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Nixed nuts

Nuts and peanuts are a common food ingredient, but even slight contact can trigger fatal reaction in people with allergy

Nuts and peanuts are a common food ingredient, but even slight contact can trigger fatal reaction in people with allergy

May 17, 2004

katec@herald-mail.com

A peanut is not a nut. It's a legume - as are peas and beans. And did you know that an allergy to peanuts can be deadly?

In the United States, as many as 100 kids die in a year due to complications related to peanut allergies, said Dr. Nicholas Orfan, an allergist in Hagerstown.

Allergies to peanuts and tree nuts - walnuts, almonds, cashews, brazil nuts, pecans - affect children and adults, about 1 percent of the U.S. population. Peanut and nut allergies are the leading cause of fatal and near-fatal allergic reactions to food, according to information on the Web site of the National Institute of Allergy and Infectious Disease at www.niaid.nih.gov.

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Anaphylaxis, a severe allergic reaction, causes difficulty in breathing and can lead to loss of consciousness - even death, Orfan said.

Six-year-old Hailey Alger is allergic to peanuts, something that has changed her life and that of her family.

Recognizing her allergy was a process, her mother, Lynnette Alger, said.

When she was 9 months old, Hailey got a hive on her lip after her mom gave her a little taste of peanut butter off the bagel she was eating. Her pediatrician thought it was just a topical reaction.

She had a more dramatic reaction at age 3 when she accompanied her family to dinner at a local restaurant where peanuts are on the tables and diners throw the shells on the floor.

Although there were no peanuts at her family's table, Hailey's skin became covered with hives - itching, stinging red patches. Her parents stopped at a nearby store and bought an over-the-counter antihistamine. Hailey was OK, but Lynnette Alger, a nurse who works for a pediatrician, took her to see Orfan.

With a single skin test, Orfan confirmed Alger's suspicion that her daughter was allergic to peanuts.

At a family reunion later that year, Hailey didn't participate in the peanut scramble with the rest of the kids but still reacted with a hive and coughing.

A kiss on the cheek from a child who had earlier eaten some peanut butter pie sent Hailey to the emergency room when she was 4.

Hailey is never far from a spring-loaded auto-injector with a standard dosage of epinephrine, which is adrenaline.

"Intervention needs to be rapid," Orfan said.

If a child with a peanut allergy is exposed, early treatment can reverse the reaction and save the child's life. Although research is under way, there is no medication that prevents susceptibility to peanut allergy, Orfan said.

People cope with doses of avoidance and epinephrine, Orfan said.

And avoiding peanuts is not easy.

Peanuts or traces of peanuts are in many foods you'd never suspect them to be in. Certain brands of chocolate ice cream, cookies, cakes and candy, some fruit rolls, some brands of spaghetti sauce, many ethnic foods, including Chinese, Thai, African and Mexican foods contain some form of peanuts. Restaurants can be a problem. Orfan cited the case of a New England college student who died after eating chili he didn't know had peanut traces in it.

Hailey is in kindergarten at Montgomery Elementary School in Mercersburg, Pa. There's a picture of a peanut and Hailey on the door to each classroom she's in, reminding everyone that she is allergic to peanuts and what to watch for in case she's been exposed.

"The school has been awesome," Lynnette Alger said.

Hailey wears a necklace with a key to a locked bag that holds the medication she would need in case of exposure. There are walkie-talkies for communication between the child's teachers and the school nurse - who now is at the school full time, Lynnette Alger said.

The Alger home is peanut-free. Lynnette Alger carefully reads all food labels. Some include a warning that forms of peanuts or nuts are among ingredients. There is no peanut butter, something Lynnette Alger loves and her 9-year-old son, Logan, used to eat a lot.

But there are risks beyond the home. Last March in San Francisco, Heather Seavolt, Orfan's research assistant, presented the results of a study Orfan had conducted. The study showed that accidental peanut ingestion usually occurs outside the home, and the comfort of a living in a strictly controlled environment may make people less vigilant in other settings.

Hailey is very much aware of her allergy and is careful about asking if foods she's going to eat contain peanuts.

"She keeps me on my toes," Lynnette Alger said.

The girl said she likes to play on the monkey bars during recess at school. She is looking forward to a family trip to Disney World in the fall.

The family didn't book the least expensive plane reservations. Lynnette Alger found only one airline that doesn't serve passengers peanut snacks. The Algers will fly the peanut-free airline. They are not willing to take a chance with Hailey.

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