Parents Beware: Peanut Allergies Are On the Rise

Parents Beware: Peanut Allergies Are On the Rise

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Peanut allergies increase by 50 percent, and food packaging can be deceptive

Wikimedia Commons

Peanut allergies have grown 50 percent since 2007.

Parents of kids with extreme peanut allergies know to scour food labels when buying candies or snacks for their children. But even an extremely careful parent could be putting their child in danger. Federal law says that manufacturers have to list when certain common allergens (like peanuts) are present as an intended ingredient in food. But it’s voluntary to list when peanuts or tree nuts are made in the same factory as the non-nut product.

And with one in 13 children now suffering from peanut allergies, or roughly two per classroom, according to John L. Lehr, CEO, Food Allergy Research & Education (FARE), that food packaging loophole could be deadly. WTOP reports that Arlington, VA mom Jodi Meyer had a scare when she inadvertently gave her allergic child Trader Joe’s cookies, which had traces of peanut in the mix.

If a person has a food allergy, the only way to prevent a potentially life-threatening reaction is to strictly avoid eating problem foods,” Lehr told us. “If you have any concerns about a product, call the manufacturer or simply do not eat it.”

Peanut allergies have increased 50 percent between 2007 and 2011, according to a data brief released by the Centers for Disease Control and Prevention. But help may soon be on the way. Doctors in Cambridge are currently experimenting with a procedure that feeds kids with the deadly allergy a small portion of peanut flour, according to Philly.com. After eating the flour four out of five children could successfully snack on a handful of peanuts.

Why are food allergies in children on the rise – and is there anything parents can do to protect them?

Around 7% of children have food allergies and, as the recent case of Natasha Ednan-Laperouse showed, in rare, tragic instances, these can be fatal. How worried should parents be?

Photograph: Guardian Design Team

Photograph: Guardian Design Team

Last modified on Mon 1 Oct 2018 22.22 BST

I n July 2016, Natasha Ednan-Laperouse collapsed on a flight from London to Nice, suffering a fatal allergic reaction to a baguette bought from Pret a Manger. At an inquest, the court heard how Natasha, who was 15 and had multiple severe food allergies, had carefully checked the ingredients on the packet. Sesame seeds – which were in the bread dough, the family later found out – were not listed. “It was their fault,” her father Nadim said in a statement. “I was stunned that a big food company like Pret could mislabel a sandwich and this could cause my daughter to die.”

This horrifying case highlights how careful people with allergies need to be, as do the food companies – not least because allergies have been growing in prevalence in the past few decades.

“Food allergy is on the rise and has been for some time,” says Holly Shaw, nurse adviser for Allergy UK, a charity that supports people with allergies. Children are more likely to be affected – between 6 and 8% of children are thought to have food allergies, compared with less than 3% of adults – but numbers are growing in westernised countries, as well as places such as China.

“Certainly, as a charity, we’ve seen an increase in the number of calls we receive, from adults and parents of children with suspected or confirmed allergy,” says Shaw. Certain types of allergy are more common in childhood, such as cow’s milk or egg allergy but, she says: “It is possible at any point in life to develop an allergy to something previously tolerated.”

Stephen Till, professor of allergy at King’s College London and a consultant allergist at Guy’s and St Thomas’ hospital trust, says that an allergic reaction occurs when your immune system inappropriately recognises something foreign as a bug, and mounts an attack against it. “You make antibodies which stick to your immune cells,” he says, “and when you get re-exposed at a later time to the allergen, those antibodies are already there and they trigger the immune cells to react.”

Allergies can have a huge impact on quality of life, and can, in rare cases such as that of Natasha Ednan-Laperouse, be fatal. There is no cure for a food allergy, although there has been recent promising work involving the use of probiotics and drug treatments. The first trial dedicated to treating adults with peanut allergy is just starting at Guy’s hospital.

“There is a lot of work going on in prevention to better understand the weaning process, and there’s a lot of buzz around desensitisation,” says Adam Fox, consultant paediatric allergist at Guy’s and St Thomas’ hospitals. Desensitisation is conducted by exposing the patient to minuscule, controlled amounts of the allergen. It’s an ongoing treatment though, rather than a cure. “When they stop having it regularly, they’re allergic again, it doesn’t change the underlying process.”

What we do know is that we are more allergic than ever. “If you think in terms of decades, are we seeing more food allergy now than we were 20 or 30 years ago? I think we can confidently say yes,” says Fox. “If you look at the research from the 1990s and early 2000s there is pretty good data that the amount of peanut allergy trebled in a very short period.”

There has also been an increase in the number of people with severe reactions showing up in hospital emergency departments. In 2015-16, 4,482 people in England were admitted to A&E for anaphylactic shock (although not all of these will have been down to food allergy). This number has been climbing each year and it’s the same across Europe, the US and Australia, says Fox.

Why is there this rise in allergies? The truth is, nobody knows. Fox doesn’t believe it is down to better diagnosis. And it won’t be down to one single thing. There have been suggestions that it could be caused by reasons ranging from a lack of vitamin D to gut health and pollution. Weaning practices could also influence food allergy, he says. “If you introduce something much earlier into the diet, then you’re less likely to become allergic to it,” he says. A 2008 study found that the prevalence of peanut allergy in Jewish children in the UK, where the advice had been to avoid peanuts, was 10 times higher than that of children in Israel, where rates are low – there, babies are often given peanut snacks.

Should parents wean their babies earlier, and introduce foods such as peanuts? Fox says it’s a “minefield”, but he advises sticking to the Department of Health and World Health Organization’s line that promotes exclusive breastfeeding for six months before introducing other foods, “and to not delay the introduction of allergenic foods such as peanut and egg beyond that, as this may increase the risk of allergy, particularly in kids with eczema”. (Fox says there is a direct relationship between a baby having eczema and the chances of them having a food allergy.)

The adults Till sees are those whose allergies started in childhood (people are more likely to grow out of milk or egg allergies, than peanut allergies, for instance) or those with allergy that started in adolescence or adulthood. Again, it is not clear why you can tolerate something all your life and then develop an allergy to it. It could be to do with our changing diets in recent decades.

“The commonest new onset severe food allergy I see is to shellfish, and particularly prawns,” says Till. “It’s my own observation that the types of food we eat has changed quite a lot in recent decades as a result of changes in the food industry and supply chain.” He says we are now eating foods such as tiger prawns that we probably didn’t eat so often in the past.

He has started to see people with an allergy to lupin flour, which comes from a legume in the same family as peanuts, which is more commonly used in continental Europe but has been increasingly used in the UK. Sesame – thought to have been the cause of Natasha Ednan-Laperouse’s reaction – is another growing allergen, thanks to its inclusion in products that are now mainstream, such as hummus. One problem with sesame, says Till, is: “It often doesn’t show up very well in our tests, so it can be difficult to gauge just how allergic someone is to it.”

Fox says it’s important to stress that deaths from food allergy are still rare. “Food allergy is not the leading cause of death of people with food allergies – it’s still a very remote risk,” says Fox. “But of course you don’t want to be that one who is incredibly unlucky, so it causes great anxiety. The real challenge of managing kids with food allergy is it’s really hard to predict which of the children are going to have the bad reactions, so everybody has to behave as if they might be that one.”

Fact No. 1: Many kids who develop peanut allergies had eczema as babies.

Ever wonder why some kids develop peanut allergies, and others don&rsquot? Experts believe it has to do with exposure to peanuts through damaged skin&mdashbefore solid foods are even introduced, says Dr. Holbreich. &ldquoIn babies with atopic dermatitis&mdasha.k.a. eczema&mdashthe skin is scaly and itchy,&rdquo he says. When peanut protein comes in contact with a baby&rsquos impacted skin, it can enter the bloodstream and create a food allergy or sensitivity, says Dr. Holbreich. (In fact, most food allergies, including egg, soy, wheat, and cow&rsquos milk, develop this way, after initial exposure via the skin.)

Peanut protein is resilient. It can spread easily throughout a home and is even resistant to standard cleaning methods, according to research published in The Journal of Allergy and Clinical Immunology&mdashso in homes where peanuts are eaten exposure is very likely. And while that&rsquos not necessarily a bad thing (not all babies with eczema go on to develop peanut allergies!), it may explain why peanut allergies develop in the first place.

The Peanut Allergy Epidemic: What’s Causing It and How to Stop It

Excerpted with permission from The Peanut Allergy Epidemic: What’s Causing It and How to Stop It by Heather Fraser. Copyright 2018 by Skyhorse Publishing, Inc.

Why is the peanut allergy an epidemic that only seems to be found in western cultures? More than four million people in the United States alone are affected by peanut allergies, while there are few reported cases in India, a country where peanut is the primary ingredient in many baby food products. Where did this allergy come from, and does medicine play any kind of role in the phenomenon? After her own child had an anaphylactic reaction to peanut butter, historian Heather Fraser decided to discover the answers to these questions.

The Peanut Allergy Epidemic
The Problem of Peanut Allergy

By 2012, as many as 2.3% of Canadian children under 18 and 2% to 3% of children in the US, the UK and AU were allergic to peanut. (See Appendix). And as children born during the first wave of the epidemic in the early 1990s have aged, the statistic of adults with peanut allergy is increasing. In 2008, an estimated 1% of the US population was allergic to this one food, about 3 million people. Four years later by 2012, that number jumped to an estimated 4 million living with a life threatening allergy to peanuts.

Peanut allergy began as a phenomenon largely affecting children living in Western countries, the US, Canada, Australia and the UK. The alarm sounded for Americans when between 1997 and 2002 the number of peanut allergic children doubled and then tripled reaching an astonishing one million in 2008. In 2010 one study put that number at 2%, an additional 500,000 children in just two years. As this book unfolds it will become evident that there is a pattern in the way in which the peanut allergy in Western and now non-Western countries has emerged—epidemic levels of peanut allergy in children are now also documented in mainland China, Hong Kong, Singapore, Israel and parts of Africa.

While the exact numbers are a matter of debate, it is clear through statistics, scientific inquiry, and simple anecdotal evidence (the parental refrain “no one had a peanut allergy when I was at school”) that the prevalence of the allergy among children has increased at an alarming rate.1 This development has altered the fabric of societies now forced to accommodate life-threatening allergies to common foods.

Families with children allergic to peanuts (or any of the other top 8 allergenic foods—tree nuts, fish, shellfish, wheat, soy, dairy, egg)2 live in a state of constant tension. If these families eat at restaurants, they do so with extreme caution. Not knowing the severity of the allergy, parents are vigilant about smears of peanut butter left on tables or on grocery cart handles. Trace amounts on the skin or lip or even the scent of the food could trigger a reaction. Parents, the child, caregivers, and teachers are fearful.
Children are segregated in school cafeterias at designated tables or left out of play because friends have peanut butter in the house. Every school now tackles the peanut question, whether to ban peanut butter sandwiches and how to educate staff and students about the deadly nature of this ubiquitous childhood food.

Public awareness of peanut and other severe food allergies has impacted education systems and social norms, provoked legal reform, and made billions of dollars for those active in the food-allergy industry. This industry’s infrastructure consists of many overlapping allergy awareness groups, international allergy associations, medical researchers, pharmaceutical companies, allergy doctors, “free from” food makers, and government regulators, all of which support or are supported by the growing legions of food-allergic children.
The inherent inertia of this industrious leviathan, however, has pushed the salient questions into the background: How has the peanut allergy epidemic developed, and why is it continuing?

It is difficult to accept the startling increase in peanut allergies in children in just the last twenty years as a coincidence or to chalk it up to genetic fluke. The challenge for any concerned medical professional has been to unearth the precise practical mechanism of sensitization common to these children—how did they become sensitized to peanut in the first place? And while there are a limited number of proven ways of “how to” make someone anaphylactic—ingestion, inhalation, through the skin, injection—no hypothesis of mass sensitization has yet connected any of these functional mechanisms to all the specific characteristics of the peanut-allergy epidemic.
Researchers have considered skin creams that contain peanut oil, peanut consumption, parasite burden, and more without satisfactorily explaining why there has been a rise of the allergy in children. Why peanut? Why has it happened so suddenly, and why just in certain countries, most of them Western?

Risk factors for developing the allergy have been explored without conclusion. These include the following: maternal age, mode of delivery, levels of intestinal flora, heredity, and even birth month and socioeconomic status. Confusing matters further is a debate over the basic concept of allergy: Is allergy the outcome of a roulette-style genetic predisposition to immune dysfunction, or is allergy an innate, purposeful immune defense?

An important and clear distinction must be made between sensitizing someone to peanut and launching the allergic reaction. Sensitization is believed to occur when a protein bypasses the detoxifying process of the digestive system and becomes bonded with blood serum. This prompts specific blood cells to create antibodies that are then programmed to recognize the threatening protein—in this case, peanut protein. The launching of an allergic reaction, on the other hand, occurs when the body is subsequently exposed to the protein and the antibodies trigger the biochemical players in the allergic reaction. Lack of a standardized definition of anaphylaxis has hampered some studies where categories of “true” anaphylaxis mediated by Ig antibodies are compared with non-Ig anaphylaxis. This is less of a concern with peanut allergy where apparent consensus is that it is almost always Ig mediated.

Immunoglobulins epsilon (called IgE) are sentries of the body. The job of the IgE is to patrol the fortress walls—mucous membranes—looking for peanut protein intruders. When they detect one of the many peanut protein epitopes (strings of amino acids that are numbered 1 through 8 and all called Ara h after Arachis hypogea, Latin for peanut)3 they alert the body, which in turn lets loose the army—the body’s immune system. A biochemical cascade is deployed that is damaging and potentially dangerous. It is typically characterized by coughing, shortness of breath, itchy skin hives, systemic leaking of blood vessels that causes swelling and potential asphyxia, vomiting, and diarrhea. In severe reactions, blood pressure drops, draining vital organs and causing the heart to stop.

Scientists have shown that the anaphylactic condition in all mammals can be achieved by inhaling peanut protein if it is combined with a toxic additive. For example, doctors have created anaphylaxis in lab animals that inhaled a mixture of peanut and cholera.4 The toxic bacteria functions as an adjuvant, an additive that excites the immune system to form antibodies. It is suggested that the toxin and benign food can become in this way linked and both remembered by the immune system.5 One wonders then at the idea of an allergy to bacteria and the toxins produced by them. Allergy to bacterial toxins has been acknowledged for many years and can result in inflammation of the tonsils and adenoids and anaphylaxis.

Researchers have not explored the role of adjuvants in peanut sensitization. They have preferred to focus only on the peanut proteins, their allergenicity, and the ingestion of them as the most obvious elements in sensitization. They seemed to think that if they could simply pinpoint the initial oral exposure to these proteins, they could stop the epidemic. To this end, they have considered the ways in which peanuts are prepared (boiled versus roasted), age when they are introduced to the child’s diet, maternal diet and breast milk, and even peanut oil used in nipple creams. Although it is possible to create the condition through simple ingestion, it is difficult. A healthy digestive system will neutralize any potentially sensitizing protein.

In fact, a 2006–2007 study stated that it did not matter whether mothers ate peanuts or not—the same percentage of children developed the allergy. Some children whose mothers did not eat peanuts before, during, or after pregnancy still developed a peanut allergy. Kids who had never been exposed to peanuts exhibited anaphylaxis on their first or second taste of it—suggesting that they were already sensitized either to peanut proteins or to proteins similar enough to them leading to cross-reactivity. Adding to the allergy mystery is the fact that Sweden, which has a low level of peanut consumption, has a higher prevalence of the allergy than the United States. Israel, which has a high level of peanut consumption, has a low prevalence of peanut allergy in Jewish children at .6% in 2012 (but a high prevalence of sesame allergy) and a high prevalence of peanut allergy in Arab children (2.6%) living in the same country.

Another puzzling feature of the epidemic is the sudden emergence of peanut allergy in non-Westernized countries like Ghana, China and Singapore. It was suggested previously by Sampson et al in 2001 that children living in China did not have peanut allergy because their peanuts are boiled which partially destroys and reduces sensitizing peanut proteins. However, the sudden and increasing prevalence of food allergy in children living in mainland China and peanut allergy Hong Kong upends this theory and deepens the seeming mystery of this allergy.

Today, thousands of research articles by doctors on the biology of the allergic reaction, clinical observations, and allergy management are available in prestigious periodicals. From this mound of information, doctors have developed and tend to favor two explanations for the current epidemic of peanut-sensitized children. They are the helminth hypothesis and the hygiene hypothesis.

Helminths are worms that live in the human intestinal tract. It surprised researchers in the 1980s to discover that people heavily infected with worms had few allergies. One study confirmed that most Venezuelan Indians living in the rainforest had worms but no allergies while very few of the wealthy Venezuelans living in the cities had worm infections, but many had allergies.

From this observation, researchers developed an explanation for all allergies: because parasites and humans have coevolved, they have an apparent symbiotic relationship in which parasites suppress allergic reactions while enjoying their human host. Without worms, the theory states, humans are unable to achieve homeostasis. In other words, immune dysfunction occurs due to lack of worms.

As an explanation for peanut allergy, the helminth hypothesis is inadequate. It cannot explain why there has been a rise of peanut allergy just in children. And given that Western countries have been largely unburdened by major helminth infections for decades, it does not explain the sudden increase of food allergy that shocked school systems in the early 1990s.

Another popular explanation for the rise in childhood allergies grew from an apparent correlation between this rise and the general decline in family size. It was proposed that unhygienic contact in large families—lots of siblings bringing illness home from school—was important for the development of a healthy immune system. The greatly expanded and much-touted hygiene hypothesis suggests that overzealous cleaning, germ-killing products, chlorinated water, antibiotics, (vaccination is specifically avoided by researchers) have “protected” Western children unnaturally. And as a result, the immune systems of First World children, in particular, are sheltered from a natural microbial burden. Their immature immune systems are understimulated, dysregulated, and therefore prone to random allergic sensitization. This malfunction is a product of an unburdened lifestyle.
The hygiene hypothesis is problematic in explaining peanut allergy. It does not consider the possibility that the immune systems of these children are not understimulated but rather overstimulated by Westernized approaches to toxic chemicals, drugs, and vaccinations. In addition, the theory does not indicate a practical mechanism of mass sensitization that would explain the sharp rise in food allergy just in children that was first noticed in the early 1990s in specific countries when a flood of affected children arrived for kindergarten. This is a primary clue to causation that researchers have either missed or dismissed altogether.

In addition, these two favored explanations for the epidemic assume that allergy is a dysfunction, that the body has made a mistake in attacking a benign substance. And yet, the opposite may be true. Some suggest that allergy has an evolved purpose seen before the twentieth century but provoked increasingly today by drugs and noxious pollutants in our air, water, and food.

American researchers Rachel Carson (1907–1964) and Theron G. Randolph (1906–1995) and evolutionary biologist Margie Profet (b. 1958) proposed that allergy is an evolved protective response. In 1991, Profet stated in The Function of Allergy that allergy is a final and often risky natural defense against toxins linked to benign substances. The IgE antibody is not, as it is generally characterized in medical literature, a rogue immune factor. It is more akin to a hero provoked by toxins the body has deemed a deadly threat. The scratching, vomiting, diarrhea, and sneezing are desperate attempts to eject a toxin as fast as possible. It is a risky reaction but one the body is programmed to unleash as a last-ditch effort to protect itself. This event occurs when the general defenses have been insufficient in preventing a specific toxin from accessing the bloodstream for a second time.

This is a provocative concept. However, because it was developed before the rise in peanut allergy, it lacks specificity—again, why peanut and why the sudden increased prevalence in children?

Conspicuous by its absence from current theories is the one mechanism that has an actual history of creating mass allergy—injection. Injection is examined in this book in some detail since it was the means by which the founder of anaphylaxis, Dr. Charles Richet, stumbled on alimentary (food) anaphylaxis in humans and animals over one hundred years ago. Richet concluded in 1913 that food anaphylaxis was a response to proteins that had evaded modification by the digestive system. Using a hypodermic needle, he was able to create the condition in a variety of animals—mammals and amphibians—proving that the reaction was not only universal but also predictable using the method of injection followed by consumption or another injection.

There are two lines of thought in the medical literature regarding injection as a mechanism of sensitization. The first is that injection, in the form of vaccination or other injections such as the neonatal vitamin K1 prophylaxis, merely unmasks genetic predispositions or tendencies to allergic disease. In short, there is something wrong with the child and not the injection(s).

The second line of thought is that there is a causal relationship between the injected ingredients and allergy—and although the proven allergenicity of vaccines is widely acknowledged, medical literature carefully avoids the question of what kinds of allergies vaccines can and do create to substances that are coincidentally or subsequently inhaled, ingested or injected. One exception to this unwritten rule was an unusual admission by Japanese doctors that an outbreak of gelatin allergy in children starting in 1988 and continuing through the 1990s was caused by pediatric vaccination. In that year, changes to the vaccination schedule in Japan meant that the DTP was replaced by an acellular version containing gelatin, the age at which it was administered to children was dropped from two years to three months, and this new vaccine was given before the live virus MMR vaccine that also contained gelatin. When children began reacting with anaphylaxis to the MMR vaccine as well as gelatin-containing foods (yogurt, Jell-O, etc.), doctors investigated. Finally, they concluded that the aluminum adjuvant in the DTaP had helped sensitize children to the “minute amounts” of proteins in the refined gelatin in the vaccine. Removal of gelatin from the DTaP vaccines was “an ultimate solution for vaccine-related gelatin allergy.” Subsequently, new cases of gelatin allergy in Japanese children dropped.

Quantities and qualities of adjuvant and other vaccine ingredients injected into children changed dramatically between 1989 and 1994 in ‘mature markets’ for vaccines including the United States, United Kingdom, Canada, and Australia. During those years, at least five new vaccine formulations for the same bacteria, Haemophilus influenzae type b (Hib) were introduced within an expanded and intense vaccination schedule. Like the gelatin allergy that emerged from a changed schedule of pediatric injections, was there some mix of ingredients that included powerful aluminum additives in the new Western schedule that was sensitizing children to peanut? The fact that refined peanut oil was a documented vaccine ingredient in the past is a subject of concern equal to the potential of sensitization to body tissues or even of cross-reactivity between dietary peanut and homologous injected proteins. These cross-reactive proteins may include those in the Hib cellular membrane or legume oil in a popular brand of the vitamin K1 prophylaxis. Cross-reactivity explains why a person who is allergic to peanuts, legumes like soy and castor beans, may also react to nuts or citrus seeds, which belong to different plant families—their proteins have similar molecular weights and structures.

As ingredients changed, the number of shots increased for kids in their first eighteen months of life from ten to as many as twenty-nine. The increase meant inconvenience to parents who would have to make more trips to the doctor and discomfort to the children who would have to experience multiple injections. To overcome these obstacles to compliance with the new schedule, the vaccines for diphtheria, pertussis, and tetanus (DPT) polio (OPV) and H. influenzae b (Hib) were administered to children in a single visit with two injections and an oral polio dose starting around 1988. By 1994 starting in Canada, these five were rolled into a single needle. Few parents realize that by design immunization provokes both the desired immune response and allergy at the same time. These natural defenses are inseparable and the more potent the vaccine, the more powerful the two responses. This is an outcome of vaccination the medical community has understood at least since Charles Richet won the Nobel Prize (1913) for his research on anaphylaxis. Anaphylaxis, Richet observed, is one of three outcomes of vaccination.

Paul Offit, chief of Infectious Diseases at Children’s Hospital in Philadelphia in 2008, dismissed concerns that the vaccination schedule was overwhelming children. To Offit, this was just not good science. Other doctors disagreed. In respected medical journals such as The Journal of the American Medical Association and Allergy: European Journal of Allergy and Clinical Immunology, doctors expressed concern over the long-term effects of early vaccinations. Some doctors state that excessive vaccination is ineffective and dangerous.

But vaccination is a complex subject, and its role in the food-allergy epidemic is difficult to address because of the heated political, social, and economic implications. It is a subject doctors avoid. And so, despite the continuing intense attention given to the peanut allergy in children, an answer to its cause(s) has not yet been found. What has emerged, instead, is a robust economy of doctor fees, nut-free foods, ongoing medical research, and pharmaceutical sales. Peanut and other food allergies have become enormously profitable. It is so much so that one market analyst has suggested that an “autoimmune index” would be a great tool for investors. This index, tagged as “save the children and make money,” would monitor the profitability of pharmaceutical stocks relative to the continued rise in peanut allergy and other childhood epidemics.

Peanut allergy began as a mere idiosyncrasy after World War II. Today, its epidemic proportions help fuel a multibillion-dollar food-allergy industry.

Bio: Heather Fraser is a Canadian author, speaker, and natural health advocate and practitioner. She is the mother of a child who suffers from peanut allergies. Fraser lives in Toronto, Canada.

11 Ways to Manage Your Child's Food Allergies

When parents talk about managing their child's food allergies, they don't usually use the word "easy". Once a test reveals the potential for anaphylactic reaction to food that's harmless to most other kids, moms and dads move about life with a constant underlying anxiety.

Dinners out, play dates, school events, camp buses, family vacations, and even a trip to Grandma&aposs can feel scary because of possible exposure to a potentially life-threatening food. Here are 11 strategies to help parents and kids feel safe and in control in the face of food allergies.

1. Get Cooking

While working hard to avoid the things that are dangerous for your child, getting acquainted with ingredients that are safe is the most productive and empowering thing a parent can do in daily management of food allergies. The more familiar you are with ingredients, products, cooking methods, and substitutions, the more in control you&aposll feel when it comes to feeding your child well and making sure he doesn&apost feel alienated.

If you can involve your child in cooking, the practice will have the same effect on her. Master a handful of reliable recipes, riff on them safely to your tastes, and sit down to meals that everyone in the family can enjoy together without worry. Excellent cookbooks, magazines, and recipe databases dedicated to food allergies are available to help. Mainstream food publications and websites often include free-of foods for readers with sensitivities or allergies.

2. Find reliable sources of research, studies on food allergies, and recalls

To supplement conversations with your allergist or pediatrician, seek out ongoing updates from a short list of verifiable news outlets and websites whose purpose is to support the food allergy community. Bookmark these to start.

FARE, Food Allergy Research and Education, is a nonprofit organization aimed at improving the quality of life and health of people with food allergies. Its website offers webinars, research summaries, toolkits, details about laws and regulations, and more.

Kids With Food Allergies is a division of theਊsthma and Allergy Foundation of America, a nonprofit that advocates and educates on behalf of food allergy families.

Clinicaltrials.gov is a service of the National Institutes of Health and allows public searches of research studies happening worldwide. It offers a glimpse into the work being done in the food allergy field. American Academy of Allergy, Asthma, and Immunology is a worldwide membership organization of allergists and immunologists. The website serves its members, but offers useful content and links for parents managing and learning about their children&aposs food allergies.

3. Compile allergy awareness products and materials

Preparation goes a long way in keeping allergy anxiety at bay. Organize an allergy kit complete with an emergency response checklist, medications and instructions, and important phone numbers. Pack it in an easily recognizable bag, like thisਊllergy medicine case from AllerMates, that you, your child, a caregiver, or teacher will remember to keep on hand. Personalized allergy alert labels, bracelets, and tags call attention to your child&aposs needs and are available online from companies like Mabel&aposs Labels.

Ask your allergist or pediatrician to print out a personalized emergency plan, or create one usingꃺRE&aposs Food Allergy and Anaphylaxis Emergency Care Plan. Food allergy awareness posters are available online and are perfect for classrooms, preschools, and daycare centers. Print one out to share with your child&aposs teacher or caregiver. You can find several options here:ਏoodAllergyAwareness.org orਊllergicLiving.com.

4. Tap into inclusive communities

Interact with other parents, caregivers, and children who are dealing with the same challenges. Communities online and in-person bring together families adjusting to life with food allergies. These people understand the ever-present hum of anxiety, and are simultaneously navigating package labels, cross-contamination concerns, school safety, epinephrine injector expenses, and all the issues you&aposre worried about that allergy-free families are not. One person&aposs quest to find answers for her own situation may prove applicable to your own, and helps prevent all parties from feeling isolated.

Get together with local peers or meet online through member forums like those at Kids With Food Allergies, Facebook pages like AllergyMom, or organizations and individuals on Twitter and Instagram (search #foodallergies). Compassionate, empathetic contacts near and far can be great resources for traveling with family, too in terms of finding reliable places to eat and other services that cater to food allergy families.

5. Find accommodating restaurants, resorts, and entertainment venues

When you are acutely anxious about your child&aposs safety, going out for dinner or planning a family vacation can feel like more trouble than it&aposs worth. Both require relinquishing a fair amount of control over preventative measures. But with food allergies on the rise, the service industry has responded in kind, helping allergic customers and families have a regular experience. Restaurant staffs are increasingly sensitive to the needs of food allergic patrons. It&aposll take some legwork to find local allergy-friendly restaurants (try Allergy Eats), but once you do, you can take a worry-free night off from the kitchen now and then.

Family-centered resorts are especially skilled at helping allergy families navigate safely. Walt Disney World stocks epinephrine auto injectors (EpiPen®) for guests throughout resorts and cruises, and note locations of the medication on guest maps. Other major family resorts like Hershey Park and The Great Wolf Lodge offer allergy-friendly menus and services, plus direct access to chefs and staff who will plan ahead for your family&aposs arrival so everyone can relax and have fun with less worry. The Airline Access to Emergency Epinephrine Act of 2015 has been introduced, and if passed, will improve accommodations for passengers with at risk of food allergy-induced anaphylaxis.

Nationwide, baseball stadiums host peanut-free days when fans can enjoy a game in no peanut zones. Food-free entertainment destinations, like libraries, some playgrounds, and museums offer fun, learning, and play free from apprehension about allergen exposure.

6. Take opportunities to shape school policy

Teachers and administrators have a lot on their plates, so helpful parental involvement is often the best way to ensure that the complicated issue of food allergies gets the attention it warrants. Volunteering to provide snacks, or suggesting that all class snacks be fresh fruits and vegetables defines a safe guideline that&aposs reasonable for all students. Collaborating with staff to write the school allergy policy, and heading up a committee to educate peers puts you in a position to design the parameters that will keep your child safe when you can&apost be there. Suggest rules that prevent food sharing in the lunchroom and that make classroom celebrations inclusive. Work with the school to create a 504 plan (available under civil rights law) or other emergency plan for your family, and offer to help inform fellow allergy families about the options that exist to protect their children. No one will be a more committed advocate for your child than you are.

7. Keep a stash of safe snacks

Most food allergy parents move about the world armed with safe snacks for their kids. The easiest choices are whole foods like fruits and vegetables. They harbor no hidden ingredients, they are portable, and often well liked by kids. They are the simplest suggestion for other adults when your child is in their care. In our snack food enthused world, it&aposs great to know that brands like So Delicious, Enjoy Life, Namaste Foods, and many others manufacture allergen-free products that kids love. You&aposll find everything from cookies and granola bars, to ice cream and cheese puffs. Ingredient labels on any packaged foods (see below) will help determine if something is free of your child&aposs allergens. Get more tips for building an allergy-safe pantry.

8. Rely on healthcare professionals that help

Allergists and pediatricians are parents&apos primary partners in the quest to keep kids with food allergies safe. Their experience and perspective, gained by managing thousands of allergy children, helps families adapt to limitations. Other practitioners who specialize in food allergy management and treatment, especially those who are immersed in emerging research and science can prove helpful, too. Nutritionists and dietitians identify deficiencies, introduce alternative products, and suggest approaches to dealing with especially limited diets of picky eaters or kids dodging a litany of allergens. Ask your allergist or food allergy community friends for a recommendation and request a consultation.

9. Understand packaging and ingredient information

Parents of kids with food allergies become voracious readers of food labels, one of the first lines of defense against accidental ingestion of an allergen. In the United States, the Food Allergy Labeling Consumer Protection Act (FALCPA) defines labeling requirements for all foods regulated by the Food and Drug Administration (FDA). It requires food labels declare any of the eight major food allergens (milk, egg, peanut, tree nut, wheat, soy, fish, and crustacean shellfish) as ingredients. Within the ingredient list, major allergens will be identified in parentheses following the common name used, for example flour (wheat), or whey (milk). Some labels include a voluntary "Contains" statement following the ingredient list, and calls out the major allergen in a short list (contains: milk, soy, egg). Labels may also include processing and manufacturing information, which highlights cross-contamination risk. Look for terms like "manufactured in a facility that also handles. ", or "made on shared equipment with. ".

10. Enlist supportive, informed family and friends

Family members and friends who understand the severity and risk of food allergies are invaluable. They can be an extra set of watchful eyes, preventing your child from taking unsafe snacks from a well-meaning friend at the playground, or from digging into the wrong treat at a play date. Help them help you. Teach them your child&aposs allergens, the signs of a severe reaction, and how to use an epinephrine injector. Forward them articles like this one and other resources that offer tools for understanding food allergies and keeping allergy kids safe. Share a good recipe for allergy-friendly cupcakes if they&aposve asked what they can make for the next birthday party. Tell them about great products at the grocery store that are safe for your child. And give them a hug for their extra efforts to be inclusive! As your child grows, his own friends can be equally instrumental in helping to keep him safe from life-threatening reactions to food if they understand and know what to do.

11. Look into treatment options

More experts and parents have embraced immunotherapy, which is the practice of exposing children to their food allergen to help manage symptoms. In fact, in September 2019, the Food and Drug Administration (FDA) announced support of an oral immunotherapy drug for peanut allergies produced by Aimmune Therapeutics, Inc. The drug, called PALFORZIA, is geared toward those aged 4-17, and it aims to help kids build tolerance to peanuts and lessen the severity ofਊnaphylaxis and other allergy symptoms after exposure. The FDA should make a decision about PALFORZIA in early 2020𠅊nd if approved, would be the first FDA-approved drug aimed at peanut allergies.

Can parents prevent peanut allergies?

Peanut allergies are on the rise in children. Can they be prevented in the womb or early childhood?

Elizabeth Goldenberg December 2, 2011

Peanut allergies affect about two percent of Canadians, but they’re much more common in children than adults. The number of Canadian children affected tripled from 1997 to 2008, and it’s not known why. This is particularly concerning because an allergy to peanuts can be quite severe — just 1/8000th of a peanut can trigger an anaphylactic reaction in some people, and the legumes are responsible for 90 per cent of deaths from allergy-related anaphylactic shock.

Should women avoid peanuts during pregnancy?
Knowing that a peanut allergy can be so serious, many parents wonder if there’s something they can do to prevent it either during pregnancy or when their children are young. But if you’re confused about whether or not you should avoid eating peanuts during pregnancy, you’re not alone. One study found that the more peanuts pregnant women ate during their third trimester, the higher their babies’ risk for sensitivity to peanuts. However, researchers are now looking at whether eating peanuts while pregnant could actually increase peanut tolerance. Until the results of that new study are known, doctors will likely recommend that expectant mothers with a family history of peanut allergies not consume peanuts while pregnant.

Could introducing peanut products at a later (or earlier) age prevent allergies?

Parents also wonder if they should feed age-appropriate foods that contain peanuts to their baby as soon as he or she is ready for solid food, at some later age, or not at all. The answer may come in 2013, when we should have the results from a study headed by Dr. Gideon Lack, a researcher in London, England. Dr. Lack is tracking two sets of children: One set is avoiding peanuts until age three, and the other is eating age-appropriate peanut snacks three times per week.

Other causes of food allergies
In earlier research, Dr. Lack found that peanut sensitization in children can also be caused by the application of ointments and creams containing peanut oil to inflamed skin. This means that reducing peanut exposure may involve more than just avoiding certain foods.

If you’re concerned about peanut exposure, consider keeping your home entirely peanut-free. Avoid toiletries or other products containing peanut oil so that you don’t pick up trace amounts from surfaces, and learn how to read labels to avoid consuming foods that may contain traces of nuts.

Elizabeth Goldenberg, Food Allergy Expert and Lawyer, is the founder of OneSpot Allergy.

Increase in Childhood Peanut, Nut, Shellfish Allergies, Study Finds

Food allergy is on the rise, with a new study presented at the American College of Allergy, Asthma and Immunology annual meeting indicating a 21 percent increase in peanut allergy in children since 2010. In tree nuts, the increase was 18 percent and a 7 percent rise in shellfish allergy in the study led by Northwestern University pediatrician Dr. Ruchi Gupta.

The study was conducted between October 2015 and September 2016, with more than 53,000 households surveyed.

Read more about the study’s findings in the ACAAI press release below:

BOSTON, MA (October 27, 2017) – Parents often worry about peanut allergies because the reaction to peanuts can be very severe. New research being presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting suggests that peanut allergy in children has increased 21 percent since 2010, and that nearly 2.5 percent of U.S. children may have an allergy to peanuts.

“While 21 percent represents a large increase in the number of kids with a likely peanut allergy, the good news is that parents now have a way to potentially prevent peanut allergy by introducing peanut products to infants early after assessing risk with their pediatrician and allergist.”

Early Peanut Introduction

New guidelines introduced in January walk parents through the process of introducing peanut-containing foods to infants that are at high, medium and low-risk for developing peanut allergies. The guidelines are based on groundbreaking research showing that high-risk infants (infants with severe eczema and/or a history of egg allergy) who are introduced to peanut-containing food early are significantly more likely to prevent developing a peanut allergy.

What’s the Problem with Peanut Butter?

Two slices of bread affixed to each other with the sticky and sweet contents of PB&J has long been an iconic symbol of American childhood. And for some adults who consume about three pounds of the creamy (or chunky) stuff on average annually, it may still be part of their weekly meal plan. But with the peanut allergy rate tripling in recent years&mdashaffecting approximately 3 million people, including 4 percent of school-age kids, according to Food Allergy Research and Education&mdashthe affordable and filling food is now starting to lose some mass appeal.

Peanut butter isn&rsquot just turning off concerned parents and those with food allergies. Health-conscious food shoppers are also making the swap for seemingly healthier nut butters made with almonds, cashews, or sunflower seeds. Interestingly enough, the nutritional differences between these butters in terms of calories, fat and protein&mdashwith the exception of sunflower seed butter&mdashare slight. In fact, peanut butter may actually be the better option for you, offering the most protein of the bunch. Here is a comparison of the nutrition of popular nut butters:

If peanut butter is nutritionally on par or superior to its peers, why is it getting a bum rap among non-allergic consumers, too?

First let&rsquos look at the different kinds of peanut butter: regular and natural. Regular peanut butter contains partially hydrogenated oil (less than 1 gram, on average), added sugar, and doesn&rsquot separate like natural peanut butter. Natural peanut butter usually only contains peanuts and sometimes salt. Organic peanut butter is a natural variety made with peanuts that were grown without pesticides and contain no genetically modified organisms (GMOs). Products advertised as &ldquoall natural&rdquo may be misleading, says Kelly Pritchett, R.D., National Media Spokesperson for the Academy of Nutrition and Dietetics, because this just means the product is free of hydrogenated oils, so some natural peanut butters&rsquo hydrogenated oils can be replaced with palm oil, a form of vegetable oil. All natural peanut butters can also contain added sugar.

The Problem with Regular Peanut Butter
Hydrogenated oils (trans fats) were designed to keep food on the shelf for long periods without the fats becoming rancid, but they&rsquore not good for your body and the government has made efforts to remove them from packaged products to reduce exposure. Different fats affect your good cholesterol (HDL) and bad cholesterol (LDL) in different ways. Good cholesterol helps clear out the artery-clogging bad cholesterol. Unsaturated fats raise HDL, which is a good thing. Saturated fats raise LDL, which is a bad thing. Hydrogenated oils are a double-whammy, as they lower your HDL and raise your LDL.

Products are allowed to advertise that they are trans fat-free as long as they contain less than 0.5 gram trans fats per serving. While avoiding trans fats entirely is the best idea, it is unlikely that such very small amounts will cause much harm as long as the person is not entirely sedentary and does not have high cholesterol&mdashthese individuals should try to avoid trans fats completely. In general it&rsquos best to look for a jar with peanuts as the only ingredient, without salt and sugar, and it should be the kind you have to stir, says Pritchett.

The Problem with Peanuts
The dangers of consuming copious amounts of peanut butter don&rsquot lie in the calories and fat alone. Peanuts have a mold that grows inside the shell called Aespergillus niger, or black mold. This mold (also found on pistachios, Brazil nuts, seeds, beans, corn and wheat products) gives off a toxin called aflatoxin which has been shown to be toxic to the liver in rodent studies, so presumably could be harmful to humans as well. Farmers try to minimize aflatoxin contamination by applying treatment to their crops, but so far, this hasn&rsquot proven 100 percent effective against the dangerous mold growth. To help minimize risk, the FDA tests foods that may contain aflatoxins. Peanuts and peanut butter are the most rigorously tested products by the FDA because they are widely consumed. &ldquoYou may reduce aflatoxin exposure by choosing only major brands of nut butters, nuts, and discarding any nuts that look moldy, or shriveled,&rdquo says Pritchett.

Besides the risk of food allergies and mold, peanut butters may also contain harmful bacteria from the crop of nuts. Just last summer, six brands of peanut butter as well as almond butter were recalled for possible salmonella contamination. If they aren&rsquot grown organically, peanuts and other nuts are often treated with pesticides and are genetically modified organisms (GMOs). This means the plants&rsquo DNA has been modified without using natural methods of reproduction. The crops produced this way are often sprayed with herbicide that kills weeds without threatening their harvest, but some people are concerned that these herbicides might cause cancer and we don&rsquot know the long-term effects of consuming GMO foods. For a list of companies that are non-GMO, check out NonGMOProject.org. As for peanut butter and other nut butters, it comes down to consumer choice if you are trying to avoid GMOs, says Pritchett. &ldquoAt the moment, we don&rsquot have enough evidence to suggest that non-GMO peanut butter is better,&rdquo she says.

The Bottom Line
While Pritchett says she thinks it&rsquos good idea to switch up the your nut butters occasionally, since almond butter is higher in monounsaturated fats, vitamin E, and magnesium than peanut butter, it&rsquos up to your taste preference since the health benefits aren&rsquot monumental. The idea that other nut butters are significantly better for you than peanut butter is generally a misnomer, says Christopher Ochner, PhD, a USANA nutritionist.

While alternative nut butters such as almond and cashew butters are usually less processed compared to peanut butter, they&rsquore two to three times more expensive, too. Processing aside, peanut butter is very similar to other butters in terms of macronutrient profile, and the nutritional differences are incremental, not life-changing unless you have a peanut allergy, of course, he explains.

What causes anaphylaxis?

Some people get anaphylaxis with no obvious cause. However, the known culprits include nuts (especially peanuts), shellfish, eggs, kiwi fruit, bee or wasp stings and medicines like antibiotics or aspirin.

Symptoms come on rapidly and are very dramatic. They include tongue and lip swelling, wheezing, dizziness, itching, flushing, palpitations, tummy pain, breathing problems, 'nettle' rash, confusion and sometimes collapse.

If you've ever had an anaphylactic reaction, it's essential to get tested for possible causes, so you can avoid it completely. You'll also need to carry treatment with you everywhere. This includes an injection pen device which gives a rapid dose of adrenaline - friends and family should know how to use it too. Wearing a medical alert bracelet is a good idea rapid treatment can save lives.

Food allergy mom helps parents overcome anxiety about early peanut introduction

When it comes to your children, you want to keep them safe, and have their best interest at heart. New guidelines recommend introducing peanut foods to infants as early as 4-6 months, which can be understandingly scary for parents.

In this Q&A Eleanor Garrow-Holding, President and CEO of Food Allergy and Anaphylaxis Connection Team (FAACT) and food allergy mom, shares her view and experience, to help ease parents’ fear.

As a food allergy parent yourself, can you understand parents’ fears about introducing peanuts early? What kind of impact will overcoming fear and introducing peanut early have on the child and family’s future quality of life?

Eleanor: As a parent of a child with multiple food allergies, I can understand the fear that a small amount of certain foods could harm my child. But, it’s important to remember that–especially if your baby is not in the high-risk category—that their risk for a reaction following the early introduction guidelines is low. And the impact on your child’s quality of life in the future without a peanut allergy could be great.

Why are the new guidelines important?

Eleanor: The new guidelines are important because they could potentially save thousands of children from developing a peanut allergy, which could change their quality of life. With food allergies on the rise in the past decade, preventing future diagnoses is very important.

What is the one thing you want new parents to know about the early intro guidelines?

Eleanor: The early peanut introduction guidelines were developed after a rigorous study showed that early introduction of peanut foods can reduce the chance of developing a life-threatening food allergy by up to 86 percent. The conclusion is based on hard numbers and science-based data.

What would you say to a parent who may be hesitant to introduce peanut?

Eleanor: Talk to your child’s pediatrician if you think they may be at high risk (severe eczema or existing egg allergy, or both). It’s important to understand how scientific studies are performed and how data is analyzed and ask questions about how guidelines are formed. If your doctor can’t answer these questions, find a board-certified allergist who can. Understanding the science behind the guidelines is vital, and can help with understanding of the benefits as well as the limitations of the current data.

Visit PreventPeanutAllergies.org for more information on the new guidelines, assessing your child’s risk, helpful tips for early introduction and baby-friendly recipes.

The Food Allergy & Anaphylaxis Connection Team (FAACT) has partnered with the National Peanut Board to spread awareness of the NIAID guidelines for the early introduction of peanut foods to prevent peanut allergy. Eleanor was not compensated for this article.

About Eleanor Garrow-Holding

As CEO of the Food Allergy & Anaphylaxis Connection Team (FAACT), Eleanor provides leadership, development, and implementation for all of FAACT’s initiatives and programs, including Camp TAG (The Allergy Gang) – a summer camp for children with food allergies and their siblings that Eleanor founded in 2009. Eleanor serves on the National Peanut Board’s Allergy Education Advisory Council, Sea World’s Allergy Resource Team, and Association of Food and Drug Officials (AFDO) Food Allergen Control Committee. In August 2015, Eleanor was inducted into The National Association of Professional Women’s (NAPW) VIP Professional of the Year Circle for her commitment to healthcare and nonprofit industries.