Vaccine for Peanut Allergy Effective in

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Registered: 03-19-2003
Vaccine for Peanut Allergy Effective in
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Fri, 07-11-2003 - 4:04pm
Mice

http://reuters.com/newsArticle.jhtml?type=healthNews&storyID=3071380



Vaccine for Peanut Allergy Effective in Mice

Thu July 10, 2003 06:00 PM ET

By Megan Rauscher

NEW YORK (Reuters Health) - US researchers believe they are on the road to developing a safe and effective vaccine for the more than 1.5 million Americans with life-threatening peanut allergy.

As reported in the Journal of Allergy and Clinical Immunology, researchers created a vaccine against three allergy-causing proteins in peanuts. The vaccine proved "very effective" in mice with a peanut allergy, Dr. Hugh A. Sampson, from Mount Sinai in New York, said during a telebriefing Thursday.

"The highest dose gave markedly extended protection," according to Dr. Sampson. "Mice that were challenged three months out after still retained full protection."

"This vaccine, which could be adopted for human use, provides some hope that within the next several years, we may be able to treat patients with and actually turn off the reaction," he said, predicting the start of human trials "within one year."

Elsewhere in the journal, Dr. Sampson and others describe a new method for diagnosing peanut allergy. "This test could dramatically reduce the need for oral challenge." Dr. Sampson told reporters.

The test, which relies on antibody differences between patients, could be commercially available within a few years, according to the report.

SOURCE: Journal of Allergy and Clinical Immunology July 2003.



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iVillage Member
Registered: 03-27-2003
Fri, 07-11-2003 - 6:10pm
Your post got me to looking around, trying to refresh my memory on this. I found a few interesting things.

http://www.thekcrachannel.com/health/1783187/detail.html

This is an article quoting a doctor who says that 62% of the cases of peanut allergy he sees can be traced back to the use of soy based formula (soy and peanuts being in the same family). Of course, he points out there is probably a genetic predisposition involved, as with most allergies, but that the early use of soy might, iho, be one of the triggers.

Here’s one on other possible triggers, primarily skin products containing peanut oil (it also mentions the possible soy connection in more detail)

http://www.sciencenews.org/20030315/food.asp

>>>Individuals don't develop allergies to peanuts or other triggering proteins upon their initial exposure. Susceptible people must first create antibodies to an offending protein, based on earlier encounters. Those early exposures don't even require eating the food. Skin contact with peanut protein, for instance—perhaps through exposure to the small amounts in peanut oil—could, in vulnerable individuals, elicit the allergy-triggering antibodies.

That appears to be exactly what happened in most of the 49 children with peanut allergy in the new British study. Almost invariably, they developed a food allergy's characteristic wheals, flushing, and hives after what appeared to be their first exposure to peanuts—usually by age 2. Further probing by the researchers uncovered that many of these children had skin contact with creams and oils containing anywhere from 0.3 to 100 percent peanut oil, according to a report in the March 13 New England Journal of Medicine……A mom's ingestion of peanut products makes no difference, Lack concludes. "Only when the peanut oil is applied to the infant's skin does it seems to make a difference—and particularly if the skin was inflamed."…..Even more intriguing, Lack says, is the fact that children with peanut sensitivity were significantly more likely to have been fed a soy-based formula or milk. Overall, 8.3 percent of the infants had consumed such products. Among those with peanut allergy, the rate was 24.5 percent. Indeed, the researchers observe, "of the 10 children for whom data on the first consumption of soy milk or soy formula were available, 9 had consumed soy before reacting to peanuts." <<<<

Now, regarding the vaccine specifically;

According to the sources I found, there are from 50 to 200 deaths due to peanut allergy in the US annually. The most reliable source, The American Academy of Allergy, Asthma and Immunology, seems to place it at around 100, and likely on the rise That would be about the same as the reported death rate from chicken pox.

Does that mean, since to date there is no way to determine which infant will go on to become allergic, that this number of deaths would justify requiring any new peanut allergy vaccine for ALL children?


This article,

http://familyeducation.com/article/0%2C1120%2C1-6060%2C00.html?ph3

actually raises this issue directly, noting that any vaccine might not work on those already allergic. Lacking any way to determine the allergy prior to its emergence, wouldn’t the only “viable” alternative be the routine vaccination of all infants?

>>>``We chose to use a preventive vaccine model instead of a treatment model,'' they wrote.

A treatment or therapeutic vaccine is used to treat existing disease, or in this case, existing allergy, as opposed to trying to prevent infection or allergic reaction in the first place.

A vaccine might not work in someone who is already allergic to peanuts, they said.

``However, given that the only treatment of food allergy is complete avoidance of all allergen-containing food products and often involves aggressive emergency treatments, pre-immunization may be a viable therapeutic model,'' they wrote. <<<


From the same link;

>>>The American Academy of Allergy, Asthma and Immunology says between one half and one percent of all Americans are allergic to peanuts, and they say most of the 125 deaths every year from food allergies are due to peanut allergy. <<<

So would it be “viable” to mass vaccinate for something that only affects between one half and 1% of the population? Or would it be massive over-kill? Since the allergy can emerge in those from non-allergic families as well as those with a history, should only those with known history get it, or everyone? Or (my view on any vaccine, of course) only those who make the informed decision to. (not a trend we see wrt any other childhood vaccine, I might point out)

Food for thought.

Finally, I recall reading about this in our local paper a while back, and that it was stated that any vaccine would have to be given frequently, (I forget how often, but quite; once a mth or so, maybe more) and not be a one-time deal. I didn’t find any reference to this in any of the articles on the vaccine I found today (actually, they were almost all the same article). But I remember discussing it with DH at the time, and thinking, “man, what a drag, such frequent shots, but I guess if you are fatally allergic, you might consider it worth it!” Anyone else read anything about this detail? Or am I maybe mixing it up with some other vaccine in development, say for diabetes or something?

Interesting topic; there must be SOME reason for the great increases lately, imo.(aside from increased diagnosis) Perhaps the greater prevalence of peanut based/containing products as speculated above? So many allergic conditions are on the rise, and some conditions like autism that are starting to be linked to allergic response. And of course, "auto-immune" conditions, (and many not considered related, like heart disease, being linked to inflammation/immune issues which constitute an overreaction of the immune system as well.) What's up, IYO?

General exposure to a multitude of things in the environment maybe, that are weakening our immune function overall, or specific triggers, or both? I do think genetics plays some role in many allergies/conditions, but typically a trigger is required; our "genes" have not changed enough in the past few generations to explain the increases, you know!

This apparent trend in immune related problems is one of the serious issues I have with manipulating the immune system with vaccines; we do not know the cause of ANY of these immune disorders, yet we "know" enough to fool around with the immune system from birth?

I don't buy it. Also, it is possible that vaccines themselves have something to do with some of these conditions, imo.

Thanks for getting me thinking/learning:)

Kimberly



Avatar for suschi
iVillage Member
Registered: 03-27-2003
Fri, 07-11-2003 - 7:35pm
I would be more interested in seeing those research dollars spent on finding out WHY peanut allergies are on the rise, instead of just finding ANOTHER vaccine to add to the ever growing list.

I don't believe it's due to more pregnant women eating nuts, that is nuts. I ate peanut butter and nuts with all my pregnancies. Something else is causing this, and they need to find out what. I never heard of a child with a peanut allergy when I was growing up, now you hear about it all the time. My son came home with a letter requesting that because a child in the school could have a life threatening reaction to anything with peanuts, to not pack anything in my son's lunch that contained peanuts. Wow. Sounds like this is one child that really needed to be home schooled.

Anyway, I can't believe that all this time and money is being put into a vaccine (well, from the drug makers pov I can) and doesn't seem like much is being done to find the cause.

Typical.

http://www.enquirer.com/editions/2003/05/27/loc_peanuts27.html

http://allergies.about.com/library/blaaaai111802.htm

http://www.healthatoz.com/healthatoz/Atoz/dc/caz/resp/allr/alert01302003.html

http://www.komotv.com/news/printstory.asp?id=21473

And a very interesting comment in the next link,

"Some children do not have fully developed immune systems when they get their first taste of peanuts, so parents may not be aware of their children's sensitivity. Any child with a family history of food allergies should never be given peanuts until after age 3 for this reason."

Hmm, seems like that would be a good reason to delay vaccines til after age 3 as well.

http://www.hopkinsmedicine.org/usfhp/patriot/november2002/peanut.htm

iVillage Member
Registered: 03-19-2003
Sat, 07-12-2003 - 9:37am
That's interesting about the lotions- VERY. And it would be a wise idea to elimainate that source of exposure, IMHO. But I don't quickly discount the role that intrauterine exposure & exposure through breastmilk aren't possible culprits additionally. BOTH theories sound like promising avenues for research IMHO. BTW, I agree about mass vaccinating for peanut allergy- not a good idea. Better, I think to figure out WHY so many kids are becoming allegic- and if a vax can help them, so be it. But if we can eliminate through other means BEFORE the allergy arises, that would be the ideal. But this vax for all is one where I would draw a line. (Aside: CHRISTINE/suschi- there's my line!) Thanks for the link- I am going to post it over on my mothers' boards as well.

http://jama.ama-assn.org/issues/v285n13/abs/jbr10043.html

Detection of Peanut Allergens in Breast Milk of Lactating Women

Peter Vadas, MD, PhD; Yvonne Wai, MD; Wesley Burks, MD; Boris Perelman, PhD

Context Most individuals who react to peanuts do so on their first known exposure. A potential but unproven route of occult exposure resulting in sensitization to peanut is via breast milk during lactation.

Objective To investigate the ability of maternal dietary peanut protein to pass into breast milk during lactation.

Design and Setting Clinical investigation conducted at 2 North American hospitals from March 1999 to October 2000.

Patients Twenty-three healthy, lactating women aged 21 to 35 years.

Intervention Each woman consumed 50 g of dry roasted peanuts, after which breast milk samples were collected at hourly intervals.

Main Outcome Measures Presence in breast milk of total peanut protein, analyzed by a sandwich enzyme-linked immunosorbent assay, and 2 major peanut allergens, Ara h 1 and Ara h 2, detected by immunoblot analysis.

Results Peanut protein was detected in 11 of 23 subjects. It was detected in 10 subjects within 2 hours of ingestion and in 1 subject within 6 hours. The median peak peanut protein concentration in breast milk was 200 ng/mL (mean, 222 ng/mL; range, 120-430 ng/mL). Both major peanut allergens Ara h 1 and Ara h 2 were detected.

Conclusions Peanut protein is secreted into breast milk of lactating women following maternal dietary ingestion. Exposure to peanut protein during breastfeeding is a route of occult exposure that may result in sensitization of at-risk infants.

JAMA. 2001;285:1746-1748

View Full Text

Author/Article Information

Author Affiliations: Division of Allergy and Clinical Immunology, St Michael's Hospital, University of Toronto, Toronto, Ontario (Drs Vadas, Wai, and Perelman); and Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock (Dr Burks).



Corresponding Author and Reprints: Peter Vadas, MD, PhD, Division of Allergy and Clinical Immunology, St Michael's Hospital, Room 8-161, Victoria Wing, 30 Bond St, Toronto, Ontario, Canada M5B 1W8 (e-mail: pv4588@home.com).

Author Contributions: Study concept and design: Vadas.

Acquisition of data: Vadas, Wai, Burks.

Analysis and interpretation of data: Vadas, Burks, Perelman.

Drafting of manuscript: Vadas, Wai, Burks.

Critical revision of the manuscript for important intellectual content: Vadas, Burks, Perelman.

Statistical expertise: Vadas, Perelman.

Obtained funding: Vadas, Wai.

Administrative, technical, or material support: Vadas, Burks.

Study supervision: Vadas.

Funding/Support: This work was supported by grants from Health Canada, the Peanut Foundation (nonprofit organization of peanut producers, growers, and sellers), the Allergy, Asthma and Immunology Society of Ontario, and Nestle Canada.

Acknowledgment: We acknowledge the valuable assistance of Maureen Hizaka and William Davidson, MD, in recruitment of volunteers for this study.




http://www.saferchild.com/fdallergy.htm

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http://my.webmd.com/content/article/1728.76325

Peanut Allergy May Be Triggered by Breastfeeding

Some Moms Should Avoid Peanut Products While Nursing

By L.A. McKeown

WebMD Medical News

Reviewed by Dr. Pamela R. Yoder

April 3, 2001 -- Babies susceptible to severe peanut allergy may be at risk from the potentially dangerous allergen even before they're old enough to eat. That's because new research shows that enough protein from a small serving of peanuts can be transmitted through a mother's breast milk, and this exposure may possibly predispose or set up some nursing babies to later experience allergic reactions.

Just a tiny amount of peanuts in food or even handling peanuts can be potentially deadly to children and adults with severe peanut allergy. The number of people affected by peanut allergy has increased dramatically in recent years, and research suggests that children at risk for allergies who are exposed to peanuts at an early age have an increased chance of developing lifelong peanut allergy.

The lead author of the new study says that until now, breast milk was not considered a potential source of the type of early exposure that can lead to development of a peanut allergy.

According to Peter Vadas, MD, the conventional advice has been to avoid giving kids foods containing peanuts until after age 3 if parents or other family members have a history of asthma, allergies, or eczema.

"Now we have to modify that a little bit," says Vadas, of St. Michael's Hospital in Toronto. "Now we also must warn these mothers to do their best to try not to eat peanut products while nursing so as to avoid indirectly exposing their children." His study appears in the April 4 issue of the Journal of the American Medical Association.

In Vadas' study, 23 healthy lactating women expressed breast milk immediately before and at timed intervals after consuming about half a cup of dry roasted peanuts. The researchers examined the samples to determine how much protein from the peanuts and whether two peanut allergens were detectable in breast milk.

Nearly 50% of the women had peanut protein in their breast milk. The protein appeared within one to six hours of eating the nuts and disappeared quickly from the milk of most women. Both of the peanut allergens appeared in the milk.

"It's been known for some time that at least some of the foods that mothers eat are passed in the breast milk," says Scott H. Sicherer, MD, an assistant professor of pediatrics in the division of allergy and immunology at Mt. Sinai School of Medicine in New York.

He says the study adds another piece to the puzzle by showing that peanuts eaten by the mother can get into breast milk "in a form and a quantity that could potentially sensitize or cause reactions in nursing babies."

The new study is in agreement with the nutrition committee of the American Academy of Pediatrics, which recently began recommending that mothers whose babies are at high risk for food allergies or other types of allergies consider not eating foods containing peanuts while breastfeeding, according to Sicherer, who provided WebMD with an objective analysis of the study.

Another expert, Marc E. Rothenberg, MD, says it still remains to be proven if the amount of peanut protein found in breast milk is sufficient to sensitize infants to developing a peanut allergy.

"The levels, in an of themselves, are pretty high, and this could explain why people have peanut allergy. ... Peanut allergy often presents in the first year of life, and we often wonder why that is if they haven't had any exposure and have only been consuming breast milk or formula," says Rothenberg, who is section chief of allergy and immunology and an associate professor at Children's Hospital Medical Center in Cincinnati. "This shows that exposure could have been through the breast milk, and that is significant. It means mothers who are breastfeeding and who are concerned about allergies should watch their diet."

Rothenberg says one interpretation of the study is that it may be possible -- by completely avoiding peanuts in infancy and early childhood -- to avoid ever developing a peanut allergy, since it usually develops early, if at all. On the other hand, he says it's also possible that some slight exposure may be necessary to strengthen the immune system to fight off or lessen the effects of a peanut allergy attack.

If you are pregnant and considering breastfeeding or already are breastfeeding, ask your doctor if you should avoid peanuts.

http://www.breastfeeding.com/all_about/all_about_peanut.html

Peanut Allergy May be Passed

Through Breastmilk



Nursing mothers who have a family history of peanut allergies may want to consider avoiding peanuts and foods that contain them while they are breastfeeding.

New research has shown that peanut allergens, which can cause severe and life threatening allergic reactions in some people, can be passed through a mother's milk to her baby. It is believed that many children who develop peanut allergies had prior exposure to peanuts earlier in life that went unrecognized. That initial exposure, which some researchers now say could have been through their mother's breastmilk, may have led them to be sensitized, leading to an allergic reaction later in childhood.

Dr. Peter Vadas of St. Michael's Hospital at the University of Toronto in Ontario, Canada and his colleagues wanted to determine if peanut allergens could pass from a mother's diet to her breastmilk and ultimately to her baby. The researchers studied 23 healthy, lactating women aged 21 to 35. The women each ate 50 grams of dry roasted peanuts, then researchers tested their breastmilk at hourly intervals for peanut protein and the two major peanut allergens. Peanut protein and the allergens were detected in 11 of the 23 women.

The researchers published their findings in the April 4, 2001 edition of "The Journal of the American Medical Association." It is important to note that the study was funded in part by the Peanut Foundation, a nonprofit industry group, and Nestle Canada, a maker of infant formula.

"We found that peanut protein is capable of passing intact from a nursing mother's diet into her breastmilk," Dr. Vadas told CBS HealthWatch. "That constitutes a potential route of unrecognized exposure of the breastfeeding infants to peanut protein and allergic sensitization to peanuts in the infants."

While not all children exposed to peanuts will develop an allergy, the researchers recommend that nursing mothers who have a family history of peanut allergies avoid peanuts while they are breastfeeding.

Meanwhile, other research has indicated that several different immunoglobulins found in breastmilk helps protect babies from various allergies.

http://www.cnn.com/2001/HEALTH/diet.fitness/04/04/food.allergies/

Breastfeeding mothers warned about food allergies

April 4, 2001

Web posted at: 2:11 PM EDT (1811 GMT)


From staff and wire reports

ATLANTA, Georgia -- People with food allergies and nursing mothers with a history of asthma or eczema may need to be more cautious about the foods they consume.

A Canadian study of 23 healthy women found that nursing mothers may pass peanut proteins in breast milk to their infants. Such early exposure to the allergen could put babies at risk for developing a potentially fatal peanut allergy.

Eight foods are known to cause 90 percent of severe food allergies:

Peanuts

Eggs

Milk and milk by products

Wheat

Tree nuts

Soy

Fish

Shellfish

Source: U.S. Food and Drug Administration



A recent Food and Drug Administration study also found that many food manufacturers fail to list highly allergenic ingredients such as peanuts, eggs and milk that are in their products. The study involved 85 manufacturers of baked goods, candy and ice cream, in Minnesota and Wisconsin.

The FDA asked state inspectors to sample egg and peanut ingredients nationwide, following an increase in food recalls for failure to list food allergens.

About 7 million Americans who suffer from food allergies rely on ingredient labels to tell them which processed foods are safe. Some food allergies, particularly peanut allergies, can be fatal -- they cause about 150 deaths each year.

The FDA report found that some products contained undeclared ingredients because of cross-contamination. Bakers sometimes used the same utensils to stir separate mixes -- one with eggs or peanuts and one without -- or they reused baking sheets. One candy company washed certain machinery only once a year, even though it processed both peanut-containing and peanut-free chocolates. Half of the companies did not check their products to make sure all ingredients were listed, the report found.

Mothers who breast-feed their children may be able to prevent them from developing such allergies by monitoring their diets, according to a Canadian study. Researchers said babies with one or both parents with a history of asthma, eczema or other allergy-based diseases are at risk of peanut allergy.

Because those children can be identified at birth, nursing mothers could avoiding exposing them to the allergen by not consuming peanut products while nursing, said David Patterson, an Indiana physician who is a fellow of the American Academy of Allergy, Asthma and Immunology.

Researchers at St. Michael's Hospital, University of Toronto, Ontario, said breast milk had been suspected as a hidden route by which children became sensitized to peanuts. Their tests on 23 lactating women between the ages of 21 and 35 support that theory.

They fed the women peanut products and detected peanut protein in the milk of 11 of the 23 participants. "It was detected in 10 subjects within two hours of ingestion and in one subject within six hours," said the study, published in this week's Journal of the American Medical Association.

Avoiding exposure through breast milk does not guarantee that children can avoid peanut allergy when they are exposed to the food at a later age. But Peter Vadas, lead author of the Canadian study, said the allergy is often triggered by exposure early in a child's development. Doctors generally recommend that parents not feed children peanut products until age 3.

The report said peanut allergy affects about 1 percent of British and U.S. preschool children. It starts early in life, seldom goes away and is associated with severe or life-threatening reactions. Peanut allergy accounts for the majority of food-induced anaphylactic fatalities, the study said.

http://www.medsafe.govt.nz/Profs/PUarticles/peanut.htm

Prescriber Update Articles

Peanut Allergy

Web site: November 2000

Prescriber Update No.20:22-26

Mary Louise Hannah, Advisor (Nutrition), Ministry of Health

Key messages:

Pregnant women in families with atopic disease (having conditions such as hay fever, asthma or eczema), are advised to avoid peanuts and peanut products during pregnancy and breastfeeding to assist in prevention of the development of peanut allergy.

For infants with a family history of atopic disease, it is advisable to solely breastfeed for at least six months and to delay the introduction of peanuts and peanut products until three years of age.

The ingredient lists on food labels are one source of information about the peanut content of foods.

The New Zealand Therapeutic Database provides lists of commercial foods, available in New Zealand, that do not include peanuts and information is available on the website: www.nztd.co.nz

New Zealand situation

New Zealand has no prevalence data for peanut allergy but nut allergy is probably in the order of 1-2%.1 The general belief amongst immunologists is that peanut allergy is increasing.1,2,3 Peanut allergy is the most common cause of food-related anaphylaxis. In New Zealand between 1995 and 1997 out of a total 221 cases of reported food-related anaphylaxis, there were 32 hospital admissions reported as being due to peanut/nut allergy.4

Information for New Zealand health professionals

The Ministry of Health’s Food and Nutrition Advisory Committee recently agreed that it would be useful for medical practitioners in New Zealand to receive information on peanut allergy, including the implications of a recent UK report. This circular letter is to provide practitioners with the most recent developments in the field. Previous information in Prescriber Update1 by Dr Penny Fitzharris, a Wellington based immunologist, discussed the possibility of prevention of peanut allergy by the avoidance of peanut products in pregnancy, during breastfeeding and in early life.1 This advice has been confirmed in the UK report.

UK report

During 1998 in the United Kingdom, the Department of Health’s Committee on the Toxicology of Chemicals in Food, Consumer Products and the Environment, produced a report to:

review the available scientific literature about the association between early exposure to peanuts and peanut products and the incidence of peanut allergy in later life, and;

advise on the consumption of peanuts and peanut products by pregnant and breast-feeding women, infants and young children.5

The Committee’s work was prompted by recent publications in scientific literature suggesting that the incidence of peanut allergy was increasing. Peanut allergy can be very severe, with fatal anaphylaxis, and is a potentially serious health hazard. Due to this severity, peanut allergy prevention is an important measure. Peanut allergy is normally a life-long allergy.

Recommendations from UK report

T

o attempt prevention of peanut allergy, the UK report recommends the avoidance of peanuts and peanut products for the following people:

Pregnant women who are themselves atopic (having conditions such as hay fever, asthma or eczema), or where the biological father or sibling of the unborn child is atopic;

Breastfeeding women who are themselves atopic, or where the biological father or sibling of the breastfeeding child is atopic; and

Children with a parent or sibling who is atopic up until until three years. It is also recommended that these children are breastfed exclusively for four to six months.

Recommendations from the New Zealand Food and Nutrition Guidelines6

The UK Report’s recommendation about breastfeeding is in accord with the New Zealand Food and Nutrition Guidelines for Healthy Infants and Toddlers, which recommends solely breastfeeding children with a family history of allergy to at least six months of age. For infants, with a family history of food allergy, the introduction of solid foods should not include whole cows’ milk, soy and eggs until the infant is at least one year old and peanut products until three years old (with whole peanut products being avoided until five years old).6 For mothers who are unable to breastfeed a dairy-based formula is the best choice.

However, under the advice of a health professional, a soy-based or other infant formula may be used.7

Advice to the general public

For the non-atopic families, avoidance of peanuts or peanut products is not considered necessary during pregnancy or breastfeeding. For infants, who are not in the above risk categories, it is acceptable for smooth peanut products, such as smooth peanut butter, to be used as a weaning food at about eight to nine months, as recommended in New Zealand Food and Nutrition Guidelines for Healthy Infants and Toddlers. As there is the possible risk of choking it is also advised that whole peanuts are not given to children until five years of age.6

Advice to those with peanut allergy

For individuals with peanut allergy it is essential that all foods containing peanut products, even in minute amounts, be avoided completely. Highly peanut-sensitive individuals who have a history of systemic reaction, need to carry kits with adrenaline and antihistamines on hand for self-administration promptly at the first sign of a systemic reaction. People allergic to peanuts should avoid all tree nuts such as walnuts, almonds, hazelnuts and pecans, even if they are not sensitised to these, to minimise the risk from contamination or confusion with peanuts.1 The reintroduction of peanuts should only be carried out when no reaction to peanut and nut products has occurred for three to five years, and under strictly supervised conditions at a specialised centre.2

Labelling requirements in New Zealand and Australia

Information on the likely peanut content of foods, or the content of other food allergens, is available to the consumer from two sources; food labels and the New Zealand Therapeutic Database. Currently general provisions for food labelling are required to comply with the New Zealand Food Regulations 1984 or the Australian Food Standards Code. In the New Zealand Food Regulations, the only instance in which peanuts may not be declared is if they are a minor component of a mixed ingredient added to a food. However, by about May 2002 Australia and New Zealand will have a joint standard for labelling of foods and all manufacturers should be working to a single standard. The Australia New Zealand Food Authority is awaiting final agreement on the draft Australia New Zealand Food Code.8 There is a mandatory labelling requirement for peanuts and peanut products in the draft Code.

Declaration of other food allergens required by new draft Code

The draft Code will also require a number of other significant food allergens to be declared on all food labels. Those food allergens include cereals containing gluten; crustacea and their products; egg and egg products; fish and fish products; milk and milk products; nuts, sesame seeds and their products; soybeans and their products; and sulphites in concentrations of 10mg/kg or more.

New Zealand Therapeutic Database

In addition to legal labelling requirements, those consumers with food allergies may be assisted by the New Zealand Therapeutic Database, which is funded by the New Zealand Ministry of Health. This database contains information obtained from food manufacturers and distributors to enable the compilation of lists of commercial foods that are free of specific allergens.

The data are available to inform health professionals and people with allergies to assist them in allergy management. Lists of foods free of the common food allergens are updated and published annually and are available on the website www.nztd.co.nz or by writing to: Mrs Alannah Steeper, NZ Therapeutic Database, Auckland Hospital, Private Bag 92024, Auckland 1.

Other Helpful Organisations

Allergy Awareness Association (PO Box 56-117, Dominion Rd, Auckland) can provide practical support to individuals and families with peanut or other allergies.

The author would like to thank a number of reviewers who provided comments on this article including: Dr John Birkbeck, Dr Jan Sinclair, Dr Rodney Ford, Dr Pat Tuohy, Dr Alison Roberts, Elizabeth Aitken, Carolyn Watts, Jane McLennan, Clare Chandler and Lyn Gillanders, and in particular Dr Penny Fitzharris.

References

1.Fitzharris P. Peanut Allergy. Prescriber Update, No.15, p.13-16, Aug 1997.

2.Hourihane J O’B, Dean TP and Warner JO. Peanut allergy in relation to heredity, maternal diet, and other atopic diseases: results of a questionnaire survey, skin prick testing and food challenges. BMJ 1996;313:518-521.

3.Sampson HA. Managing Peanut Allergy. BMJ 1996;312:1050-1051.

4.Extract and format. 1 July 1995-30 June 1997 public hospital discharge data. New Zealand Health Information Service. Wellington: Ministry of Health 1998.

5.Peanut Allergy. Committee on Toxicity of Chemicals in Food, Consumer Products in the Environment. HMSO. London: Department of Health (UK) 1998.

6.Food and Nutrition Guidelines for Healthy Infants and Toddlers (Aged 0-2): A background paper. Wellington: Ministry of Health 1999.

7.Soy-based Infant Formula. Wellington: Ministry of Health 1998.

8.DRAFT Australia New Zealand Food Standards Code. Wellington: Australia New Zealand Food Authority 2000.





iVillage Member
Registered: 07-14-2003
Thu, 07-17-2003 - 1:27pm
This is really interesting. Let me start by saying that I am generally very skeptical of vaccines though my ds is fully immunized. Here is some background: My son is 3 years old. He was breast fed for 3 weeks and then on milk based formula, no soy. At age 12 months my son had a peanut butter cookie, to my knowledge his first exposure to peanuts. I say to my knowledge because peanuts are in TONS of things one would not expect them to be in. At age 13 months, I gave him a piece of bread with peanut butter which he ate and within minutes developed huge hives and began scratching his eyes. A dose of Benadryl and it went away. It took us over a year to get an appointment with an allergist and when we did he had a skin test to peanuts and tree nuts. The skin test to peanuts was positve. His blood level, however, was very low and a food challenge was suggested. I talked this over with my ped. and we decided to forgo the food challenege which could be dangerous and treat my ds as if he indeed does have the allergy. We decided to re-do the skin test when he is about 7 years old. Not a month later, after eating lunch at my mom's, my ds entered the room with hives on his upper lip, neck, and chin. Again, benadryl cleared it up. We re-read the ingredients for everything he had eaten: Ravioli, applesauce, and graham crackers. No peanuts. But my mom had eaten a graham cracker with peanut butter smeared on it and shortly thereafter she gave my son a kiss. Bingo! Reaction. The allergy history in my family: My sister and I have seasonal allergies, my brother is allergic to pet hair/dander and my sister has exzema. That's it. Now, for the peanut oil on the skin thing. It is possible to have a contact allergy to something and not have a reaction if it is ingested. That happens a lot. Blood samples help determine this.

I don't think that if this vax turns out to be effective we should give it to everybody. Maybe to at risk kids. I don't know if this is the same vax I saw on the national news recently, but if it is, it would not be the type of vax given to everyone anyway. It was a vax given only to people who are allergic and allowed the person to consume more peanuts before having a reaction. This could reduce deaths from reactions caused by accidental exposure.

You can't even compare this to chickepox. Yes, Peanut allergy and chickenpox may kill about the same number of people each year, but almost everyone in the population gets chickenpox during childhood. Contrast that with the percentage of people with peanut allergy which is obviously much less. That would mean as a percentage chickenpox kills almost nobody whereas allergic reactions kill many more.


And finally (beware I am going to get angry here) this for the mom who told the story of her child's school and the letter asking her not to send peanut products to school to protect an allergic child. You are so out of line to suggest that kid (or mine) should be home schooled! What a terrible thing to say! It is not a disability, it is an allergy. The last I checked, allergic kids have a right to public education just like your kid. Maybe you should home school your kid so that mine doesn't have to come into contact with ignorant attitudes like that. Your little sweetie with his peanut butter and jelly is the equivalent of a gun in a backpack to that allergic child. If the gun stays in the backpack no one gets hurt. If it comes out and they start playing with it, someone could get shot. Maybe they die and maybe not, but they do get hurt. Similary, if that allergic child accidentally ingests that peanut butter and jelly (kids share food all the time) he's gonna get hurt or die. Maybe it's better to just leave the gun at home, huh? Peanut allergy is a matter of life and death. Have a little respect. I really found your post distasteful, as if you couldn't tell.

As for causes of this allergy and the increas in incidence, I have no clue. Maybe it's because we bombard our kids with a zillion vaccines before they can even hold up their own heads, walk, or say "Da-da." you know, auto-immune arguments again. Wouldn't that be funny? Developing a vax for something caused by vax? I have no proof and I have no theories, all I know is that my son is in danger every time he puts food in his mouth and has to carry epinephirne with him probably for life. I just hope everyone out there can be respectful of those of us who live with this. Thanks.

iVillage Member
Registered: 03-19-2003
Thu, 07-17-2003 - 2:40pm
Interesting post! After reading your last paragraph, I thought you might just be interested in 2 current debates going on at the Hot Debates board on Parent Soup. Terms of Service prevent me from linking to the particular questions, but you might be interested in the dialogue~

~miki

Avatar for suschi
iVillage Member
Registered: 03-27-2003
Thu, 07-17-2003 - 2:57pm
Well, since your anger was directed at me, I will respond,

Why should 1 child in the school affect EVERY OTHER CHILD IN THE SCHOOL because he has a life threatening peanut allergy. So every child in the school cannot bring ANY TYPE of peanut product to school for his lunch. We now have the school dictating what the children cannot bring, (and you yourself admit how many products do contain trace of peanut something or other) and that covers a lot of products. A peanut butter & jelly sandwich is a pretty common lunch for school children. In fact, I remember that was usually what was packed in my own lunch everyday, it was all I would eat. So why should over a thousand children be affected for an allergy of one? Seems to me the obvious choice would be to homeschool this ONE child (instead of the thousand + others) because of his life threatening allergy. If it were my child, I wouldn't depend on others for his life, especially when you are counting on parents of so many children. I would HOMESCHOOL my child without a doubt. I am amazed that you think so many should alter what they do to protect one. Do you have any clue how many items that are NORMALLY packed in school lunches contain products with peanuts or traces of? Yet you think I am ignorant because I disagree that all students should have their lunches altered in such a way to accomodate ONE CHILD? I have enough to keep me busy with 5 kids and working part time without having to ensure each lunch I pack for my children contain NO peanut products whatsoever. Like I said, if it were my child with a life threatening allergy like that, I would not have him in public school to begin with, period. Sorry if you find my post distasteful, but I tell it like I see it. I don't believe in tip toeing around the issues fearing someone may get their feelings hurt. You can put me on ignore if you don't like it.

I have a child with a heart/lung defect, should I be racing to the school demanding that every child who has any cold symptoms be kept out of school to ensure my child doesn't get sick. Would you find this an unreasonable request?

Christine

iVillage Member
Registered: 03-19-2003
Thu, 07-17-2003 - 3:39pm
Actually, susch, it's not up to you. The US Dept of Agriculture addresses allergies. Those that could result in a life-thretening episode constitute a disability, for which the public school system IS responsible.

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http://www.cleveland.com/living/plaindealer/index.ssf?/base/living/1058261857122360.xml

Interestingly enough, private institutions seem to be more progressive in banning peanut products from the school.

~Miki

iVillage Member
Registered: 07-14-2003
Thu, 07-17-2003 - 3:47pm
My God, form your post you would think the school asked every parent to give a vital organ so that one kid would not die!

No, the whole school should not be expected to refrain from packing peanut containing products. And as a mom of a child with the allergy, I know how many products contain nuts or traces of. BUT..I do not think it unreasonable for the children in the class with the allergic child to keep the peanuts at home. The ones likely to be eating lunch with the allergic child. That would be like 30 kids max? And I am speaking from a standpoint of elementary aged kids, the ones that may forget to ask if something contains peanuts and cannot read well enough to check labels for themselves. Some schools now do allergy-free tables for kids, but one problem with this is the isolation of children for something they cannot help. hardly fair, IMO.

And here is the difference between my child with peanut allergy and yours with heart/lung problems. Even if it was feasible to tell any child with cold symptoms to stay away from your child/stay home, that would not prevent your child from picking up potentially life threatening viruses. Viruses have an incubation period, so it would just be silly to even say that. By the time symptoms are present, the virus has most likely spread. Not to mention, symptoms are subjective as to their severity and cause. A runny nose could be the child developing seasonal allergies or getting over an illness that is no longer contagious. Peanuts are not subjective like this. My child has NO chance of having a problem as long as peanuts are not present. Your child can still get sick, symptoms or not. You are comparing apples to oranges here. Not to mention that if I knew your child I would have enough respect for him/her to stay away if I knew I was sick. Why would you not do the same for my kid? How do you know this is the only allergic child in your school? With the incidence of allergies rising, there are likely to be many more if there aren't already some you don't know about. And why is it so hard to send tuna or bologna instead of PB&J anyway? Just wondering. My friend is a kindrgarten teacher with two allergic kids in her class. She asked parents not to send any peanut containing snacks for birthdays or holiday celebrations and to avoid peanuts in their kid's lunches as much as possible. The parents had no trouble with this, I'm not sure why you do. BTW, she teaches in a small town of a few thousand people and has two allergic kids in just one class, yet you are telling me that out of thousands of kids only one has an allergy?

Finally, of course I will protect my child as much as possible. Homeschooling is not the answer to that. He cannot go through the rest of his life at home because I am afraid he may ingest a peanut somewhere. I am not going to tell him he can't go out to eat or to a birthday party because he may ingest a peanut. When he is young, I will put stickers on his clothes saying "please don't feed me I have food allergies." If I cannot be with him I will make sure that an adult who will be is aware of his allergy and knows how to use the Epi-pen. But I am not going to make him stay inside forever. He deserves to be able to go to school if I want him to. Plus, you are not being realistic with the homeschool thing. Many families can't afford to have a parent stay home and homeschool. haven't you realized that living is expensive? I think more parents should be at home with their kids, but homeschooling is a huge committment considering you as a parent (and most of us have no specialized training to be classroom teachers) are going to be expected to give your child the same knowledge they would get in a classroom where the teacher is trained. You're telling me that I should keep my kid home in lieu of inconveniencing you even though I also pay taxes to support that school. Again, pack some tuna fish so that my five year old kid can play and learn at school like all the allergy free people out there instead of being forced to stay at home like he has a contagious disease. In a couple of years he will be able to think/read enough for himself that he can protect himself. Until then, it is my job as his mom to protect him and if I decide to send him to the public shool which I help fund, it is their job to protect him because that is what I am paying them to do. I don't think that eliminating nuts from his classroom is too much to ask cosnidering there are doszens of other things kids can eat for lunch. I continue to respectfully disagree with you.

Avatar for suschi
iVillage Member
Registered: 03-27-2003
Thu, 07-17-2003 - 4:03pm
Well, it isn't just the classroom we are talking about with 30+ kids. They are talking about the ENTIRE school, because the kids don't eat in their classroom, they eat in the cafeteria. A trace of peanut butter on the table could set him off. So either the school needs to provide a special place for this child to eat, or find another solution. But to expect an entire school of kids (approx 1200 in this case) to not have ANY type of peanut product is an unreasonable request. My kids don't like tuna or bologna. Or many other alternatives. They like peanut butter, that is their favorite. PB&J, and crackers w/PB, celery w/PB, carrots w/PB. They like Hazelnut butter as well. Why should I force my children to eat something different than what they are used to, and they enjoy, because ONE child in a school of 1,200 is allergic?

But it seems you agree with me on this anyway,

"No, the whole school should not be expected to refrain from packing peanut containing products."

I could see if it was just the classroom. I would request my child be allowed to eat in the cafeteria in that case.

In many cases, there is a fever before other symptoms break out when a child is ill. So of course feverish kids would have to be kept home as well. I don't feel this is comparing apples to oranges. It's making demands on every other child in the school to protect one who has a life threatening condition. I however will not depend on others for my child's health. We didn't put him in daycare for that reason, to lessen his exposure to others. However he will be starting Kindergarten next year. If I find that he is getting sick too often by being in school, I will arrange MY life to homeschool, not attempt to arrange a thousand others. I know living is expensive, but how many things do you have that you don't really need?

Christine

iVillage Member
Registered: 03-19-2003
Thu, 07-17-2003 - 4:59pm
<>

Luckily, most of the schools with peanut-allergic students do not share your POV.

And truly, if your children eat nothing but things with peanut butter- well that doesn't sound lke too varied a diet anyhow ; -) Why should a child w/a life-threatening allergy to a NON-ESSENTIAL food be denied public education or risk his/her LIFE because your children are picky eaters?

Also, not YOUR call to tell others to home-school or what they can(not) afford. Their children are, by law, entitled to public education, and if the schools & gov't. agencies see fit to ban peanut products, eat it up or homeschool your own.

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