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Ask Dr. Sue
PEANUT ALLERGY
Dear Dr. Sue,
My five year old daughter has been
diagnosed as being allergic to peanuts. Since she'll be
starting kindergarten next year, and I will have less
control over her life, my anxiety has been steadily
increasing. What can I do to be sure that she'll be
safe?
Anxious mom
Dear Mom,
True peanut allergy is a frightening matter, since it
can definitely be life-threatening in a very short
amount of time, following exposure to only a tiny amount
of peanut allergen.
For those who don't understand the true magnitude of the
problem, approximately 0.6% of children under age three
are allergic to peanuts. This incidence seems to
be steadily increasing, probably because peanuts are so
widely used and are so often included in the diets of
children whose immune systems are not mature yet.
Peanut allergen also passes through breast milk, so
children are often sensitized even before they get their
first mouthful of solid food! (For this reason, if
your family has food allergies, don't eat
peanut-containing foods while you are breastfeeding and
don't feed peanut-containing foods to your children
until they are at least three.) It is believed
that peanut allergy is the most common cause of
food-allergy death in the United States. A
reaction to peanut allergen can include any or all of
the following symptoms: hives, itching (anywhere),
swelling (anywhere), red and watery eyes, runny nose,
vomiting, diarrhea, stomach cramps, change in voice,
cough, wheeze, difficulty swallowing, difficulty
breathing, throat tightness, a sense of doom, dizziness,
fainting, color change and death. The reaction can
occur immediately, occasionally causing death within
minutes. It can also be more slow in onset, taking
an hour or two to develop. Even if the first
reaction is treated promptly with epinephrine (AS IT
MUST BE!), there can be a second, delayed reaction four
to six hours later, which can also be fatal.
The mainstay of avoiding an allergic reaction to peanuts
is by avoiding peanuts, but that only sounds simple.
Peanuts are used in many prepared foods, including
chili, egg rolls, candies, baked goods and many Asian
foods. There have also been fatalities in children
who simply ate a cookie from a plate that had previously
held cookies with peanuts in them, and in children who
re-used a knife that had been used to spread peanut
butter, even though it had been wiped "clean."
So what can you do to keep your daughter safe?
-
Your child should have a minimum of
two doses of epinephrine at her school. It
needs to be IMMEDIATELY available. It is best
if it follows your child if she goes to a different
room for music or P.E.
-
Every adult in the school needs to
know who the children with significant allergies
are, how to use the epinephrine, and when to give it
(which is anytime a reaction is suspected; they must
be aware that they should not wait for severe
symptoms to develop). This includes bus
drivers, camp counselors, playground aides, and
anyone else who might be the first to recognize a
problem.
-
Your child should wear a Medic-Alert
bracelet.
-
Once epinephrine is given, your child
MUST be transported to a hospital Emergency Room,
preferably by ambulance. The school should not
waste time trying to reach you: they can call
you from the hospital or call you while your child
is enroute. Find out if paramedics have Epi-pens
available in your state (not all do). If not,
a school staff person should travel to the hospital
with your child with the second dose of epinephrine
in hand, and be prepared to use it if her symptoms
worsen.
-
You should meet with school personnel
yearly and before any special activity (such as a
school-sponsored trip) to review your child's
Anaphylaxis Plan. Your daughter's pediatrician
will make the plan, with input from you.
-
All school staff who might be
involved in giving your daughter food or supervising
activities involving food must know to read labels
looking for peanut, or for other designations that
could mean peanut (like hydrolyzed vegetable
protein, or groundnuts.) If your child will
eat at school, I strongly suggest that you send a
home-packed lunch, and instruct your daughter (and
her teacher) that she cannot trade any part of her
lunch with someone else. If you decide to have
her eat in the cafeteria, inform them in writing of
her peanut allergy, and discuss with the cafeteria
staff whether they have been instructed about
cross-contamination of foods during preparation.
(They should have access to literature from the USDA
called "Accommodating Children with Special Dietary
Needs in the School Nutrition Program:
Guidance for School Food Service Staff.")
-
Ensure that food brought in for
special occasions will be purchased in stores,
rather than home-made, and will have intact labels
with complete ingredient lists.
-
Teach your child not to even share
food containers or silverware with another child.
-
Teach her to wash her hands before
and after eating.
-
Send special treats to the school on
party days, to substitute for any forbidden food,
and consider keeping a supply of safe treats stored
at school for those unexpected celebrations that may
arise.
-
Ask the school to send a letter to
every parent advising them that there are peanut
allergic children attending the school, and
requesting their cooperation in not sending any
foods with peanuts in them to school. The
letter should also educate parents about the
life-threatening nature of peanut allergy. It
could also discuss how easily cross-contamination
can occur: in jam or jelly by using the same
knife used for peanut butter; in cookies by being in
the same cookie jar which had held peanut butter
cookies; or in donuts which may have touched peanut
butter coated donuts.
-
Your daughter's teacher must remember
her allergy when planning classroom activities:
peanut butter is sometimes used to make homemade
playdough and birdseed balls, and some stuffed toys
and bean bags are made with peanut shells, for
example.
Useful information and resources:
-
Dey Laboratories, maker of Epi-Pen
Jr. (22 to 45 pound child) and Epi-Pen (over 45
pounds). Both are now available as a two-pack, with
a free Epi-Pen trainer included. These are
self-injectable devices. 1-800-755-5560.
-
Anakit, a pre-loaded syringe, which
also comes with two doses of epinephrine. Made
by Bayer Laboratories, Spokane, WA.
-
The Peanut Allergy Answer Book,
$10.95, The Parents Guide to Food Allergies,
$15.00
Both available online at
www.foodallergy.org, or by calling The Food
Allergy and Anaphylaxis Network at 1-800-929-4040.
-
A Preschooler's Guide to Peanut
Allergy, available for $5.00 plus $1.50 postage
from The Ticketar Company, 1306 East 15th Ave.,
Vancouver, B.C. Canada, V5N 2E4, or email
ticketar@mcd.on.ca
 
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