Children Having Allergic Reactions to Peanuts at Earlier Ages

RALEIGH, N.C. _ Children are having potentially life-threatening allergic reactions to peanuts at much earlier ages than a decade ago, signaling a need to be even more vigilant about offering toddlers and preschoolers that old childhood staple _ peanut butter and jelly.

Even though pediatricians recommend waiting until children are at least 3 to give them foods containing peanuts, Duke University Medical Center researchers found that kids born after 2000 experienced their first adverse reaction to them at a median age of 14 months.

Ten years ago, that median age was 2 years according to the Duke team, which published its findings Sunday in the journal Pediatrics.

The Duke findings are the latest wrinkle in a world where food allergies among children are so much more prevalent that some schools across the country have taken to banning peanut products altogether.

While peanut allergy is still relatively rare, affecting about 1.8 million Americans, researchers agree that the numbers are rising _ particularly among children. Studies suggest the incidence in children under 5 has doubled since 1997, though the Duke researchers and other scientists don’t fully understand why.

It could be that doctors are diagnosing the allergies more than in previous generations. It could also be that food-processing and dietary changes play a role, as do environmental pollutants.

One popular theory, according to the senior author of the Pediatrics article, is the so-called “hygiene hypothesis,” which, simply put, argues that our children are born into a world so scrubbed of germs and bona fide threats that the immune system begins to attack everyday substances such as peanuts, eggs, wheat or milk.

Dr. Wesley Burks, chief of pediatric allergy and immunology at Duke and senior author of the journal article, has been working on ways to densensitize kids to food allergies by exposing them to small doses of the allergens over time.

In collaboration with scientists at Arkansas Children’s Hospital, Burks’ lab reported early this year that they successfully reversed egg allergy in children by feeding them small but increasing amounts of egg protein.

Burks has been using the same approach with peanuts, though it likely will be years before the therapy is widely available.

Until then Burks suggests keeping an antihistamine such as Benadryl on hand in case of emergency. Serious reactions typically require treatment with epinephrine, a hormone that can quickly stop a life-threatening allergic episode.

Jodi Stokes, of Charlotte, N.C., had a huge scare two years ago with her youngest son.

Her older son, Kyle, was crazy about peanut butter so she had no reason to think Kevin, the youngest, might be allergic to peanuts.

Shortly after Kevin’s first birthday in July 2005, with the blessing of her pediatrician, Stokes spread some peanut butter on crackers and offered them as a snack.

Within a minute or two, as Kevin handled the crackers, Stokes noticed a bumpy red rash creeping up his arm. A moment later his eyes were swollen shut, his face had puffed to twice its normal size, and he was gasping for air.

“It was the scariest thing I’d ever seen,” said Stokes, who called 911. Kevin, now 3 years old, is a patient at the Duke pediatric allergy clinic. “He was unrecognizable within minutes.”

A child’s first exposure to peanuts might not come from food they eat, Burks said.

Exposure could come in the womb, if Mom eats peanuts. Or a youngster could touch or inhale peanuts present in trace amounts around them at home or day care. More study is needed to understand that aspect of the phenomenon, Burks said.

A person’s immune system must have already encountered an allergen at least once in order for their body to react to it.

After the first exposure, the immune system marks the substance as foreign and begins to produce antibodies to the allergen. The next time the immune system encounters the substance it attacks, triggering a powerful reaction that may include itching, swelling, rashes, vomiting, diarrhea, coughing and wheezing. If the reaction is severe enough, a person can go into what’s called anaphylactic shock, which can kill.

Up to 200 Americans die from anaphylactic shock caused by food allergy each year, according to the Food Allergy & Anaphylaxis Network, a health advocacy organization based in Fairfax, Va. Food allergy results in more than 30,000 emergency room visits each year, according to the group.

After Kevin’s frightening reaction, his mother purged their house of all peanut products and began strictly policing what Kevin eats at birthday parties and on play dates. Kevin is also allergic to eggs, which makes eating away from home even more challenging.

“I try to focus on what he can have, not on what he can’t have,” said Stokes, co-founder of Parents of Allergic Kids, a Charlotte-area support group. “But food is everywhere and you have to be vigilant. The fact is, (Kevin) has something that can kill him in an instant.”

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