Fifteen years ago, Michele Milligan was enjoying a candy bar when her 2-year-old son, Lars, asked for a bite. As the sweet mix of chocolate and peanuts hit his mouth, he quickly spit it on the floor. Moments later, his throat began to swell, choking off his air supply and turning his face purple.
Michele and her husband rushed Lars to the car and raced to the hospital, calling the emergency department en route. A medical team was waiting when the family pulled up to the entrance. They grabbed the boy from Michelle’s arms, rushed him inside and immediately began administering life-saving medication that re-opened his airway and began reversing the allergic reaction.
The cause: peanuts in the candy bar.
Peanut allergy on the rise
According to a Learning Early about Peanut Allergy (LEAP) study published in The New England Journal of Medicine in 2015, peanut allergies among children in Western countries:
- Have doubled over the last 10 years from from 1.4 percent to 3 percent.
- Are the leading cause of anaphylaxis — the type of severe allergic reaction Lars experienced.
- Are also the leading cause of death caused by food allergies.
That same study provided the clearest evidence yet about how best to reduce the rate of peanut allergies. LEAP researchers found that children who incorporated peanut-containing food into their diet as infants had significantly lower rates of peanut allergies compared to the control group of children who avoided peanuts altogether.
That study was the basis for new guidelines announced in 2017 by the National Institute of Allergy and Infectious Diseases regarding the “early introduction of peanut-containing foods into the diets of infants at various risk levels for peanut allergy.”
Institute introduces new recommendations
The recommendations call for:
- Introducing age-appropriate peanut-containing food to children with severe eczema, egg allergy or both, as early as 4 to 6 months of age to reduce the risk of peanut allergy. The guidelines recommend the children receive a blood test or skin prick test first to determine if the child tests positive for sensitivity or allergic reaction. That information will guide decision making about if and when to introduce the peanuts and how best to do so.
- Infants with mild to moderate eczema should have introduction of age-appropriate peanut-containing food around 6 months of age to reduce the risk of peanut allergy.
- Infants without eczema or any food allergy should have age-appropriate, peanut-containing foods freely introduced in the diet together with other solid foods.
The Institute’s recommendations received extensive publicity when announced earlier this year, and therein lies the concern. Milligan doesn’t doubt the science behind the study so much as the details, which may be lost on parents who only read the headline. After all, giving a child with severe allergies too much peanut on a first exposure could cause a significant reaction.
“I’m afraid it opens a Pandora’s Box, especially if they have no experience with food allergies,” she said.
Banner Medical Group allergist William Culver, MD, who treats Milligan’s son, understands her concern and says parents should discuss with their physician the particulars of introducing peanuts and other high-allergy risk foods to their children.
The challenges of testing for food allergies
Predicting allergies can be challenging, he said, because so many tests have false positives or false negatives. He said the blood and skin prick tests are useful but must be correlated with other data, including family history and evidence of any food sensitivities the child may have.
Once that information is known and it is determined to be clinically appropriate to introduce peanuts to the child, he recommends a tiny amount of peanut butter, no more than what fits on the finger nail of the child’s pinky.
“I equate it to driving,” Dr. Culver said. “You don’t just give a kid keys and send them behind the wheel. You start slow.”
A life-changing experience
Milligan said her experience with food allergies has been life changing. She has two sons and both have major food allergies, but she and their father do not.
Lars, now 17, is allergic to peanuts, blue food coloring, cucumbers and pumpkin. Her oldest son, now 26, is allergic to most fruits and vegetables, seasonings, red and blue food coloring. He also reacts to genetically modified foods.
Lars’ peanut allergy is unusually severe. He withdrew from his high school in favor of home schooling because just being near classmates who ate something with peanuts before school could cause a reaction.
The family now eats mostly organic foods. And, they eat nothing processed or made in a facility that also processes anything with peanuts.
“Our diet is very minimal in terms of variety,” she said.
Because of Milligan’s experience and her willingness to share her knowledge with others, Dr. Culver often gives her number to other patients who have children with severe allergies.
“He calls me Momma Bear,” she said. “I have had lots of interaction with schools, done a lot of education with schools and their staffs.”
Research improves understanding
Dr. Culver said decades of research triggered by the emergence of human immunodeficiency virus (HIV) greatly increased understanding of the human immune system and related health issues like multiple sclerosis, diabetes, asthma and allergies. New treatments for asthma and eczema hit the market every couple years. And, he expects research will yield even more treatments for immune-related disorders in the years to come.
In the meantime, for those with food allergies or those who suspect may have food allergies, he recommends the following:
- Cause and effect. If someone has a reaction every time she ingests a particular food, she likely has an allergy or sensitivity. It is best to avoid these foods.
- Careful observation. When introducing high allergy risk foods, always observe the individual carefully for any signs of reaction.
- Know what to do if there is a reaction. Doctors typically encourage people with severe allergies to have an epinephrine auto-injector, such as EpiPen, at home and to know how to use it. The auto-injector is a device with a needle used to inject epinephrine, a medication that reduces the harmful effects of the body’s allergic response and can open airways in individuals having an anaphylactic reaction.
- Re-evaluation. Not everybody who had a reaction as a child will have a reaction later. Individuals who have avoided foods for many years should talk to an allergist before they try the food again.