A Straight Dope Classic from Cecil's Storehouse of Human Knowledge

Are peanut allergies for real?

June 13, 2003

Dear Cecil:

Forty years later, I dimly remember a bologna contingent. There was also a tuna fish faction, and the chicken-noodle-soup-in-an-Underdog-thermos brigade. A fringe weirdo or two might've favored liverwurst. But the plurality, if not majority, of the brown baggers in my grade school lunchroom were staunch peanut butter and jelly devotees. I ate a PB & J sandwich every single day of grade school. I never got sick of them, and so far as I can recall, nobody got sick from them, either. Today, however, peanut allergies are so widespread in schools — or at least so feared — that many lunchrooms and preschools ban peanut butter altogether, while others enforce a separate seating area for the PB & J coterie. (Children excluded from this group sometimes suffer from peanuts envy, also known as Peter Pan syndrome.) I do not belittle anyone's allergic woes, but I do wonder why such a perennially popular and heretofore benign comfort food has so suddenly mutated into typhoid goober.

Cecil replies:

You got me, bubba. Peanut allergies have been around forever, but peanut phobia blew up out of nowhere. Ninety-four percent of the journal articles I turned up by searching on "peanut" and "allergy" in an on-line medical database (165 out of 176) were published since January 1995. Now a week doesn't go by without some new sign that peanut butter is to the 21st century what fleas and rats were to the 14th. Recent bulletins:

  • A nanny in the UK was tried for child abuse last year after feeding a peanut butter sandwich to a toddler. The boy struggled for breath, lost consciousness, and was taken to a hospital. A witness testified that the nanny was told the child was allergic to peanuts, but that she'd said, "This way we will find out for sure and see if his mother is just neurotic." (She was found not guilty.)
  • An Australian teenager on a field trip in 2002 ate a spoonful of peanut butter, went into cardiac arrest, could not be revived by paramedics, and died soon after arriving at the hospital.
  • Last year New York Times columnist Jane Brody reported that young people have died after eating (1) chili thickened with peanut butter; (2) a sandwich made with a knife earlier used to make a PB & J; (3) one bite of a cookie containing finely chopped peanuts; and (4) a cookie whose package didn't mention peanuts, but to which the manufacturer had added peanut batter because he had some extra and didn't want to waste it.
  • This March the New Jersey state assembly passed a resolution encouraging schools to set aside peanut-free areas in cafeterias, and it's considering bills requiring restaurants to post notices when peanuts are used in any dish. In Hershey Foods factories, some manufacturing lines are set aside solely for foods containing no nut products.

According to the medical journals, a severe peanut allergy kills either by laryngospasm (instantaneous swelling and closing of the vocal cords) or by anaphylactic shock, which sets in minutes or hours after exposure and is usually associated with a catastrophic drop in blood pressure. For hypersensitive individuals, a kiss on the cheek from someone who's been eating peanuts can cause a reaction. Parents of allergic kids often carry an epinephrine syringe so they can administer prompt treatment, and adults carry their own auto-injectable supply.

Is the danger real or just hype? Probably both. The number of deaths in the U.S. due to food-related anaphylactic shock is small, at most 200 annually, 80 percent of which are due to peanuts or "tree nuts" (walnuts, pistachios, pecans, etc). One UK study estimates that the annual risk that a food-allergic child will die from a reaction is 1 in 800,000. Food allergies aren't as common as people think. Surveys have found that as many as 30 percent of respondents believe they have a food allergy of some kind; the actual prevalence is 4 to 8 percent for kids and 1 to 2 percent for adults. Still, that's a lot of people. An estimated 1.5 million Americans have peanut allergies, and emergency rooms treat about 30,000 cases of food-related anaphylactic shock each year.

Are peanut allergies becoming more common? Many researchers think so, but the evidence isn't overwhelming. News reports last fall told of a fresh study showing that the prevalence of peanut allergies was increasing. But what the study actually said was that between two groups of about 1,200 children born roughly six years apart, the number of cases had risen from 6 to 13 — "a strong but statistically nonsignificant trend." Then again, enough studies have shown some sort of increase to make you think something must be going on. But what? Nobody knows. One theory: The developed world has become so antiseptic that kids don't build up natural immunity, and their bodies overreact when exposed to allergens. Peanut allergies show up early in life; sufferers often also have eczema, asthma, hay fever, or other food allergies (particularly to other nuts). Though research is inconclusive, if allergies run in your family and you get pregnant, you might want to shun peanuts to avoid giving a peanut allergy to your child — and don't feed him any peanuts before age three. If he's already got an allergy, teach him to cope as best he can; there's at least an 80 percent chance he'll have it all his life.

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