Food Allergy Backlash Boards the Bus
“Many social situations focus around food,” he notes. Everything from eating in restaurants, visiting friends and family, birthday parties and play dates now require more questions, conversations, and worry. “What’s hard is when the families of children without food allergies don’t accept that this is life for the families with kids with food allergies.”
The diagnosis of any significant medical condition will alter a person’s life. But what sets food allergy apart is the need for the cooperation of others: whether that’s a separate pan at a restaurant or asking non-allergic children to wash their hands after eating or to avoid certain foods in their lunch bags.
“The one thing with food allergy,” says Pistiner, “is that it involves other people’s children. In some cases, it involves changes in classroom celebrations, and schools having policies of being ‘peanut aware’. Those have an impact on the kids without food allergy.” Harada agrees. She believes a lot of the resistance to accepting food allergies as serious stems from asking someone not to eat something, or not to bring something to school.
Managing food allergies requires participation from the community, which includes people who may not be convinced that changes are necessary. Because of this, the schools that deal with them best have clear, consistent policies in place that have been developed by people on all sides of the issue.
The school bus example given by Christakis “was an unfortunate incident,” says Pistiner, who has trained school nurses on practical food allergy management in the professor’s home state of Massachusetts, as well as New York and New Jersey. “But that’s not the way most schools are dealing with this.”
Dr. Susan Waserman, an allergist and clinical immunologist in Hamilton, Ontario, is of the view that in Canada, most parents, children and schools are handling food allergies in a reasonable fashion. “You can always find people who are extremely anxious, who go overboard,” she says. “But by far, the majority of my food allergic patients cope well and their responses are appropriate.”
Some anxiety does come with the diagnosis – it’s just that most allergy experts do not see the mass hysteria that Christakis identifies. Even if there is trepidation inherent in learning to cope, Muñoz-Furlong reminds us of the basics: “This is a medical condition, diagnosed by a physician. This is not parents deciding one day – ‘I think I’ll say my child is allergic to peanuts.’” She adds, “I think what these reporters are missing is that every one of the parents who has a kid with a food allergy wishes they didn’t.”
AT THE heart of the parental worry over food allergies is the fear of death, and the visceral need to protect a child from it. While death is by no means a common occurrence with food allergy, anaphylactic reactions do have the capacity to shut a body down. Allergy experts say fatality statistics are a flawed measure of whether school and other accommodations are needed – but it is those numbers that support the critics’ statements.
Very few people die, they say, so why all the fuss and restrictions? Broussard used the Centers for Disease Control figures of 11 deaths a year in 2005 to swipe at FAAN’s estimate, from the Mayo Clinic research, of 150 deaths. Statistics, of course, depend on the information that’s analyzed.
In a previous BMJ debate, Hourihane and other allergists, along with Muñoz-Furlong, stated that emergency room reporting of fatal food anaphylaxis is not reliable. Attending physicians may never be made aware that a patient’s extreme distress started with food and list the cause of death as another condition, such as cardiac arrest or asthma. This is especially considered the case with asthma, which can be fatal of itself, or a symptom of anaphylaxis that’s triggered by food. Sometimes the cause won’t be known, but the allergy experts say such a case is often coded as an asthma death – of which there are about 3,900 a year in the United States.
McMaster’s Waserman concurs: “People have reactions all the time that they may not tell anybody about, they go to the emergency and these things are called ‘acute asthma’ or they’re mislabeled as some sort of adverse event.”
But whatever the actual number of deaths from food allergy is, it seems unlikely to be enough for the doubters. “Only 150 people (children and adults) die each year from all food allergies combined,” writes Christakis. “Compare that number with the 50 people who die each year from bee stings, the 100 who die from lightning strikes, and the 45,000 who die in motor vehicle collisions.”