Our city paper has a weekly column that busts five common opinions about a topic in the news that week. Sometimes they are really out there, and sometimes they're just fun. The concept got me thinking about how much people don't know about allergies, too.
I get a lot of questions about the safety precautions we and our school follow to lower the risk of cross-contamination of foods in my daughter's world. I think these questions are about often-misunderstood concepts that, when explained well, can change a non-allergic person's perspective about food allergies pretty quickly. Sometimes, it's those "aha" moments that gain food allergy kids new advocates.
It's easy, as a protective parent or as a food-allergic school kid, to become wordy or sound defensive when people ask about allergy safety. This is especially true when the precautions have worked so well that almost no one remembers seeing a serious reaction.
I like to remind myself---a lot---that most people are asking about safety efforts because they want to help or understand it better, not because they are feeling put out. It's also good to remember that most people you meet don't have the same concerns, necessarily, but they make adjustments every day for something that is a basic part of their own lives---whether that is timing a commute to have family breakfast, working part-time because of a shoulder injury, or something else that is a normal part of their routine but that can seem foreign to you. As usual, kindness and information go a long way in keeping everyone happy and safe.
So, here are my five myths about food allergy reactions and precautions, in no particular order:
1. Hand sanitizer or water is enough to remove unseen allergens from skin.
This is a teeny peeve of mine, because my daughter has reacted violently to unseen dairy or peanut butter on lips, hands, tables, and more. The food particles remain behind even if hands look clean, and no amount of water alone will remove all of them. Likewise, the goal of sanitizer is to remove bacteria and other germs---not food particles or substantive stuff like dirt. Sanitizer is probably worse, in fact, because people don't wipe their hands on anything else afterward, so they really just rub any remaining food proteins into the hands all over again. Please use soap and water.
Research about food allergies has exploded recently, and it covers everything from prevention, treatment, and cures to where the risks lie. Dr. Wood, a noted allergist in Baltimore, conversed with the AAAAI about cleaning allergens off of hands after a study he conducted compared water, soap, sanitizer, and wipes. Only water and hand sanitizer were inadequate: allergen remained with either option. Wet Ones, baby wipes, and soap and water removed all detectable allergen. That seems pretty clear.
Short answer: Sanitizer and water might feel like good efforts, but they simply rub around particles on your hands. Research shows: hand wipes or soap actually dislodge and remove the proteins. Fewer germs, dirt, and allergens left behind.
2. Skin contact alone with a food allergen can lead to anaphylaxis.
You might wonder: Why bother with school protections to avoid skin contact with allergens? Skin contact doesn't affect breathing, right? Right. It makes sense that skin contact leads to hives and itchy skin, not shock.
A quick "what if?" is insightful here, though. What if that food-allergic kid rubs the skin that has the allergen, gets peanut butter protein on his fingers, and then wiggles a loose tooth? Now, skin contact has introduced an allergen into the child's saliva, GI tract, and blood system, and anaphylaxis is a serious possibility.
Anaphylaxis is a tricky concept to understand, especially for people who have not seen or experienced it (I wouldn't recommend either, by the way). It involves a multi-system over-reaction that, without emergency treatment, can quickly start shutting down organ systems. The lung, skin, stomach, and blood vessels overreact in a matter of minutes to stop breathing, swell up tissues, and cause vomiting. Confusion, dizziness, and weak pulse are symptoms of dangerous blood pressure changes.
Food allergy---especially to peanuts, tree nuts, shellfish, milk, and eggs---is the most common cause of anaphylaxis and is most often fatal from the breathing problems and the severe drop in blood pressure. Anaphylaxis can occur immediately, hours later, or both; teens and people with asthma have higher risks of death.
So, short answer: Skin contact alone does NOT lead to anaphylaxis...but it certainly increases the likelihood of allergens getting into the mouth, so many parents of kids with food allergies worry just as much about skin contact as they do about accident ingestion from shared food.
3. Time is enough to remove unseen allergen particles from desks, cafeteria tables, or shared school supplies.
With the rise of peanut allergy diagnoses in school-aged kids, it's no wonder that parents and teachers worry about the potential for unseen peanut butter on shared items and areas. In 2013, researchers took a clear look at how long unseen peanut allergen remained on tables without cleaning and with different cleaning methods. Like with hand washing, water alone removed little to no peanut allergen from the surface. Active cleaning (more than a quick swipe) with products like Lysol or Clorox, or even dish soap, effectively removed all peanut allergen.
Most surprising, though: When the surface was not cleaned at all, peanut residue remained at its original level for 110 days. One hundred ten. Remember your kid's 100th day of school party? Beyond that long.
Short answer: Allergens don't just disappear. Please clean, well, with cleaner or soap. It's healthier all around, anyway.
4. Only peanut allergy is deadly.
So many people we meet are protective of our daughter specifically about peanut exposure. And I am grateful, because it means that they are trying, they understand the seriousness, and they are just plain kind. It's harder for people to understand that all of the top 8 food allergens (and any food allergen, like sesame, even if it doesn't make this US-based list) have the potential to cause anaphylaxis. Our bigger concern, in fact, is dairy exposure, because milk products seem to be everywhere when you're surrounded by kids. Just like peanut dust in the air can trigger reactions in some kids, milk proteins from steam can enter the air.
Short answer: Any food allergen has the potential to trigger anaphylaxis. Allergists are the best guide for understanding individual risks and reactions, and supportive friends or colleagues should follow the allergic person's lead on how dangerous a particular food might be.
5. Constant exposure "reverses" allergies in kids.
Food allergies may be on the rise, but there's so much great research out there about reversing this trend. The LEAP and LEAP-ON studies, in particular, are trying to change attitudes about and better understand the timing of giving peanuts to babies and kids.
It's hard to understand why some kids develop allergies and others in the same family just don't, or have other ones. The immune response is such a complex mix of genetics, environment, and other health conditions. LEAP and LEAP-ON support the concept that exposure---regularly, and even noncontinuously---before an allergy develops can teach the body tolerance sometimes, and that is a huge step.
But kids who already have food allergies aren't in this group...at least not yet. Exposure won't "cure" my child's allergies, and no parent likes to go down the "what if" road when it comes to decision making about their kids. We didn't restrict peanuts or tree nuts for either of our children according to age; one refused to eat anything but PB&Js as a toddler and the other headed to the ER after her first try. Who knows how that really comes about.
Short answer: We still don't know exactly what turns on or off our immune systems to cause allergic reactions. We do know that allergy development is highly individualized and that exposure after an allergy develops is still considered unsafe outside of controlled settings like doctor's offices.
If you are new to living with food allergies, whether they are your own, your child's, or a friend's, these probably are only a few of the questions rolling around your head. Check out the American College of Allergy, Asthma, and Immunology's food allergy information page for some great starter resources and tools.
And remember, from both perspectives, that kindness goes a long way in living with allergies and with each other.
Hi, I'm Nicole.
ABOUT THE BLOG
An apothecary is a person or a place. Either one implies healing and relates to pharmacy in its truest sense, as a source of treatment and advice.
This blog is my way of uniting my pharmacy training with my efforts to provide a healthy and safe lifestyle for my family. In true apothecary form, I research and prescribe alternative ingredients that work just right in each specific recipe, and I would like to share the results with anyone who needs help making their own family’s kitchen allergy safe and heart healthy.
Nicole Van Hoey's books on Goodreads
Bakery Bites: Breads and Treats Without Dairy, Eggs, Nuts, Seeds, or Soy
ratings: 1 (avg rating 5.00)
Kitchen Adventures With Multiple Food Allergies: A Recipe Collection for Celebrations Without Dairy, Eggs, Peanuts, Tree Nuts, Seeds, or Soy