Toddlers & Teens

One of the biggest challenges we have in managing our daughter's anaphylactic peanut allergy is that she has no idea that she is allergic to anything. She is only two and it just does not register. What is disconcerting however, is that one of the most vulnerable groups to a fatal allergic reaction are teens. Though teens are well aware of their allergy, the teenage years are very challenging and kids just want to fit in. Unfortunately this often means that teens choose 'fitting in' over carrying epinephrine auto-injectors, asking about ingredients and asking the boy they are about to kiss whether he ate peanut or other allergenic foods that day.

FAAN is actively involved in an awareness campaign for teens. I recommend that you take the time to read and watch their multimedia press release. You should also visit their FAANteen site.

This Is Just Not Fair!

I pride myself on being a strong person. This whole peanut allergy thing brought out a new element in my psyche however. Last Sunday we were at a brunch hosted by our dear friends who happen to be from France. The laid out a beautiful spread with croissants, pains aux chocolates, pointe aux cerises, brioche, crepes and of course champagne!

While we really enjoyed our time, I did have a personal 'rock bottom' experience which had nothing to do with our hosts. Of course our daughter loved the sight of the gorgeous spread that lay before us. All I could do however was give her a platter of baguette and apple slices with juice. Our mistake was not bringing a specific breakfast for her but in reality I was more struck by the difficulty of managing her allergy in this situation.

I had an amazing Nutella crepe ... of course Nutella has hazelnuts and though she did not display an allergy to walnut with our allergist, it does seem that people can be allergic to specific tree nuts so it is not worth taking the risk. I decided to put jam on her baguette and reached for the knife ... of course I quickly recoiled as the knife neared my outstretched hand - the knife had been used to spread Nutella on another crepe.

So I asked for a new knife and while I did that my daughter reached out and grabbed a slice of brioche which has (I think) has egg in it ... I quickly took it out of her hands.

Even as I write this a week later I still feel a little overwhelmed. We are not 'those parents'. Dealing with peanut allergy, egg allergy and anaphylaxis is very difficult for us given that our natural style is laisse faire. Obviously we are still adjusting to our 'new reality'. It is very difficult for people who are used to being the life of the party to now shift into seemingly neurotic, overbearing parent mode. It is just bizarre.

I have to admit that as I looked around the brunch table and saw the other couples enjoying themselves, laughing, chatting all the while (appropriately) oblivious to the fact that I was struggling to make sure my daughter had something safe to eat, the first thought that entered my mind was 'this is just not fair'.

I know how ridiculously defeatist that sounds but it was the first thought that entered my mind. I am a big proponent of 'it is what it is ... move on'. I am a realist by nature.

That is all the more reason that I felt I should blog about my moment of vulnerability ... it was an out of character experience that in retrospect I feel was totally justified and appropriate. Sometimes this whole thing is overwhelming. Sometimes parents of anaphylactic children will feel all alone. We are lucky ... our friends are very supportive. That being said it is unnatural to worry so much about every little thing your child eats ... you have to be strong! The allergy is omnipresent.

Rolling Eyes

As I read through the numerous articles, blogs and stories about anaphylaxis I have noticed a disturbing trend. It seems that when other parents, teachers, principals, etc. are told about severe allergy they often 'roll their eyes'. Unfortunately some of these people did not understand the true severity of the allergy until a child under their care died.

Here is an example from a live chat from the fall of 2006 at AllergicLiving.com with Sara Shannon: "Sabrina had a reaction at her public school the year before she died, and the reaction was handled improperly. Looking back, I see that as a warning. I went to the school to discuss how the reaction was handled, and I was greeted by rolling eyes (sad to say but it’s true). (This person now cries to this day about what happened to my daughter, by the way.) At the time that I was greeted with rolling eyes, I accepted their lack of belief and didn’t feel I could do anything about it, based on my past experience with the education system. My solution was for Sabrina to have complete avoidance of her allergens and hopefully she would not have a reaction at school."

Another example comes from Australia where a coroner's inquest is looking into the death of a young boy who was given peanut butter despite their being prior knowledge of his allergy. The boy's mother, Martha Baptist "told a packed session of the Victorian Coroner's Court that one mother at the kindergarten had rolled her eyes when she repeatedly asked her not to bring food with nut traces."

What I find troubling about this is that Baptist was trying to inform the other parents of the allergy but they treated her with disdain. Then the unthinkable happened ... the mother who rolled her eyes 'rolled in' with a peanut butter sandwich and it led to the boy's death. "Martha Baptist told the court that after her son's death it took her three months to work up the courage to ask the parents on duty that day what food was given to the children. Two mothers she asked, including a woman called Angela Berry, told her the children had eaten nothing but fruit.
But Martha Baptist told the court a third woman she knew from a mother's group later told her Angela Berry had in fact brought a peanut butter sandwich in on the day Alex died but that Ms Berry had told her not to say anything about it."

If that wasn't bad enough, to add insult to injury "lawyers for Berry asked Alex Baptist's paediatrician whether she was aware the boy had been referred to a neurologist for investigation of possible epilepsy, on account of an incident where as a baby his eyes rolled up in his head and his body went limp while breastfeeding." The doctor denied that this had occurred.

These examples make me roll my eyes. Allergic children rely on the support of school staff and the cooperation of other parents. Though people's attitudes seem to have come a long way in the last few years, it is disappointing to continuously see life threatening allergy met with rolling eyes, as if it was a nuisance to others.

As parents of an anaphylactic daughter it is impossible to read these stories without picturing this happening to our child. I suspect it is also nearly impossible for those who rolled their eyes to live with the fact that they did not take anaphylaxis seriously until it was too late.

Only through continued education, training and support programs will the non-allergic world understand the perpetual risk that our allergic kids face.

Sabrina's Law Heads West

Registrants* with Anaphylaxis Canada received a notice yesterday about a new bill headed to the British Columbia Legislature. The private member's bill is being proposed by David Cubberly, MLA for Saanich and seeks to implement policies in public schools with respect to anaphylaxis. Titled the "Anaphylactic Student Protection Act 2007", the bill is largely based upon Ontario's famous 'Sabrina's Law' legislation.

This legislation is very beneficial for parents of allergic children, and increases the safety of the school environment for allergic children. I am very pleased at the thought of the law being in place well before our daughter enters the school system.

"To find out how you can support this bill personally, contact your MLA directly. Click on the following link to send an email to your MLA today: http://www.leg.bc.ca/mla/3-4.asp and also provide a copy of the email to: Mr. Cubberley's office at david.cubberley.mla@leg.bc.ca and to Hon. Shirley Bond, Minister of Education at shirley.bond.mla@leg.bc.ca."

*If you have not signed up for Anaphylaxis Canada's free registry you should sign up here today. The registry provides product alerts and other relevant updates.

Peabutter

I recently posted about Peanut Butter Bans in schools. While regular readers know that I take a moderate stance on peanut bans, in the post linked above I did review the common reasons that parents of non-allergic children give to support why peanuts bans do not make sense. In reviewing whether peanut butter was the only thing many kids like and whether it is truly the most economical source of spreadable protein, I presented Peabutter as an alternative.

This week I tried Peabutter and I am going to feature it in a debut section of product reviews that we'll have on NoPeanuts.

In reviewing food products I will review taste, texture, price, ingredients.

Taste: The taste was okay. At the risk of sounding like a sommelier, the initial taste is quite pleasant and almost nutty. From there though I found the pea aftertaste to be strong ... not surprising I suppose! I did not find this to replace the Adams peanut butter of days gone by.

Texture: The texture was similar to that of the more highly-processed creamy peanut butter products which are very common. It was a little too creamy for my liking but I was an Adams fan ... all natural, nothing but peanuts.

Price: The price of Peabutter was fine ... it was only about 50 cents more than peanut butter.

Ingredients: As for the ingredients, I preferred Adams because it was all natural. Peabutter has icing sugar and hydrogenated vegetable oil on its ingredients list. To be fair, these ingredients are also in many generic creamy peanut butters but that was also the reason I did not eat those products. I ate all-natural peanut butter with a single ingredient: peanuts! We typically avoid products that have 'hydrogenated' or 'icing sugar' on the label.

Overall: If your family likes regular creamy peanut butter then Peabutter would probably work. Many people have given this product a good review online but I am not sure it is the right peanut butter substitute for people who enjoy all-natural peanut butters. I would be unlikely to purchase it again.

I will try Sunbutter, though I notice that there is added sugar in that product as well. I'll try it with an open mind as I really think these are great product alternatives for families with children who have peanut allergy. I encourage you to try them to make up your own mind ... I am just passing along my own (perhaps dissenting) opinion.

I think the solution for me purely from a product perspective is almond butter, though I am terrified to eat it! We have one daughter with anaphylaxis to peanut and a 4 month old daughter who has signs of eczema and thus is at risk of a peanut allergy of her own.

Maybe in 10 years I can eat almond butter but not today. I had big hopes for Peabutter!

Does Allergy Reduce The Risk Of Cancer?

I have started to read more on the science behind severe food allergies. That research led me to a Wikipedia page on IgE where I came across the following statement: "although it is not yet well understood, IgE may play an important role in the immune system’s recognition of cancer".

Obviously I was intrigued. There are many conflicting studies on whether there is indeed a relationship between IgE, allergy and cancer. One of the best summaries of the science was found in a 2005 edition of the journal Allergy. The authors conclude that the "the epidemiological knowledge about the relationships between allergy and cancer is still incomplete and does not point to a clear-cut direction." This is not surprising given that there is a significant need for more research on food allergy overall, let alone in such a specific area.

That being said, the authors noted that a comprehensive review of the exiting studies led them to a "general conclusion ... that despite the mixed results ... allergy is associated with a reduced risk for cancer". This is not true for all forms of cancer however, indicating that any possible relationship might be site specific.

What an absolutely fascinating area of research! Perhaps immune support against some forms of cancer will prove to be a positive side effect of spending your life dealing with a severe food allergy. It will possibly take decades of research before we have the answer.

Pat-A-Cake, Pat-A-Cake

As a peanut parent I have to deal with severe peanut and egg allergy in the household, as well as anaphylaxis. As a fairly creative person I also have to deal with random thoughts. When the two team up it makes for some weird combinations. Tonight I was playing Pat-A-Cake with my daughter and had the weird thought that she might actually be allergic to Pat-A-Cakes. Turns out that I was right ... there are eggs in the recipe. I guess we have to play the egg free version of the game!

You've Got Text

Due to the high volume of food allergy related product recalls in recent months, the Food Standards Agency in Wales is offering text message alerts for recalls. This would be helpful to those who have anaphylaxis to the major food allergens (and a mobile phone). It is important that they are aware of the recall as soon as possible due to the risk involved.

Life Before FAAN

I just read a great article on Anne Munoz Furlong the founder of FAAN. This organization has made a significant contribution to the allergy community and is a true success story despite its (at times vocal) critics on the message boards. It is amazing to think about what things were like 22 years ago when Munoz Furlong's daughter was found to have anaphylaxis and food allergy. It puts things in perspective: "(Munoz Furlong) would have welcomed a quick accurate diagnosis, a telephone support line and newsletters to consult, food labels identifying allergens, and cookbooks with allergen-free recipes. None of these resources were available." Sounds like we have it much better. I am not sure how you would manage an allergy in that support-free environment. Parents with newly-diagnosed cases of food allergy have much to be thankful for!

In the article, Munoz Furlong neatly articulates some of the biggest issues facing those with allergies. "The greatest challenge people with food allergies face today is 'convincing other people that food allergies are real ... that every bite can cause a serious reaction ... that it's a real concern, to a child, to know that birthday cake was made with milk or another allergen....The general public needs to understand there is no break, no seasonal component [as with hay fever] ... you have to eat. You have to have help from other people."

It takes a village ... FAAN has made a positive contribution.

Oh, The Irony

It was made known to me that today the top banner on NoPeanuts featured a Google-generated banner ad for Peanut Butter Squares. That's hilarious. (Thanks Jason for pointing it out).

Garden State

In New Jersey a new law was passed that "calls on the New Jersey Department of Education to create food allergy management guidelines for schools, and calls on school districts to develop food allergy policies based on the Department of Education guidance". This is a pragmatic framework for districts to work within and could render the 'peanut ban' a relic of the past.

Atopy vs Peanut Butter

We have wondered if we in essence caused our daughter's peanut allergy. It would be awful if we did. My wife ate peanut butter frequently during her pregnancy and we have wondered if somehow this was linked. New research seems to exonerate us.

The UK has long been a leader in peanut allergy and anaphylaxis awareness. As a result, 65% of the women surveyed avoided peanuts during pregnancy even though only a fraction had a history of allergy. The other interesting stat is that of the 13 babies (2%) that developed a peanut allergy by the time they were two, only 3 of the mothers ate peanuts during pregnancy but 11 had a history of atopy.

It seems that peanut allergy is more closely linked to atopy than to gestational peanut consumption. My wife's eczema (and childhood anaphylaxis to penicillin) thus appears to have contributed more to the peanut allergy than did peanut butter on her toast while pregnant.

I learned something new tonight ... I did not realize that eczema is also an IgE-related response. It makes sense as I had read before that eczema is a precursor to peanut allergy but I did not realize that they were effectively a similar reaction.

So far our second daughter does not appear to have eczema ... let's hope for the best!

Peanut Bans Banned?

Over the past week I have seen numerous cases where peanut bans are being revisited or failing to gain traction. In Connecticut a board decided to keep peanut butter on the school menu and as seen yesterday an Iowa school board decided to rescind their prior approval of a peanut ban. The reasons given for not enacting a peanut ban are typically the right-to-choice for the non-allergic and the fact that creating a peanut free school creates a false sense of security. There is also the issue of how to deal with serious food allergens other than peanut, given that they can also cause anaphylaxis.

Though I would gladly accept a peanut ban if it was approved, I tend to lean toward a more pragmatic approach as noted in yesterday's post.

Blood Testing

One of the toughest moments for the parents of a child with food allergy related anaphylaxis is the first allergy test. Our daughter's skin-prick test felt like an exercise in confirming what we as parents already knew. We had seen severe reactions to peanut and egg so we knew the result before we went in.

The test did not provide us with new information though it was helpful to confirm the sensitivity to peanut and egg allergens. Unfortunately the test is not able to assess severity. It was also interesting to learn that it is possible to trigger an allergic reaction and as a result our daughter was tested using peanut or egg extract without breaking the skin due to her history of prior reactions.

Another option is to go the blood test route. There is an interesting article in the NY Times today about the value of blood tests. Here is a key excerpt from the article:

"Allergists have typically turned to blood testing as a last resort when skin testing cannot be used. ... Yet studies have found that newer blood tests are as sensitive as skin tests and less subjective. The blood test is also part of a larger debate about who should be treating allergy sufferers. Blood testing would allow pediatricians and other primary care doctors to diagnose allergies and treat many patients. But allergists contend that these generalists are not qualified to assess the laboratory results."

This will likely be a hot topic for debate in the short term.

A Dreadful Note

The 'It Takes A Village' series here on NoPeanutsPlease focuses on food allergy from the perspective of those who support food allergic children with in the community - teachers, other parents, child psychologists and even the peanut industry. Ironically I have devoted little time to the perspective of those who actually have the peanut allergy.

This week I had a post called 'Code 2' which discussed a first-hand account of an anphaylactic reaction. Very scary and quite thought provoking. It gave me more insight into what it is like to go through an anaphylactic reaction and left me wondering how somebody could adapt to multiple near death experiences. Today I had a similar reaction to a story about what it's like to be a 12 year old child with a peanut allergy within the school setting.

Parents have the best of intentions. We've explained the allergy to caregivers before and in future would surely send in notes and anaphylaxis response plans for teachers in daycare or elementary school. Parents are correct in thinking that these actions help make their kids safer. However, the flip side is that the child's feelings and self-image are also important and need to be considered. This may sound obvious but the article makes it clear that there is a delicate balance to be struck, as safety is generally not 'hip':

"In my backpack on the first day of school ... is a note from my mother to the teacher telling her about my severe peanut allergy. Every year at this time, I have to hand in this dreadful note. The teacher stands in front of the whole class and reads this note out loud ... I feel so guilty because the some kids sigh and say, "Awwwww." It's so embarrassing because after the teacher is done, some students walk up to me and say, "Thanks a lot, Allegra!"
"... Two years ago, my mom gave me a hideous denim purse to put my EpiPen in. I had to carry it around everywhere I went. I am not what people call the most girly girl, so I was not happy about that."

We'll have to make sure our daughter picks out her own purses! I also think it would be important, when she is more aware of her allergy, to get her perspective on what form of communication would be the most comfortable for her. I will never sacrifice safety purely for her comfort, but they do go hand-in-hand and if there is a way to accommodate both I will certainly try. As seen in the article, if our daughter does not like the purse for her Epipen then she will not bring it with her and that puts her life at risk.

Peanuts 'Strongly Discouraged'

I posted recently about an Iowa school board that voted 6-0 to approve a peanut ban. After a public outcry the ban has been pulled. Instead peanuts will be 'strongly discouraged' in the school. It would be interesting to see if this has the same effect. I actually don't have a problem with it as most parents will cooperate. Furthermore, as seen in the Child article this week some parents are going to send peanuts in just to make a point. It's that minority of parents that we have to fear.

Given some of the vitriol on the messages boards in Iowa, it sounds like that state could do with an education roadshow on food allergy. While I understand that this is a minority of kids and peanut allergy is not the only concern, claims that peanut allergy doesn't exist are just absurd.

I suspect that some people are just trying to get a rise out of 'peanut parents'. They think this is a game. Unfortunately they also cannot see the larger issue which is the safety of all children. To them a peanut ban means that peanut parents win and they lose. At the end of the day the fact that peanut is strongly discouraged is a good thing for peanut parents. As noted today however, the intensity of the debate also continues to solidify my opinion that bans are not the way to go.

Nobody wants to be dictated to and the majority of parents are fully willing to cooperate. There has to be a less confrontational way to handle this.

Leaving My Safe Zone

Recently, our family took a weekend trip to Whistler. I thought travel planning and preparation with kids was a lot of work before I knew about my daughter’s allergy…I didn’t know what I was in for once the allergy was added to the mix.

As I prepared for the trip I found myself going over and over the list of things we needed to bring, desperately afraid I was going to forget something that could cost my daughter her life. It seems silly now but it was the first time I was leaving my ‘safe zone’. I hadn’t realized how much work we had done to make our home and daily activities ‘peanut free’ and allergy safe.

The night before we left my head was riddled with ‘what if’ scenarios. What if the condo we are staying in has peanut residue from a previous tenant? What if the other people in our group forget where the Epipens are? What if…

Of course the weekend was fine and we had a great time with the kids snowshoeing and playing in the snow. I relaxed. However, as we were leaving everyone wanted to stop for brunch before we hit the road. As soon as we walked into the diner my muscles tensed and my brain went into overdrive. My eyes kept scanning the restaurant for signs of peanut and it did not help that when we sat down there was a basket of peanut butter and jam packages right in the centre of the table.

Before we ordered my husband asked the kitchen our standard questions to determine what our daughter could eat and as usual we got the weird looks and rolling eyes. We concluded the pancakes should be safe and my daughter gobbled them down. As we were all getting our jackets on my fear was realized and our daughter had a few hives on her chin and hands.

We gave her a dose of Benadryl and waited about thirty minutes before the redness began to subside. The entire drive home I was on pins and needles. Everything was OK and thankfully the episode did not escalate. We never did figure out what specifically caused the reaction.

What this experience taught me (and the experiences of those that have posted on our blog) was that my fear is warranted. My daughter is going to come in to contact with peanuts and I am not going to be able to predict the time or place. I alone am not going to be able to make the world outside my ‘safe zone’ allergy safe and I could drive myself crazy trying to make it so. Some of the best advice I received via the blog was to simply be prepared for a reaction and not spend my days trying to prevent one.

Let Them Eat (Purchased) Cake

In New Zealand there is a debate about baked goods in preschools. One major preschool company has mandated that baked goods have to be store bought. Another local preschool company indicated they allowed home baked goods and instead manage allergies by keeping a list of the food allergies for the children under its care.

Either policy could work well as long as there is discipline to following the guidelines. It might be argued that the list method is preferable in some ways due to the fact that it promotes awareness of the individual kid's allergies while not outlawing home baking.

The bottom line is that it comes down to trust and logistics. Does a school feel it can manage the list of allergies effectively and does it trust parents of non-allergic kids to be cognizant of these allergies when preparing baked goods for the class. I see both sides of the coin.

A great quote in the article comes from 'nutritionalist' Bronwen King. She said that "it was a shame that home baking was not allowed. Ms King feels 'the demise of home cooking means that people lose cooking skills and those are really important when it comes to nutrition. I know centres have to err on the side of caution but I do wonder if we are going too far when it comes to allergies.' Ms King said parents should also consider other ways of celebrating their children's birthdays".

This is thought provoking. Many people find baking to be the most enjoyable form of cooking. Is the removal of baked goods from schools going to result in a culinary and cultural erosion? It is a fair question. When I was a kid food allergy was not an issue, at least not visibly. We had bake sales every week for one thing or another and I never remember a classmate having an allergic reaction.

Alas, the times have changed. Ms King wondered if we have gone too far. Given the rapid acceleration in the prevalence of food allergy and the increasing number of kids with anaphylaxis we cannot be too safe when working with the youngest, and most vulnerable kids. So, no, we have not gone too far but we could perhaps do a better job of getting to the end result.

I challenge dietitians to come up with healthy alternatives to the birthday cake. Kids love fruit, for example, and a there would be a multitude of fun things to do with fruit to celebrate the birthdays in a given week or month. If the cake theme is preferred, what if once a month a local baker came in with ingredients to show the kids how she makes an (allergy free) cake? Parents could participate in both of these events. Either of these would be fun, safe and ultimately shows parents how to make healthier food.

Outright bans often generate animosity and kids would likely prefer 'funner' ways to manage food allergy. 2007 will be the first year our daughter goes to preschool so this is an imminent issue for us.

PBJ

One of the common arguments against a peanut butter ban in schools is that the good ol' PBJ sandwich is a cheap way to make a nutritious lunch. "The majority of parents ... don’t support a peanut butter ban ... (because) it makes an economical lunch, and often is the only thing their kids will eat," according to a school board member from Connecticut.

Though it could certainly be true that this is the only thing many kids will eat, I suspect it is also true that many parents find that PBJ is the quickest and easiest thing to make that is also nutritious. Simplicity might be the key.

Product reviews seem to indicate that kids are amenable to a switch to Peabutter. That leaves only the 'economics' argument. PeaButter costs $8 per pound vs $5 for peanut butter. If the average sandwich takes 1 oz of peanut butter then we're looking at 44 cents a sandwich for peabutter and 28 cents for peanut butter. Based on the meagre savings of 16 cents per sandwich you are saving about 80 cents a week by opting for the cheaper alternative. Hardly a compelling reason to avoid the switch if it promotes safety for allergic children.

If kids like Peabutter and it is still fairly inexpensive, then a school ban on peanut butter seems to be less aggregious. Throw in a few coupons from the maker of Peabutter to help the product gain traction and I think we'd have a winner.

Eggless Pancakes

This morning I figured I would get up and make pancakes. Regulars at NoPeanuts know that our daughter is anaphylactic to peanut and also to egg white.

So I began the search for the eggless pancake recipe. What I quickly noticed is that eggless pancake recipes are basically the same as regular recipes ... you just leave out the egg. Surprising huh? I made my favourite wholewheat buttermilk pancakes and ... you guessed it ... just left out the egg. They came out just fine. Too funny.

Code 2

Among my various feeds tonight I came across a message board post that recounted the first-hand version of an anaphylactic reaction. One poster summed it up best when he applauded the poster for maintaining a sense of humour.

Our daughter had a similar episode due to peanut allergy, complete with the hives, swelling, no-Epipen, 911 call, and the ambulance ride - albeit a Code-2-free ride. It is eerie to gain a better understanding what she might have went through.

The Kiss

I find it amusing how many times I still see the famous case of the Quebec teenager who supposedly died as a result of a kiss from her boyfriend who had recently eaten peanut butter. It is fairly well known in 'peanut circles' that this is actually not the final ruling by the coroner, and in fact the kiss was not the cause of death. I find it even more amusing when the health editor of a major news organization leads with it in a story:

"The severe and often life-threatening reaction some children have to certain foods is no secret. In one prominent case, a Canadian teenager with a severe peanut allergy died after kissing her boyfriend who ate a peanut butter sandwich a few hours earlier."
- Dr. Manny Alvarez, Managing Editor of Health News, FOXNews

Dr. Weisnagel's site sets the record straight.

Continental's Drift

Most airlines now at least refrain from serving peanuts during a flight if a severely allergic passenger is on board. This is true even for Southwest Airlines who has marketing messaging built around 'flying for peanuts'. The last bastion of airborne peanut inertia seems to be Continental according to an article in the Cape Cod Times. They feel that because they cannot guarantee a peanut free environment they won't even bother trying. That's the spirit.

Here is an interesting graphic from the story. Continental must be proud of its lonely status at the bottom of the list in the category "won't accommodate peanut allergies".

As I wrote in my prior articles on airline travel, the solution is quite simple when an allergic passenger makes it known ahead of time that they are coming:
a) Don't serve peanuts.
b) Make an announcement to let other passengers know that there is a child with a severe peanut allergy on board and that it would be appreciated if all passengers refrained from eating peanuts.

It's not that complicated. I'm not looking for a guarantee. 'Safer' is fine.

It Takes A Village - Peanut Terrorists

I just read a excellent yet disturbing article about the challenges that can face our allergic children in schools. It is one of the most comprehensive articles I have read to date on food allergy. One section of the article talked about how other parents and other kids can react in a very hostile and dangerous fashion to those who have allergies. Here are a few excerpts ... what are these people thinking?

"a parent of a nonallergic child announced at a PTO meeting that he'd continue sending his child to the elementary school with peanut butter sandwiches and tell his child to "smear" the peanut butter along the hallway walls."

What message does that send to the child of that astute parent?

"Snarky comments about the "peanut police" pepper blogs and online message boards. "We are considering dressing our daughter on Halloween as 'The Death Peanut,'" one parent joked."

Indeed. Forgive me if I do not join you in laughter.

"At the middle school, a teacher brought in a homemade casserole containing nuts and invited the allergic boy to eat it; when he said he couldn't because of his allergies, she had him stand outside the classroom (in the cold) while the other students ate. This child was also taunted and bullied by other students in the cafeteria, including one who refused to move from a peanut-free lunch table and ate a peanut butter sandwich—which resulted in the boy's suffering an extreme allergic reaction that landed him in the hospital"

This article just left me frightened. I could not conceive of intentionally jeopardizing the health and safety of any child. That is just twisted. Will we really have to go through this? Let's hope that these people are truly at the fringes and that the majority of parents take a safer, 'saner' approach.

According to Connie Weil, PhD, a psychologist at Children's Memorial in Chicago, severe food allergy is a "chronic illness, but it's a hidden illness, so it's misperceived by society." While that neatly summarizes the underlying issue, misperception is one thing but terrorizing allergic children is shocking even if extremely rare.

Though our being aware of these scenarios makes our daughter safer, I actually wish I never read that article.

Allergy Free Peanuts

We've talked before of the efforts to build the GMO peanut. There are several reasons given for this product: enhanced yields, more flavourful end product and of course a peanut that might be safe for the peanut allergic public. Recently funding was approved for research into the development of the GMO peanut.

Led by Peggy Ozakis, the research will endeavour to bring a GMO peanut to market in five years. As long as safety of the GMO product is not a concern, more efficient production and a better end-product are reasonable goals.

Checkbiotech.org also mentioned that there would be more peanut biofuel available. Ironically, parents of peanut allergic kids might be better-served burning peanut oil in their vehicles versus jumping on the allergy-free GMO peanut bandwagon.

Even if these peanuts are safe, consider having to educate your child in this new world. 'Okay honey, this is important ... the peanuts on the right are safe but the peanuts on the left are not ... you can see the difference right?'

Battle Peanuts

Sometimes you just have to laugh ... we sit down to dinner tonight and as usual our little toddler wanted to watch Elmo or Blue during dinner. Tonight I just had enough ... I needed to find a compromise.

Aha! ... how about Iron Chef on the Food Network ... she loves to watch that.

We are three minutes in and I find it bizarre that there are peanuts being frozen, deep fried, smoked, roasted and included in everything from french toast to halibut.

Ah yes ... welcome to Battle Peanuts. I guess the judges are allergy free!

I can't imagine how our daughter would fare if she dove into the Egg Battered Peanut Crusted Halibut served over Peanut Butter Pasta.

In the words of his uncle ... Allez Cuisine!

I Can't Kiss The Baby?

Over the last week many people have been led to believe that kissing babies could cause peanut allergy. The immunologists cited in the article warn that kissing babies who have eczema, right after you've eaten peanut, increases the risk of the baby developing peanut allergy. They continued to say that though kissing was an important part of childhood development, kisses with a high volume of saliva should be avoided ... not sure what the volume threshold is but I suspect that most of the kisses you give your kids are just fine.

There are many related stories to the release of this news from LEAP and it consistently seems that the real news is that there appears to be a definitive link between peanut allergy and eczema.

While sensational kisses are getting the headlines, albeit those with high volumes of saliva, there really is profound news here: babies with eczema are at greater risk to develop a peanut allergy.

But this is not the full story ... it is yet to be determined whether the children who go on to develop peanut allergy are genetically predisposed to peanut allergy or if the childhood exposure combined with eczema is a 'cause'. Best to err on the safe side and practice avoidance of course, but I look forward to a day when this question is answered.

1000 Peanuts

NoPeanutsPlease.com crossed the 1000 visitor mark today!

I am happy to see increasing traffic each week and am pleased that I reached 1000 visitors in my first 60 days. I find it flattering that there are now a number of subscribers via RSS feeds and I really enjoy getting your emails with positive feedback on the usefulness of the blog.

Thanks to those who have visited to date! I look forward to our continued dialogue on anaphylaxis and food allergy. The increasing traffic is a positive incentive to keep the blog active ... stay tuned!!

Cheers,

NP.

Six Degrees From The 1%

In writing my Airline Policy post I found myself hung up on the fact that many people view severe food allergy as "only affecting 1%" of the population. Through my research I have come across a number of sites dedicated to children lost to food allergy. Tonight I came across a touching tribute for a young girl named Kailey who suffered a fatal anaphylactic reaction to milk in March 2005. I cannot even imagine what her parents and family must have endured.

In the context of such a loss, the "1% argument" lacks empathy. The "1% argument" also fails to consider that severe food allergy affects many more people than those with the actual allergy.

The common response to a mention of our daughter's peanut allergy is for people to tell us about a food allergy in their life, or in the life of somebody they know. I suspect that despite such a small proportion of the population being severely allergic to food, within six degrees of separation just about everybody is affected.

It truly takes a village!

Peanut Rack Attack

So we were in Shoppers Drug Mart today. As I put our purchases on the checkout counter I looked away from our daughter for maybe 20 seconds. When I looked back she had pulled a bag of honey-roasted peanuts from a kid-level rack and was trying to open it with her teeth. My heart skipped a beat. I quickly grabbed the bag but it served as a reminder of the constant battle we'll have with this allergy. Sometimes you feel like you're surrounded.

She cried when I took the peanuts away ... she has no idea!

Airline Policy

This week Qantas followed the NoPeanuts airline theme and announced a new peanut policy. As regular readers know, after our West Jet experience this week I have had a bee in my bonnet with respect to airline peanut policy. It was interesting to read the Qantas policy and see the same verbage all over again. Like West Jet, Qantas will no longer serve peanuts and will also try to avoid serving foods with peanut ingredients. The airline also included the standard wording about the inability to provide a peanut free plane.

To me the ‘cannot-provide-a-peanut-free-plane’ concept misses the mark. People often assume that peanut parents are expecting peanut-free environments. We’re not. We know that’s often impossible. All I am looking for is a quick announcement to other passengers to let them know that a severely allergic child is on board and that it would be appreciated if they did not eat peanuts.

I am left wondering why airlines and other passengers might deem this announcement unreasonable … here are the standard points of contention that I come across online:

Contention #1: Peanut dust inhalation does not cause anaphylaxis

In 1998 the U.S. Department of Transportation proposed that airlines provide peanut-allergic passengers with ‘peanut free’ seating areas. The proposal was denied by congress due to the lack of evidence demonstrating that peanut dust inhalation causes anaphylaxis. Many studies have shown that inhalation of peanut dust can cause a reaction for those allergic to peanut, but the reaction is typically restricted to skin and upper-respiratory symptoms and does not usually result in anaphylaxis. That being said, it has been shown that when >25 people are eating peanuts together on an airplane the reaction can be sufficiently serious to require epinephrine. That risk supports the current ban on peanuts being served in-flight as followed by many airlines.


Contention #2: It’s only 1% of the population … why should we cater to them?

The incidence is higher in young children and has doubled in the past five years. Furthermore, 50% of the cases involved oral ingestion of the allergen and the median age of those who suffered a reaction was two years!! Thus it is reasonable to infer that the most common reaction resulted from a young child eating a peanut … ie: not from inhalation!

It also appears that young children were disproportionately represented in the sample of in-flight allergic reactions. Young children do not know they are allergic. Young children also end up crawling around the floor of the plane (not exactly the cleanest of places). If a child finds a peanut on the floor it will likely end up in their mouth. You know what happens next.

Since it appears that children are the most at risk, it is worth taking the necessary precautions. Making a quick announcement to other passengers is a simple way to create a safer environment for peanut allergic children.

Contention #3: People with a peanut allergy should travel in the morning

It is common for airlines to suggest morning travel for the peanut allergic as people are less likely to eat peanuts and the planes are cleaned overnight. I think that this provides a false sense of security.

Per my Air Peanut article, we flew at 8am and the planes were far from clean. Also, though it is less common for people to eat peanuts early, it does happen. Recently I traveled to the USA and the gentleman directly behind me ripped into a large bag of peanuts at 7am.

Though traveling early is perhaps a good idea, the courtesy announcement I seek would have a greater impact on passenger safety. What happens when the gentleman behind me nods off due to the early flight and drops his bag of peanuts on the floor? He did fall asleep but I am not sure where the peanuts went …

Contention #4: Peanut-allergic passengers should just be prepared

Any parent of an allergic child would be prepared with EpiPens and Benadryl but that is not enough. The contention that passengers should be prepared makes sense for adults but remember that peanut-allergic children would likely not understand their allergy.

Furthermore, this objection requires the underlying assumption that people know they are allergic in the first place. We found out on Boxing Day that our daughter is severely allergic to peanut. Though we suspected an allergy we did not know it was this severe until we saw the anaphylaxis first hand. Unfortunately, that is commonly how severe food allergies are discovered.

There is a first time for everything and though the risk is remote, it is possible that a child could have her first anaphylactic reaction on an airplane. In many ways that would be a worst-case scenario.

Contention #5: Airlines cannot provide a peanut free plane

While this is true, it is also not what I am asking for or expecting. I know that expecting peanut-free is Utopian; however, in addition to not serving peanuts it would be very helpful if the flight crew could let other passengers know that there is a peanut allergic child on board. This will create a safer environment.

As a parent I would still not let my guard down should such an announcement be made. Even better, other passengers would now be aware. In the case of my 7am trip to the USA, I had the aforementioned passenger eating peanuts directly behind me. That would pose a significant risk to my daughter if she had been on the flight. Obviously the passenger would not know where every peanut from every hand-full ended up. Our daughter’s anaphylaxis is triggered by a fraction of a peanut and one breakaway peanut could prove fatal. Is it really worth the risk?

I contend that it is reasonable for the airline to announce, as a courtesy, that there is an allergic child on board and that it would be best for people to not eat peanut.

I have to believe that most people, upon hearing that announcement, would forgo their peanuts to ensure the safety of an unsuspecting allergic child?

West Jet told me that they could not make the courtesy announcement due to legal exposure. I feel that not making an announcement is a bigger legal risk … a carefully crafted announcement would reduce legal exposure and also make kids safer.

This is a no-brainer.

Sound Familiar?

After my post this week on our West Jet travels, I thought it ironic to read this article. Airlines need to start putting passenger safety before supposed legal liablility. As I wrote in 'Air Peanut', communication to the rest of the plane would be a valued courtesy and the announcement need not be done in a way that upsets corporate counsel. It was clear this week that our daughter's anaphylaxis is not something that West Jet feels comfortable with.