Saturday, February 7, 2009

Hard to judge how rational the fear is

A recent article in Salon.com about peanut allergy got my goat.  Here's my reaction.

Fear is only irrational if it is out of proportion to the risk. The problem with peanut allergies is that, for many of us, it is difficult to assess the risk of us or our children becoming severely ill or dying from exposure to peanuts. Certainly, for some people, the risk became quite obvious the first time they or their child was rushed to the emergency room, but for many others the allergy is identified in relation to treating less sensational threats, like eczema or asthma. For those people identified through skin prick tests or blood tests as likely to have an allergy, or those who had a reaction to eating peanuts that was not confirmed by a physician, assessing the risk is decidedly more fuzzy.

If the average time from exposure to anaphylactic reaction is 10 minutes, then anyone caring for a potentially allergic person must know how to administer their epipen. Most people have never triggered an epipen and have no specialist training in recognizing an allergic reaction, so for them the best way to control the situation is to prevent exposure to the allergen. This is true not just for parents, but for childcare centers, kindergartens, and schools. For children who are too young to read the ingredients label, or who lack the life experience to know that something called "satay chicken" contains peanuts, it is pivotal that the environment they are in contain as few allergen containing foods as possible. This is why carers of children are increasingly choosing to restrict common allergens from places that are largely populated by children who are too young to protect themselves.

The author implies that many of the children described as allergic to peanuts or other foods are not. Though many people misuse or do not distinguish between the terms "allergy" and "sensitivity", it is not fair to denigrate the experiences of those who suffer serious discomfort from eating certain foods, whether they have been confirmed by a skin prick test or not. Neither skin prick tests nor blood tests are 100% predictive of allergic reaction or lack thereof. The Australasian Society of Clinical Immunology and Allergy states
"When properly conducted, the skin prick test is a highly sensitive and specific test for the presence of allergen-specific IgE antibody. However, the presence of IgE antibody (as defined by a positive skin prick test) does not prove that the patient is clinically reactive to the allergen."
They go on to state that wheal size is not predictive of the severity of symptoms. Controlled food challenges, where the subject eats the food in question in a controlled environment, are considered the gold standard for determining food sensitivity.

My son, who suffered from severe eczema as an infant, has had multiple positive skin prick tests to peanuts (and never negative) but never had a reaction that could be definitively attributed to peanuts. Still, the allergist recommended avoiding all nuts until he was older. After accidentally exposing him to almonds with no negative effect, I foolishly decided to challenge him with cashews, to which he had a severe, but not anaphylactic, reaction consistent with allergy and later confirmed by a skin prick test. We now carry an epipen. As much as I would like to believe we will never need it, it would be irresponsible of me to ignore the recommendations of his allergist, who I must assume knows more on the subject than I.

Though many people with peanut allergies do not have life threatening reactions to eating them, the conclusion I've drawn from countless hours spent trying to determine how serious my son's allergy may be is that the medical studies cannot conclusively say that the severity of one person's reactions will always be consistent. Hence, he may have hives one time he eats peanuts and anaphylaxsis on another occasion. Then again, he may not, but how am I to know. And that's my point. Without more accurate tests to predict the severity of a reaction then one must conclude that a life threatening reaction is possible for anyone who demonstrates some kind of reaction.

I'm all for ridding the world of misinformation, and I appreciate the author exposing the questionable statistics of the FAAN and the motivations of Ms Munoz-Furlong, but I think the author has failed to provide clarity about peanut allergy. Despite any of his efforts to the contrary, he has produced an article that belittles those who express concern for the welfare of the children in their care. If a skin prick test predicted that a child in your care was probably allergic to peanuts, and whose doctor recommended avoiding peanuts and carrying an epipen, you would never forgive yourself if that child died because you did not take the advice seriously.

No comments:

Post a Comment

I'd love to hear your thoughts on the matter. Please note that I review all comments before they are published, which means it may be a few days before they appear on the blog.