Peanuts and Pollen

Celia Milne May 15 2000

Peanuts and Pollen

Celia Milne May 15 2000

Peanuts and Pollen

Celia Milne

Millions of Canadian parents, having been told their children are allergic to something, meticulously keep them away from peanuts, milk or other foods, pollen, mould, dust mites, animal dander, chemicals or insect venom. Parents of non-allergic kids are affected, too. They rack their brains each morning to pack school lunches without a trace of peanut oil, and many search drugstore shelves for unscented shampoos and soaps. It would seem that childrens allergies and sensitivities have reached epidemic proportions. But is that so?

Establishing any rise in the prevalence of children’s allergies is like sneezing into the wind. Statistics Canadas most recent numbers are from 19961997, when it asked Canadians if they had allergies diagnosed by a health professional. Among those aged 19 and under, 6.8 per cent reported food allergies and 18.9 per cent other allergies. Trouble is, there are no data to establish any kind of trend. In 1991, Statistics Canada found a higher incidence—31.2 per cent in the 15 to 19 age-group—but with a different question that made no mention of a health professional’s diagnosis. Other studies have found allergies among as many as 38 per cent of teens.

It doesn’t help that standard tests used to diagnose food allergies are so inaccurate they may be creating alarm where none is warranted. Fewer than 60 per cent of people who test positive on prick skin tests for reactions to food allergens actually have the allergy, says Dr. Janice Joneja, head of the allergy nutrition research program at Vancouver Hospital & Health Sciences Centre. Laboratory blood tests, called RAST or ELISA, tend to be even less accurate, she adds. Such inconclusive testing, says Edmonton pediatric allergist Dr. Stuart Carr, raises unnecessary alarm with constant misdiagnoses. “The prevalence of food allergies is vastly overestimated,” Carr states. “That, in turn, tends to dilute the importance of strict avoidance for those people with real, severe allergies.”

Does it really matter whether the numbers are increasing or

overstated? Not according to population health expert Dr. Earl Berger of Toronto, simply because allergy rates are alarmingly high by any count. “A very substantial proportion of the population has allergies,” he says. “It is really scary.” And there is no questioning the seriousness of perhaps the hottest topic in pediatric allergy—the peanut. Even its extract can cause anaphylaxis, a severe reaction that produces hives, facial swelling, shortness of breath, nausea or abdominal pain and, in extreme, potentially fatal cases, seizures, irregular heartbeat,

shock or respiratory distress.

But the severity of some responses to peanuts may, ironically, be giving other allergies an unnecessarily bad name. Reactions to many other foods such as milk, eggs and soy are generally not life threatening. What is more, according to Joneja, fully 90 per cent of children who have food allergies will outgrow them by the age of 7. She recommends periodic retesting by having children eat or touch a suspect food in a safe setting, “before the person is condemned to a lifetime of avoiding that food.” For children thought to be severely allergic to a food, that could mean putting a tiny trace on their lip in a hospital, with resuscitation equipment nearby.

For Leah Flor, intentionally putting peanuts anywhere near her daughter is simply terrifying. The Prince George, B.C., lab technician watched as Jenna, now 8, nearly died at seven months after picking up a cracker with peanut butter and getting some in her eye and mouth. “I am not tempted to test her, no,” says Flor, 31. “Not after what I saw.” Jenna’s face swelled, her eyes watered, she began to shake and then her breathing became raspy as her throat started to close. Flor got her to the hospital within 10 minutes, but by then she had almost lost consciousness. Doctors pumped Jenna full of adrenaline, put an air tube down her throat, and she survived.

Since then, Jenna has had two, less severe, reactions just from having someone who has eaten peanuts touch her. Understandably, her mother is on hyper-alert, trying to ensure that Jenna’s classrooms are peanut-free zones, carefully checking food labels for traces of peanuts and making sure there are EpiPens (epinephrine auto-injectors that provide an antidote) and people trained to use them wherever Jenna goes. “People think of me as overprotective,” says Flor. “They say, ‘There’s that woman again. She’s asking parents to change the way they feed their kids.’ ”

But children’s allergies are not a private issue, nor are they isolated occurrences. Whatever the trend in incidences, says Edmonton’s Carr, it is becoming “hard to find a classroom without a peanut allergy.” School officials are leading the charge of allergy awareness. “Schools are agents of change,” says Gordon Bell, 51, principal of the 360-student South Sahali Elementary School in Kamloops, B.C., which is converting to a scent-free policy in September because one boy is sensitive to perfumes. Bell, a teacher for 29 years and a principal for the past 15, says he never expected to spend so much time on issues such as children’s allergies. “There was a big turn in the road somewhere along the line,” Bell observes without complaint. “Now, a lot of time, energy and effort goes towards social issues and away from the three Rs.”

Airborne allergens such as those from pets, mould, pollen and dust mites don’t get as much attention as food allergies, but they make kids miserable with a range of symptoms,

from allergic rhinitis—which feels like a bad cold—to rashes, asthma and even anaphylaxis. What is clear is that recorded rates for asthma, commonly caused by allergies, are rising, from about 2.5 per cent of Canadian children in 1978 to at least 12 per cent this year. Medical authorities can track asthma rates through physicians’ billing records because there is a specific category for that condition. Allergies are not traceable that way, because doctors generally bill for treating a symptom (“weak and dizzy,” for instance) rather than an allergy.

For asthmatic kids, avoidance of allergens is the best medicine. Where that is not possible, bronchodilators, or “puffers,” are continually improving, becoming more child-friendly and longer-acting. Fruit may help as well. An Italian study of more than 17,000 children has found that those eating vitamin C-rich fruit such as kiwi or citrus fruits five to seven times a week were 30 per cent less likely than other children to develop asthma symptoms.

Why asthma is on the rise is hody deI bated in scientific circles. Children may be 1 over-exposed to allergens as tightly sealed f homes and schools keep dog and cat dander, I tobacco smoke, dust mites and other hazards I inside. On the other hand, one theory gain| ing popularity is that modern environments “■ are too clean. With the immune system less likely to be preoccupied in attacking bacterial or viral infections (because of antibiotics, vaccinations and more sterile surroundings), it may overreact to minor irritations caused by allergens, resulting in the range of symptoms associated with severe allergies.

Bolstering the cleanliness theory, recent research shows that kids born into families with lots of older siblings, and those from small families who start day care before age 1, are less likely to develop allergies than children from small families who aren’t exposed to grubby playmates until later. Other studies show that children from farms and infants with cats or dogs in the household also tend to develop fewer allergies.

Scientifically, the jury is still out on exactly what makes children develop specific allergies. It does seem that both environmental and genetic factors are involved. Within a generation or so, say some specialists, children whose parents have allergies may be good candidates for a vaccination to erase their allergic tendency. “I am hopeful there will be a vaccine down the road,” says Edmonton’s Carr. Even so, that would be too late for children like Jenna Flor, whose allergies are already activated. “This is a life-anddeath situation,” says her mother, Leah. “Every day I hope and pray this isn’t the day.”