“It’s hard,” my doctor warned. As she palpated my throat and peered into my ears, we talked through why doing it would be good for me, despite the challenges. I had no dire disease. I ate colorful balanced meals. I exercised 45 minutes every day. But life had always presented low-grade symptoms: fatigue, medium vitality, puffy face, lethargy after eating and a suspicion that gluten wasn’t doing this particular body good. Staring down the tunnel at my mid-30s encouraged me to figure it out. Without cash for a fancy food intolerance blood test, I had one option: the anti-inflammation diet.
It required a six-week commitment to cutting out dairy, potatoes, gluten, wheat, rye, barley, all sugars, soy, corn, caffeine and anything refined. Then when your body is cleared, you reintroduce each food one at a time and take note of your reaction. Sort of like a science experiment.
“Oooh, no bread or cheese,” I said with a wince. “My staples.”
“I know.” She nodded.
“No anything,” I added. Yikes.
Little did I know that “doing without” would be the least complicated part for me. Anyone can stop eating a certain food. But separating yourself from the masses via food choice leads to social ramifications — an outcome I should have anticipated, since I too had rolled my eyes at the recent gluten-free fad. All across America, Gen Y women, and some of their hip elders, were attaching the label to themselves as if it were a sparkly tiara. Having grown up abroad consuming unmentionables like pâté and contaminated drinking water, I did not want to associate with a righteous crew cringing at wheat products. But lean, healthy food did matter to me, enough to have devoted my young adulthood to laboring on organic farms and apple orchards.
“Let’s do it,” I blurted out to my doctor. She handed me the Do’s & Don’ts sheet and I dashed home, excited.
“What can you eat?” asked my husband.
“Vegetables, whole grains, wild game.”
He wanted to try it with me.
After three days, he backslid, salivating, to his coffee, milk, cheese and bread. I stuck it out because I had to.
Week by week, small miracles happened.
First, the brain fog lifted. Instead of plodding, I pranced from task to task. Moods evaporated. PMS gone. Cramps? Poof. I woke ready for the amazing day ahead, and if that involved being on hold for 52 minutes with my credit card company, then so be it. Life was grand. Some might have even called me perky. People would search my eyes and say, “What’s changed? Something’s changed.” I would fill them in on what felt like my own private revolution: I’ve been drugged my whole life. Did I temper my response? No. The newly indoctrinated are always high on their discoveries.
But my discovery was not yet complete. With a few weeks to go before testing, the culprit had not been tagged. I still wanted to poke my head into every home and say, “Do y’all know about this?”
And therein lies the problem.
Never, no matter what, preach.
Aware of my potential to saturate people with this exuberance, I tried to play it cool when my in-laws arrived for a visit. No one they knew would ever “do” such a diet. It must have looked ridiculous to them. I explained it minimally. But soon my special bowls of quinoa started to make me uncomfortable.
One night, my mother-in-law announced that she’d like to make a deer roast. Perfect: vegetables, whole grains, wild game.
“Now that I can eat!” I announced.
Dancing around the kitchen, I chopped carrots as relief washed over me, so pleased that I would finally be able to join the family, participate in my mother-in-law’s cooking and not linger as the outsider. She seemed relieved, too.
But when I spun around to a vision of her dusting white flour over the meat, my heart sank. I was kaput. She probably assumed that a little flour didn’t count. It wasn’t a hunk of bread after all. How could I explain — without sounding like an ingrate — that even a little bit of flour would destroy the experiment I had been so carefully developing for over a month?
Nervous and tongue tied, I waited until the last and worst moment.
“Molly, would you like some?” she asked, holding a thin slice of meat over my plate.
Let’s just say that I stumbled. I tried to make a joke. Like a fool, I apologized.
Everyone tried to change the subject.
How do you stay a decent member of society while abandoning the foods that most people eat every day? No one instructs you on this process. And charting that awkward terrain was only just beginning for me. After introducing each food individually, the culprit appeared. My gluten sensitivity manifested quickly: sleepy, bloated, irritable, headache. Dairy also turned my stomach. I had officially morphed into that chick with the hoity-toity food intolerances. Now what? No one opts out of the ancient act of communal eating. Food lubricates conversation. If you eat this and I eat this, then we are friends.
Time passed.
My siblings croaked over the phone, “Do you eat anything?”
At first, I avoided dinner parties. Then I brought my own food to them.
One afternoon, as a friend hounded down a barbeque sandwich and I sipped on water, he made this comment about a mutual friend: “She isn’t picky at all. She eats anything. I love when a person is open like that.”
Whether he meant it as a sly attack or not, the message was clear. That gung ho woman was not me. She probably flitted around carefree. I, however, was “picky.” And who wants to be that? The word even sounded bad — constrained, hair tight in a bun, so damn un-fun. Though I did not have celiac disease or a deathly peanut allergy, I had become the Queen of Intolerance herself, proud of her pantry of grains and refrigerator bursting with raw vegetables.
Here’s the thing: Food gets personal, cultural and economic. People bare teeth to defend why they eat what they eat. Even I had started to. It’s deep-in-the-gut primal. So, after his comment, I began to steer toward the middle road. When a friend’s toddler baked a cookie just for me, I ate it. My whiskey glass, despite the rye, raised itself during a celebration. At the home of a sourdough bread baker, wheat melted in my mouth.
Sometimes, we have to weave between honoring community and self.
All of which cemented my approach.
Now, six months later, I’ve figured out my how. At home, I cook up food that energizes me — which means no gluten or dairy. I no longer apologize for that choice. I am picky about what nourishes me because being deflated doesn’t serve me, or anyone around me. But it is not my dogma. Though I’m willing to be insane and buy gluten-free oats for $3/lb., I refuse to lose grace with my friends or hosts. I don’t flag the term gluten-free around. At a dinner party, I scan the scene, stick to wine and dodge appetizers. But when we sit down to great grandpa’s lasagna recipe, I ask for a small slice and partake. Isn’t sharing food one of the ultimate nourishments for the soul? Worst case: I end up bloated, excessively tired and cranky for a few days. That’s OK. That I can tolerate.
Gwyneth Paltrow gushes over gluten-free. Chelsea Clinton’s wedding cake was baked without it. The new Old Spice guy avoids the ubiquitous protein to help stay buff. In fact, odds are good you too have tried — or at least encountered — a product with the gluten removed.
Because gluten-free is what low-carb was a decade ago: The “it” diet discussed on daytime talk shows, promoted by hyper-slim actresses and adopted by masses. Grocery aisles are stocked with the likes of gluten-free pasta, crackers, cereal and beer.
Americans are enthusiastically exiling a dietary staple that wasn’t even in most people’s vocabulary a decade ago.
But why?
Unlike some other dietary boogeymen like trans-fats, gluten is not inherently bad to eat. Only a small percentage of people can’t tolerate the protein, which occurs naturally in wheat, barley and rye. Plus, banning gluten from your diet can be really hard.
Not only is gluten an essential element of traditional breads and pastas (it’s the protein that gives them their structure), it often is used as a thickening agent in processed foods, such as ketchup and ice cream. And cutting out gluten is no guarantee of weight loss.
The fad seems to be partly fueled by the celebrity factor: Paltrow talks it up on her website, Clinton stirred online chatter this summer when she ordered a gluten-free cake for her big day, and the muscular guy on the funny Old Spice commercials recently told Jay Leno gluten is one of the things he cut from his diet.
Then there are the claims that going “G-free” makes you feel more energetic.
“I feel better when I don’t do it. If I go out to a restaurant with friends and I have a beer and a plate of pasta I’m going to feel it the next day. No one wants a gluten hangover,” said Silvana Nardone, former editor-in-chief of Every Day with Rachael Ray magazine. Nardone, the mother of a teenage boy with a gluten intolerance, just released a cookbook of gluten- and dairy-free recipes titled “Cooking for Isaiah.”
These sort of claims are common, if hard to prove. But that hasn’t slowed the industry’s growth.
U.S. sales of gluten-free food has more than doubled since 2005 to over $1.5 billion, according to the market research company Packaged Facts. And the growth spurt is expected to continue at least through 2012.
Gluten does affect some people, notably people with celiac disease. But celiacs, who suffer an immune reaction if they eat food with gluten, such as bread or pasta, are estimated to represent less than 1 percent of the population.
Some other people have less severe gluten allergies or sensitivities. Dr. Alessio Fasano, director of the Center for Celiac Research at the University of Maryland School of Medicine, figures that up to 7 or 8 percent of the U.S. population have some kind of sensitivity to gluten.
Yet about a quarter of U.S. adults are either trying to reduce or completely avoid gluten in their diets, according to the marketing firm NPD Group’s Dieting Monitor. That means most of the people eating gluten-free foods probably don’t have to, but want to.
“Some of the people we’re talking about most are people who are dabbling in raw foods and dabbling in vegan and dabbling in different things and they see gluten-free as part of that world,” said Shauna James Ahern, better known as the popular blogger “Gluten-Free Girl.”
Ahern, diagnosed with celiac at age 38 after feeling “low-level lousy” her whole life, said that even as dabblers drop the diet, they build awareness of gluten-free, which leads to more people getting diagnosed. That’s why she thinks the diet will still be around in a decade.
Many of these gluten watchers are people like Akiia James, a 33-year-old news producer from Durham, S.C., who already was healthy and fit before she decided to cut out gluten and dairy several months ago.
“The main thing is just feeling better after you eat, not feeling the weight of eating,” James said. “I mean, I never anymore feel like I’m stuffed … I think I still eat the same amount, but the ingredients play a big part.”
Why people report feeling better is not totally clear. And the connection may be indirect. People who eliminate gluten-rich foods may eat more produce, and therefore have a healthier diet overall, said Dee Sandquist, a spokeswoman for the American Dietetic Association.
Fasano suggests that gluten is generally harder to digest, perhaps because it was only introduced to the human diet about 10,000 years ago. In evolutionary terms, that’s not a lot of time to adapt to digesting a new protein.
Dr. Brian Bosworth, associate director of the Gastroenterology Fellowship Program at New York Presbyterian Hospital/Weill Cornell Medical Center, noted that while gluten can certainly be an irritant to some people, he wouldn’t make a blanket statement that it’s harder to digest for everyone.
“I don’t think that, in general, that there’s a reason to strictly avoid it,” said Bosworth, who has celiac disease.
Sandquist says there’s no harm in avoiding gluten, as long as you eat a balanced diet. But she said it can be a challenge to eat a nutritionally sound without gluten, despite the recent proliferation of products.
And watch out: just because a product is labeled gluten-free doesn’t mean it’s low in calories. And some gluten-free prepared meals can run high in both calories and salt.
“There are just as many calories, if not more, depending on the food choices,” Sandquist said. “It’s all about the food choices.”
We were in Hawaii five years ago, eating at the kind of fish restaurant where, maybe, you’d want to wear a shirt with sleeves and shorts that didn’t double as a bathing suit. Once we were seated, our waiter got all poetic about the nut-crusted opa and Mom warned him that she had food allergies, just a few. From his back pocket, the server immediately withdrew a deck of pink cards that looked like a prescription pad, thumbed one off the top of the stack and placed it down on the table. Bookended by triple asterisks, it read “GUEST ALLERGY CARD,” all bold, all caps; its instructions: “List All Problem Foods.” The word “All” was double-underlined for emphasis because double-underlining, it seemed, was the top defense against anaphylactic shock.
It was a surprising intervention at the time, this card, but its presentation had a clear antecedent. Even five years ago, benchmark publications like the Journal of Allergy and Clinical Immunology and Current Opinion in Immunology were releasing figures signaling an allergic surge. The number of people reporting peanut allergy had doubled. Food allergy on the whole was escalating. It now affects 6 percent of young children and 3-4 percent of adults in the United States. Emergency rooms are seeing an estimated 125,000 patients annually for food allergy, and 15,000 patients per year for food-induced anaphylaxis. Eager to self-diagnose as we are, between 20 and 30 percent of Americans now believe they have some kind of food allergy whether, in fact, they do.
This spring, British researchers are embarking on what’s said to be the largest ever clinical trial having to do with peanut allergy. By administering low doses of peanut to allergic patients, they’re hoping to eliminate the allergy in three years. But the answer to the problem of life-altering, even life-threatening, food allergies may lie somewhere far from desensitization models and British laboratories. The answer might, in fact, be Chinese and thousands of years old.
Dr. Xiu-Min Li, the director of Mount Sinai Hospital’s federally funded Center for Chinese Herbal Therapy for Allergy and Asthma in Manhattan, has had success treating asthma with traditional Chinese medicine (TCM) — using an herbal therapy of her own devising. About 10 years ago, Li began wondering whether TCM might also be applied to food allergies since allergic asthma and allergic reactions to food have similar immunological blueprints. While there’s no actual mention of food allergy in traditional Chinese medicine, a complete medical system in which the taste of an herb helps determine its therapeutic function, there is talk of symptoms like those experienced during an allergic reaction.
“I found information about one formula in particular,” says Li. “It dealt with parasites and was used when people got stomach problems, vomited, and lost sensation after eating. It sounded like what we now call anaphylaxis.” The formula, called Wu Mei Wan, dates back nearly 2,000 years and was recorded in the Shang Han Lun, one of the classic tomes of traditional Chinese medicine and a basis for all of its future pharmacology. Li and her team of chemists, biologists and researchers modified this original formula by adding to its preexisting mixture of 10 botanical ingredients, an 11th called Ling Zhi, or, “wooden mushroom,” so-called for its ligneous appearance.
“It was like discovering an ancient treasure,” says Dr. Li. “But this formula is really based on our advanced knowledge of chemical footprints, what we know about the general principles of food allergies, and the critical knowledge we have about drug manufacturing.” It melds together the ancient system of Chinese healing, its emphasis on energy flow and systemic balance, with cutting-edge biochemistry. “We know all the molecules,” says Li. “It’s not like we just go into the woods, find a magic mushroom, and say, here’s our medicine. Every chemical is mapped, every component is tested.”
Researchers have yet to single out a cause for the surge in food allergy rates, but are looking into a host of hypotheses. They involve things like: time of exposure to popular allergens (how old we are when we first eat or touch certain things), the way processing methods affect food proteins (for example, a dry roasted peanut, the kind we eat, is far more allergenic than the boiled and fried ones popular elsewhere in the world where peanut allergy is virtually nonexistent), personal hygiene (we’re so clean we’re misprogramming our immune systems to attack the wrong things, like food proteins), genetics (there is a link), and a host of environmental factors (air pollution, whether it’s better to live on a farm).
In terms of finding a cure, human clinical trials have only been going on for the last five years or so. If you are allergic to a food, clinical wisdom, just like the “GUEST ALLERGY CARD,” holds you simply don’t eat it. Hippocrates, in ancient Greece, suggested ingesting small, incremental doses of the allergen — this, an early stab at oral immunotherapy and thus the aforementioned desensitization method — until tolerance was established. “Most [food allergies],” he said, “are curable by the same means as those by which they are produced.” But his method ran the risk, as it still does now, of provoking a reaction. Oral immunotherapy can be effective. A 2009 study at Duke University has, in fact, demonstrated that children with peanut allergy can establish tolerance after an eight- to 10-month course of treatment, during which they ingest portions of peanut in doses starting as small as 1/1000 of a nut. The problem with this method, however, is that no absolute guidelines for efficacy or safety have yet been found.
Notably, Li’s formula — Food Allergy Herbal Formula 2, or, FAHF-2 — which her team has simplified over the course of their research, is the only investigatory oral food allergy treatment not to contain even a modicum of a popular allergen. Its components are Chinese plum, Sichuan pepper, coptis rhizome, philodendron bark, dried ginger rhizome, cinnamon twig, ginseng root, Chinese Angelica root, and the potent wooden mushroom. There’s no nut in it, no shellfish, no milk. It goes another route entirely by, not, as Li, says “targeting specific allergens.” Instead, it seeks to create a totally balanced immunological response, in which all the relevant cells, chemicals and molecules respond to a perceived toxic situation by working in concert with the drug to maintain equilibrium.
“It’s the first immunotherapeutic approach to completely protect against peanut-induced anaphylaxis in an animal model,” says Dr. Julie Wang, the principal investigator for Li’s herbal trials. And since it’s uncommon to have an allergy to just one food, FAHF-2 also works in a multiple-allergy food model, meaning it’s been shown to suppress allergic reactions in mice with coexisting peanut, fish, and egg allergies. It also provides long-term protection, keeping allergies at bay for up to nine months in mice (a quarter of their lifespan) after treatment ends.
Most recently, FAHF-2 completed an extended Phase I human trial with 18 participants, including children, taking the formula three times a day for a period of six months. Plans are in place to start a larger Phase 2 trial this spring with 60 participants, further exploring its safety and finally getting into the all-important matter of efficacy in humans. Li and Wang believe their herbal trials will conclude, if all goes well, with the backing of both the federal government and a major pharmaceutical company in about two years’ time — a year ahead of the British study. “It’s the trial I’m most curious about,” says Dr. Hugh Sampson, one of the foremost leading figures in food allergy research, the director of Mount Sinai’s Jaffe Food Allergy Institute, and a co-patent holder on the formula. “It’s so different than anything I’ve been brought up to do. In the animal model, it looks very promising. Then again, scientists have cured mice of many diseases, so we’ll see what happens”
One of the most baffling moments of my undergraduate experience occurred late one night, when a student with a severe peanut allergy returned home from class to discover that her bedroom door had been smeared with peanut butter. When exposed to even small amounts of peanut, the girl’s windpipe could clamp up — and she could go into shock. She immediately left the dorm, never to return. (The culprit was later discovered to be another student who had taken issue with something the girl had said.)
Even if you haven’t experienced as dramatic a peanut-related incident as that, if you’ve eaten at a camp or at a college cafeteria in the last few years you’re aware that food allergies are no laughing matter. Peanut allergies affect 2 percent of Americans, and, according to the Asthma and Allergy Foundation of America, are the most common cause of death by foods. Soon, if one group of British doctors are successful, that may be a thing of the past.
As the Telegraph reported over the weekend, British researchers are about to launch the largest-ever investigation on peanut allergies, using 100 children between the ages of 7 and 17. This work is follow-up to a successful smaller study, conducted by researchers at Addenbrooke’s hospital in Cambridge, England, in which 20 of 23 participants were able to overcome their allergies by gradually being exposed to larger and larger amounts of peanut. Dr. Andrew Clark, who works for the hospital, told the Telegraph that he wants to establish a “clinical treatment that … could spread to the rest of the country” and he’s anticipating that such a result could happen within the next three years (something the Telegraph is touting as a “cure”).
For thousands of children even a small exposure to peanuts can cause a sudden release of histamine and other chemicals into the bloodstream, which can lead to swelling and anaphylactic shock (which can, in turn, constrict airways, cause heart failure and death). The cause of the allergy isn’t clear — it isn’t tied to consumption during pregnancy and it may or may not be linked to levels of early childhood exposure — but the number of children affected by food allergies has been on the increase over the past decade.
The so-called desensitization treatment used by the British doctors isn’t entirely new either. Last year, doctors at Duke University used a similar treatment on 33 children with peanut allergies. They slowly increased the amounts of peanut that the children would consume, from 1/1000 of a peanut to 15 peanuts per day. By the end of the study, four of the children were able to stop treatment and continue eating peanuts — a result confirmed by immunological indicators.
Unlike many other trials, the Brits didn’t use injections, but mixed peanut parts into yogurt. They gradually increased the children’s tolerance over two years until some could consume five nuts at a time. As Dr. Clark said, at the beginning “they would worry it would cause a reaction or even kill them,” but now “they can go out and eat curries and Chinese food and they can eat everyday snacks and treats.”
In the long run, Clark claims, the strategy may also be applicable to other food allergies — a bit of news that is sure to get many parents very excited, and could make the lives of a lot of dining hall chefs considerably easier.
To The Editors of Salon.com:
In a recent posting, “The fear about peanut allergies is nuts,” Rahul K. Parikh, M.D, voiced his opinion that food allergy statistics are not valid, in particular those provided by FAAN. We would like to correct some of Dr. Parikh’s errors, misconceptions and mis-statements.
Dr. Parikh would have his readers believe that the data is not based on science, but hearsay. FAAN is a science-based organization. The statistics reported by FAAN are from peer-reviewed studies published in leading medical journals. The studies used survey instruments set up to weed out non-allergy reports. The limitations to the studies have been noted in the published articles.
Most recently, government agencies such as the CDC and FDA have published their own independent studies and the data estimating the incidence of emergency room visits was published by a group at the Mayo Clinic in Rochester, MN.
The FDA study by Ross MP, et al titled, “Analysis of food-allergic and anaphylactic events in the National Electronic Injury Surveillance System” (NEISS) reviewed data from 34 EDs from Aug 1 to Sep 30, 2003. Extrapolation of NEISS data predicts 20,821 hospital ED visits, 2,333 visits for anaphylaxis, and 520 hospitalizations caused by food allergy in the U.S. during the 2-month period studied.
The recent CDC Study (Branum AM, Lukacs, SL, “Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations.” National Center for Health Statistics, Centers for Disease Control and Prevention Data Brief) reported an increase in food allergy among children and a 3.5-fold increase in approximately 9,500 hospital discharges related to food allergy among children under 18 years of age during the period 2004 – 2006 compared to the period 1998 – 2000.
Regarding the estimated incidence of anaphylaxis outside the hospital setting, the Decker WW, et al. study titled, “The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project” (REP) published in the Journal of Allergy Clin Immunology is based on the medical records of nearly all the residents of Olmsted County. It is one of the few places in the world which can provide data for the occurrence and natural progression of disease over the past 50 years. More than 900 publications have been produced from the REP. Extrapolating from that data, the investigators estimate 150,000 reactions per year for anaphylaxis and 50,000 for food allergy, representing a significant increase. The Rochester Epidemiology Project is funded by the National Institutes of Health. The data from which statistics for food allergy are derived is based on well accepted standard scientific methods of reporting epidemiology.
Dr. Parikh states that “Several states have passed laws mandating public schools be ‘peanut-free zones.’” We are unaware of any states at all that have passed such a law.
FAAN clearly acknowledges that there are children who have been diagnosed by blood test results alone. Our organization tries to help families find physicians who will be able to accurately diagnose their child’s food allergies in order to avoid unnecessarily restricting a child’s diet. In 2007, FAAN co-sponsored a meeting with the National Institutes of Allergy and Infectious Disease (NIAID) and the American Academy of Allergy, Asthma and Immunology (AAAAI) to assess the need for developing national guidelines for the diagnosis and treatment of food allergies, in order to help physicians who are not trained in allergy learn to evaluate and eventually treat food allergy. The NIAID is continuing this important work.
Until there is a cure, education is the key. FAAN’s goal has always been and will continue to be to educate, advocate, and support research to help individual families cope with their child’s food allergies in order to keep children safe. We will continue to follow and report on the peer-reviewed published scientific literature.
FAAN Medical Advisory Board Members
Hugh Sampson, MD, Director
Allan Bock, MD
Wesley Burks, MD
Clifton Furukawa, MD
John James, MD
Stacie Jones , MD
Todd A. Mahr, MD
James Rosen, MD
Scott Sicherer, MD
F. Estelle R. Simons, MD
Steve Taylor, PhD.
Robert Wood, MD
John Yunginger, MD
Robert Zeiger, MD
In 2005, a 15-year old Canadian teenager named Christina Desforges kissed her boyfriend and died. Her death, reported around the world, was initially blamed on peanuts. Desforges was allergic to peanuts and her boyfriend had eaten peanut-butter toast hours before their deadly smooch.
Sudden death due to an allergic reaction to food is known as anaphylaxis. When you eat peanuts (or some offending food), you break out in hives, your face swells and your larynx constricts until you can no longer breathe, all in a matter of minutes. Shocking. Tragic. Scary.
Desforges’ story is the kind that has moved anxious parents, politicians and school board members to join a crusade against peanuts. Several states have passed laws mandating public schools be “peanut-free zones,” and parents now hover over food labels with Draconian vigilance, checking and double-checking them for signs of peanuts. Could that knife that just cut the birthday cake have been in the vicinity of peanut butter?
Peanut-allergy panic has spread across the nation. In a recent essay, Harvard physician and sociologist Nicholas Christakis relates an incident in which a peanut was spotted on the floor of a school bus, “whereupon the bus was evacuated and cleaned (I am tempted to say decontaminated), even though it was full of 10 year olds who, unlike 2 year olds, could actually be told not to eat off the floor.”
Actions like that are no doubt overdue in the minds of organizations like the 30,000-member Food Allergy and Anaphylaxis Network (FAAN), a Virginia-based advocacy organization that has led the fight to raise awareness about peanut and other food allergies in both children and adults. Go to its Web site and you’ll see some eyebrow-raising points.
• The incidence of food allergies has doubled over the past 10 years.
• Food allergy is believed to be the leading cause of anaphylaxis outside hospitals, causing an estimated 50,000 emergency department visits each year in the U.S.
• Each year in the U.S., it is estimated that anaphylaxis caused by food results in 150 deaths.
Those FAAN numbers get cited in nearly every news report about food allergies. The organization’s founder, Anne Munoz-Furlong, mother of a food-allergic child, is well known in the media as a food allergy expert. She has done her own research and her studies have been published in medical literature. Now major medical groups, like the American Academy of Pediatrics, have recommended that children avoid eating peanuts until age 3. As for consuming other potentially allergic foods (such as strawberries or dairy), the AAP has, until recently, suggested that kids wait until age 2.
But on closer examination, food allergies are not the epidemic we’ve been led to believe. FAAN’s advocacy may have helped to create rules and laws that are based less on sound science than on a significant misrepresentation of facts. Ironically, by accepting these facts, we may be increasing our risk of developing food allergies.
Consider the claim that food allergies have doubled. FAAN states it drew this conclusion in part from doctors’ “reports” (that is, anecdotes and not hard data about confirmed allergies). FAAN’s claim is also based on a study looking at the prevalence of peanut and tree nut allergies. In that study, funded in part by FAAN, researchers, one of whom was Munoz-Furlong, obtained data by conducting a telephone survey, in which they asked questions about whether someone at home has a nut allergy.
Besides the problem that FAAN took information about a specific type of food allergy and applied it to all food allergies, telephone surveys are notoriously inaccurate. They’re subject to recall bias: People have to pull events out of imperfect memories.
There’s also good evidence that parents overestimate the prevalence of food allergies in their kids. In one 2005 study, parents reported that 7 percent of kids under age 3, 10 percent who were age 3, and 8 percent over 3 had food allergies. But when researchers tested those kids to confirm these self-reported diagnoses, there were no confirmed cases under 3, only 2 percent at age 3, and 1 percent over age 3. Other studies have shown similarly large discrepancies between what parents believe about food allergies and what tests confirm.
Further, what constitutes a peanut allergy for a parent is not what constitutes it for a doctor. If a child has diarrhea or vomits after eating nuts, it may signal a food allergy, but it may also mean food poisoning. The FAAN study did not confirm its subjects’ claims that they were allergic to nuts. That would have required medical records and testing, neither of which were included in the study. Valid confirmation depends on a blood or skin test. Potential allergens are placed on or just underneath the skin to see if they trigger a localized allergic response. Although even those tests can be unreliable, as they don’t always pinpoint which food may or may not be the problem.
Let’s look at FAAN’s claims that 50,000 people a year end up in emergency rooms with allergic reactions and that between 150 to 200 people die each year from anaphylactic shock. That 50,000 is extrapolated from a study in which researchers looked at emergency room visits, due to anaphylaxis, in a single hospital over 10 years. The number of visits during one year was actually 211. The researchers then estimated that 211 people from one E.R. adds up to 50,000 people across the country. Whether that’s true remains to be seen. There’s no evidence that visits in one hospital correspond to visits in hospitals across the country.
What’s also misleading is how FAAN couches this information in its press kit: “Food allergy is believed to be the leading cause of anaphylaxis outside the hospital setting, causing an estimated 50,000 emergency department visits each year in the U.S.” In fact, the study is citing any cause of anaphylaxis. FAAN suggests that 50,000 people visit an E.R. due solely to anaphylaxis from food allergies. That’s simply not true.
The claim that 150 to 200 people die each year from anaphylaxis is grossly exaggerated. In 2004, the Centers for Disease Control cited just 14 deaths due to anaphylaxis. The only known registry of deaths from anaphylaxis noted 33 deaths between 1994 and 1999. Remember, all of these estimates refer to the total number of people who had an anaphylactic reaction for any reason, not just from peanuts or other foods.
Facts ought to be stubborn. In the past, Munoz-Furlong has stated that one child dying from an allergic reaction is too many. But Harvard doctor Christakis, again, puts things into perspective. “There are no doubt thousands of parents who rid their cupboards of peanut butter but not of guns,” he writes, comparing the alleged 150 children and adults who died from peanut allergies to the 1,300 who die from gun accidents each year. He goes on to note that 2,000 kids drown each year. Indeed, the most common cause of death in kids is accidents. “More children assuredly die walking or being driven to school each year than die from nut allergies,” Christakis writes.
The worst fallout is that doctors and medical groups who have fallen for the FAAN hype are doing more harm than good with their prescriptions to avoid peanuts. A study published last year compared the prevalence of peanut allergies in Jewish children in the United Kingdom (where young kids are told to avoid peanuts) with those in Israel (where peanuts are fine).
Unlike the survey-based studies before it, researchers administered two strictly validated questionnaires to identify kids with allergies. Then those kids were tested. In all, about 5,000 kids were included in each group. The result: Less than 2 percent of U.K. children were allergic to peanuts, compared to a mere 0.17 percent of Israeli children. The authors concluded: “Paradoxically [avoidance of peanuts] might be promoting the development of peanut allergies and could explain the continued increase in the prevalence of peanut allergies.”
For those who argue that heightened awareness about food allergies is more beneficial than underestimating them, consider the psyche of kids who fear they have an allergy. They often wear a bracelet or necklace identifying them as food allergic and carry injectable epinephrine wherever they go. While those measures are justified for truly allergic kids, what about those who may not be? Research has shown these children report feeling more anxious, restrict their activity and are more worried about being away from home than even children with Type 1 diabetes.
The mismatch between the fears and the facts is beginning to surface. Recently the American Academy of Pediatrics reconsidered its policy of preaching avoidance. In a statement, it declared: “It is evident that inadequate study design and/or a paucity of data currently limit the ability to draw firm conclusions about certain aspects of [allergy] prevention through dietary interventions.” In addition, a new international and comprehensive study is now under way to uncover solid data about the true incidence and prevalence of food allergies.
And what about Christina Desforges, the young girl who received the kiss from the peanut-contaminated lips of her boyfriend? She suffered from asthma and died of a severe asthma attack, likely triggered by smoke. A coroner reported that on the night she collapsed she had smoked marijuana and spent hours at a party where people were smoking pot and tobacco.
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