- The Washington Times - Sunday, December 17, 2000

Debbie Conner always has the cards nearby.

The little yellow cards, which Mrs. Conner got from the nonprofit Food Allergy Network, contain lists of foods that are not safe for her 5-year-old daughter, Erin, to eat.

For Erin, who has food allergies, there is no room for error no chocolate, no Chinese food and absolutely no peanuts.

With a peanut allergy as severe as Erin's, even a trip to the circus where peanut shells litter the floor can lead to an attack, Mrs. Conner says.

"I have been extremely ada-mant," says Mrs. Conner, of Sterling. "I don't want her to feel sick or label herself as different. We have been dealing with this since Erin was very small, so she doesn't know it any differently."

Peanut allergies present a huge challenge for both parents and children. Peanuts or traces of peanut oil can be found in everything from baked goods to candy to that common childhood favorite, peanut butter. So in addition to finding nutritious foods a child can eat and in Erin's case, that is complicated by a dairy allergy, as well parents have to educate their children and themselves as to what foods are safe.

If not, the results can be life-threatening. Allergic symptoms can range from upset stomach and hives to anaphylaxis, a constriction of the airway that demands immediate medical attention, says Dr. Dean Metcalfe, chief of the Laboratory of Allergic Diseases at the National Institute of Allergy and Infectious Diseases.

While some food-allergic children may outgrow dairy and egg allergies, a peanut allergy tends to stay for life, Dr. Metcalfe says. It also is rare to be only mildly allergic to peanuts, he says.

"Peanut is a serious allergy," he says. "Even a child who had a mild reaction the first time he was exposed to peanuts could have a severe one the next time. So if an allergy test confirms a sensitivity to peanuts, it is important to avoid peanuts and peanut products altogether."

About 3 million Americans have a peanut allergy and about 125 people die annually from it, according to data from the American Academy of Allergy, Asthma and Immunology (AAAAI), the professional organization overseeing more than 6,000 allergy specialists.

While the number of cases hasn't necessarily risen in recent years, public awareness of the problem has, says Dr. Martha White, an allergist at Washington Hospital Center and a spokeswoman for AAAAI.

"Peanuts are so commonly eaten, so there has been a big push to educate the public," Dr. White says.

A cure in sight?

The only way to prevent an allergic reaction is avoidance, Dr. White says. Unlike an allergy to pollen or pet hair, for instance, there are no shots or pills to ward off symptoms.

It has been particularly hard to study peanut allergies because of the potential danger in inducing a reaction in an allergic person, she says. However, researchers have recently narrowed down which peanut proteins may cause the problem and determined a genetic link to the disorder.

Several studies are now under way to test gene therapy as a vaccine. In 1999, doctors at Johns Hopkins Medical Center treated mice with a vaccine comprised of the gene for the anaphylaxis-producing antigen. Those mice in turn developed antibodies to the antigen and showed a substantial reduction in their reaction when given peanut particles, wrote Dr. Kam Leong, lead author of the study, which ran in the April 1999 issue of the journal Nature Medicine.

"We are hopeful that in the next decade, we will find a way to induce tolerance," Dr. Metcalfe says. "It seems doctors know enough about immunology now that we will get there, but just to get it through clinical trials would take at least five years."

Avoidance is not so easy

Avoiding peanuts and peanut-related products is not as easy as it sounds, says Anne Munoz-Furlong, founder of the Food Allergy Network. The Fairfax-based group offers advice for those with food allergies.

"Peanuts can be listed so many different ways on a label," Ms. Munoz-Furlong says. "They can be listed as ground nuts or monkey nuts. There is peanut flour in many cereals and soups. Cakes, cookies and crackers can pose a risk, too."

Reading labels is of utmost importance, but even that is not foolproof, she says. Food manufacturers voluntarily label "may contain peanuts" on their product only if they cannot guarantee cross-contamination with peanut-containing products.

"I have to read the labels on everything," says Jean Hunt, a Fredericksburg, Va., resident whose 8-year-old son, James, is highly allergic to peanuts. "I was going to give him an Eskimo Pie one day because I thought that was safe. Then I read the label, and it wasn't."

Even if a product was made in the same pan as something containing peanut flour, it could cause a reaction in someone who is severely sensitive, Ms. Munoz-Furlong says.

Being in the proximity of a peanut can cause a reaction as well. Erin Conner had a mild reaction when she stood close to a neighbor's bird feeder, which contained traces of peanut oil.

Traveling by plane, where peanuts are often served as a snack, is a problem for some extremely peanut-sensitive travelers. Two years ago, Congress considered but did not pass legislation that would ensure peanut-free buffer zones on flights. Now it is up to the traveler and the airlines to discuss safe seating, Ms. Munoz-Furlong says.

Mrs. Hunt worries about James' proximity to peanuts even at home. James has had four accidental exposures. One of them occurred at home after he and his brother, who is not allergic, shared a bowl of popcorn.

"My other son, Graham, is 12 and a picky eater," Mrs. Hunt says. "He likes peanut butter and jelly sandwiches. He ate his sandwich, and did not wash his hands and later shared a bowl of popcorn with James. James ended up having a reaction and we had to go to the hospital."

Mrs. Hunt and Mrs. Conner both are never without an EpiPen, an automatic injector that contains epinephrine, a form of adrenaline that can help prevent anaphylaxis if injected immediately

"I don't go anywhere without one," Mrs. Conner says.

An antihistamine such as Bena-dryl will also help with minor reactions, such as itchiness, Dr. White says. However, an EpiPen also needs to be on hand for the potentially severe reactions.

"The school should have one, the parent should have one," she says. "Everywhere the child goes, there should be one close by. It won't do any good if it is just sitting in your purse."

Being honest with an allergic child is also crucial to avoiding an attack, Ms. Munoz-Furlong says.

"Parents need to talk to their children," she says. "They need to know they cannot take chances."

Mrs. Conner says she has tried to communicate how serious Erin's allergies are and at the same time not scare her since Erin was very young.

"I would advise other parents to try and live life as normally as you can and to not make the child feel paranoid," Mrs. Conner says. "I have explained to Erin since she was very small that she has allergies, that she could get sick and stop breathing."

Mrs. Conner recently saw her work in action. Last Halloween, Erin knocked on a door in the neighborhood. Instead of saying "trick or treat," Erin announced: "I can't have chocolate or peanuts."

"At first I was embarrassed," Mrs. Conner says. "But then I was proud."

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