Peanuts: The classroom killer

By Lydia Monin

When her daughter was diagnosed with a life-threatening peanut allergy, Kiwi mum Lydia Monin turned her home into a nut-free zone. But life outside is a never-ending risk assessment, she says.

Peanuts can be extremely dangerous to those who are allergic. Photo / Thinkstock
Peanuts can be extremely dangerous to those who are allergic. Photo / Thinkstock

I thought of that scene from Pulp Fiction - the one where John Travolta has literally one stab at pumping an adrenalin shot into the dying girlfriend of his crime lord boss. There were no mobs, molls or disco-dancing scientologists in my case. I'd just been told that my 1-year-old daughter had a peanut allergy, which could potentially kill her, but I could save the day with a well-delivered dose from an auto-injector.

It didn't sound like a big deal, until the paediatrician informed me that it's not unknown for parents faced with a child in anaphylactic shock to accidentally inject their own thumbs.

We'd become members of the unenviable club of parents dealing with peanut allergy.

We're the ones who linger in the supermarket aisle, peering at food labels. We're the ones who drag around a bag stuffed with adrenalin pens, antihistamine liquid, an Action Plan and all kinds of hand and surface wipes. We're the ones who generally look anxious.

The number of peanut allergy sufferers has risen dramatically in recent years, especially in richer countries. It's thought that up to 3 per cent of Kiwi children have the allergy and only 10 per cent to 20 per cent will outgrow it. Dr Vincent St Aubyn Crump, director of Auckland Allergy Clinic, says 20 years ago he saw about one patient every six months but now he's seeing four a week.

The humble peanut is much feared: by child carers, schools, airlines, restaurants and food manufacturers. Nuts, it seems, could be lurking almost anywhere. Signs over supermarket shelves of fresh baguettes warn off allergy sufferers, and other foods you'd never normally associate with nuts are labelled "produced in a factory that also handles nuts" or "cannot guarantee nut-free".

Peanut butter sandwiches powered me through most of my school days. Then there were roasted peanuts we ate after school at a neighbour's house, big bags of raw peanuts we shelled for fun and little shiny packets of peanuts we burst open on aeroplanes.

Nobody seems to know why the once-staple snack has become such a problem. Genes play a role: a child whose parents have allergies is more likely to react to peanuts. But there also seems to be something about our Western lifestyle that's to blame. It could be that we're keeping things too clean, a lack of Vitamin D, changes in our diet, the way we prepare food, pollutants or stress.

The advice used to be simple - just avoid what you're allergic to - but now there's a different school of thought. "The biggest treatment up until now has been telling parents and everyone to avoid the allergen. And kids, families ... they got rid of the cat, the dog, they changed their dietary habits, got rid of peanuts," says director of Professor Graham Le Gros of Wellington's Malaghan Institute of Medical Research.

"And that's the exact time when allergy rates have been increasing and are still increasing, all due to this avoidance approach to allergic disease and clearly that hasn't got anything to do with it, it's something more fundamental."

In our case, our daughter's paediatrician told us he'd test her for tree nuts in a year or so but until then, steer clear of all nuts. Peanut and tree nut are the food allergies most likely to be fatal. So our house became a nut-free zone. Out went the jar of peanut butter and the muesli with nuts. Labels on every bottle, jar and packet were checked.

But there's no such thing as a nut-free zone outside. Another child's peanut buttery hands could have touched anything from the pedestrian crossing button to the swings at the playground or the toys at someone else's house.

Dealing with peanut allergy is a never-ending risk assessment. The other day a birthday cake appeared during my daughter's music class. It looked harmless enough but it was easier to avoid the cake than to launch an investigation into whether it could be contaminated. Passing on a piece of cake is easy; a 40-hour trip between New Zealand and Ireland is another matter. It's difficult to pack enough fresh food to last a trip half way around the world and it's unrealistic to expect every cafe and airline along the way to guarantee nut-free products.

The older my daughter gets, the less I'll be able to protect her. Next year she'll start preschool, then comes school and the teenage years. Adolescents and young adults are more likely to die than the closely supervised under-5s - as children get older they take more risks. They want to be "normal" so they might not carry their adrenalin pen.

Deaths from peanuts are rare because of the high awareness about the allergy and because sufferers are encouraged to carry an adrenalin pen, or autoinjector as it's more formally known. But Crump says the pens are expensive, so some New Zealand GPs are giving parents ampoules of adrenalin and a syringe instead.

"I can't imagine any parents are going to be able to keep a cool head to be able to break an ampoule and draw up the adrenalin in the syringe and inject it," he says.

More preschools and schools are banning nuts. Crump doesn't think bans on peanuts or any other foods are a good idea. "By banning, you get a false sense of security because the staff would not be geared up for dealing with an emergency ... What's to stop a kid bringing peanuts into the classroom and then somebody having a reaction?" He thinks educating all staff about managing an allergy is a better approach.

Penny Jorgensen, from Allergy New Zealand, thinks banning nuts in early childhood education is sensible, especially as young children are such messy eaters. But she says by the time they're 6 or 7, children with allergies need to learn good habits like not sharing food and washing hands.

Worldwide, there is a growing fear of nuts and their potential danger. In 2008, a school bus full of 10 year olds was evacuated and cleaned in Massachusetts after a peanut was spotted on the floor. British newspapers recently ran a story about a private boys' school asking parents not to let students eat any nuts for breakfast in case the smell set off an allergic reaction in another child.

"The flipside of the fact there are so many sufferers," our paediatrician told us, "is that a cure will probably be found in your daughter's lifetime."

Children have been able to build up their tolerance by eating increasing amounts of peanut in trials. It's certainly not something to be experimented with at home and Crump thinks another year or two of fine-tuning is needed before any such treatment could be available to the general public.

"These are amazing studies to be coming through, just because of the risk associated with giving somebody who has a peanut allergy the allergen to desensitise them," says the Malaghan Institute's Dr Elizabeth Forbes-Blom. "But these are very carefully chosen groups of individuals and that's why it takes quite a long period of time to get from that first study that shows hope, to something that's going to translate to all peanut allergy sufferers in the clinic."

It might be a treatment only for those who can afford it. Because of the risks involved, especially in the build-up phase, patients would have to be under strict medical supervision.

Why children seem to start off with eczema and then go on to develop a peanut allergy could hold clues for treatment and prevention. Peanut allergy started to become a huge problem during a time when peanuts were banned for pregnant and breastfeeding women and babies under 1. Forbes-Blom says this may have changed the way we're exposed to peanuts.

"It is possible that having eczema in early life and being exposed to peanut through the skin where allergic inflammation is already going on might be the trigger to becoming sensitised to peanut. When the child is then exposed to peanut through the gut, they could go on to develop a peanut allergy. We are trying to work out how this happens."

A vaccine against allergies is something else the Malaghan Institute's working on.

Forbes-Blom hopes peanut allergy can be solved within a decade. "We're working here on many allergic diseases, including peanut allergy, but the quality of life and the issues that surround peanut allergy make the fight that much stronger."

One of the children's records on constant rotation in our house features an old traditional song from America. It was big in the 40s, but not quite so popular now...

"Found a peanut, found a peanut, found a peanut just now; Just now I found a peanut, found a peanut just now.

"Cracked it open, cracked it open, cracked it open just now; Just now I cracked it open, cracked it open just now."

And so it goes on, with: "It was rotten, ate it anyway; Got a stomach ache, called the doctor; Operation, died anyway."

It all turns out okay in the end: "Was a dream, was a dream, was a dream just now; Just now it was a dream, was a dream just now.

"Then I woke up, then I woke up, then I woke up just now; Just now I woke up, I woke up just now."

These days I'd rather skip the song and move straight on to the next one about the magic dragon who lives by the sea.

We hope our daughter will be lucky and outgrow her peanut allergy. If she doesn't, we hope she can be treated or cured before she becomes a risk-taking teenager. And we certainly hope that by the time she has children the idea that a peanut can kill you will once again be the stuff of bad dreams.

- NZ Herald

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