Tree Nut and Peanut Allergy

Pat, Deirdre, Connor, and Fiona had the opportunity to spend a few weeks in Florida at the beginning of this year. They expected to have a warm, fun getaway. For the most part, it was both of those things.

However, life being unpredictable, something occurred that none of us expected. After an outing to a duck pond, the family got a few snacks for the car and loaded up to go to another destination. The kids got their duck-shaped cookies, and both of them quickly rejected them -- which was highly unusual. Fiona took a small bite and threw hers saying "icky." Nothing more was thought of it until they reached their destination a short time later. When Deirdre opened the door to take Fiona out of her car seat, she had labored breathing, was turning blue, and was barely conscious. She looked at Deirdre and quietly said "Save me, Mommy."

Deirdre rushed everyone to the closest Emergency Room. She was in a town she had never been to and had to find it in a sheer panic. She was taken in immediately and during the examination, Deirdre was asked a series of questions. Among them was, "has she had any nuts?" Deirdre has made a strict practice of keeping nuts away from Connor and Fiona because of the dangers of a nut allergy. Unbeknownst to her, the innocent looking duck cookie was loaded with nuts and threatened little Fiona's life. The ER was able to treat Fiona with a series of IVs and other methods, and they were released. **As a side note, Connor was not left out of the fun, he had a trip to the ER 3 days later.

Upon arriving back in Massachusetts, Deirdre took Fiona to her pediatrician at Children's Hospital to be tested for nut allergies. They were called with the results yesterday: Fiona has a severe nut allergy. Connor will be going in for testing next.

As a family we are all conscious of sugars and carbs because of the family history of Diabetes. We are now learning about nut allergies. Michael and I had a conversation many many years ago with a genetic counselor that told us that nut allergies were growing and have affected the way that schools handle food. Now we get to see for ourselves.

We are new to this allergy, and our information will evolve over time. But I'd like to share what we have learned so far (from KidsHealth):

Peanuts are among the most common allergy-causing foods, and they often find their way into things you wouldn't imagine. Take chili for example: It may be thickened with ground peanuts.

Peanuts aren't actually a true nut; they're a legume (in the same family as peas and lentils). But the proteins in peanuts are similar in structure to those in tree nuts. For this reason, people who are allergic to peanuts can also be allergic to tree nuts, such as almonds, Brazil nuts, walnuts, hazelnuts, macadamias, pistachios, pecans, and cashews.

What Happens When Someone Has a Nut Allergy?

An allergic reaction happens when someone's immune system mistakenly believes that something harmless, such as a tree nut or peanut, is actually harmful. The immune system responds by creating specific antibodies to proteins in that food. These antibodies — called immunoglobulin E (IgE) — are designed to fight off the "invading" proteins.

IgE antibodies trigger the release of certain chemicals into the body. One of these is histamine (pronounced: hiss-tuh-meen). The release of histamine can affect a person's respiratory system, gastrointestinal tract, skin, and cardiovascular system, causing allergy symptoms like wheezing, stomachache, vomiting, itchy hives, and swelling.

Reactions to foods, like peanuts and tree nuts, can be different. It all depends on the person — and sometimes the same person can react differently at different times. Some reactions can be very mild and involve only one system of the body, like hives on the skin. Other reactions can be more severe and involve more than one part of the body. Most reactions last less than a day and affect any of these four body systems:

1. Skin. Skin reactions are the most common type of food allergy reactions. They can take the form of itchy, red, bumpy rashes (hives), eczema, or redness and swelling around the mouth or face
2. Gastrointestinal system. Symptoms can take the form of belly cramps, nausea, vomiting, or diarrhea.
3. Respiratory system. Symptoms can range from a runny or stuffy nose, itchy, watery eyes, and sneezing to the triggering of asthma with coughing and wheezing.
4. Cardiovascular system. A person may feel lightheaded or faint.

In really bad cases, tree nut and peanut allergies can cause a condition called anaphylaxis (pronounced: ah-nuh-fuh-lak-sus). Anaphylaxis is a sudden, potentially life-threatening reaction that, in addition to the symptoms mentioned above, can make someone's airways swell and blood pressure drop. As a result, the person may have trouble breathing and could lose consciousness.

Peanut reactions can be very severe, even if a person isn't exposed to much peanut protein. Experts think this might be because the immune system recognizes peanut proteins more easily than other food proteins.

Although a small amount of peanut protein can set off a severe reaction, it is rare that people get an allergic reaction just from breathing in small particles of nuts or peanuts. Most foods with peanuts in them don't allow enough of the protein to escape into the air to cause a reaction. And just the smell of foods containing peanuts won't produce a reaction because the scent does not contain the protein.

In the few cases when people do react to airborne particles, it's usually in an enclosed area (like a restaurant or bar) where lots of peanuts are being cracked from their shells. Although some people outgrow certain food allergies over time (like milk, egg, soy, and wheat allergies), peanut and tree nut allergies are lifelong in most people.

Other reading claims that 18% of children with peanut (not necessarily tree nut) allergies outgrow them. Researchers in Britain have found that children with tree nut allergies (such as cashews and walnuts) have more severe reactions than those children allergic to peanuts only. According to recent research by Scott H. Sicherer, M.D., associate professor of pediatrics at the Mount Sinai School of Medicine in New York City and a researcher in the Jaffe Food Allergy Institute, there is a 30 to 60% chance of a child with a peanut allergy to develop a tree nut allergy. The research goes on to claiming a link between cashew allergy and a severe allergy to poison ivy.

How to avoid peanuts and tree nuts

The Federal Drug Adminstration (FDA) requires that food containing allergens be properly labeled. From FoodAllergy.org:

The Food Allergen Labeling and Consumer Protection Act (FALCPA), which took effect January 1, 2006, mandates that foods containing milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat, and soy must declare the food in plain language on the ingredient list or via:

• the word “Contains” followed by the name of the major food allergen (milk, wheat, or eggs for example); or

• a parenthetical statement in the list of ingredients, e.g., “albumin (egg)”.

Such ingredients must be listed even if they are present in colors, flavors, or spice blends. Additionally, manufacturers must list the specific nut or seafood that is used (e.g., almond, walnut, cashew; or tuna, salmon, shrimp, or lobster). While more than 160 foods have been identified as causing allergic reactions, the eight foods listed above cause 90% of food-allergic reactions.

FALCPA will certainly make label-reading easier for the millions of Americans living with food allergies. Keep in mind, however, that the law only applies to products labeled on or after January 1, 2006; depending on a product’s shelf life, it may take up to a year before all products list ingredients in simple language. Until then, continue to read all labels carefully and be on the lookout for scientific terms (i.e., “casein” for milk, or “albumin” for egg).

While Connor and Fiona are not our children, they are the closest we will ever have. We hold them dearly to our hearts and obviously their health and safety is paramount. We will learn as a family what questions to ask and how to deal with this complex allergy. As with diabetes, having a nut allergy requires careful reading of labels. Deirdre, Jon, and Pat will be taking lessons on using an Epi-pen. All will be well in the end.