MastAttack response to the recent letter from the National Peanut Board

This post was written to directly stand against a letter recently published by the National Peanut Board (a real name that I did not make up). That letter can be viewed below and insists peanuts do not pose the risk many believe they do to allergic persons. I go through it line by line with the text from National Peanut Board prefaced with “Letter” and my thoughts prefaced with “My response.” As usual, sources are always cited.

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Letter: It’s time to say goodbye to peanut allergies –

My response: Completely agree. Hooray! This guy for everything!

Letter: -not peanuts.

My response: Hmmm. Well, that took a jarring turn pretty quickly. That’s like saying it’s time to say goodbye to lung cancer, not cigarettes.

Letter: Breaking up is never easy. Today, a 50-year relationship comes to an end as Southwest Airlines stops serving complimentary peanuts on its flights. We’ve enjoyed our time together, but we have to tell our friends…it’s not us.

My response: Relationship drama does not belong on social media. Ten points from Slytherin.

Letter: You see, removing or banning peanuts from airplanes – or classrooms, or theaters or any public space – is a solution that is outdated and not rooted in today’s science.

My response: As a scientist, speaking on behalf of science everywhere, this is the stupidest thing I’ve ever heard. As if avoiding a potent allergen will ever be outdated. Give me a break. *rolls eyes*

Letter: Only somebody who unplugs their Walkman to check their beeper still thinks that location bans are the best way to prevent allergic reactions to peanut exposure.

My response: First of all, don’t hate. The 90’s weren’t that bad.

My response: Secondly, location bans are one piece of a complicated system that peanut allergic people utilize to find safe spaces and keep themselves out of danger. Location bans especially make sense in venues where a person can’t just leave if they find themselves confronted by a dangerous allergen. Like, I don’t know, a metal tube hurtling through the sky at warp speed?

Letter: While Southwest can do what they want to do – and we trust they’re doing it with good intentions – our job is to make sure the decision doesn’t cloud the extraordinary work being done by researchers, health professionals and allergy advocates.

My response: The extraordinary work being done is not in any way clouded by the fact that location bans are absolutely necessary in some situations. Although given the doozy that is the next paragraph, I would venture that the “problem” is that the author of this press release fundamentally misunderstands the current research findings. Hold onto your hats! This next paragraph of this press release is going to. Blow. Your. Mind. (And not in a good way)

Letter: Today, we know that peanut bans, while intended to protect those living with peanut allergies, don’t always work and create a false sense of protection.

My response: So because they don’t prevent every instance of peanut triggered anaphylaxis, we should just not have peanut bans anymore? Come on. Even the National Peanut Board has to realize how phenomenally asinine this statement is.

My response: Let’s say you are driving in a car that has four windows. Suddenly, it begins to pour. The rear passenger side window isn’t going up for some reason. Are you not going to close the other three windows to afford yourself some protection from the rain? Because this press release says they would just never even touch a window button again because when three of the windows roll up, the driver feels a false sense of security from the rain. That is how stupid this is.

My response: Anaphylaxis at school has become increasingly common.

  • “Most significant reactions in children are attributable to peanuts, fish, shellfish, egg, soy, wheat, tree nuts [and] milk.” (Sicherer 2010)
  • “Fatalities in school aged children in the United States have primarily been attributed to peanuts, tree nuts, milk, and seafood.” (Sicherer 2010)
  • “The Centers for Disease Control and Prevention recently reported an 18% increase in food allergy among school-aged children from 1997 to 2007; 1 in 25 children are now affected. Results of studies of children with food allergy indicate that 16% to 18% have experienced a reaction in school. Allergic reactions or treatment for anaphylaxis also occur in children whose allergy was previously undiagnosed (25% of cases of anaphylaxis). Fatalities were noted to be overrepresented by children with peanut, tree nut, or milk allergy.” (Sicherer 2010)
  • “In case series of fatalities from food allergy among preschool – and school-aged children in the United States., 9 of 32 fatalities occurred in school and were associated primarily with significant delays in administering epinephrine.” (Sicherer 2010)

Letter: A person will not have a life-threatening reaction by simply being in the same room as peanuts or peanut butter. You have to ingest the allergen.

My response: This is patently, verifiably false, and you should be ashamed of yourselves for saying it. You should be ashamed of OPENLY LYING about whether or not having peanuts nearby can kill someone. You should be ashamed that misinformation like this further endangers the lives of allergy patients around the world. You should be ashamed that an allergy patient might believe the words in this press release and injure themselves or worse. Where’s your false sense of security now?

My response: The American Academy of Asthma, Allergy, and Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology (ACAAI) sit on a joint task force together for the purpose of developing a robust set of medical guidelines to protect patients with allergies. AAAAI and ACAAI both acknowledge that anaphylaxis can occur without ingestion of the trigger.

  • “Severe allergic reactions may be seen in some patients who only inhale or come in contact with food allergens.” (Sampson 2014)
  • “Some patients may experience symptoms on inhalation of a food allergen but not experience symptoms after ingestion of the same food allergen (eg, baker’s asthma).” (Sampson 2014)
  • “Therefore, it may be necessary to avoid food exposure by routes other than ingestion.” (Sampson 2014)
  • “In some cases, severe allergic reactions may be seen in patients who only inhale or come in contact with food allergens, thereby making avoidance even more difficult.” (Sampson 2014)
  • “Patients who are extremely allergic to peanuts might have a reaction at a ball game when peanut particles from husking are blown in the wind and inhaled by that individual and in airplanes when another passenger is eating peanuts.” (Sampson 2014)
  • “Transportation by various means also presents a risk of accidental exposure. Air travel has received the most attention, but long rail trips (especially in foreign countries) and cruise ships present their own set of risks that must be anticipated.” (Sampson 2014)

My response: Other groups also reported that anaphylaxis can occur without ingestion of the trigger.

  • “In some cases, severe allergic reactions may be seen in patients who only inhale or come in contact with food allergens, thereby making avoidance even more difficult.” (Chapman 2006)
  • “Allergic reactions that result from direct skin contact with food allergens are generally less severe than reactions due to allergen ingestion. Reactions that result from inhalation of food allergens are generally less frequent and less severe than reactions caused by either direct skin contact or ingestion. Exceptions to these generalizations are more likely in occupational environments and other settings in which food allergen sensitization occurred via either inhalation or skin contact.” (Chapman 2006) Author’s note: Please note that this was not tested on mast cell patients so reaction severity may vary.
  • “Anaphylaxis from non-ingestion exposure, such as contact with intact skin or being close to an allergen, is uncommon [but does sometimes occur].” (Lieberman 2015)
  • “Case reports and controlled studies in which foods are vaporized through heating have shown that reactions, primarily respiratory, can be elicited. These observations support limiting exposure to allergens being cooked.” (Sicherer 2010)

My response: Anaphylaxis to peanut can be life threatening.

  • “Peanut and tree nuts account for most fatal and near-fatal food allergic reactions in the United States.” (Chapman 2006)
  • “Peanut allergy affects approximately 0.6% of the general population and is the most common cause of fatal food induced anaphylaxis.” (Chapman 2006)
  • “In case series of fatalities from food allergy among preschool – and school-aged children in the United States, 9 of 32 fatalities occurred in school and were associated primarily with significant delays in administering epinephrine.” (Sicherer 2010)
  • “IgE-mediated food allergy is associated with an increased risk of death after accidental ingestion.” (Sicherer 2010)
  • “Although subsequent reactions are not necessarily more severe than initial reactions, they may be. For example, initial mild reactions to peanut may be followed by more severe reactions on subsequent exposures.” (Sicherer 2010)
  • “Clinical factors such as a history of asthma, previous reactions to trace exposures, and allergies to foods mentioned previously are potential risk factors for fatal anaphylaxis.” (Sicherer 2010)
  • “Food allergens are a frequent cause of severe anaphylaxis, particularly in patients with concomitant asthma and allergy to peanut, tree nut, or seafood. Such reactions may be biphasic or protracted. Food allergy should be considered in the differential diagnosis of patients who have idiopathic anaphylaxis.” (Sampson 2014)
  • “A study showed that peanut can be cleaned from the hands of adults by using running water and soap or commercial wipes but not antibacterial gels alone.” (Sicherer 2010)

Letter: We also know that introducing peanut foods to an infant as early as 4-6 months can reduce peanut allergy development by up to 86 percent.

My response: YOU GUYS, I FOUND THE ONLY TRUE STATEMENT ABOUT PEANUT ALLERGIES IN THIS ENTIRE PRESS RELEASE. But don’t get too excited because this only pertains to IgE mediated allergies, traditional allergies. There are a number of food allergies that are not mediated by IgE. If you have mast cell disease or eosinophilic GI disease or FPIES, the age when you introduce a food isn’t the driving issue in whether or not you tolerate it.

 

Sources cited

Chapman JA, et al. Food allergy: a practice parameter. Annals of Asthma, Allergy, and Immunology 2006;96:S1-S68.

Lieberman P, et al. Anaphylaxis – a practice parameter update 2015. Ann Allergy Asthma Immunol 2015;115:341-384.

Sampson HA, et al. Food allergy: A practice parameter.  J Allergy Clin Immunol  2014;134:1016-1025.

Sicherer SH, et al. Clinical Report Management of Food Allergy in the School Setting. Pediatrics 2010;126:1232-1239.