Monday, October 5, 2009

Peanut Allergy: Is it Possible to Have a MILD Peanut Allergy?

Twice in the last week, someone I've come in contact at school with has brought up the concept of having a 'mild' peanut allergy. Is there such a thing?

Case 1:
We have this thing in B's class where parents bring in a snack that corresponds to a letter - so someone will bring blueberries for 'b' day, apples for 'a' day, you get the picture. So it's c day and I find out what the snack is (hoping for canteloupe). It's corn muffins - rats. So I ask if the parent has brought in a label or ingredient list. B's teacher says 'B should be able to have them - X's mom made them and he has a peanut allergy too. But his is mild, unlike B's'. I was about to give her a speech about how there are no mild nut allergies, but I shut my trap. (I've come to find out that this boy doesn't have an epi or any meds in class either - avoids peanuts, but still has mixed nuts, Planter's I suspect, in his lunch on a regular basis. yikes. That's fodder for a whole other post though.) Did I let her have the muffin? Nope. She got a treat from her treat bag.

Case 2:
B had another substitute teacher. Her first sub had a daughter with a peanut allergy (such a relief!). Today's sub was fine when I told her about B. She mentioned that her daughter is allergic to bees and is well versed in the epi (another relief!). She asked me the level of B's allergy. Was it mild? This time I did explain that there is no mild allergy, at least in my opinion. But I showed her where B's epi was in class and she was prepared. No snack today (kids bring their own most days) so I stressed to her that there shouldn't be an issue and just stressed the meds were there just in case (that's when I discovered the kid from case 1 didn't have meds in class).

So my stance is that there are no Mild Peanut Allergies. That being said, REACTIONS can be classified as mild, but a peanut allergy itself? I wouldn't go there. You can have a mild seasonal allergy but with a nut allergy, all bets are off. I haven't done a tremendous amount of research on the subject, so I can't send you to the scientific literature on pubmed, but I can say without a doubt that you can have mild reactions for years and then experience anaphylaxis, and death due to peanut ingestion. I'm just a few degrees of separation from someone who learned it the hard way.

And that's not a chance I want to take (I know - I'm so boring). So to whom it may concern: B has a severe allergy. Until that skin test and food challenge comes back negative, let's keep it that way.

In my personal opinion, people who treat their nut allergy as mild are playing with fire. What do you guys think? Has your allergist described your (or your child's) allergy to nuts as mild? Ours errs on the side of severe, no matter what the numbers say.


Deb Horowitz said...

I think my blood pressure just went up.

I just had a similar experience with someone saying their child had a mild peanut allergy and then proceeded to give him a grocery store bakery cookie with chocolate candy bits.

Playing with fire for sure.

I am also boring and predictable with what I will allow to enter my child's mouth. I get tired of defending myself, so I end up biting my tongue a lot

Anonymous said...

I'm right there with ya'. However, as you probably know, food allergies are classified on a scale from 1-6 (6 being the worst allergic). Allergists rate allergies based upon skin or blood tests to the allergen.

My son is a 6+ (off the 100% scale), so let's just say I probably offend many more parents & teachers out there than you ever have. :-)

Can an allergy be classified as "mild?" IMHO - yes. However, a fatal reaction can occur ANYTIME. So, don't play with fire.

P.S. - I'm also getting very tired of hearing parents, teachers and school administrators say they their kid is allergic to peanuts, but it's not "severe."

Pez said...

Yes, reactions may be mild but there is no way to predict if the next reaction will result in anaphylaxis or not. I have a friend who tells me that her mouth gets itchy and throat feels tight when she eats walnuts. She did not realize those where signs of an anaphylactic reaction and she does not have an EpiPen! Yikes!!

Nicole said...

I hear ya and it really irks me when people refer to mild peanut allergy. Plus how can you say that a person can have a "mild" peanut allergy and then say "but there's always a chance for an anaphylactic reaction" in the same sentence? If there's a chance for a severe reaction, then it's a severe allergy in my opinion.

My son's teacher has child with a more "mild" peanut allergy. She lets him have may contains, etc. I guess she can do what she wants with her own kid, but my kid will only eat what he brings and that's that.

Feener said...

since i am new to all this PA stuff i find this very interesting. my daughter was recently dx, she had a reaction when she ate an ice cream bar that had peanuts in it. she threw up and started getting hives on her tummy as well as a whezzing cough.

she was blood tested and tested severe, a 6 on a scale of 1 to 6. However, she can be around peanut butter and nothing happens. i have kissed her after i had a reeses and she was fine. so when someone starts talking about how severe sometimes i think they might be referring to if the person can even be near a peanut OR is it ingestion only ? not sure. either way, she has an epi pen and i make sure she never eats anything w peanuts or other nuts. she just started school and now halloween ????

ChupieandJ'smama said...

I *always* seem to have to explain about J's reactions. Yes, wheat and egg are severe (we've seen that) and tree nut, oat, barley and rye are unknown (although I suspect they're severe too). WHY MUST I EXPLAIN THIS??? Does it matter? He's allergic. He has an EPI. I just want to scream "DON'T FEED HIM ANYTHING AND CARRY THE DANG EPI WITH YOU AT ALL TIMES JUST IN CASE". But that would make me a crazy allergy mom, wouldn't it?? :)

Sean said...

It's always been my understanding that allergies can be mild. After all, some people with allergies have frequent serious reactions and some go a lifetime without ever firing an epipen. It seems logical that not all allergies are created equal.

That said, it's really a distinction without a difference. As others have said there's really no way to know with certainty how severe an allergy is, and a "mild" allergy can still produce a fatal reaction.

If my family is one of the lucky ones and my daughter's peanut allergy is mild, that's great. But we'll never really know, and it won't change anything we do.

wimom said...

I am 32 and have had a peanut allergy since I was little. The 1st exposure (age 1) I spit peanuts out from on top of a donut. The 2nd exposure my eyes swelled up the next day. I was treated for other allergies & asthma at a allergist. We were told to avoid items with peanuts. I never was prescribed or carried an epi-pen until after high school when I went on a cruise. My typical reaction (about 9-10 accidental injestions in my lifetime mostly in grade/high school) to peanuts is vomiting, and swelling of eyes or slight swelling of toungue, once I got hives, never had any asthma/breathing related symptoms after injestion. I can "taste" the peanuts-- so many times I don't even swallow and spit out the food item and rinse my mouth. I do consider my peanut allergy possibly life-threatning.

Recently, I was asked to give a presentation at a daycare my sister-in-law worked at after finding out a incoming child was peanut allergic. I gave the basic presentation avaiable on FAAN. Before I began, the director announced to the teachers that the childs allergy wasn't as severe as they thought. Of course, my speech included the fact that you cannot predict the symptoms of the next reaction. My son (who reacted from a peanut 2 yrs ago) and I both only had delayed swelling in one eye after our first exposure. My son has not had another incident and his RAST test was negative for peanut allergy. I am 100% sure that his reaction was from a peanut m&m the night before. The nurse said DO NOT GIVE HIM PEANUTS EVEN IF THE TEST WAS NEGATIVE. We carry benadryl and epi-pens as well.

I grew up before they had manufactured on a/in a blah,blah statements on food products. I read ingredients and NEVER had a reaction from pre-packaged products (non-bakery) that did not have peanut in the actual ingredients. I have eaten hundreds of candy bars milky way, kit-kat, mini plain m&ms etc. and did not have a reaction. After working for a food manufacturer, I was further assured that there is suppose to be an allergy cleanup after any of the top 8 allergens before going to another product. This was required by our auditors and USDA. I feel that most reputable manufacturers would follow this as well. The company lawyers also said that a may contains or manufactured in/on statements did not prevent the manufacturer from lawsuits, the manufacturer is still liable since peanuts are not listed in the ingredients. However, some companies seem to rely on this statement:

I do avoid bakery items, blizzard type ice cream mixtures, topping on ice cream at a make your own ice cream sundae bar, m&m's, so I am cautious in settings where there could be cross contamination by a unskilled or hurried worker such as Ice cream shops or Grocery stores.

Technically, I usually have an anaphylaxis reaction everytime however I have not gone into shock but I do not rule it out either. I am extra cautious with my son.See the letter I wrote to my child's teacher here:

Mild allergy? you can't afford to take a chance. If you have asthma too, your risk goes up.

Anonymous said...

I can relate to many of the previous comments. My daughter is PA. We recently took her for a check up with the allergist and he had this interesting fact for us.
There was a study done to determine the percentage of peanuts found in products that carry a label of "may contain peanuts". Any guesses? 20% contained traces of peanut! So, for us, this completely reaffirmed the fact that we do not give our daughter any products that "are manufactured in a plant" or "may contain". We feel it is a dangerous game that we don't want to play.

On another note...Thank you for your website! I just wish other people would take the time to educate themselves about this allergy.

wimom said...

I should clarify that I do not allow my son to eat products that I am not familiar with or that state "may contain peanut or traces of" but we eat products that say manufactured in a plant that produces peanut products.

If I did not have a peanut allergy myself and hadn't grown up without the warnings on most foods, I would be as cautious as most of the other parents and wouldn't allow it.

My point is that I would not freak out about my child accidently eating a chocolate candy bar that did not contain peanuts after all there is an 80% chance there was no trace (according to the above statistic). I don't think that anyone is wrong to be careful and there is never anything too cautious in dealing with a Peanut allergy.

Anonymous said...

I agree that everyone has a different comfort level. And, although I may not agree with your take on it, that's okay because as parents we can all choose to raise our children the way we feel is best.

Anonymous said...

I'd like to offer a little clarification about the different warnings found on products (made in the same facility, shared equipment, may contain, etc.). These warnings are all voluntary and can be worded the however the manufacturer wants. There may be no difference in how the products are produced but they may have the warnings stated differently.

When we first started, I thought that there was some reason as to when the different warnings were used, but there isn't. Something that says "may contain" may not contain. Something that says "made in the same facility" might have significant traces of peanuts. Be sure not to assume that one with the warning worded a specific way is more or less safe than the others. The only way to know for sure is to contact the manufacturer.

wimom said...

True that the statements are voluntary and there is not standard for which statement or wording you use for a particular situation.

A relative hosting a party picked up Cherrio's snack mix because she knew it had no peanuts. After further examination the ingredients do not list peanuts but underneath the ingredient list it states- Contains: peanuts. The company response was that if a product comes in contact with an allergen ingredient then it will be in the contains statement but not in the ingredient list.

You are rarely going to get a "for sure" answer from a company due to liability reasons. They also can't be 100 positive because the raw materials used to make the products come from so many other manufacturers. The responses you get are form letter responses that are developed by the QA and legal department. Companies know they are still liable regardless of the warning statements so they do take the efforts to have allergen cleanups for the top 8 allergens. Auditors insist on it.

But there are not suppose to be traces of anything other than the ingredients listed. They are liable if there is, not that I would want to risk my life on that alone. It is cheaper to discourage people to eat it than to have a lawsuit. They also are pressured by the public to announce what allergens are in the production plant. Good if you want to know if there is a chance, but very confusing for the allergic.

Nuts are a very healthy food, if you are not allergic. Peanuts aren't even a nut. In my family, we can eat almonds and pecans but not walnuts. To lump all tree nuts together or peanuts with tree nuts is unfair. Not many people can pick their own nuts :). Try to find a company that doesn't put "manufactured in a facility that produces peanuts/tree nuts" on a bag of nuts-- virtually impossible and the bags that don't have such a statement doesn't mean that it doesn't have thoses items in thier plant either.

I stick to brands I know, brands I have used for years which I have had no problems with. The only accidental injestion incidents I have had as a child were because I didn't ask what the ingredients were in something homebaked or served out of the package. I never had a reaction to a pre-packaged food that did not have peanuts in the actual ingredient statement.

Not many of you can say you also grew up with a peanut allery before there were warnings. So you can understand my frustration when all the foods I regularly have and thought were peanut-free suddenly have warnings on them. It makes it extreamly difficult to educate my peanut allergic child and his caregivers what he can and can't have or why his caregivers won't allow him to have foods that I allow him to have because of the warning statements.

I am not trying to say that anyone is being to cautious. I am just letting you know that for 30yrs this is the way that has worked for me. I am letting you have a glimpse inside the food manufacturing world. That there are guidelines for production regarding allergens.

I would not trust statements/responses of food companies --I know because I used to have to write/give them to people. There was a fine line between what was a recipe secret/ or the wording to protect our liability / honesty with the consumer.

Leigha said...

I think a peanut allergy could be mild, because I have a sunflower seed allergy that is truly mild - my reaction is an itchy mouth/throat, but nothing else. So I don't carry Benadryl or an Epi-Pen and don't do anything special except avoid sunflower seeds. However, I would be much more cautious if it were my child OR if I were allergic to peanuts or tree nuts instead of sunflower seeds (I have always been told that peanut/tree nut allergies can escalate worse than allergies to most other things). My child does have severe allergies (anaphylactic reactions) so of course we carry Benadryl and Epi-Pens everywhere but even if her symptoms were less severe I would do the same thing.

Following HIM said...

I totally hear you on no mild food allergy. I LOVE it (HATE IT) when people ask if I can have things I clearly can fried food, chips, or candy. Hope Missy lou is enjoying school!

alison - surefoodsliving said...

I agree with your post... I do think that an allergist has steered the patient wrong if they have been told that they have a nut or peanut allergy and don't need an EpiPen -- this is what happened with my first allergist and I didn't know any better. Luckily we have never had to find out what kind of reaction my daughter would have, but even if "mild" that doesn't guarantee that it won't be more severe the next time, as you mentioned.

Nancy R said...

My impression when asked about the severity of my daughter's allergy is that the person is asking (but not necessarily using these words) if it's an ingestion issue, or if it's being nearby - say if someone in the room is eating peanuts or peanut butter. In that case, yes, a person across the room can eat peanuts without E having a reaction...but when we're talking about settings where other kids are eating peanut products all bets are off because we're relying on them to adequately clean up after themselves.

Anonymous said...

I think there is a such thing as a mild peanut allergy. Severe would be swollen face and tongue, difficulty breathing etc. My 16 month old has been getting a pink rash with small bumps around his mouth and on his only happens directly after eating peanut butter. It goes away within an hour. The one constant was the peanut butter-so off to the dr for confirmation

Anonymous said...

I'm very new to nut allergies. My son (13) had a reaction after eating Nutella. Swollen face, red blotches and a little scratchy throat. He has seasonal allergies but never a reaction to foods. Pediatrician had me take him to an allergist. He is allergic to all nights with hazelnuts producing the worst reaction. He has eaten peanuts his whole life with never a reaction and the allergist said he could still eat them even though he did react as allergic. We were prescribed epipens and told to always have Benadryl on hand. Would this mean he has a mild peanut allergy?

Anonymous said...

I have a 5 year old,she has peanut allergies.I wouldn't say she has "mild peanut allergy",But when I first told my sister-in -law she called "bullcrap" and gave her a Reese and she told me my daughter was fine(yes I did want to kill her),No reaction whatsoever.of course short after my daughter thought she was not allergic and tried to make a peanut butter sandwich the 2nd time she was at her aunts home.Of course she had her 2nd ever reaction and her eyes were swollen for the rest of the day,slowly going down.she does have the EPI pen,now understand that she is allergic .our dr.told us that maybe Reese are too processed to have her body recognize it. Was a once in a lifetime thing..

SolinahH said...

Hi New PA mom here.

No one in our family has any food or environmental allergies. I am the only one in our family and i am allergic to penicillin (and it's derivitives)
we are huge PB family lol (4 kids)
when our last boy was around 11months old I gave him some of my PB toast and about 5 minutes into eating it, i noticed that he got a few hives around his eyes (he is notorious for smearing food all over his face/hair) so we took it away from him, wiped him off and the hives went away within the hour. I figured he just was not ready for peanut butter so decided to wait and try again later on. I didn't refrain from giving him products/cookies etc that "may contain traces, or processed in plant that processes peanuts" and he's always been fine. He has even eaten reese PB cups with no reaction. when he was 17 months old we tried again, and again within a few minutes had hives around his eyes. So we went to the allergist who did the skin test and told us he is allergic to peanuts. she did not mention the severity of it, only that the reaction didn't do anything to his heart or breathing and prescribed epi pens. She told us that he is okay with tree nuts and that we will have to make major changes in our house, not keep any peanut products at all (Hard for the 3 other kids who live off PB)lol. We have educated the other kids on how to properly make their PB sandwiches (using the dedicated "peanut" plates and thoroughly washing their knives in hot soapy water before putting them in the dishwasher etc) I suppose my confusion is how eating pad thai, and reese and other cookies etc do not give him a reaction. The allergist also said there is a good chance he will outgrow the allergy in his teens and booked us in for yearly testing moving forward.
I guess my 2cents would be that i would consider my son having "mild" allergy, more of a "sensitivity" compared to a friend who's kid goes into full anaphalactic shock if he touches things with traces of peanut products
we of course take his portion of pad thai out firs then add the peanuts now and do not directly give him any peanut ingredients anymore but i guess i'm confused and it's we feel like criminals when we hide and sneak into another room to gobble down a PB sandwich ~ as my now 19 month old of course freaks out if you dont give him what you are eating... :(

Selena said...

Even though this article is a few years old, I'd like to direct
everyone to this great article on peanut allergy:

Here are some pertinent excerpts:

Does having only a mild reaction to eating a peanut
guarantee that future reactions will be mild?

No! Although it is common for patients to have similar
reactions upon re-exposure to peanut, mild reactions
do not rule out the possibility of having a
more serious reaction with subsequent exposures. In a
study from the United Kingdom, one-third of peanut
allergy deaths occurred in people whose prior
reaction to peanut had been mild.

Does the height of the score for peanut skin testing
or allergy blood testing (ImmunoCAP) predict the
severity of reactions?

No! Severe reactions can occur whether the positive
score is high or low. On rare occasions reactions can
occur even when the tests are negative. In such instances,
the low level of allergy antibody that is present is below
the detectable limits of the test but is adequate to activate
mast cells and basophils upon peanut exposure. If the history
suggests that this may be the case additional skin testing
with fresh peanut may be needed or careful graded food
challenge by an allergist certified by the American Board
of Allergy and Immunology may be undertaken for proper
diagnosis and clarification.

Conversely, high skin test and/or allergy blood test scores,
although worrisome, are not a guarantee that an allergic
reaction will occur. (Some such patients may have already
developed tolerance or the test is positive due to allergy
to one of the “milder” peanut proteins).

Unknown said...

I've been allergic to all nuts for my whole life, and all of them only give me hives or itchy skin sometimes. I consider it mild. While I dont go around eating spoonfuls of peanut butter, I'll enjoy a PB$j sandwich occasionally. same thing with my chocolate allergy. yes be cautious, but I DO have a MILD allergy that just needs supervision instead of abstinence

OCNetty said...

I am mildly allergic to peanuts. They make my skin and scalp itchy and dry and I develop temporary excezma. If I remove them from my diet the symptoms go away. Most of my life I have eaten peanuts and dealt with the symptoms as a minor irritation. Now I eat almonds and other "real" nuts instead.