Don't Kill the Birthday Girl

by Sandra Beasley

  In an interview for Living Without (a magazine that caters to those with food allergies, celiac disease, and other dietary restrictions), Jackie Clegg Dodd—wife of U.S. senator Christopher Dodd and mother of two children, including Grace, a child with multiple food sensitivities—recounted an experience that epitomizes the extreme scenarios associated with peanut allergies:

  One time I was flying with Gracie and her baby sister and the airline rep informed passengers that they couldn’t eat tree nuts and peanuts during the flight. As we were taking off, the woman seated behind me threw a fit about it. I offered to share lunch with her grandchild—I’d packed plenty of great food—but she declined. Then as we were beginning descent, she gave her grandchild a peanut butter and jelly sandwich. Within minutes, Gracie was projectile vomiting. There I was alone, nursing one baby while the other was going into severe anaphylaxis. When the plane landed, we went straight to the hospital.

  Clearly, the PB&J-smuggling granny is the bad guy in this story. Yet I find myself nagging at what is known, and what is implied. What does Dodd think was the reaction catalyst? Was it the smell of the peanut butter? Peanut oil contact-transferred up to their row in a matter of minutes? Isn’t it more likely that the child ingested an old crumb in the area of her seat, or that one of her own snacks was contaminated?

  What if that woman’s grandchild had allergies of her own? I think of all the times a peanut butter sandwich or peanut butter pretzels served as my anchor for a long trip. Even a supposedly allergy-friendly in-flight meal usually arrives with a fat slice of cucumber in the salad and cost-friendly cantaloupe mixed among the fruit. There’s something slightly self-righteous in Dodd’s offer of her “great food.” I imagine someone offering my mother a package of Garden Salsa (and whey-laced) Sun Chips instead, or a home-baked brownie, with the presumption that it will be a welcome option for her hungry child. The exchange would not go well.

  I’ve heard advocates for nut-free zones say “anyone can live without nuts for [a meal, a ball game, a flight].” That’s true, I guess. But what if every one of the “big eight” allergen contingents demanded the same courtesy, every time? Do those who want public spheres to be free of egg or dairy or shellfish have any less right to the safety of their children than those who want protection from nuts?

  The same 2009 study that demonstrated a 9 percent prevalence rate of peanut-sensitive antibodies revealed a 12 percent prevalence rate of antibodies respondent to milk. There are multiple times I’ve had reactions in a movie theater upon sitting too close to someone with buttered popcorn. My eyes blur, and I begin to wheeze. But it would have never occurred to my folks to lobby theater owners to designate popcorn-free shows. On an airplane, it is true that I blanch when someone sits down with a bag from California Pizza Kitchen. For the next few hours, I’ll lean in the opposite direction to breathe, and make sure my seatmate’s oily napkins don’t land on my lap tray. But I can’t imagine requiring a pizza-free flight.

  Why is a generation of children being raised under the belief that it takes a village to avoid a peanut?

  • • •

  “Kids don’t want to feel different,” asserts Jenny Kales, a Chicago writer, mother of two, and author of The Nut-Free Mom blog. We’re on the phone, talking about the challenges of raising a child with food allergies. She is determined to make her daughter feel protected without setting her apart. Neither Kales nor her husband has allergies of their own. So when their child Alexandra first seemed to be repelled by nut-based foods, beginning in early childhood, “we thought it was just her preference.”

  Then, in 2004, a teacher forced the four-year-old to try a bite of the peanut butter and jelly sandwiches being served in her preschool facility. At the end of the school session, Kales arrived to find her daughter had swollen eyes and hives. She asked why she had not been called and was told, “You were about to pick her up anyway.” The school officials suggested Alexandra might have an undiagnosed allergy. While Kales was driving to the store to buy Benadryl, her daughter began exhibiting anaphylaxis. Alexandra vomited and fainted.

  “I’ve never in my life seen anything like that,” Kales remembers. Though Alexandra had seemed “perfectly healthy” up to that point, testing confirmed IgE sensitivity to peanuts and tree nuts. The family began changing their lifestyle to keep her safe—starting with transferring her to a preschool more careful about allergies.

  Many educators don’t think about the thousand little ways food substances can sneak into the school day. Wheat makes an appearance in Play-Doh; egg is often used in tempera paints. Someone’s well-meaning donation of moisturizing soap might feature soy proteins, cucumber additives, or cashew oil.

  Take Elmer’s glue. It may be dairy free now, but for years it used casein (a milk derivative) as a binder. Small wonder, given that the parent company, Borden, was primarily in the dairy-product business. Elsie the Cow was a real cow, purchased in Connecticut and subsequently promoted as Borden’s unofficial mascot. Her “husband” was a bull named Elmer, who became the mascot of Borden’s chemical division. Hence, Elmer’s glue.

  Kales has become what she calls a “food detective,” always on the lookout for hidden dangers. She uses her blog to share her findings with the larger community of allergy moms, posting two to three times a week on media coverage of medical research, tips for surviving the holidays, and reviews of the latest nut-free product brands. Unfortunately, manufacturing trends for the food-allergic sometimes pit those with different sensitivities against one another. As more parents are trying to protect their children from wheat allergies or celiac disease, gluten-free baking products—which often use nut flour as a substitute—are popping up everywhere.

  “I am terrified by gluten-free,” Kales says. Nut flour is a growing problem in restaurants as well. When it comes to family outings, they rarely grab a meal unannounced. Kales calls first to speak with a manager and make sure her daughter can be accommodated.

  “You lose a lot of life’s spontaneity,” she admits.

  Kales finds it easier to keep a nut-free household, rather than risk accidental contamination. My mother did not keep milk in our fridge for the same reason; for years, my parents gave up blue-cheese dressing on salads.

  For his workday lunches, Kales’s husband sometimes “cheats” by indulging in peanut-laden Thai food. That means being quarantined from contact with his daughter until he’s had a chance to fully wash up.

  “Alexandra asks him, ‘Why would you get that?,’ ” Kales says. I understand her daughter’s sense of betrayal, especially at the age of ten. I felt the same way when my father used to buy strawberry milkshakes at the drive-through.

  In order to continue keeping their daughter away from nuts, the family found an elementary school that allows the children to go home for lunch. But there is a trade-off for this freedom; when Alexandra wants to stay, there is no peanut-free table, as there are at some schools. No matter how carefully she seats herself, the migratory habits of kids in a lunchroom make it impossible to prevent exposure.

  Remembering the many times I ended up in the school clinic, and thinking of all the horror stories one hears about peanut sensitivity, I ask how bad her reactions have gotten. Her mother’s answer shocks me, but not in the way I expect. In the five years since Alexandra’s diagnosis, and given what Kales acknowledged have been “extreme lifestyle changes,” the number of subsequent anaphylactic reactions has been: zero. None.

  I’ve got the phone cocked to my ear as Kales is talking about how her daughter’s face broke out in a rash after eating some Chinese noodles—in other words, evidence that her tree-nut allergy is still a real threat, even if it’s never been witnessed in a confirmed anaphylactic moment. I’m listening. But mainly I’m transfixed by the realization that this family thinks in terms of the reaction. One episode that set off a complete lifestyle change. One episode that might define a year.

  I grew up thinking in terms of not the reaction, but a reaction, perhaps as many as one a
week. Trial and error has been my way of life. It’s not that my parents were negligent; they just had a different understanding of what my options were.

  “Why have a problem with a peanut-free table?” Kales asks. Though she does not support school peanut bans—“it’s not practical”—she wishes cafeterias would refrain from actively selling nut-based foods. And she’s relieved that their school has prohibited birthday treats across the board. “No one gets them; it’s not just my daughter.”

  I ask what she thinks about airplanes. Kales pauses, and in that pause I hear the hesitation of many allergy moms: Do I speak in terms of my child and my experience? Or am I hoisting a banner for all allergic children?

  She references the work of Dr. Hugh Sampson, director of the Jaffe Food Allergy Institute, to explain the danger of the mile-high environment. Allergic reactions are triggered by exposure to proteins. During the pulverizing and sorting processes common to the manufacture of many single-serving foods, proteins become powdered and cling to the inside of the package. If you’ve ever licked your finger and swept it along the inside crease of a potato chip bag, you know what I’m talking about. The air in a plane’s cabin is both pressurized and recirculated, so that nut residue has nowhere to go once released. As Dr. Sampson’s work has suggested, the residue can reach critical mass when dozens of passengers open packages all at once.

  A frequently cited 1996 Mayo Clinic study showed significant accumulations of nut protein in the air filters of many commercial planes. This study, like many in the allergy world, suffered from a relatively small sample size—two planes, each of which had logged five thousand hours of flight since its last filter change. But the meager evidence, combined with the pressure of advocacy groups, has been enough to convince the Department of Transportation to investigate the possibility of establishing peanut-free zones on passenger airlines or banning airline distribution of peanuts entirely.

  Some companies have acquiesced, including American Airlines and Northwest Airlines, which switched to pretzels. Others are holdouts; Southwest Airlines considers nuts, served in a package proclaiming “Byte-sized Fares,” an important part of its market positioning. Since their low-overhead structure also includes open seating, Southwest officials have argued that buffer zones would be impossible to secure. Sometimes the decision is made by the politics of the business. When Delta—not coincidentally headquartered in Atlanta, Georgia, a peanut production capital—acquired Northwest Airlines in 2009, peanuts returned to NWA flights.

  I get that people with allergies would rather avoid the risk of itchy eyes, a runny nose, and the emotional drain. What I don’t get are the people pitching it as a scenario of life or death. Airborne reactions are real. Anaphylaxis is real. But it’s as if the mainstream media, becoming aware of the two around the same time, melded them as one phenomenon: airborne anaphylaxis. And a generation of parents have convinced themselves this hybrid is a legitimate and pervasive threat. Really?

  “Our doctor has mentioned it is a misnomer,” Kales says when I ask for her take. “We don’t worry about it too much.”

  Even as a nut-free mom, she is skeptical of parents who claim their children have had severe reactions to the smell of an allergen. She should be. Scent is carried by pyrazines, organic compounds that stimulate the mucous membranes of your nose (and are also responsible for shaping flavor). These chemicals are fundamentally different from proteins. So until the model of allergic reactions changes, there is no way a smell alone can trigger an IgE-based reaction.

  What a smell could trigger is a psychosomatic reaction based on the conditioning of past experience. Symptoms such as rashes, hives, vomiting, and rapid fluctuations in blood pressure, temperature, or respiration—all these symptoms are indicative of allergic reactions, and all are phenomena that laboratory subjects have been shown capable of manifesting in response to nothing more than sufficiently stressful situations. I’m not saying that these reactions should be dismissed; they have to be treated immediately, on the presumption that they are IgE based. But when backtracking later to identify the origin of a reaction, it is important to open your mind to all the possibilities.

  Once, my parents took me to Hersheypark in Pennsylvania. I’d begged to go, but upon arriving found the constant references to milk and milk chocolate a little creepy. I didn’t want to be greeted by people dressed as foil-covered Kisses. I couldn’t have any of the free samples. Boarding one roller coaster, I overheard someone say that we would swing over Chocolate World, the on-site candy factory.

  I became certain, certain, that a puff of milk-laced exhaust would kill me. But it was too late. I was strapped in. As we rounded a sharp curve, we entered a pocket of air that seemed particularly heavy with the stink of chocolate. My small, adrenaline-filled body tensed up. My face felt hot. I began to wheeze. I got off the ride in tears, went straight for my inhaler, and spent the rest of the afternoon in the refuge of the carousel.

  For years I described this incident as another one of my allergy attacks. I suppose there’s a thousand minor ways I could have been exposed to milk proteins during the day. But I don’t think that was the culprit. Not this time. I was a fearful child, self-consciously primed to have a reaction, and so I did.

  Honest discussion of these types of reactions—which might help us bridge the gap between what is viscerally experienced and what is medically justifiable—is stifled in the allergic community. We feel like we can’t afford to give up any ground, because some want to believe almost all allergic reactions are psychosomatic.

  In an infamous January 2009 Los Angeles Times op-ed column, Joel Stein called allergies a “yuppie invention.” He was drawing on an essay in the British Medical Journal, by Harvard University sociologist Dr. Nicholas Christakis, on the notion of contagious anxiety. It didn’t help when Time magazine, in an article published that same month, quoted Christakis as using the term mass panic to describe the attitudes of many parents and school officials toward food allergies.

  The reaction was, well, mass outrage. Dr. Robert A. Wood, a professor of pediatrics at Johns Hopkins University School of Medicine, published a Los Angeles Times rejoinder calling Stein’s column “insulting and inappropriate.”

  Yet he did not entirely disagree with Christakis. The impetus for Christakis’s original BMJ commentary was an incident of a bus being evacuated in the Massachusetts school district where one of his own children attended classes. Why the evacuation? A peanut found on the bus floor. These weren’t preschoolers unable to discern a threat or keep their hands out of their mouths. These were ten-year-olds. Wood acknowledged that for that age, zero tolerance is probably an unnecessary precaution.

  “It’s an unfortunate situation,” Wood told Tiffany Sharples, the Time reporter, “if a family with an inaccurate perception of the allergy leads a child to believe that a Snickers bar from fifty feet away is a lethal weapon.”

  There must be a compromise between the cavalier and puritanical. Right?

  “There’s something about peanuts and peanut butter that makes people crazy—on both sides,” Jenny Kales warned me. “Peanut butter is iconic, so strongly associated with childhood. Banning it is seen as anti-American.”

  For the peanut farmers, this isn’t just a matter of patriotism; their livelihoods are at stake. Every store or institution that bans peanuts hurts business. So does every peanut-related death that circulates in the news.

  In March 2000, Dee Dee Darden founded the National Peanut Board (NPB), a representative body for peanut farmers. The board’s activities, which focus on scientific research, domestic advertising, and export promotion, are funded through a 1 percent assessment levied on annual peanut crop values. Soon after the board’s formation, Darden approached the council’s leaders with a radical idea: to fund not just agricultural science but research into the explosive rise of peanut allergies.

  “We faced a lot of opposition at first, especially from those in the industry,” Darden says. “They thought if we talked about it to
o much, it made it a forefront issue.”

  Darden was determined. “I’d heard all the numbers,” she tells me. “We wanted to have a positive impact on the situation.” Darden, then in her early forties, had grown up in a farming family of Suffolk—“there wasn’t hardly a day I wasn’t out in the dirt”—in a region of Virginia once referred to as the peanut capital of the world. “It was hard to believe. I never knew anyone who had any allergies, much less peanut allergies … but we didn’t want to be ostriches, with our heads in the sand.”

  Darden and her colleagues wondered where their relatively small amount of start-up money could make the most difference. So they created the Scientific Advisory Council (SAC), a rotating panel of five leading doctors and scientists from the United States, Canada, and the United Kingdom. Though each member is already prominent in the field of allergy study, the SAC’s biannual meetings bring them together for brainstorming sessions, for the opportunity to share research results, and to decide which proposals the NPB should offer future grant support.

  “They were like little children, all excited to be in the same room,” Darden remembers. “You know, like when children’s faces light up? We were a bunch of peanut farmers, putting all these great minds together.”

  In the past ten years, the SAC has overseen the cumulative allocation of nearly $7 million of NPB funding for allergy study and education. One vein of research looks at which peanut-preparation techniques release the most proteins. On a molecular level, it turns out that dry roasted peanuts are more “allergic” than ones that have been boiled. This may explain why frequency of peanut reaction is so high in the United States, where dry roasting is the norm, even in the production of peanut butter. In China, where peanut consumption is comparable but the peanuts are steamed or boiled, the incidence of allergy is low.