pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Peanut Allergy On The Rise

I don’t usually post articles with such an intense featured image; but, I want to, perhaps, set a new mental image for people when they hear the words “peanut allergy.”

I believe the medical profession (and others) are doing the community a disservice by using the words “allergy” in relation to peanuts for it brings to mind runny noses, coughs, itchy eyes, rashes and wheezing when it SHOULD bring hospital beds, respirators, cardiac arrests and even worse.

Nut allergies rarely stop at mere “annoyance” symptoms but are the kind that mandate the carrying of an epi-pen on ones person 24-hours a day, 7-days-a-week, 365-days a year! This is the risk of full anaphylaxis we’re talking about in most cases. In many cases, people don’t even need to ingest the things but only breath air where peanut allergens have been volatilized or touch residue on surfaces.

The seven-year-old boy in the photo was given a birthday-party, chocolate covered nut as he exited school, spit it out when he realized it contained a nut, then collapsed in front of his mother who was picking him up from a British school. Do you see why I think we should invent a new word for this issue?

child with peanut allergiesWhat prompts this article now is the recent release of a new study about the topic in Minnesota. Olmsted County researches have reviewed hundreds of medical records searching out all new diagnoses of “peanut allergy.” Dishearteningly their small county had seven new cases per 10,000 children in 2007 compared with only two per 10,000 in 1999.

They know this because there is a county-wide electronic health record system which also reveals that 65 of every 10,000 children in the county had a verified peanut allergy in 2007.

What makes this study a bit unique is that these are “real” figures based on verified data and testing and not upon the standard research method of using questionnaires. Undoubtedly, if questionnaires had been used these data would be higher.

But unfortunately, the findings aren’t unique to Minnesota. An alarming rise in nut allergies has been worrying physicians all over the world for several years and remains an enigma.

The three-hundred percent increase was reported about in the Journal of Allergy and Clinical Immunology [Sep 3rd, 2012] and more fully delineates their findings. Over three quarters of new diagnoses were in children under two years old, and about 70% were boys.

And even more unfortunate, we still don’t have a clue about why this is happening. At least one pediatrics professor (Scott Sicherer, Mount Sinai School of medicine) has conjectured that our currently better hygiene makes our immune systems “less busy” with germs and possibly more prone to attack harmless food proteins — (huh?) Or, perhaps being indoors, less sunlight and use of sunscreens might alter young children’s immune system responses.

I’m not a professor, and certainly am not a researcher in the subject, but it seems to me that since we’re talking about a finding largely affecting the youngest of children, especially under five, we ought to start looking at what has been going on in our lives during that time. Genetically engineered foods, massive use of things like high-fructose corn syrups in almost everything we eat, and bringing to market highly sophisticated drugs with (as yet) poorly delineated knowledge of their side effects – for example.

The bottom line is that no one really knows why this is happening yet, and because peanut reactions can be severe if not lethal, measures against accidental exposure are extremely important such as peanut bans on airplanes, peanut-free sections of baseball stadiums and “school safe” packaged snacks manufactured in nut-free environments. I have a feeling that we’ll need even more of these before this is over.

[J Allergy Clin Immunol 2012.]

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