25 September 2008

In case of allergy, give the first taste of peanuts in the doctor's office

Safety note: Many parents strongly objected to this hack (see comments) and pointed out that it could lead to a dangerous situation if the child is indeed allergic to peanuts. I posted this hack for vetting by the group, and the majority say it's unsafe. It's worth reminding everyone that Parent Hacks is not a place to get definitive medical advice. If you are concerned about any kind of food allergy, work closely with your pediatrician.

Thank you to all who commented. I learned a lot. -- Ed.

From Lee:

This idea came to me while talking with a friend who wasn't sure if her son was allergic to peanuts. His blood tests were inconclusive and the pediatrician said that the only way they'll know for sure is if he has a reaction.

I suggested to my friend that they give him the peanut sample at the doctor's office at his next well visit. Next to the ER, that's probably the best place to be if you're having a reaction, right? So then I got to thinking that any parent could do this at the appropriate well visit (I plan to when my son turns one).

A few things to think about:

- The peanut sample would need to be super-confined so as not to leave peanut contaminants in the doctor's office (maybe give the sample in the car before you go in? Something like a Peanut M&M or a Ritz cracker sandwich thing?)

- If I'm not mistaken, it's not always the initial peanut exposure that leads to problems, it's the second one. So maybe give the first taste the night before?

I'd be curious to hear what the parents of peanut-allergic kids think of this idea.

Well?

Related: DIY cookbook for families with food allergies

Your comments

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If there is reason to believe allergies may be a problem and other tests are inconclusive, most allergists will administer the suspect food in the allergist's office.

Giving the night before @ home may not be a good idea. I live far from a hospital, so not a good idea for us (we already know about our son's peanut allergy, so we have an epikit handy). Consider your ability to get help fast before playing with potential allergens.

Also remember that allergic reactions can take a couple of hours to occur. So no reaction in 15 min is a good sign, but maybe not the whole story.

I do like the Peanut M&M suggestion. The peanut and any peanut dust are well contained in the chocolate, so you giving that to your kid at the Dr's office significantly reduces the risk of leaving peanut protein around for my kid to encounter.

I think parents obsessing over food allergies need to read this:

http://www.harpers.org/media/slideshow/annot/2008-01/index.html

The threat has been vastly overhyped.

Shannon....While there may be more press about food allergies the fact remains that they are growing. You may feel it is silly so it is pretty clear to me that you have never seen your own child react to anything. Reactions that can lead to death. So while you may think it is parents "obsessing" over food allergies, it is my daily life you seem to want tot trivialize. I deal with it every day at every meal or snack. So try to be a little considerate of those of us out here who had to deal with life threatening allergies every day. It is not an obsession, it is keeping my child safe and alive.

I will also say to the original poster of the hack, I HATE the idea of you bringing any food into the Dr. office. The fact is that children are messy and your "test" can become a life or death issue for my child. Our Dr's office has a sign posted that there is NO eating or drinking the the office to protect those of us who do have children with food allergies. I would not take a loaded gun and leave it out in the Dr's office so why should you do something that is potentially as dangerous to my child?

My sister is a nurse practitioner and has reason to believe that my nephew is allergic to nuts. I keep asking her when she's going to take him to get tested so we can just KNOW one way or the other.

The last time I asked she told me that sometime very soon she and her friend (another nurse practitioner) are going to park outside the Children's Hospital and give my nephew a peanut butter sandwich. I'm pretty sure she was kidding, but who knows.

My worry with this is that a child would not react to the first exposure which would convey a false sense of comfort. I'm not an expert but I know that some allergens have to be introduced more than once before a person reacts.

This strikes me as impractical.

It will take more than a few hours from first exposure for enough antibodies to develop to promote future reactions. For some kids, it may take more than one exposure (especially if the first exposure is small), leading you to believe your child is safe when they aren't. On the other hand, some kids will have been exposed incidentally already, and the supposedly safe "first" exposure could trigger a life-threatening reaction.

And, as has already been mentioned, it may take a few hours for a reaction to develop.

If you feel you must experiment with potentially life-threatening reactions like this instead of getting formal testing done, please first research allergic reactions and how they develop to make sure your experiment makes sense and is as safe as possible.

My son had a peanut allergy which he thankfully outgrew, but the first time we actually did give him peanuts, our Allergist told us to come park in his office's parking lot and give them to him there. We spent about and hour eating peanuts and walking around the office. It made me feel a lot better and luckily he was just fine.

There is a simple, inexpensive, and relatively conclusive test for peanut allergies. It is a blood test called RASP. Any pediatrician can order it, and it is much more accurate than skin tests.
If your child has never shown sensitivity to peanuts, it does not occur in your family, and the doctor has not indicated any risk, then eating a PB&J *outside* the office is fine. But please, please, please do not test fate if you have any risk factors. It is like having your precocious child go play in traffic to test hand-eye coordination. Likely the cars would stop, but what idiot would do this?

Shannon, that is an interesting article. Sometimes people take things farther than necessary - and I would never advocate knowingly using bad data to make a point. On the other hand, this is very serious for the people who are effected (even if that number is small compared to society as a whole.)

As a father of a toddler with a sever nut allergy, I understand that can be difficult for parents to know how much protection is too much.

I think the thing to remember is life sucks if we are overcome by fear. Children are killed everyday in accidents (car, water, etc.). But society is used to that. You are not supposed to have to go to the ER after eating normal food. We are not used to that and it scares us.

Parents need to exercise wisdom in caring for their kids. The first time sending your child into any risky situation (school, driving, spring break) is scary - even more so if you cannot be with them to help them. Teaching a child to appropriately deal with his or her allergies is wiser than teaching a child to live in fear. That is certainly true. Since we know that it is really possible for my son to die after eating nuts, we carry an epikit. It is wise to be prepared, and preparation helps ease fear.

The truth is, I cannot provide perfect protection for my kids - despite how much I want to. Only God can do that. I have to do what is wise and leave the rest to God.

The RASP test is good, but can still be inconclusive. There are appropriate times (e.g. inconclusive blood tests, as noted in the original text from Lee) to test an allergy by consuming the allergen. When that is appropriate, an allergist will supervise.


I'm interested in this because my 3-year-old daughter is at a higher risk for shellfish allergy because my husband is allergic to shellfish. So I am terrified to give her shellfish and just sit there waiting to see if she has reaction. I asked the pediatrician if we could have her tested first and she said we could if she really really wanted, but she didn't think it was necessary, that we should just watch her closely after the first time she has some. But I'm still really worried about it. I know that I need to find out though before she is old enough to start regularly going to friends' houses, parties, etc. where she could encounter shellfish without me around.

Stephanie and BT, I don't doubt that you are good, well-informed parents trying to do the best by your kids. The simple fact is that according to the CDC (not the fake numbers cooked up by advocacy groups) twelve people a year die from food allergies. TWELVE. To compare, 73 people die each year from lightning strikes. So for most children, the risk of being struck by lightning is many times greater than the risk posed by food allergens.

The truth is that many parents VASTLY overestimate the threat that things like peanuts pose to their children. Also, the allergy tests all (even the blood test) have high rates of false positives. If you have good reason to know (not just one test result) that the threat to your kid is real and life-threatening--if you are among the tiny, tiny number of parents who truly have to worry about this--then you certainly have my sympathy. But for the parents who have absolutely no reason to suspect any problem with allergies, and are still considering camping out by the emergency room for their kid's first taste of peanut butter: Relax. Look behind the hype. You almost certainly have nothing to worry about. You may think 'better safe than sorry' but teaching your child to be afraid of food is a bad lesson. So just be aware of the true risk before you make your decision.

Shannon,
Thank you for the link to the interesting article. I used to be a member of FAAN as my son has many food allergies, and a few intolerances. I found them to be overbearing and far too protective for those people who clearly do not have anaphylactic reactions to their allergens. If people are truly concerned about reactions, visit an allergist and have the CAP RAST test done and a skin-prick test. A *good* allergist will advise you of the next steps if something comes back positive. Would you have your child aggravate a bee to get stung in order to know whether or not they were allergic?

Problem with this is that not all allergies become apparent on the FIRST exposure to an allergen. It's more often the 2nd or 3rd exposure after the body has had time to produce the anti-bodies to the allergen.

Do actual doctors actually recommend this approach? I feel it would be not useful. The first exposure does not produce a reaction. After antibodies build up, an exposure may manifest on subsequent exposures. So just because the parking lot peanuts produce nothing doesn't mean an allergy wont' develop and you are home free. Unless you're only ever eating peanuts outside the hospital. It doesn't seem necessary or useful.

My earliest memory is being asked to kiss a monster that was in my mom's bed. I later learned that it was my mom back then, but I hadn't recognized her because of the hives. She carries an Epi-Pin and has been in the ER numerous times because someone was POSITIVE the food she was eating didn't have peanut in it. The anaphylactic reaction proved them wrong but it was too late.

Lee and others: I am horrified that this is being treated as a hack. If you consider your child's health to be a trivial matter then go ahead and try this idea. If your child dies, I will mourn for you regardless of your lack of common sense. Maybe food allergies are given too much attention these days and are no longer being taken seriously. Please trust those who know: they are serious. Deadly serious.

sorry for my tone Asha, but I don't think this should have been posted as a hack. This is medical advice- bad advice.

My son has life threatening allergies to milk and eggs. It's no hype. We found out the hard way when he was only 8 months old. If you suspect or worry that your child might have a food allergy, have your pediatrician refer you to an allergist - it should be covered by insurance. There are tests they can provide. Any oral challenges (testing of actual food items) should happen at the doctor's instruction, at the doctor's office. They will administer the food in small but gradually increasing dosages until a reaction develops (if at all). They have benedryl and epi-pens on hand and the rooms will be specially cleaned after the tests. Do not play roulet with you child's life or the next child's by bringing food unannounced into a dr. office where it could harm someone else - esp. peanuts or sesame or other fatty / oily food allergens. We were lucky; a drop of milk spilled on his arm - and he developed hives from wrist to face. So we got by on a warning, as it were. He tests off the charts... no hype here. I wouldn't wish it on anyone else, but it is (inexpicably) on the rise. Keep our babies safe!

According to my allergist (I have life threatening food allergies) the theory behind the increase is immune system "boredom". We, humans, have come such a long way in vaccinating against so many diseases, that the human immune system has very little to fight so, due to a human microevolutionary process, the immune system has begun to react to the proteins in milk, peanuts, eggs, etc. Don't get me wrong, I am blessed not to have a kiddo with food allergies, but I would rather have a kiddo with a peanut allergy than diptheria. The point is, that food allergies ARE on the rise, and thank goodness there are only 12 deaths a year - thank goodness and thank "over reactive parents".

I had eaten tomatoes almost daily my whole life, when I was 30 I had a severe reaction. Shannon, I totally get what you're saying, a few cases make a big media splash and all of a sudden everyone and their goldfish has allergies. In this case, however, there is significant scientific proof.

This is not good advice, please speak to your pediatrician or an allergist.

Shannon, this is an interesting way to hold this discussion, eh? You are right when you said "So for most children, the risk of being struck by lightning is many times greater than the risk posed by food allergens."

This is exactly why I advocated the use of wisdom in parenting. I spend much more time teaching my toddler son not to run out into the street and other such dangers than I do teaching him about his food allergy. I think we agree that teaching a child to live in fear of foods is not good. I tried to be clear about that in my 2nd post, but I don't think it was as clear as I thought.

Please provide a source from the CDC citing 12 food allergy related deaths per year. I think this will go a long way to help calm some fears.

I agree with you when you say "But for the parents who have absolutely no reason to suspect any problem with allergies, and are still considering camping out by the emergency room for their kid's first taste of peanut butter: Relax."

On the other hand, I ask that you cut some slack to the parents who are dealing with this. I had no idea how hard it could be to loose a grand parent until it happened to me. I had no idea how hard it could be to raise a child, until I had some of my own. I had no idea how hard and scary it could be to have to take your child to the ER because he struggles to breath until it happened to me. Until it happened to me, I had no idea how hard it could be to feed your child when there is no one (even the doctors) to help you understand exactly what to avoid.

If you have no reason to suspect sever food allergies, don't worry about it. All of the deaths that I have read about involve people who already knew of their allergy.

If you don't have reason to suspect allergy, then you don't need a doctor's supervision for eating. If you do have a reason to suspect a sever allergy, don't start with a consumption test. The allergist will help you know when it is time to do a test like this and he or she will supervise.

CDC link and quote http://www.cdc.gov/HealthyYouth/foodallergies/index.htm

Food allergy is an abnormal immune response to certain food(s) that the body reacts to as harmful. Estimates of the prevalence of food allergies range from approximately 4% to 8% of children and 2% of adults.1,2 Though reasons for this are poorly understood, the prevalence of food allergies and associated anaphylaxis appears to be on the rise. Risk factors associated with food allergy include: family history of asthma and allergies, genetic predisposition to allergic disease, elevated allergen-specific serum immunoglobulin levels (IgE concentrations), and being younger than 3 years of age. There are eight foods that account for 90% of all food-allergy reactions cow’s milk, egg, peanut, tree nuts (for example, walnuts, pecans, almonds, and cashews), fish, shellfish, soybeans, and wheat.2,3,4 While 3.3 million Americans are allergic to peanuts or tree nuts, 6.9 million are allergic to seafood. Combined, food allergies cause 30,000 cases of anaphylaxis, 2,000 hospitalizations, and 150 deaths annually

"Only" 12 deaths per year? Great news, unless it's your child who's one of those.

I'm grateful as all get-out that we don't face food allergies with our 4 yr old. But I certainly "get" the deep concern and hyper-vigilance of those whose offspring might be so affected. Food products are everywhere, and so the general population doesn't treat is as the potential danger it could for a select few. To you or me, it might just be a cookie, but for someone else, it might be a life-endangering item. A little empathy, please.

Unless you have a reason to believe your child could have a peanut allergy, such as family history, it's seems unnessary to have your child's first bite of peanut at their wellness visit. My child was diagnosed w/milk and egg allergies at 7 months. No family history. He ate peanut products several times before having a reaction at age 2. Same with tree nuts - ate walnuts, almonds just fine but that tiny, tiny bite of cashew gave him an anaphylactic reaction. My advice to parents who have concerns about allergies is to discuss with your pediatrician. If you have a family history, go one step further with an allergist who can order blood work and/or a skin test.

I would definitely discuss this with the pediatrician first. The thing that strikes me most about Lee's message (and obviously others with more experience have other concerns as well) is that the age of one year seems rather early to be introducing peanuts, especially if you are concerned about a reaction. Advice I read about this suggested waiting until age three, or even later, to introduce peanuts if there is a family history of allergy. I'm peanut-sensitive, but not allergic -- I don't respond with hives or difficulty breathing. Nonetheless, I waited until my daughter was over two before giving her peanut butter. She seems fine with it (she's four now), but I still watch her for symptoms.

I just wanted to add that children that are at risk for allergies should not eat nuts until they are 3 - not one as mentioned in the post.

The first thing I thought was that a peanut M&M is a choking hazard for a one-year-old.

My child is not at risk for a peanut allergy, but we haven't given her any peanut products yet at 13.5 months. We are waiting until she is closer to 2.

Just read that article that was linked to. I can attest to the false positives. Take a look at my arm during my allergy test:
http://www.flickr.com/photos/peevedmichelle/2111503722/
I was supposedly super allergic to peanuts and hazelnuts and shellfish. I knew it was ridiculous because I have eaten all those with no issues. Two day later I had a bag of peanuts with no reaction. Recently, I gorged myself on a dinner of shrimp, crab, lobster and scallops. I did have a little bit of nose itchiness after that.

Why just stop at peanuts? How about tree nuts? Eggs? Milk? Soy? I am very tired of people that are paranoid about food allergies. Unless you have a diagnosis, please don't fret about the possibility. All of this paranoia makes it tough on those of us like me that really do have kids with life threatening nut allergies. It makes it hard for people to take food allergies seriously.

Believe me - if your kid has a food allergy, you will be able to figure it out. I did - you will, too. Instead, channel all that worry that you've got your kid properly restrained in their infant seat. (most people don't, you know)

Wow. Okay.

First, the hack should be, IMHO:

"ASK your doctor if you should consider an in-hospital trial of any foods. And then if they say yes, go to a pediatric allergist and ask them, because they're the ones who should determine this, and for what foods. They also have the expertise and equipment on hand for reactions. The regular pediatrician is a screener for allergy issues, not a specialist."

Yes, it is scary to consider whether your child will react to peanut. 150 deaths (the cdc number quoted above - I think the 14 is specifically peanut, I've seen that number quoted before) isn't piffle, but first filter for whether it is relevant to your situation. Two parents with allergy history is enough to raise flags (even if not food allergy), but even then.. well, our pediatric allergist was fantastic, and they did NOT recommend in-hospital food trials for peanut for us. Yes for some patients, but it is case-by-case, NOT a cookie-cutter answer!

For us, it was 'Avoid for three years, then introduce advisedly' (due to the allergy history, severe on both sides) for any of the big eight that we hadn't yet exposed, and consume in moderation regularly for everything that we had exposed and had not seen reaction to. We did in-hospital trials of several foods for one child, and they're LONG - we're talking spending half a day hanging out having them check back in as we fed increasing amounts of citrus, banana, and blueberry. All negative, which was GREAT - but also useful because it proved that Miss M's biggest issue was that she has a very sensitive histamine process, which triggers off things not involving the immune system. (She is also allergic to cow's milk and chocolate, and has dermatographia, which is roughly a histamine reaction to friction, pressure, and/or temperature change.) She acclimates to foods over repeated exposures, rather than the other way around, without any classic allergy (IgE) signs. And given the relatively high risk scenario we had, it's notable that peanuts were NOT trialed in-hospital. (It does look like she may also be allergic to shellfish, which, like chocolate and strawberries, doesn't require IgE to set off - they're direct histamine triggers, and since she's easily triggered anyway, it's a likely jump. We're keeping her away from shellfish, for now. Strawberries are fine, so far, though they have too much fructose for her.)

So. No, please don't take foods to the pediatrician to trial. But yes, you can ask the pediatrician if you should see an allergist for further assistance, ideas, and guideance. It should be the allergist's call whether an in-hospital trial is needed.

What if there happens to be someone in that doctors office who is severely allergic to peanuts??? Yes, there is medical help right there, but you just caused another person to suffer a major medical emergency, just because you want to use the place as a testing lab.

About needing to be exposed once before you are allergic: the very first solid food my mother ever fed me was bananas at 6 months old. I puffed up like a little balloon, even the bald spot on my head. My poor mother *freaked* out. If it is indeed true that you need two exposures to react, then I recieved the first in utero or via breastmilk. So if there is a family history of severe allergies, take the first exposure seriously, and follow your pediatrician's recommendations.

[Incidentally, I didn't have another banana for a decade (when I accidentally drank some fruit juice that had some banana), but still reacted strongly then.]

On psychosomatic reactions: I thought I was crazy for the longest time. I would frequently eat stuff that I thought was safe (I also have a peanut/nut allergy), and end up with a mild to severe reaction. I didn't know if there were traces of nuts, or what, and frequently worried that I was "doing it to myself", especially when I was a teenager. Then, in my twenties, my husband cooked a dish of all safe ingredients--except he crusted it in mustard seeds, which I had never eaten. I reacted like crazy, and realized that all these years, my various reactions to mayo, salad, Indian food, etc., etc., were actually reactions to mustard.

I'm sure there are people out there who overreact, but I beat myself up for 20 years thinking that I was overreacting, and it turns out that I just hadn't quite pinned all my allergies down.

First and foremost, to answer the question of the original poster, I think it's a bad idea. I think if you are not comfortable or convinced about the advice that your doctor has given you, it's time for an open honest and constructive talk with your doctor. Or time to find one that will listen to your concerns and spend time with you to make a plan.

Shannon, have you talked to your children about "stranger danger" and the like? b/c according to *some* available stats, there are only 115 stranger abductions of children per year in this country. (Read below.) Would you stop teaching your children to beware strangers?

Stats can be tricky, and people can slant the facts in order to argue a point. Like I just did. And just like your magazine article did. Personally I would prefer to get medical advice from say, Children's Hospital, than Harper's Magazine. According to Children's hospital, an average of 10 children in every school across the country are affected by food allergies. In my mind, that is a LOT. http://www.childrenshospital.org/dream/spring2007/when_food_can_kill.html

Just because "only" 12, or 100, or 1000 people actually die per year from food allergies... does that make the trauma of a child and their parents who goes through a reaction negligible because they didn't happen to die?

I will tell you flat out that as a parent who had to call 911 and have paramedics respond to my hive covered son after he was exposed to peanuts... I found your post insensitive.

As frustrating as I find this conversation, I also am happy that it's here and raising awareness. Maybe there's a person out there who will stop and ask me if it's o.k. before they hand my son the cookie that he wants, but would actually harm him.

Food allergies can develop any time at all between birth and 5. Which is tricky b/c it can render testing meaningless by giving false negatives. If there is a history of allergies in a child's family, there is a higher chance of developing a food allergy. Anyone concerned should discuss it with their doctor, not experiment on their own.

Food allergies can get progressively worse with multiple exposures. Similar to how bee sting reactions can become worse with each new sting. I had a hard time explaining this to my family - they actually thought that I was being way overprotective of my son b/c of the "traditional" way that allergy shots work - if you get allergy shots the shots actually contain small amounts of the substance that you are allergic to (for instance, ragweed pollen) which helps your system build up a tolerance for it. FOOD ALLERGIES DO NOT WORK THIS WAY!!!

FWIW, the blood test is called RAST (not rasp - and I'm only saying that in the interest of keeping factual information correct.) Our allergist told us that the skin test is more reliable than the RAST test, but was very open that not all doctors share his opinion. Our son has been outgrowing his allergy, and this year his RAST scores came back as zero (=not allergic) but his skin tests still reveal the allergy.


Re my child abduction analogy:
(During the study year, there were an estimated 115 stereotypical kidnappings, defined as abductions perpetrated
by a stranger or slight acquaintance and
involving a child who was transported 50 or more miles, detained overnight, held for ransom or with the intent to keep the child permanently, or killed.)

Ugh. Meredith Broussard. She disgusts me. She has single-handedly endangered the well-being of children across the country by downplaying the effects of food allergies. Yeah, we don't need mass panic, but we don't need her convincing people that food allergy parents are crazy, either.

I don't know where Shannon got her stats, but here's mine (from the CDC):
"food allergies cause 30,000 cases of anaphylaxis, 2,000 hospitalizations, and 150 deaths annually"
http://www.cdc.gov/HealthyYouth/foodallergies/index.htm
Call me foolish if I take my kid's food allergies seriously AND don't allow him to play out in thunderstorms. I wish people who have no idea what they're talking about would just stop talking.

As for the original poster, this is awful advice for your child and for your friend. If your friend is concerned based on test results, a visit to an allergist is in order. As for Lee, if there is no reason to assume there's an allergy, wait until he's a bit older (nut products are discouraged under the age of three, but certainly they aren't necessary at one). When he's ready, give him a small amount of peanut butter and watch for a reaction. Do this several times when you have time to watch him (not right before bed or naptime). There's no guarantee - food allergies can develop at any time, but that should help you rest easier.

Honestly, I expect better from Parent Hacks. This isn't the place to speculate on medical advice.

Kate -
You're absolutely right and we should have said USUALLY - and I understand exactly what you mean. I would occasionally go into full blown anaphylactic shock for no apparent reason. After months of trying to convince the world (and myself) that I was not just a big nut-job (pun intended) I found out I have a rare disease that causes the accumulation of mast cells. I wasn't crazy either, just difficult to diagnose.

Some important comments so far, but one thing that I haven't seen mentioned is to be careful about assuming that your pediatrician's office is prepared to deal with true anaphylaxis (uncommon but not rare). I am a pediatric ER doc and many pediatricians in our area have approached our group about how to be more prepared for office emergencies....because the reality is that most pediatricians haven't had to manage a life-threatening emergency in their office, and perhaps more importantly, the staff may be even less trained, and the equipment may be either nonexistent, or old/expired, or buried under boxes of urine specimen cups, or the staff just doesn't feel comfortable using it. This is not a criticism of pediatricians or their offices - they're not SUPPOSED to be able to handle anaphylaxis etc on a daily basis (unlike an allergist). So as for the original hack, I'd give it a thumbs down, and would definitely think it unwise to do without discussing it with the pediatrician first. Just my 2 cents.

There should not be "hacks" for serious health-related issues for children. If you suspect your child may have a food allergy, ask your pediatrician for skin/blood tests or a referral to an allergist to have them done.

As others have said, an allergic reaction isn't always immediate. At 1 year, my daughter reacted to dairy by breaking out in hives where it touched her skin (eating cereal by hand out of a bowl). The reaction was pretty immediate and obvious so we got a referral to an allergist. What surprised us was that her skin prick test also came back positive for eggs (we'd actually fed her scrambled eggs with no ill results), then a blood test backed up the dairy and egg allergies.

At 33 months, her allergist let her do a food challenge for dairy, which she passed. We waited another 6 months to do the egg challenge. It seemed she was going to pass that as well, then after the last feeding, just before they released us (an hour after it started), my daughter broke out in hives, had a sneezing fit, her eyes nearly swelled shut, and she threw up all over herself. She was immediately given Benedryl and her symptoms subsided within 10-15 minutes. We still had to stay a while longer before her doc would let us go. Then as soon as we got home, she had diarrhea, threw up on herself while still on the potty, and broke out in hives while in the tub being cleaned. We had to go right back to the allergist's office.

Thankfully, the second attack was her body's final purge of the egg in her system, and she didn't have any respiratory distress, except for some sneezing. Still, I am very glad that we were at a doctor's office when this happened and they were able to react right away.

You should not test for a food allergy without adequate medical supervision.

When my 5 year old presented with non-acute food related allergy symptoms, the pediatrician told us that the allergy tests were inconclusive for children under 1 so a trip to the allergist is unnecessary. He said that we needed to eliminate foods from the breastmilk and diet and figure out the culprit on our own. Was this incorrect information?

Jenna, is your daughter 5 months or 5 years?

I have a three year old that is allergic to Cinnamon and a wife who, at the age of 25, just recently became allergic to black pepper. We still have both products in the house, we just know who can have what and who can't. In most areas, an ambulance is only a few minutes away and they are there to be used. I'm sure our parents weren't this paranoid, and we all grew up just fine.

What a great site thank you. Responding to Peanut Allergy Hack. My daughter has an allergy to peanuts (all tree nuts), egg, fish and dairy. Needs and epi pen for dairy. I have eaten peanut butter around her almost every day of her life and had NO idea. On the dairy front same thing. My recommendation is to have child in allergist office if you suspect something. We needed (after three exposures to dairy - yogurt at nine months twice and some cracker with casinates - yes that is dairy... - she got a slight rash around her mouth) a nurse to come in and administer an epi shot as my daugther's arm began to blister from her wrist to her elbow and her breathing became a problem - all due to the pin prick of dairy they had placed on her arm.... Beware. AND keep in mind every child is different. I had no idea what we were up against. Hack may be perfect for others....

It is easy to say parents are obsessing over food allergies until it is your little 2 year old who is having the reaction. Potential anaphylactic reactions are nothing to fool around with.

I hate to be harsh but, this is a STUPID idea. Please get medical advice from the professionals not parent hacks. This would be a great forum for discussing how to live with allergies, many parents who live with this everyday probably have great advice. However, I would never ask a lay-person to diagnose or treat my child. As a nurse, I will tell you if you did this at our office we would call 911, same thing you would do at home. We are not equipped to deal with a fatal reaction. I think others above have left great advice. We all need to protect our children as we see fit but, medical concerns should always be discussed with a professional not treated like a sixth grade science project. I mean...are you serious?

Dear Lemon,

Your right. I meant 5 months old. He is now 9 months old. Breastmilk for a 5 year old sounds a little weird, huh?

Asha here. First of all, thank you ALL for the strongly-worded discussion.

You're right -- *in no way* is this site a place for definitive medical advice, nor has it ever purported to be. Parent Hacks is a place to tap collective wisdom of just the sort you're providing. Lee came up with an idea she thought would help, and you (collectively) are pointing out the flaws in her reasoning.

I will post a safety note at the top if this hack, but I'm glad I posted it -- we're all receiving an education here.

Silly and irresponsible hack.

@Shannon: While very few people die of food allergy exposure, many are effected by it. My child has very sensitive allergies to dairy and nuts. A friend of hers ate a peanut butter sandwich 3 hours before their play date and some of the protein was still on her hands. After only 15 minutes of play I watched my daughters face blow up, covered in warm bloated splotches. Her eyelid nearly covered her vision entirely. She was scared, itchy and in pain. She was still able to breathe, she was technically okay... but it was terrifying still for this 2 year old and her new mommy.

Please try to be sensitive to this issue in the future as I'm certain you wouldn't wish this on anyone's child and absolutely wouldn't want to experience this with your own.

It is not at all "insensitive" to point out that the hype surrounding this issue is completely out of proportion to the true risk. I repeat what I said above -- to parents of truly allergic kids, of course you have my full sympathy.

But the fact that parents of children who have shown no symptoms and have no family history of allergies are *even considering* hovering by the doctor's office while introducing peanuts shows how overblown this scare has become. Parents are frightened out of their wits for no good reason, they are infecting their children with panic, they are wasting their attention and resources on nonsense like this. It should stop. We can have sympathy for the very small number of children with life-threatening allergies, and their parents, WITHOUT contributing to this kind of hysteria.

Be careful of pine nuts also. We had to rush our then six-year old to the ER after our pesto pasta dinner, when he suddenly began swelling all over. He's not allergic to any other nuts either.

Shannon, I am very interested in your point of view, b/c as the mother of an allergic child, I think it is very important that I understand where you are coming from. I mean that sincerely, and hope that you respond to my questions.

The original poster was referring to a friend who's child had a suspected allergy. Otherwise a doctor would not have given this child an allergy test. Allergy and other medical tests are not just done willy nilly! To my understanding, you read the post as if the parent had absolutely no reason to suspect an allergy. Lee, the original poster, did not give us that information. For all we know she had a good reason to be concerned; maybe the mother, father, or sibling also has allergies.

Lee, the original poster was actually not that far off the mark. Take out "pediatrician's office" and plug in "allergist's office" and you pretty much have a simplified explanation of the usual protocol to deal with allergies.

Do you think that 8% of children being affected by allergies is not true, not a big number, or just not all that serious? Many schools are going "nut free" or have peanut free tables. Is that being hysterical in your opinion?

My son has just started school, and I've been surprised about the apparent lack of understanding about his allergy. He has a peanut free table at lunch, but his teacher announced (after it had happened) that the policy for birthdays is to give out small donuts. While I NEVER expect the world to bend to us (after all, we are just one allergic family living in a world of allergens) I do expect the opportunity to send in a cupcake for him as a replacement. I can't imagine giving anyone's child food without getting the other parents permission first. Would you perceive that as high maintenance or unreasonable?

What do you think that the true risk actually is, and what level of coverage do you think it deserves? Does it surprise you that food allergies in children doubled between 1997 and 2002?

I agree with previous comments that the "kiss of death" story was nothing but sensational, the same type of sensation that Anna Nicole Smith's death created.

http://www.nowpublic.com/health/experts-ponder-why-so-many-children-have-food-allergies

Hey Jenna, My first reaction was "I guess I've heard of stranger things than bfing a 5yo... but what the heck for each her own, right? :-)"

My first comment would be that you should have a great relationship with your pedi. If you don't, ask around the neighborhood and switch. If you have questions or feel rushed, or just don't trust the advice, switch.

My understanding is that blood tests for allergies under the age of 5 are just not all that reliable b/c an allergy can develop out of the blue, even if there has been no prior reaction. After discovering my oldest son's allergy, I immediately wanted to test his 2yo and infant siblings; my doctor and I together decided to spare them the needle prick. We could do the blood test and it could come back negative, give us a sense of "security" and then they could develop the reaction anyway. Or they could test a false positive.

Most children will NOT have an allergy, and because your child might have a food sensitivity does not mean they will automatically develop an allergy.

I've had different friends who ebf effectively eliminate a few different culprits; diary and/or soy seem to be the biggest ones. Google Kelly Moms - they have great advice on all bf topics I could ever think of, and a LOT of how to info.

Good luck!!

Hi Lemon, I am happy to respond to your questions. I want to stress that I am not attacking you as the mother of an allergic child -- I have every sympathy for your difficult position. I trust that you have done multiple tests and educated yourself on this issue, and not merely succumbed to hysteria. My comments are primarily directed at parents who do NOT have the assurance of their doctors that severe allergies are a risk for their children, and who are nonetheless freaking out. Sadly there are a lot of these sorts of parents -- they are not dumb or uneducated, they have merely been whipped up into a frenzy by irresponsible media stories. And yes, I think this particular forum thread tends to contribute the hysteria.

You ask first: "To my understanding, you read the post as if the parent had absolutely no reason to suspect an allergy." Yes, and that's because the tests, and their doctor's advice, left them with absolutely no reason to suspect that their child has a severe allergy. The doctor's advice was NOT to follow up with further testing in a controlled environment. The doctor's advice was to go about their daily lives normally. "His blood tests were inconclusive and the pediatrician said that the only way they'll know for sure is if he has a reaction." That means: come back if your child has a reaction. It does NOT mean, rearrange your lives on the assumption that your child will die if his lips touch peanuts.

"Inconclusive" means there is no good reason to suspect an allergy. If there was good reason to suspect one--especially a life-threatening sort of allergy--the doctor would have proposed the appropriate sort of follow-up tests. It is not the responsibility of parents to structure their own psuedo-medical trials!

You go on to ask: "Do you think that 8% of children being affected by allergies is not true, not a big number, or just not all that serious?"

I think it is all of the above. First, it is not true. If you read the article I originally linked to (http://www.harpers.org/media/slideshow/annot/2008-01/index.html) you will see how the numbers have been inflated.

Second, the number of children who are SERIOUSLY affected by food allergies is not a big number any way you slice it. Let's put aside the most conservative estimate (which is twelve deaths annually) and accept the most inflated figure that even the advocacy groups put forward, which is 150 deaths annually. This is still a TINY, TINY number. I mean, it is about twice the number of people who die each year from being struck by lightning. It is very, very small.

Thirdly, yes, it is not that serious. The percentage you cite (8 percent) is all children who suffer from ALL allergies. Most of those allergies are quite mild. OF COURSE it is heart wrenching when your own kid gets hives. But the fact is that hives are *in most cases* a mild condition that goes away on its own. You may think it's "insensitive" to say that, but it's just the plain truth--and acknowledging this truth spares many, many more children the irrational fear of a society hysterical about peanuts.

You ask: "I can't imagine giving anyone's child food without getting the other parents permission first. Would you perceive that as high maintenance or unreasonable?"

No, not at all. I don't think it is high maintenance or unreasonable to send special food with your child to school. I think the school should accommodate you in that, at least if you can produce a letter from a doctor. I think most schools should accommodate the health needs of minorities. Where I suspect we differ is that I think schools shouldn't treat peanut allergies as the *default* for their students.

You ask: "What do you think that the true risk actually is, and what level of coverage do you think it deserves?"

About the same as the risk of death by lightning strike. I think most children should be educated about what to do in thunderstorms -- they should get out of the water, they should not take shelter under a tall tree, etc. -- and I think most children should be educated about the signs of severe food allergy. But it should not take over our lives. It should not be something that most parents spend a great deal of time worrying about. It should not be something that we cause our children to fear irrationally.

I have done my best to answer all of your questions honestly, so I hope you will do me the courtesy of answering mine:

Why do you think it threatens you for someone to point out that life threatening allergens are rare, and that most parents should not restructure their lives around the threat of allergens? Leukemia among children is rare, after all, and nobody denies that the parents of leukemia-stricken children deserve the greatest sympathy. Why do you view it as a personal attack for me to point out that most parents do not need to worry about food allergens?

@Shannon, IMHO, the answer to your last question is again with the thinking process of the other adults around the child in question.

I agree that life-threatening allergies are rare. However, both articles like the one you quoted and even doing the research themselves tends to make some people ASSUME that a child presented as having a peanut allergy has parents who are just hysterics who can't get a grip, and there isn't a REAL problem. Because if it was THAT rare, then at least some of the people around me are lying, and the only way to tell is to test my theory on them, or assume they're all liars. Faced with uncertainty about how rare is rare, they jump to the far end of the spectrum, and reject all cases as invented parental paranoia.

I can't count the number of stories I've heard about relatives (let alone strangers) that go 'My grandma decided to test the theory, because, you know, the allergy thing is blown way out of proportion. Luckily I grabbed her hand before she could succeed.' And that's relatives, trying to sneak peanuts to their peanut-allergic relations - whom they love, in most instances. You also get things like the secret posted on PostSecret, that said something like 'I want to feed you peanuts secretly because I believe you're just saying you're allergic to get attention.'

That's the threat. It isn't the facts, it is the 'poo-pooing' approach to the over-exposure and (yes, media frenzy) over the facts, which leads to rolled eyes and resistance and attempts to undermine, rather than to asking for detailed explanation of the issues in this particular instance. Because the media does frenzy on this, people tend to link the frenzy to the parents, even if the parents are the rational, logical, sane parents of an actually tested allergic child.

I could blame the media for the frenzy, but it is also up to each person to not give in to the attempts to polarize life that such frenzy induces. Educate the parents who are taking things too far (like the one in the OP, whose child has no known risk, or the one referenced by the OP, who needs to talk to an allergist about what they actually need to do in this case, or ask them to find a doctor they trust more so they will listen better to what WAS said), rather than jumping on their case and relishing pointing out how far outside the normal response you think they've gone. ("You" being generic here, but there was a tone of that in your responses. 'HA, caught *another* parent being an idiot! SEE?' Gently is okay, and when you show your frustration so clearly, it doesn't read as 'this ANNOYS me' but 'I know better than you!' - which then goes right back to that fear that you're the kind of person who might slip a child peanuts just to prove your own beliefs in their regard, or that your voice might encourage someone else to do so - even though you're obviously rational enough to not go there yourself.)

Also, since random strangers CAN affect the disease path for a child with severe allergies, and cannot really touch the life path of a child with leukemia (barring during active chemo, and even then kids doing active chemo aren't always even allowed in public places due to the infection risks, and when they do go to school, the classes have to be treated carefully, etc. But because the course of treatment isn't life-long, it is accepted that *temporary* changes to 'living a regular life' are fine, they will not be 'forever'... compare again to severe allergy), that example isn't effective. I can't think of another disease where random strangers can cause your child to have a severe event or die, throughout their entire life, any day. Can you come up with one? Closest I can get is regarding other people's behavior while driving, but that's something everyone faces, not just a few. Imagine if only a few kids were at risk of severe injury or death if there was an auto accident, but other kids would not be hurt at all... Same division of reactions - 'MY child wouldn't be affected, so why do I have to drive safely just for a few kids?' Or, talk to the CDC about chicken pox vaccination, where the death rate is about the same from chicken pox, and the CDC scientists have determined that the best course of action for the entire nation is to vaccinate universally. The rate of death is comparable, the rate of mild-to-severe experience is comparable, and the CDC thinks it is fair to vaccinate universally because of the risk to a few individuals. (Not really a fair comparison, either, since there's no risk of an outbreak of allergy by contagion... but that's the one I came up with, pre-coffee, this morning).

I do agree that many people are in a fret about their child's potential allergy risk, without cause. But the answer IMHO, is better found by seeking common ground and problem solving or providing guidance.

One more comment to Shannon... when a pediatrician says that tests are inconclusive, that does not mean that a parent has no evidence that a child has an allergy. A friend of mine had a child who broke out in a rash whenever he came in contact with milk and rejected milk products. The pediatrician told her to feed him milk for a week and see if he developed hives. Pediatricians are not allergy experts and should not have the final word when parents are concerned. The best advice would be to consult an allergist who is capable of proper testing and advice. By the way, the boy in my example does indeed have a milk allergy. This is one example of several in my own personal experiences of pediatricians giving less than ideal advice (Ours told us that we didn't need to carry an epi-pen - we should just avoid nuts. The allergist thinks differently)

I see no reason to suddenly assume with no other evidence that your child might have a food allergy, but presumably those parents had a reason for the initial testing (a mild reaction, a history of food allergies, etc.) and weren't sure how to proceed.

Shannon, I agree with you that there is no general cause for hysteria, but your throwing around of stats (the 150 stat is NOT inflated according to the CDC - why would you believe Meredith Broussard over the CDC?) isn't making the point. Parents who feel they have a legitimate reason to be concerned should not be made to feel overly dramatic. We are all striving to do the best we can for our children. It's hard enough without strangers throwing judgments around. Focus on your own children (if you have any) and parenting skills and leave everyone else to do the same.

Hey Shannon, good evening! Thanks for your very thoughtful responses. FWIW it's not lost on me that you are mostly talking of people whose children don't have allergies. Most people don't have them. The OP "inconclusive" test was read by me as "possibly" allergic. Otherwise the word "Negative" would have been used. My own sons tests for shellfish, dairy, soy, and wheat were negative. He is positive for peanuts, and inconclusive for cashews and almonds. Allergy tests for the under 5 crowd are tricky b/c their immune systems are not developed fully.

Here are my answers:

We seem to disagree on the definition of a life threatening allergy. Just b/c someone didn't actually die does not mean that they did not experience a life threatening event. Anaphylaxis reaction can be life threatening if not treated. How many heart attacks would be fatal if a defibrillator weren't used? And how many anaphylactic events might turn fatal if the intervention of an epipen weren't used? I don't know the answer for either, but when I hear about 30,000 anaphylaxis events (and I'm guessing, I'm too tired to look it up) I'm reading that as 30,000 life threatening events. Even though my son is barely allergic anymore according to the tests, the allergist I saw told me to tell *everyone* around us that he has a "life threatening allergy." He specifically instructed me to use those exact words, b/c there is absolutely no way to tell how far an event will go if not treated. You said that hives would go away on their own, but that's not necessarily true. And hive are what you can see on the outside. When you have hives on your skin, it's very likely that you ALSO have hives/welts/swelling occurring anywhere along the digestive tract from mouth to anus depending how fast it may travel through your system.

Most parents don't structure their lives around allergies. And I don't expect a school to default to being peanut free, unless they have an individual who would react to even the scent of peanuts in the air. Such severity is rare, but does exist and usually does not start out that way. Such severity has most certainly built up over time and repeated exposures.

I do expect ALL schools to have a plan on how to keep children with allergies safe. Hedra had an excellent point: random, and possibly very well meaning strangers can impact your child's health status. Think of how helpless that might make you feel as a parent.

I think that ALL parents absolutely should have awareness that food allergy is not rare, is in fact dangerous, and that it gets progressively worse with each and every exposure becoming more and more severe (so I don't see it as my son just getting hives, I see it as one step closer to anaphylactic shock.) I would personally breathe much easier if I felt other parents had a basic understanding of how their actions could unintentionally harm someone else's child. For instance, after heading for the playground or other public play area, parents should make sure that if a child has consumed a messy snack that the parent clean the child's hands and clothes thoroughly. So my yogurt covered child will not cause an allergic reaction to your dairy allergic child. I recently cleaned up someone else's snack in the toddler space (designed for 0 - 3yos) at the children's museum near where I live. Honey roasted peanuts. In my mind, that's just not fair play. Choking hazard AND common allergen.

One last point worth mentioning is that I think that a lot of the "paranoia" stems from the fact that we are talking about little children who lack the understanding, sophistication, and ability to communicate to be able to keep themselves safe. What better way to send your 4yo allergic child (who is truly incapable of being their own advocate) to a new school than in a "I am allergic to XXX!! Don't feed it to me!!!" tshirt? My child doesn't know that he can only eat homemade cookies. He wants one of the delicious ones you had that was just made at the bakery (right after the batch of peanut butter cookies.) And it's sad to me that I have been places where other children are eating ice cream that he *desperately* wants and doesn't understand why he can't have it. Naturally I try and avoid those situations. Birthday parties are very hard.

FWIW one of my inlaws has a peanut allergy, and I *love* hanging out with her b/c she can tell me what's safe for her and what's not. For instance, when she can eat a birthday cake from a bakery, I let my son eat it too. I have no allergies, and have NO idea how protective is too protective for my son. If we can steer clear of all nuts in the next year, his chances of outgrowing this is very good and we'll hopefully never have to worry about it again. BUT, if he is exposed he probably will react, and will have to deal with this for the rest of his life. That's a lot more pressure than just hives. Wouldn't you be a little paranoid too?

And as a little lighthearted joke, I don't think that you were personally attacking me or any other parent. I just think that you were wrong. :-) And that is truly meant as a joke to make you smile.

My sister's best friend died at the age of 21 from a peanut allergy. She was at a wedding and asked the caterer if the cookies contained peanut oil and they said no. The couldn't get her to the hospital fast enough and she lapsed into a coma and died the next day.
It was horrible for everyone, of course.
I will never forget my sister standing over her grave, crying "what am I going to do without you?".
Enough said.

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