Focus on food allergy, part 1: COMMON MYTHS

In honor of National Asthma and Allergy Awareness month, we will share a series on food allergy focusing on everything from myths to personal stories of dealing with food allergy.

There is a substantial amount of false information available on the internet and it can be very difficult to separate fact from fiction in food allergy.  This post will try to correct some of these myths.  (This article is adapted from “Common questions in food allergy avoidance”, written by Maureen Egan, MD & Matthew Greenwalt, MD and published in the Annals of Allergy, Asthma & Immunology, March 2018.)

MYTH: MY CHILD HAS A PEANUT ALLERGY, SO I NEED TO REMOVE ALL PEANUT PRODUCTS FROM MY HOME.

FACT : If a food allergic person touches a surface (such as a table top) that has remnants of the food still on it and then puts the hand into their mouth or touches their eyes, a reaction can occur, but this is considered an ingestion (eating it), not an inhalation (breathing it) reaction.  Some families may choose to be peanut free at home, but that is a personal decision. If a family chooses to keep peanut (or any allergen) in their house, they should wash their hands with soap and water after eating it, and clean the table top with cleaner or commercial wipes. Hand sanitizer does not remove food proteins.

MYTH: IF A PERSON WITH A PEANUT ALLERGY SMELLS PEANUT BUTTER, A REACTION CAN OCCUR.

FACT:   It is a common myth that if peanut is present in a room, it can be inhaled and will trigger a serious allergic reaction.  This is not true. Allergic reactions happen due to the protein in the food - the odor from peanut butter is not a protein so a reaction will not occur. While touching peanut protein may cause symptoms such a rash on the area where it was touched by the peanut butter, a serious reaction should not occur unless peanut protein is eaten, or touches the eyes, mouth, or inside of the nose. Shelling peanuts may cause some protein to go into the air, but it becomes nearly undetectable within moments after the person finishes shelling peanuts. However, it is not uncommon that there is anxiety around the odor of peanuts. A proximity challenge can be done to assure the person that there is no reaction from being in the room with peanut products if necessary. [ NOTE: Cooking foods can release proteins into the air. People with shellfish allergy, for example, can have severe allergic reactions from being near cooking shellfish.]

MYTH: IF I AM ALLERGIC TO PEANUT, I CAN’T EAT FOODS COOKED IN PEANUT OIL.

FACT: There is some truth to this statement because there may be peanut protein in crude or cold pressed peanut oils.  However, in general, most peanut oils are highly refined and contain little to no peanut protein.   The same is not true for some other oils (This will be discussed further in part 2 of this series).

MYTH: IF I AM ALLERGIC TO PEANUT, I CAN ONLY TRAVEL ON AIRLINES THAT DO NOT SERVE PEANUTS.

FACT: Studies do not support the myth that a peanut allergic person can have a serious reaction if he or she inhales peanut protein on an airplane. Again, if a reaction occurs, it is due to eating or touching a contaminated surface and then touching your mouth, eyes, etc. Wiping down the tray table, armrests, video monitor and window (if the person is at the window seat) with a commercial sanitary wipe (but not hand sanitizing gel) as soon as seated is the best protection. Also, check in the crevices of the seat for any peanut shells or pieces left by a previous passenger.  However, it’s always important to pack your epinephrine autoinjectors in your carry-on luggage.

MYTH: I NEED TO AVOID FOODS IF THE LABEL SAYS THAT THE FOOD “MAY CONTAIN”, “MIGHT CONTAIN”, “MADE IN A SHARED FACILITY” OR “MADE ON SHARED EQUIPMENT”.

FACT: The FDA requires that if a food contains milk, egg, fish, crustacean shellfish (but not mollusks), wheat, peanut, tree nuts or soybean, the label must clearly state this.  However, there are no regulations defining how or when to use these other phrases which are called Precautionary Allergen Labeling (PAL). While it is commonly recommended that patients with a food allergy avoid foods with a PAL, a number of studies have shown that the risk of a significant food allergy reaction in such patients is low.  The decision to eat or avoid foods with a PAL is an individual one and depends on a patient’s (or parent’s) risk tolerance, as well as on how the avoidance of such foods will affect the person’s (and family’s) quality of life.

MYTH: ALLERGEN BANS IN SCHOOL ARE NECESSARY TO PROTECT A CHILD WITH A FOOD ALLERGY.

FACT: This is a very emotional topic for many parents and school personnel.  Allergic reactions in school are common and have been reported to occur in 16%-18% of food allergic children.  The theory that complete avoidance in schools seems to make sense, but it is nearly impossible to do for a variety of reasons.  In addition, there is no evidence that banning a food such as peanut is effective.  A 5 year review of the usage of injectable epinephrine (such as an EpiPen) in Massachusetts’ schools showed no difference in the usage of epinephrine to treat food allergic reactions in schools that banned peanut versus those that allowed it into the school.  Think about this as well:  we do not ban milk in schools, yet many young children have a cow’s milk allergy. A nut free table is an option, especially for young children with a food allergy, but once children are old enough to understand that they should never share another child’s food, there is probably not a need for a nut (or milk, or egg) free table. It can be lonely sitting at the food allergy table.  Additionally, as children grow, they need to learn to navigate a world with their food allergen in it. School is a great place to learn to practice safe eating habits in a controlled environment

MYTH: A CHILD’S GREATEST RISK OF A FOOD ALLERGY REACTION IS DURING LUNCH IN THE SCHOOL CAFFETERIA.

FACT: 79% of food allergy reactions occur in the classroom, not the lunch room. This can be due to use of food in classroom projects or celebrations. It is safest to have food-free celebrations and art projects so that all children can participate without fear of reaction.

Stay tuned for Part 2 which will answer some commonly asked questions about food allergy.