Cracking the Mystery of the Peanut Allergy


What started as a tranquil summer day at the beach turned into a life-changing saga for one New Jersey family.

Flash back to last August: Ivana Capra, her husband Rui, and their two children were on the way home from a trip to the Jersey Shore. They polished off a seafood dinner and made a quick pitstop for ice cream before reaching their house in Kenilworth. All was fine until two hours later, when Capra was giving her one-year-old son Michael a bath.

“He just started swelling and vomiting,” she says.

The infant’s symptoms progressively became more severe. “His breathing got heavier and he was gasping for air, so we drove him to the emergency room,” says Capra. “We thought it was a reaction to bad calamari.”

The E.R. clinicians gave the baby Benadryl and a shot of epinephrine. That treatment worked — he soon returned to normal.

A few days later, Ivana took Michael to an allergist and explained that the boy had a reaction to seafood. “The doctor said, “What you’re describing doesn’t really make sense,” Capra recalls. “He tested Michael, and sure enough, he wasn’t allergic to fish — he’s allergic to peanuts.”

The Reese’s Peanut Butter Cup ice cream was the culprit.

peanut allergies

Ivana Capra with her son Michael

While it was a relief for Capra to know what caused the allergy attack, the diagnosis was unnerving. Peanuts are in so many foods — could they be avoided completely? Are these allergies lifelong or could people outgrow them? And how exactly did they develop into such a big deal?

Those are questions that the medical community is still sorting out.

 A Modern Epidemic

Peanut allergies occur when a person’s immune system identifies the protein as a threat and goes into overdrive trying to protect the body when it’s ingested. The symptoms of a reaction range from mild (dry mouth or a rash) to severe (anaphylaxis). A shot of epinephrine can reverse the effects if the medication is administered within a few minutes.

Peanut allergies have been around for centuries but have become much more common over the past 20 years. Since 1997, the estimated number of cases has quadrupled.

The mainstream media has also honed in on peanut allergy stories due to a number of tragic — and shocking — events. The hysteria reached its peak in 2005, when it was widely reported that a 15-year-old girl had a fatal reaction after she kissed her boyfriend while he had peanut residue in his mouth. The story later proved to be false, as the coroner found that the girl died from an asthma attack triggered by secondhand smoke at a party.

That being said, peanut allergies can be fatal. In November 2014, a college student in Michigan passed away after a reaction triggered by cookies that had peanuts in them. Two years ago, a Long Island boy died after he ate trail mix. There have been dozens of other cases as well.

Due to the severity of peanut allergies, school administrators have amped up precautions. Since the late 1990s, many schools have banned peanut products on their campuses. Despite their noble intentions, the bans haven’t been universally popular. Last fall, the PTA in Omaha, Nebraska, organized a town hall meeting to address parents’ complaints that their kids were being deprived of an American lunchtime tradition: the peanut butter and jelly sandwich.

“As a parent, I’m upset because my daughter loves [peanut butter and jelly] and is now looking at whether she wants to sacrifice that for the next however many years,” argued one parent.

That led to a heated exchange. “I watched my daughter almost die and none of you had to do that!” said the mother of the allergic child, fighting back tears. “She’s five [years old]. She was on continuous nebulizing treatments with oxygen for four days.”

School administrators are stuck in a tough position. While only about one percent of the total population has a peanut allergy, it’s tough to ignore the safety measures when the consequence could be the death of a student.

“We still stand in very strange place in trying to decide what’s the safest and best for everyone,” says Dr. Janna Tuck, a spokesperson for the American College of Allergy, Asthma and Immunology. “We’re working on those social issues.”

“We all live our lives with people who are completely unaware of our allergies, so we have to learn to police our own environment and be safe,” she adds. “The children deserve safety and for protocols to be in place, but eliminating peanuts in schools leads to [other parents] saying, My child is milk allergic or egg allergic — there shouldn’t be milk and eggs in the school. There has to be some middle ground.”

A Little Dirt Could Be Good For You

So, what caused this rise in peanut allergies in the first place? There are several theories.

A study earlier this decade found that allergies are more prevalent in children from affluent families. Also, kids who grow up on farms tend to be less prone to them. This research supports the hygiene hypothesis — that living in environments that are too clean can disrupt a developing immune system.

“People are kind of designed to be exposed to bacteria and viruses,” says Dr. Tuck. “There’s some supposition that [our environments are] so clean that the immune system has shifted from protecting us from these things to [instead] developing this allergic phenomenon.”

The way peanuts are cooked and processed may also be a factor. In the United States, most peanuts are roasted while in countries like China — where peanut allergy rates are lower — they are fried or boiled. Roasting peanuts may change their composition in a way that negatively affects some human bodies.

And then there’s the matter of when kids are first fed. A common practice in the U.S. over the past two decades was for mothers to breastfeed infants and not fully introduce food until the baby reached the age of six to 12 months. Many doctors also advised parents to avoid feeding their children peanuts until the age of two.

That advice may have been flawed. In February, a study by LEAP (Learning Early About Peanut Allergy) reported that including peanut products in the diets of infants led to an 81 percent reduction in allergy development.

The study also found that Jewish kids living in the United Kingdom (where peanuts were not fed until the age of one) were 10 times more susceptible to allergies than children of similar ancestry in Israel (where they were fed peanuts at age 7 months).

“For decades allergists have been recommending that young infants avoid consuming allergenic foods such as peanut to prevent food allergies,” said lead researcher Dr. Gideon Lack. “Our findings suggest that this advice was incorrect and may have contributed to the rise in the peanut and other food allergies.”

Putting Allergies to the Test

That brings us to one final question: Do peanut allergies last forever? The answer: Not necessarily. “It’s estimated that 20% of people who have a food allergy have it go away with time,” says Dr. Tuck.

Tuck studied under Dr. Wesley Burks, who has pioneered a treatment called sublingual immunotherapy — a doctor “challenges” the allergy by putting a dab of peanut under the patient’s tongue to test whether a reaction will occur.

Dr. Tuck recalls treating an eight-year-old allergy patient who was afraid of eating peanut butter, so she used a tongue blade to put a tiny bit of it in his mouth. “He did fine,” says Dr. Tuck. “He called me the next week and said, “I love Reese’s! I’m so happy you did the test.’ The only way to tell if you truly have a food allergy is to do a challenge.”

Until it’s proven that the allergy has dissipated, patients and their guardians must take every possible precaution. It’s something that’s always front-of-mind for Ivana Capra after her Jersey Shore trip. She keeps an EpiPen in her diaper bag at all times in case of an emergency, and her parents have one for when they watch baby Michael. The allergy has turned her family’s life upside down, but Capra remains hopeful that her two-year-old will one day outgrow it.

“I’m curious to get him retested,” she says. “For now we pretty much avoid peanuts as much as we can.”


 

Author annotation: 

If anything needed translation, it was the peanut allergy. Equal parts confusing and terrifying, it’s a topic I’d been curious about for years (perhaps the curiosity stemmed from that peanut powder murder scene in The Da Vinci Code). I felt a traditional written narrative would best suit the multiple layers of the topic — telling the story of a parent of an allergic child, including insight from a board-certified doctor, and highlighting recent studies that explain why these allergies have developed so rapidly in recent years.

Sachin Shenolikar, Editorial 

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Cracking the Mystery of the Peanut Allergy