about that peanutty kiss of death…

My latest rant comes courtesy of my sister Mollie, whose own blog is very entertaining reading, by the way. Mollie clipped me an article from the Jan 2008 issue of Harper’s Magazine: Everyone’s Gone Nuts- The Exaggerated Threat of Food Allergies, by Meredith Broussard.

Broussard’s article has caused a lot of anger among parents whose children have food allergies, since she argues that “the rash of fatal food allergies is mostly a myth.” According to people living with food allergies, that is just not the case. Broussard does say that “there is no question that food allergies are real,” and I have several mom friends who could give personal vehement support to that statement.

But here’s what struck me about that article. Remember that story about the teenage girl who died after her boyfriend ate a peanut butter sandwich and kissed her? (That story had my mother-in-law so spooked that, after eating a handful of peanuts, she CHANGED HER ENTIRE OUTFIT before holding her grandchild, who DOES NOT HAVE a peanut allergy, by the way. “All I could think of was that poor girl!” she told me later. ) Well, guess what?

In the case of the peanut butter kiss, a coroner later ruled, to no fanfare, that the girl… actually died from an asthma attack.

OK. That was like finding out there was no Easter Bunny. That absolutely COULD NOT BE. But I’ll be damned if Broussard isn’t right. Right on cbsnews.com, there it was– Coroner: Peanut Kiss Didn’t Cause Death.

Here’s my problem with this. When the media whips us into a frenzy, and then it turns out they were wrong, why can’t they say “our bad” with the same bullhorn that they scared us with? If I did a poll (and perhaps I shall) I think I would find that about 80% of mothers had heard about the peanutty kiss of death. And about none percent of those moms would have heard that it was actually untrue. How are we supposed to keep our heads on straight when there is no voice of reason to balance out the fearmongering?

COULD an extremely peanut-allergic person die by being exposed through a kiss? Perhaps. But, apparently, this poor girl didn’t, since her boyfriend had ingested the sandwich nine hours before, and the allergens can only live in saliva for about an hour. We have to look to one another as our voices of reason. So tell your friends. The Jif Reduced Fat smooch was not deadly, after all. And, would you believe it- third grade boys do not have cooties.

ADDENDUM

I’m adding to this post, after receiving a comment what I was saying “could cost a teenager their life.” Ohhhkayyy, I thought, I’ve touched a nerve here. So I did a little more online research.

The blogosphere, I have found, is alight with commentary on Broussard’s piece, mostly from moms of kids with food allergies, who are ready to storm the offices of Harper’s with pitchforks and torches. There are many, many people taking exception to her suggestion that fatal food allergies are way overstated. I just wanted to clarify my own position on this, which is: I am no expert. I certainly think food allergies are real (and so does Broussard, for that matter). There is a kid in my son’s class who can’t eat dairy, soy, egg, gluten, wheat, nuts, or legumes, which honestly boggles the mind, wondering what could be left for him to consume. I understand that it is a modern epidemic– as to why, I’d like the experts to figure out.

The point I was making is that the famous girl who died from a mere kiss from a boy who had consumed a peanut butter sandwich– didn’t. That’s what the coroner ruled. And no one has contested that. But we didn’t hear about that part of the story, only the sensational, your-children-are-never-safe part. My point is that the media does everything they can to fan the flames and scare us, but does nothing to soothe our jangled nerves, when it turns out they were wrong. I don’t mean to belittle the entire topic of food allergies in our kids. I just want the media to report its dangers– and the dangers of cough syrup, and lead-laden toys, and Crocs, and Bumbo seats– accurately. Hope that clarifies things.

{ 6 comments… read them below or add one }

Canico January 28, 2008 at 4:09 pm

Actually, you are wrong and should have done more research. Your comment at the bottom could cost a teenager their life. You need to read the article in response to Meredith Broussard’s at http://www.healthcentral.com. A doctor, not a failed relationships expert(aka…Meredith B.)comments on her trash story. There is such a problem with her article, Harper’s has pulled their annotation section this month and WNYC is interviewing Dr. Hugh Sampson, world reknowned doctor, this Thursday. Here are some quotes that are accurate:

Can asthma be part of an allergic or anaphylactic reaction?

MP: Yes. Anaphylaxis can trigger asthma attacks that are notoriously difficult to treat. Wheezing, cough, chest tightness, and shortness of breath commonly occur during an asthma attack but are also life threatening symptoms seen during anaphylaxis (Wang. Clinical and Experimental Allergy, 37, 651-660). In some cases, respiratory symptoms can be the only manifestation (Moneret-Vautrin et al. Allergy. 2005: 60: 443-451). Anaphylaxis presenting in this way must be quickly treated with epinephrine. Prior to the advent of albuterol, epinephrine was the drug of choice for asthma exacerbation. When in doubt, use your epinephrine and call 911.

SM: How real is the threat from so-called “second-hand exposure,” like a kiss, to an allergen?

MP: Allergens can be transferred through saliva, so the second-hand exposure threat is real but entirely avoidable. Rosemary Hallett and colleagues at the University of California Davis School of Medicine reviewed data collected on 379 subjects with self-reported immediate nut or seed allergy and found that 20 subjects (5.3%) reported that they experienced reactions from kissing. Most of these reactions were mild but 20% did experience respiratory symptoms (Hallett et al. N Engl J Med 2002; 346:1833-4). Studies in other countries showed that people with food allergies reported that they experienced allergic symptoms after having “close physical contact (for example, kissing) with someone who recently ate something they were hypersensitive to (Eriksson et al. Journal of Investigational Allergology and Clinical Immunology. 2003 13(3):149-154).

In 2006, Maloney and colleagues conducted a study measuring the amount of peanut protein in 1 ml of saliva at certain times after eating a peanut butter sandwich and following various interventions. The study showed that soon after eating peanut butter salivary levels of peanut protein were high enough in some to cause a reaction. Additionally, 13% of subjects had detectable peanut protein in the saliva after 1 hour. No subjects had detectable salivary peanut protein several hours later and after eating a peanut-free meal. This study supports the reports of patients experiencing symptoms after kissing and demonstrates that oral contact with saliva, such as from sharing utensils or cups, can contain significant amounts of allergen and should be avoided. Additionally this study gives some guidance as far as interventions that can reduce the risk of a reaction other than complete avoidance (Maloney et al. JACI. V 118, (3) 719-724).

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Amy January 28, 2008 at 7:11 pm

Your concerns about food allergens are understandable, and since I’m not an expert on the topic, I will certainly read up on what you are suggesting. My gripe, however, is that the media completely hyped this one girl’s death, terrifying all of us, when, in the end, she did NOT die from a food allergy. My point is that when the media chooses to sensationalize such things, they should at least try to let us all know when it turns out they were wrong. From what you have written, it does not seem that the coroner’s report on that poor teenager’s death is being contested. So I stand by my point, since I never, at any point, suggested that food allergies are not both real and dangerous. I put Broussard’s article out there as a springboard for discussion- not as gospel truth. Thanks for your response. As a concerned parent, you can bet I will read your suggested link. Thanks again, Amy

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Mollie January 29, 2008 at 1:41 pm

Let’s not overlook Broussard’s main point (tangential to yours, but relevant): the “awareness-raising” groups that have formed around food allergies peddle these stories to the national media complete with misreported facts and misleading statistics, and the media swallows it whole because it makes a good story. The FAAN members’ hearts are undoubtedly in the right place, but the “One death is too many” defense is not an acceptable answer to “Why are you reporting inaccurate statistics?” And Harper’s shouldn’t be the only outlet that cares enough to do a little fact-checking.

(I also cry BS on the “Harper’s has pulled their Annotation section this month…” assertion above. If the article were found to be faulty, they would pull the article itself from the web — or, more likely, add a note to the online version saying so. Their not running “Annotations” in the Feb. issue does not itself indicate a problem with January’s issue.)

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Canico~Gateway FEAST Co-Coordinator January 29, 2008 at 4:37 pm

Here is the link for the article from a doctor not affiliated with FAAN. What you are not understanding is that asthma attacks can be part of an anaphylactic respose. It explains it better in this article. The coroner ruled the girl died from an asthma attack = anaphylactic reaction. A child who has food allergies + asthma can die from an asthma attack from the food protein the are allergic to. My son has displayed similar reactions. The article is hear.
http://www.healthcentral.com/allergy/c/3900/19063/nuts-doctor

If you read it you will see that Meredith B. has also quoted statistics innaccurately. She is a freelance writer on failed relationships who claims she has food allergies like to Vermouth. You can’t be tested for that in a doctor’s office–who exaggerating now? That’s why people are having a problem with this. An unqualified person writing innaccurate articles who people like your families will take for fact. One death to anything is too many–if it were your child, you wouldn’t say that. Look at SIDS awareness, leaving infants in hot cars, strangulation by pull cords. Does it matter how many kids died from those? It’s awareness and awareness saves lives. Google Molly Shannon if you get a chance.

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David Marc Fischer January 29, 2008 at 7:12 pm

amy: “My point is that when the media chooses to sensationalize such things, they should at least try to let us all know when it turns out they were wrong.”

Perhaps they shouldn’t sensationalize these things in the first place. As you saw, the follow-up on that particular story is all over the web. But it’s hard to imagine media putting a correction in the headlines the way they would with a sensational story.

mollie: “the ‘awareness-raising’ groups that have formed around food allergies peddle these stories to the national media complete with misreported facts and misleading statistics, and the media swallows it whole because it makes a good story. The FAAN members’ hearts are undoubtedly in the right place, but the “One death is too many” defense is not an acceptable answer to “Why are you reporting inaccurate statistics?” And Harper’s shouldn’t be the only outlet that cares enough to do a little fact-checking.”

I’m not sure that FAAN peddles such stories all that much. The main problem doesn’t even seem to be media that seize on extreme and exceptional cases. To me, the main problem are media that use reporting that, feeding on prejudices and doubts, undermine the credibility of people who are on medical diets.

Broussard tries to sling mud at FAAN and suggests that it relies on inaccurate statistics, but I think if you look carefully at the article she really doesn’t support many of her claims. Even if her claims about that one statistic hold up, it’s just one statistic and it isn’t a particularly strong claim in many respects: it’s only a difference of 188 in a pool of hundreds of millions of people, it doesn’t address the main dilemma of people with allergies (which is preventing reactions including anaphylaxis), etc.

The Harper‘s article actually strikes me as poor, as it doesn’t seem well fact-checked and it doesn’t seem to support its criticisms and insinuations with facts. It actually strikes me as one of those sensational studies that we seem to agree as part of the problem. It might turn people away from FAAN, which (as I understand it) actually does rely on facts and offers very reasonable advice to families on working with doctors and other families to live satisfying and healthy lives.

I was going to sign this with a link to a blog item I posted about this, but I don’t think I’m able to do that. You can check it out here.

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Canico~Gateway FEAST Co-Coordinator January 31, 2008 at 4:11 pm

On September 29, 2003, Sabrina Shannon ate lunch at her high school cafeteria. She ordered a plate of French fries. Because she was allergic to milk, peanuts
and tree nuts, Sabrina had checked at the start of the school year to be sure the ingredients in the fries and the oil in the deep fryer were safe. About half an hour after lunch, Sabrina started to feel ill. She had trouble breathing, which she thought
was due to her asthma, so she took several puffs from her inhaler. Sabrina went to the school office to call her mother, but her condition got worse before her mother could arrive. When a student told the school staff about
Sabrina’s food allergies, they called 911 and the operator
dispatched an ambulance. A teacher ran to Sabrina’s locker to get her auto-injectable epinephrine, but
Sabrina collapsed into unconsciousness and stopped
breathing. School staff started CPR and administered
Sabrina’s EpiPen®.
Sabrina arrived at the hospital just 30 minutes after she went to the school office with breathing problems. She died the next day. Although her symptoms started
with bronchospasm, the cause of death was anaphylaxis. Sabrina was 13 years old.

What Do Your Symptoms Say?
Thirty million people in the United States have asthma. Many of them also have food allergies and are at risk of anaphylaxis – a potentially life-threatening
allergic reaction. (Experts estimate that about 10 percent
of children with asthma have food allergies too.)Symptoms of anaphylaxis can include hives, facial swelling, difficulty swallowing, abdominal cramps, vomiting, diarrhea, a drop in blood pressure, breathing
problems and unconsciousness. However, according to Hugh Sampson, MD, Director and Division Chief, Early food allergy
symptoms can be mistaken for asthma symptoms.
Using epinephrine early can save lives.
12 ALLERGY & ASTHMA NETWORK MOTHERS OF ASTHMATICS BREATHERVILLE.ORG
Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Mt. Sinai School of Medicine in New York, “Patients experiencing anaphylaxis may not have all these
symptoms during a reaction.” In addition, early food allergy
symptoms can be mistaken for asthma symptoms. “When
skin symptoms are not present and the patient is having difficulty
breathing,” adds Sampson, “it can look and feel like an asthma attack.” To further complicate the issue, people with asthma are
at risk for more severe anaphylaxis symptoms. “Individuals
with food allergy who have underlying asthma are at an
increased risk of more severe food-induced reactions because they frequently will have bronchospasm (tightening of the muscles in the airways) as a component of their reaction,” says Mary Farrington, MD, an allergist at Virginia
Mason Medical Center in Seattle,WA. “They may not initially
realize that they are having an allergic reaction to an
accidental ingestion of their food allergen, but rather think
they are having a sudden, severe ‘asthma attack.’ This confusion can lead to a delay in epinephrine use, which is
critical for the adequate treatment of anaphylaxis. If
patients with food allergy and asthma have sudden onset of
severe asthma symptoms following food ingestion, they
should presume that they had an accidental ingestion of
their food allergen and immediately use their epinephrine.”
Dr. Farrington adds, “After epinephrine is used, patients
need to be immediately evaluated in the emergency department for ongoing treatment of anaphylaxis. Some individuals will have a second episode of significant
anaphylaxis symptoms following an initial improvement after epinephrine use.”

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