We do not have adequate studies to state the general risk of chickpea allergy among children with peanut allergy. Peanut is a legume and it shares similar proteins with many other beans. However, in a U.S. study performed many years ago, only 5 percent of children with a peanut allergy had allergic reactions to other beans tested.

A tricky problem is that if you use blood or skin tests to beans for a person with a peanut allergy, about half the time the tests are positive even though 95 percent of the patients can eat the beans. The tests are affected by immune responses to shared bean proteins that are not important when it comes to allergic reactions.

Studies of chickpea and lentil allergy emanating from Mediterranean countries do note a high correlation of allergic reactions among pea, chickpea and lentil. Over two-thirds of children reactive to one of these three, reacted to another of the three. However, peanut allergy was uncommon in these children.

It appears that if a child with peanut allergy has already been tolerating peas, there is a much lower chance of having allergy to chickpea. Conversely, if peas caused a reaction, the risk of chickpea and lentil allergy is quite high.

Individual advice may vary, but if chickpea was already eaten and tolerated, there would be no reason to avoid it because of a peanut allergy. Lastly, a positive allergy test to chickpea in a person with peanut allergy does not prove an allergy and a medically supervised feeding (e.g. a food challenge) may be warranted.

Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Mount Sinai School of Medicine in New York. Together with Dr. Hemant Sharma, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.

On April 7, 2013, Adrian Gutierrez, an 8-year-old boy from Monmouth County, New Jersey, experienced a severe reaction and died in hospital. The reaction came over the boy on his family’s drive home from church, following a visit to a coffee shop. The boy’s mother suspects that Adrian, who was allergic to dairy and peanuts, may have accidentally sipped from his brother’s hot chocolate with milk. (Adrian had ordered a hot chocolate with  soy milk.)

One news report stated that an epinephrine auto-injector was administered to the boy. However, it is not clear whether the shot was given immediately after the reaction began, or  whether there was a significant delay. In the case of a severe allergic reaction, epinephrine should always be administered right away, as the drug can be less effective if a reaction has progressed.

On March 13, 2013, Maia Santarelli-Gallo, a 12-year-old girl from Burlington, Ontario (in Canada), appears to have experienced anaphylaxis during an outing to a shopping mall with her father and older sister. Local news reports suggest Maia had reacted to dairy and egg in the past, but her parents had been told she was intolerant rather than allergic, and she had never been prescribed an auto-injector. At this point, it is not definitively known what caused the reaction, but milk is suspected – since the last thing Maia ate was an ice cream cone.

Asked to comment on the girl’s fatal reaction, allergist Dr. Susan Waserman expressed profound concern to the local press. “It speaks to the need for proper diagnoses, proper education, how the family was told to handle this supposed food intolerance,” she said, adding that better support for the family would have led the girl to have an auto-injector. “The whole community feels terrible when we feel something like this,” she said.

On March 8, 2013, Cameron Groezinger-Fitzpatrick, a 19-year-old from Plymouth, Massachusetts, died from his peanut allergy while home from university for spring break. His family has said that a friend had offered him a cookie, which was supposed to be peanut-free but turned out to contain peanut butter.

According to ABC News, Cameron’s mother was told over the phone by a 911 operator not to administer an expired EpiPen which was in a nearby cupboard. Cameron’s current auto-injector couldn’t be found in time, as he had not finished unpacking for his visit.

“I didn’t know you can die from nut allergies. I feel foolish,” Robin Fitzpatrick, Cameron’s mother, told ABC News.

These tragic events reinforce the need for allergy education and having epinephrine always ready to access for those with food (and sting) allergies.

In more positive news, several states are beginning to see the importance of readily available epinephrine and are passing bills that allow doctors to prescribe “stock” auto-injectors to schools. These devices can used in emergencies for students who don’t have an auto-injector on school premises (in some cases, it may be a first allergic reaction).

Kentucky, Nevada, Oregon, Georgia and Tennessee have all seen recent progress in such bills in their state legislatures. In fact, Kentucky Governor Steve Beshear will be holding a formal ceremony to sign that state’ stock epinephrine bill into law on April 22, 2013.

The discussion around this article has become a wonderful opportunity to explore with our patients their concerns about the real risks of food allergy, their hopes for a cure, and their understanding of where things stand in that search for a cure. Since you may have some of the same questions, allow me to review some key perspectives and hopefully find common ground on which we can all agree.

Those living with food allergy are all too aware of the risks of accidental food allergen ingestion. However, we strive to provide our patients a balanced approach, where we encourage vigilance at reducing those risks, but work to prevent that from evolving into debilitating anxiety. This requires a clear understanding of the real risks of food allergy.

One area fraught with ambiguity for patients is food allergen labeling laws. The Food Allergen Labeling and Consumer Protection Act (FALCPA) does not permit any of the eight major food allergens to go unlabeled as ingredients, regardless of the quantity present. However, what is very troublesome to families is that FALCPA is silent on the issue of cross-contact.

Cross-contact can and does sometimes occur in manufacturing.  There is no guidance given to manufacturers as to when a precautionary label (often referred to as a “may contain” warning) should be included.  Fortunately, efforts are under way by the Food and Drug Administration (FDA) to help reform how manufacturers use these precautionary statements.

Another important point of discussion raised by the Times article is the true risk of anaphylaxis due to skin exposure to food allergens. In the Spring 2013 issue of Allergic Living, Dr. Scott Sicherer addresses this question (pages 24-25), explaining that anaphylaxis from skin exposure is very unlikely because the skin barrier prevents the protein from entering the blood system. So, for most with food allergy, playing a game with a ball that had briefly contacted an allergen would not be expected to pose a significant risk of anaphylaxis.

Also of concern to patients was the reference in the Times article to a mortality rate from food anaphylaxis of 1 per 1,000 for “severely allergic” children. It is critical that patients understand that this figure was derived by comparing the estimated number of food allergy deaths in the U.S. to the number of annual emergency department visits for food anaphylaxis. Another approach favored by many puts the risk at more than 100 times lower, or five to 10 per one million.  This approach has the advantage of making the comparison to the total food allergy population in the U.S.

Undoubtedly, even one death from food allergy is a tragedy because it could have been prevented. For those with food allergy, it is important to understand that this risk can be significantly decreased by exercising vigilance in avoiding food allergens and always having access to epinephrine.

Another area of discussion after the Times article revolved around the emotional toll that food allergies can take on families, particularly when severe allergic reactions have been experienced in the past. Our goal is always to help families work through their fears and arrive at a place where affected children feel safe and in charge of their allergies.

Certainly, the psycho-social impact of food allergy is real and, as research is beginning to demonstrate, often detrimental. But there is help, and fear should not be accepted as the norm for those with food allergy. For times when anxiety becomes overwhelming, a counselor, psychologist, or psychiatrist can teach specific coping mechanisms.

While no one would choose to have a food allergy, some of our young patients have gained great empowerment from their experience – a sense that if I can manage my food allergies, I can do anything. So, as the name “Allergic Living” epitomizes, a balanced approach is important to ensure that having a food allergy does not prevent one from truly living.

Next: Community’s Role in the Quest for a Cure

Entering its third year of national distribution, Allergic Living magazine is bolstering its editorial presence with the addition of Alisa Fleming as Senior Editor.

Fleming is an accomplished writer and the author of Go Dairy Free: The Guide and Cookbook for Milk Allergies, Lactose Intolerance and Casein-Free Living. She is also the founder of GoDairyFree.org, North America’s No. 1 dairy-free website.

“We’re thrilled to have Alisa on board,” says Gwen Smith the magazine’s Editor. “She brings outstanding ideas, knowledge and passion to Allergic Living‘s coverage of food allergies and intolerance.” Fleming will continue her popular No Dairy, No Gluten recipe feature in the magazine, but “in the role of senior editor, Alisa gets to show her skills well beyond her great food writing,” Smith says.

Since its launch across the United States in the spring of 2011, Allergic Living magazine has grown rapidly and gained a reputation for editorial excellence. Smith is a former senior editor of national magazines and newspapers, many of Allergic Living’s writers are well-known health journalists, and its expert columnists include allergists Dr. Scott Sicherer (Mount Sinai School of Medicine), Dr. Hemant Sharma (Children’s National Medical Center) and Dr. Clifford Bassett (Allergy & Asthma Care of New York), as well as dietitian and celiac expert Shelley Case. For the Canadian edition, regular allergist columnists are Dr. Susan Waserman (McMaster University, Hamilton) and Dr. Wade Watson (IWK Health Centre, Halifax).

Other expert voices include the National Foundation for Celiac Awareness (NFCA), the Asthma and Allergy Foundation of America (AAFA), FAAN (now FARE, the Food Allergy Research & Education organization) and Anaphylaxis Canada.

From family feuds with relatives who don’t “get” serious food restrictions to social concerns like dating and eating out and societal issues like bullying and avoiding allergens at school, Allergic Living is the go-to magazine for managing the real issues facing those with allergic or celiac disease.

For the 2013 publishing season, the magazine plans to tackle issues such as marital stress and food allergies and the mystery of adult-onset allergies. Meantime, the magazine’s food editors are already testing dozens of inspired new allergy-friendly recipes – while their journalist colleagues have begun work to uncover the latest on research progress. As well, readers can look forward in 2013 to smart advice on reducing toxins and allergens in the home and even the tricks to allergy-friendly gardening.

“We are privileged at Allergic Living to work with the best in the fields of food and environmental allergies and celiac disease,” Smith says. “And in her new role, Alisa Fleming will help us to set the bar even higher for the incredibly helpful articles we can deliver to readers.”

For more about Allergic Living magazine, including the newly released Winter edition, contact: editor@allergicliving.com.

View a sample edition of the magazine here.

If necessary, the counselors may put the auto-injector in the child’s hand and “guide” it.

Jean-Pierre Ménard, a Quebec lawyer who specializes in medical rights, told Le Journal de Québec newspaper that the rule – intended to protect the counselors against liability – contravenes Canada’s Charter of Rights and Freedoms, since the Charter says that every human being whose life is in danger has the right to be saved. In addition, he says this “incomprehensible” rule should instead have the City of Quebec worried about prosecution for instructing caregivers, in essence, not to save a child’s life.

Similar restrictive camp policies have arisen in some parts of the United States.

Gervais Bélanger, director-general of Asthme & Allergies Québec, says he finds the day camp rules for not administering auto-injectors “inexplicable”and “unjustified” – since this puts the onus on allergic campers between the ages of 4 and 12 to self-inject at a time when they are having an anaphylactic reaction. (Epinephrine is an emergency medication, and it would be rare for a young child to self-inject.)

Bélanger is one of the members of the Coalition for Megann’s Law, which is urging the Quebec government to pass a law on school food allergy accommodations that would include school staff auto-injector training and preparedness to act in an allergy emergency.

On behalf of the coalition, he has written letters to the Quebec camping association and to the president of the Office of Professions of Quebec, the provincial agency that reviews the regulations adopted by various organizations. Bélanger makes these groups aware of a regulation amendment that the Quebec College of Physicians proposed in June to allow non-medical persons to administer epinephrine auto-injectors.

The College of Physicians has a 45-day commenting period on changes, so while its proposed amendment will clarify the rules for non-medical people caring for allergic children and ultimately should have a positive impact on day camp rules, it won’t help parents and campers this summer.

Adults and children in a recent study could correctly identify, on average, fewer than half of an assortment of the peanuts and tree nuts that are among the most common food allergens in the
United States.

Parents of children with peanut and tree nut allergies did no better at identifying the samples in the survey than did parents of children without this food allergy. And only half of participants with a peanut or tree-nut allergy correctly identified all forms of the nuts to which they were allergic.

The 19 samples included various nuts in and out of the shell, and some were chopped, sliced or diced just as they appear on grocery store shelves.

The findings suggest that education about the appearance of all forms of peanuts and tree nuts is an important follow-up to the diagnosis of any kind of nut allergy, researchers say. An estimated 1.2 to 1.4 percent of Americans are allergic to peanuts or tree nuts.

“When we ask patients to avoid peanuts and tree nuts, we shouldn’t assume patients know what they’re looking for, because they may not. It’s worthwhile to do some education about what a tree nut is, what a peanut is, and what they all look like,” said Todd Hostetler, assistant professor of pediatrics and internal medicine at Ohio State University and lead author of the study.

The study included samples of peanuts as well as cashews, Brazil nuts, pistachios, almonds, pecans, walnuts, hazelnuts, Macadamia nuts and pine nuts. The research is published in a recent issue of the journal Annals of Allergy, Asthma & Immunology.

Next: Questions on 19 Nut Forms

New research out of Australia holds great promise. A study team announced in December, 2010 that they had discovered fragments of peanut protein that may be the key component to a peanut vaccine that could be given by injection.

Allergic Living’s Lisa Ferlaino spoke with Dr. Robyn O’Hehir, the team’s leader and a professor of allergy and immunology at Monash University in Australia, about the discovery and what it means.

Why the focus on immunotherapy as a treatment for peanut allergy?

“Allergen immunotherapy is the only treatment that can actually change the natural course of allergic diseases. We know from the aero-allergens such as house dust mites and grass pollens, and even from bee and wasp venom, that allergy shots make a big difference in people’s lives. That’s what we’re striving for.

We also know that peanut allergy is becoming more common worldwide, and that people find traces of peanut in unexpected foods. That’s one of the reasons avoidance isn’t really sufficient.”

Peanuts have long been viewed as too risky for immunotherapy, too likely to provoke anaphylaxis. How do you address that?

“By studying the white blood cells of patients with peanut allergy, we’ve been able to narrow down the core epitopes – the critical fragments of peanut protein that drive the allergic response in people with peanut allergy – and we’ve identified ones that are too small to cause anaphylaxis. They won’t bind to IgE [allergy antibodies], but they’re big enough to kickstart the immune system to develop tolerance.”

Are these fragments parts of peanut’s infamous Ara h 1 and Ara h 2 proteins?

“Yes. We’ve identified the critical peptides [protein fragments] in Ara h 2, the major peanut allergen. That’s the one most associated with anaphylaxis. Ara h 1 is also important, and we’re well on the way to identifying the critical peptides in it, too.”

There are a few peanut therapies in the works. Is your research unique?

“There’s a lot of research in animal models [using mice], but our research looks at human white blood cells. That’s important, because peanut allergy is not a natural condition for mice.”

Next Page: More questions on the vaccine

Following are some key points from her interview with lead investigators Dr. Steve Taylor and Dr. Joseph Baumert of the Food Allergy and Resource Program (FARRP).

Bio information: Dr. Taylor is a food scientist and the director of FARRP at the University of Nebraska-Lincoln with degrees in food science and biochemistry. Dr. Baumert is a food scientist and co-director of FARRP, with degrees in animal science and food science.

Gwen Smith: Gentlemen, thank you for your time today. Let’s start with the bigger picture for AL readers: What is the purpose of establishing a safe level of peanut for the peanut-allergic?

Steve Taylor: The purpose would be to establish target levels for the food industry and for public health agencies such as the Food & Drug Administration to use to guide product labeling.

GS: And you’ve spoken before of the concerns for consumers with allergies in the family ….

Joseph Baumert: This is very important. What we see is with the proliferation of these precautionary or “may contain” labels. Without some benchmark level that regulatory agencies or food companies can go by to know when there is a legitimate need to use that type of advisory labeling, it continues to proliferate. It’s to the point now where consumers are confused as to whether there’s actual risk involved.

On the consumer side, as an endpoint, we’d like for those individuals to be able to feel confident that if a product has a precautionary label on it, there’s a definite reason that they should avoid. Whereas, if it doesn’t have that [may contain] label, it’s because it does not fit that benchmark dose below which the vast majority of allergic individuals would not react if they bought that product. That would open up a lot more choices for allergic consumers.

ST: I think you can appreciate the predicament the food company faces without thresholds. They really don’t want anybody getting sick from their product.

But without the guidance of thresholds, they may slap terminology like “manufactured on shared equipment with peanuts” or “manufactured in the same facility as peanuts”, or “may contain peanuts” on a whole litany of products where the risk of peanut exposure is really pretty small. Now, we have to make sure that it’s so small that there would be almost no risk of a reaction.

GS: Now if I’m the average parent of a peanut-allergic child, probably I’d probably contend that the safe level of peanut in a food product is zero. But for you two, as the experts on food science, you would say that, no, a level of zero isn’t possible. Can you explain to readers, who aren’t food scientists, why that’s so?

NHL & NBA owner Ted Leonsis

From hanging out with movie stars to schmoozing with international royalty, Ted Leonsis enjoys a pretty glamorous lifestyle. Still, days spent on planes, film sets, galas and sports arenas present a special challenge for the Internet executive turned sport-team owner and filmmaker. That’s because Leonsis lives with life-threatening allergies to peanuts and tree nuts, not to mention environmental allergies and asthma.

Leonsis, who’s best known for owning the NHL’s Washington Capitals and the NBA’s Washington Wizards, spoke to Allergic Living’s managing editor Kim Shiffman and revealed a lot about balancing an on-the-go lifestyle with his severe allergies.

Exactly what are you allergic to?

I’m allergic to every nut imaginable, plus cats and dogs, dust, mold, all the pollens, trees and grass. I’ve got a litany.

When were you diagnosed?

When I was a baby, my mom knew something was wrong with me because of how I would react to some foods. It was hit or miss, and she just thought, “Boy, guess he didn’t like that.”

Then one day I went shopping with her at Christmas, and they were roasting nuts in the store. The steam was going up in the air, and as we were walking down the aisle, I went into anaphylactic shock. An ambulance came and they took me to hospital. My mother didn’t know what had happened, but the doctor asked a lot of questions, sent me for skin tests and that’s when they realized how much allergy I had.

What’s the worst allergic reaction you’ve had?

One I remember that was really, really bad happened when I was 9 or 10. I went to a sleepover at a friend’s summerhouse, and he had cats. It activated a really bad asthma attack; I couldn’t breathe and got a bad headache. They took me to the hospital.

But more recently, in 2006, I was producing a movie – Woody Harrelson was in it and a bunch of other movie stars. We were on a studio lot in L.A. and it was late at night, maybe 10:30 p.m. Because it had been such a successful shoot, the crew ordered chicken-salad sandwiches from some famous L.A. restaurant. This is what they always did to celebrate.

The sandwiches came, and I took one. After a couple of bites, I noticed something crunchy. It was cashews. Immediately I started to get hives on my hands, then my ears, then my tongue. And I thought, “Here it comes.”

Next page: “They’re going to find me dead in this bathroom!”

At age 7, Alexandra took such delight in being a Girl Scout Brownie. She wore her Brownie vest proudly, earned “Try-It” badges with enthusiasm and sold an impressive number of cookies during the annual sale. The kid was as dedicated as anyone else in her Brownie troop and she deserved this summer adventure. But I wasn’t sold. Was the camp ready for a child with life-threatening allergies to peanuts and tree nuts? Would she be safe?

Since her food allergy diagnosis at age 4, I had vowed to support Alexandra in enjoying normal life activities. Still, summer camp presented several unknowns, including a distant location and a new group of caregivers. Plus, my daughter was still very young. I argued with myself about the pros and cons of each decision. If I let her go to camp, was I risking her health? If I didn’t let her go, was I risking her self-esteem?

Before my husband and I had made a decision, I happened to be chatting with another Girl Scout mom. She was concerned about camp, too. “My daughter is so small,” she explained. “I’m afraid if she sinks in the pool, no one will see her.” That’s when it hit me. Every parent worries about something. Worrying is not exclusive to parents of kids with food allergies. No matter what your situation, it’s not easy to let go. I decided to learn more about the program.

What I found out was encouraging. The camp didn’t serve peanut butter, employed a full-time EMT and trained its staff in EpiPen usage. After more discussion, we decided to give it a go.

When the first day of camp rolled around, my daughter’s eyes sparkled with happiness as she boarded the bus and waved goodbye. And when I picked her up at the end of her first day, she was tanned, tired and happy. I relaxed just a little. Maybe things would be just fine.

But on the second day, the phone rang. I could see it was the camp. My heart raced as I choked out a greeting. “This is the medical office,” said the voice on the line. No! My heart was pounding so hard that I barely heard the next sentence. “Alexandra scraped her foot on the bottom of the pool and was bleeding, so we gave her a Band-Aid. It’s camp policy to report any injuries that result in bleeding.”

I exhaled and hung up. Minor bleeding was definitely preferable to a food allergy emergency. A scraped foot? No problem.

On Day 4, another call from the medical office. I tried not to panic. Turns out, it was just another minor injury, once again resolved with a simple Band-Aid.

On the last day of camp, the Girl Scout leader called me from her cell phone. I was sweating as I answered, convinced that this had to be “The Call.”

“Is Alexandra OK?” I blurted out. “She’s fine!” was the cheerful reply. Apparently, my daughter had been offered a snack at a campfire celebration and wanted to double-check with me before eating it. I was giddy with relief as I thanked the troop’s leader and gave a thumbs-up to the treat.

When I hung up, I couldn’t do anything but laugh. After all of my concern and repeated phone calls from camp, we had made it through the week without a single food allergy emergency. Even better, I now had solid evidence that my daughter was checking foods before eating them – a huge step in her food allergy independence.

That summer, we both gained a lot of confidence about the future. Our camp experience taught me that even though food allergies require planning ahead and certain precautions, they do not define my daughter.

Another important thing I learned? Along with the EpiPen, never forget the Band-Aids.

Jenny Kales is the author of the blog The Nut-Free Mom and a freelance writer who covers parenting topics. She and her husband and two daughters live near Chicago. To comment on this article or to suggest your own Our Story, e-mail us at editor@allergicliving.com.

First published in Allergic Living magazine.
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Read also:

- Managing a Peanut Allergy
- Dating with Allergies
- Flying Tips
- Nut Allergies at School