When Goobers Attack
Peanut Allergy
---Originally published in the print edition of The Boise Weekly, November 6, 2006---

Dear Dr. Rabin:
I panicked yesterday when I had just finished making a birthday cake for a co-worker and realized I put in almond extract forgetting she's highly allergic to peanuts. I called her right away, and fortunately she told me she's always been OK with "tree nuts" and not to worry. Whew! Her daughter also has a peanut allergy and has to sit in a "peanut-free zone" during lunch at her elementary school. It seems like so many more kids have peanut allergies now than when I was in school--I don't ever remember anybody who couldn't eat nuts. Why is it everywhere now?
--Lizz1001

I love the idea of a protective zone. Extending the idea further and creating a personal zone around each individual could be a godsend. In my own, for example, I would not allow Neil Diamond songs, vacation pictures or cilantro (cilantro is, in fact, the devil's work). Also, people would be prohibited from any graphic discussions of accidental injuries, no matter how hilarious they think their story may be. Weak stomachs have their limits.

Pardon the levity, but I had to get in my wisecracks before I tackle the deadly serious subject of peanut allergy. Of all food-related allergies, peanuts are to blame for the vast majority of severe reactions requiring medical attention and are responsible for as many as 200 deaths per year. Within minutes of consuming even a fraction of a single peanut, the most sensitive may notice itching in the back of the throat, hives, nausea and shortness of breath. If not acted upon immediately, swelling of the throat tissue can restrict breathing with obvious grave consequences.

As allergies go, peanuts are just one among many. Along with them, the most common foods to spark a reaction include milk, eggs, tree nuts (almonds, walnuts, pistachios, etc.) and fish. But unlike egg or milk allergies, most people never outgrow their severe reaction to peanuts. Although there is no dispute that rates of allergy and asthma (a loosely related respiratory disorder) are increasing, the perception of exponential growth of food reactions may be erroneous; a recent study demonstrated that although one-quarter of parents believe their child has a food allergy, only 4 percent actually do. Parents shouldn't be faulted, however, since the most common sensitivity test, the skin-prick method, frequently generates false positive results. An inaccurate diagnosis can have a strong effect on a child: a 2003 study showed that kids simply told they had a peanut allergy felt even more anxious and restricted than kids with actual juvenile diabetes.

Regardless of exact numbers, it is clear that rates of peanut allergy are significantly higher in North America than in Africa or Asia, where peanut consumption is nearly as common. To explain this difference, theorists produce hypotheses faster than my mom can produce vacation pictures. The hottest new theory states that our society is too clean--we now spend more than 90 percent of the time indoors in our Purell-created bubbles, unexposed to previously common germs and worms. Nice for us, but children may need exposure to the often-putrid microbial underworld for proper immune system development. A 2002 article in the Journal of the American Medical Association showed that kids with pets were 45 percent less likely to develop allergies than kids without (unlikely to include hermit crabs). This hygiene hypothesis is still not fully accepted, but Pigpen may now gain a bit more respect from Lucy and Schroeder.

A second compelling model is based on research that shows peanut allergy is more common in children who also have had skin rashes like eczema. Following the logic, researchers noted that many skin creams contain peanut oil (sometimes called Arachis oil) that may enter the bloodstream through the raw broken skin. One study showed that nine out of 10 peanut-sensitive children had been exposed to peanut-based creams in their first six months. It could be argued, though, that they were also exposed to those god-awful baby headbands or Neil Diamond music during the same period; coincidence does not prove cause and effect.

Some treatments are on the horizon--at least some that may reduce the severity of the reaction, or that increase the amount of peanuts necessary to cause it. Work is being done with injected antibodies that increase the threshold of exposure so an accidental bite of a secretly deadly macaroon won't send you to the hospital in an ambulance. Supervised food tolerance programs have shown promise, too, by slowly increasing intake to build up the body's acceptance. But don't try this at home; it can be quite dangerous. Just ask me--I tried it with cilantro.

"The Antidote" was a weekly column published from July 2005 to March 2008. Dr. Rabin tackled the hype surrounding alternative medicine, folk treatments, miracle supplements and cures-for-all-ills. His skeptical, evidence-based approach did not earn him many friends among local practitioners and multi-level marketers, but his monthly salary of two movie tickets made it all worth it.

Dr. Ed Rabin, Chiropractor

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Dr. Ed Rabin, Chiropractor  500 W. Idaho St., Suite 240, Boise, ID 83702  (208) 955-7277