There are times that you come across people who seem to have a different food allergy every half hour. For example, 'I have an allergy to dairy, I can't possibly have cream in my scrambled eggs' but they're more than happy to drop a couple of cappuccinos and a slice of cake with cream.""

That is just bizarre ... these 'Pseudo-Allergic' folks either think that having anaphylaxis is somehow cool or else they are simply craving attention. That is the sort of thing that makes people lose patience with those who are truly allergic. If you are on a diet or have some other reason to avoid a certain food product, just ask them to leave it out ... don't tell them you are allergic. If you are too embarrassed to ask them to leave it out then eat it or order something else.

Since Boxing Day we have not eaten out with our daughter. I still would not be able to enjoy my meal. We'll get there.

NP.

Peanut Bowl

I figured that with the Big Game coming on Sunday I should have at the NFL's peanut-related facts and tidbits.

• Super Bowl fans consume 2.5 million pounds of nuts during the game each year

• At the game itself vendors will serve 1000 cases of peanuts. Stacked on top of each other they would be taller than the Empire State Building.

• "Wal-Mart will sell enough Planters(R) dry roasted, honey roasted, and
  cocktail peanuts for Super Bowl Sunday that, if you stacked the
  containers on top of one another, they would equal the height of
  108 Empire State Buildings."

• A bag of peanuts is four bucks at the Super Bowl. With water being $5 peanuts are the cheapest thing on the menu. Peanuts cheaper than water? Oof.

• Trent Green, whose team was nowhere near the Super Bowl, is a donor to FAAN.

• The USA Football website actually has tips for coaches on how to handle anaphylaxis emergencies. That's pretty cool.
  

• Before anaphylaxis found its way into our lives, I had attended several NFL games and I am pretty sure that every time I have devoured a bag of peanuts, dropping a bagful of shells all over the ground in the process. You just don't think about it.
  

• New Orleans Saints QB Drew Brees, who almost made it to the Super Bowl this year, is allergic to dairy, wheat, gluten, eggs and nuts

• This year's Super Bowl MVP could be none other than Charles "Peanut" Tillman of the Chicago Bears. "When Charles Tillman was just a baby, his aunt likened his small frame and shape to a peanut. From that moment on, the nickname "Peanut" stuck to Tillman and it's the only name his Chicago Bears teammates use for the 6-1, 196-pound star cornerback."

• Advertisers are 'nuts' to be spending ~$3M for a 30 second ad slot!
  

Enjoy the game.

NP.

Desert Peanut 'War' continued

The East Valley Tribune published an editorial today in respect to the Arizona allergy legislation that I blogged about this week.

My basic contention was that legislation alone is not the solution. We need to support teachers and provide them with encouragement as well as training. We can't just make rules and hope that they are applied. It doesn't work that way and that has little empathy for the teacher who is truly frightened at the though of plunging a needle into the leg of a child who is in the middle of an anaphylactic reaction. That is scary even for parents of allergic children.

Here is the editorial text ... note the NoPeanuts comment added at the bottom =)

The basic logic flow of the editorial is that children with allergies deserve special attention but that somehow a law that forces teachers to be at the front lines of emergency response is an abdication of parental responsibility.

I don't understand that. Parents of anaphylactic children are not asking teachers to raise their children, they are asking them to do whatever they can to return their children alive at the end of the school day. Through prevention and proper emergency response training teachers WILL save lives!

That is a good thing. It Takes A Village to Avoid A Peanut - we need the teachers on our side!!

The editorial then goes on to say that this abdication of parental responsibility will create societal problems.

"Less parental involvement means more poorly adjusted children who don’t fare well in school — and became burdens as adults for the rest of us to care for through poverty assistance, drug treatment programs and jail cells."

That is irresponsible to write in my opinion.

In the context of this editorial, the Tribune is basically saying that allergy laws will result in more people going to jail down the road? Is that the connection that they are trying to make? That is a bizarre comment.

Here is my comment on their site:

NoPeanuts
I agree with the overall sentiment that legislation alone is not enough and I blogged on that this week (see my post Desert Peanut 'War' at www.nopeanutsplease.com). That being said, I feel that teachers are on the front line of dealing with allergic children. Teachers will be put in life and death situations ... that is unavoidable. I just think that training and support is even more important than legislation. To say that legislation is an abdication of parental responsibility and that will ultimately result in more people ending up in jails is a big leap though ... you lost me there. The bottom line is that teachers have these children all day and anything we can do to help teachers save the lives of allergic children (whether achieved through prevention or proper emergency response) is worth pursuing. NP www.NoPeanutsPlease.com It Takes A Village To Avoid A Peanut
February 2, 2007

Peanut Oil Refinery

News broke today that a major peanut manufacturer is expanding its operations into the peanut oil business. The major driver behind this is the market forces of the anti-trans-fat movement. Trans fat is going to be aggressively pushed out of the food supply it seems and peanut oil is in a great position to takes its place.

The article is entitled "Peanut oil production doubles with new US Golden Peanut refinery" by Lorraine Heller. I have quoted below in peanut coloured text (fittingly in a font called 'Georgia').

"Leading US peanut supplier Golden Peanut Company is expanding into the peanut oil market, with the start up this month of a new multi million-dollar oil refinery.

"The firm said it is due to start supplying customers next month with refined, bleached and deodorized (RBD) peanut oil, which can be used in fried products and baked goods, and as a flavor carrier.

"The expansion, which will occur adjacent to the company's existing peanut shelling and oil crushing plant in Dawson, Georgia, is expected to double the production capacity of refined peanut oil in the US.

"The trans fat issue is just blitzing the US market, and is really driving demand for peanut oil is, which is trans fat free. Its health benefits have become one of the main selling points for the product,” said Bruce Kotz, vice president of Specialty Products at the Golden Peanut Company."


I have to admit that my first reaction was basically fear for my daughter's anaphylaxis to peanuts. How would she function in a world that would see a burgeoning supply of peanut oil? This plant alone doubles the peanut oil production in the marketplace. What happens when five more plants follow suit?

In a flash I considered moving to Raleigh so that we could be closer to Dr. Wesley Burks and his immunotherapy research! My daughter would be safer and they have an NHL hockey team.

But then I read on ...

"According to Kotz, other advantages of the oil include its clean flavor, low level of saturated fat, high smoke point and good stability.

Refined peanut oil has also been shown to be allergen free, meaning that people with peanut allergies are able to eat products made with the oil."

Did you say allergen free? After I read it I remembered that Patrick Archer, head of the American Peanut Council had explained this to me during our call a couple of weeks ago (article forthcoming!). Unrefined peanut oil is allergenic, however its presence is not common. That being said, unrefined arachis oil is sometimes mixed with refined peanut oil to add flavour but that should be indicated on the label (more information on peanut oil here)

Phew! One less thing to worry about ...

NP


NP revision:

After writing the initial article I found the following excerpt at Anaphylaxis Canada. Looks like it is 'better safe than sorry' with refined peanut oil!

Highly Refined Oils
All oil sources should be declared on food labels despite the suggestion that “highly refined peanut and soybean oils be excluded from the labelling requirements because these two products do not contain sufficient amounts of protein to elicit allergic reactions”. 6 There have been contradictory reports on the allergencity of highly refined peanut oil, as noted below:

There has been considerable confusion about whether the oils (e.g. of peanut, tree nuts,
cotonseed) are allergenic. In the past there was an unsupported assumption that they must be;
hen an equally unsupported view that oil does not contain protein and therefore they cannot be.

In 1997, papers on peanut oils by Hourihane et aland tree nut oils by Teuber et al, showed that
unrefined oils were allergenic but refined oils were not. However, a later paper by Olszewski et al (1998) reported the presence of protein allergens in refined peanut oil. The obvious explanation of the contradiction between the results of Hourihane et al and Olszewski et al is that they were using two different samples of "refined" peanut oil, which in turn suggests the conclusion that the unqualified term "refined peanut oil" cannot be assumed to meannon-allergenicity. This further suggests that unless the oil is highly refined, analytically monitored and designated non-allergenic, peanut oil should be treated as allergenic.

Additionally, it appears that government has limited control over imported foods, which may or may not adhere to food labelling regulations. Rather than state that highly refined peanut oil is ‘safe’ and unrefined peanut oil is not safe, it may be easier to include the oil source on all labels and leave investigation up to the consumer.