No nuts, please!

For most Americans, peanut butter is a major food group. Butfor some, it’s poison. A nut-allergy specialist talks about a problem that’s onthe rise.

Marc McMorris, MD, is medical director of the University ofMichigan Health System’s Food Allergy Clinic, which evaluates and treats peoplewith food allergies. Health Monitor spoke with Dr. McMorris about nutallergies.

HM: Experts say the number of children with nut allergies inthe United States has risen rapidly in the past several years. What’s going on?

Dr. McMorris: If you include allergies to peanuts as well asto tree nuts such as cashews, pistachios, and almonds, the number of kids withnut allergies has doubled in the past few years. We don’t know why. Some peoplebelieve the way we process peanuts in this country makes them more allergenicthan they are in India or China. Here, we dry-roast them. This exposes peanutsto very high temperatures that appear to increase the release of allergenicproteins. Peanuts that are boiled at lower temperatures do not produce the sameamount of allergenic proteins, and are therefore less irritating to the immunesystem. Other people cite the “hygiene hypothesis.” That’s the belief thatbecause we have conquered so many diseases in this country, our immune systemsno longer have to fight disease as hard as they used to and are reacting moreto allergens. We’ve seen that in Third World communities where people’s bodiesare overwhelmed with fighting disease, there are fewer allergies.

HM: How serious is this problem?

Dr. McMorris: It’s very serious. Nut allergies affect about3.3 million Americans. Of the approximately 150 people who die from foodallergies each year, over 90% die from nut allergies.

HM: What precautions can families coping with nut allergiestake?

Dr. McMorris: The most important thing is to make sure theperson with the allergy avoids the food. Most parents don’t have a big problemdealing with this in their own homes, but there are also babysitters, daycarecenters, schools, and relatives’ homes. You’ve got to really put a kind of“bubble” around the child.

HM: Do some people outgrow nut allergies?

Dr. McMorris: Yes. Current data show that about 20% ofchildren outgrow peanut allergies and about 10% outgrow tree nut allergies. Themost difficult time for kids with nut allergies is from age 12 to about age 22.It’s a time of risk-taking and believing you’re immortal. You really have toteach kids that this is a serious problem. Tell kids to show their friends howto use their EpiPens. (An EpiPen is a syringe loaded with epinephrine, ahormone that can reverse a severe allergic reaction called anaphylaxis and savea person’s life.)

HM: What’s ahead for people with nut allergies?

Dr. McMorris: Because nut allergies have become such a bigissue, a lot of research is focused on how to treat them. Studies have shownthat children with nut allergies have a lower quality of life than those withdiabetes because so much energy is focused on worry. But it will be a differentstory ten years from now. By then, there may be new treatments and even avaccine to protect against nut allergies.

Caring for Chris and Matt

Rea Ackerman was enjoying an afternoon at her parents’ homewhen one of her twin sons, Christopher, 4, asked a question that would changetheir lives forever. “Can I have one of these?” he asked, pointing to a bowl ofpistachio nuts.

He ate one nut. Within 15 minutes, his face was swollen andhis words became garbled. At a nearby hospital emergency room, the doctordismissed Chris’s symptoms as minor, and the family left with someantihistamines and reassurance.

Later that night, Ackerman checked on her sleeping son. Shefound him unable to speak, barely able to breathe, and covered with hives fromhead to toe. On their second hospital visit, Chris was given epinephrine, adrug that reverses allergic reactions, and the family learned the cause of hisproblems: He had a nut allergy, and he could have died.

It turned out that Chris and his twin brother, Matt, now 13,both have nut allergies. If they eat peanuts or tree nuts, their bodies will gointo anaphylactic shock. Without prompt treatment, they could die. “Over theyears, our sons have learned to ask, ‘Can I eat this? Is it safe?” saysAckerman, 52, a graphic designer from Dobbs Ferry, N.Y.

These days Ackerman reads food labels carefully, neverleaving the grocery store with a product that contains or has been producedwith nuts. “Our doctor put the fear of God in me,” she says. “I’ve told my boysto always be on the safe side.”