The Nut Problem

How has this become such a big problem so fast?

Only twenty years ago, peanuts and tree nuts were a ubiquitous part of everyday kid life. Almost every child brought a peanut butter and jelly sandwich to school for lunch and ate it in the cafeteria. Since then, peanut and tree nut allergies are up over 400% and are the most prevalent and fastest-growing food allergy. Even worse, they are the most dangerous and among the least likely to be outgrown in adolescence.

Why is this?  The prevailing theory is called the “hygiene hypothesis.” This theory states that a lack of early childhood exposure to infectious agents, symbiotic microorganisms and parasites suppresses the natural development of the immune system and increases susceptibility to allergic diseases.

The hygiene hypothesis also helps explain why in recent years the rates of allergy growth in the developing world are greater than in the developing world; modernization brings both the good and the bad to developing areas.  It appears that the more we shield ourselves, the more vulnerable we become.

Peanut and tree nut allergies in particular are unique because the proteins from these nuts trigger a very aggressive immune system response. The absence of traditional and historical enemies causes the immune system to focus its excess capacity on these proteins. This causes allergy rates to increase over time. In 1997, an estimated 0.6% of children had a peanut or tree nut allergy. Today, the rate of occurrence has grown to 3.1% and is expected to continue increasing.  These increased rates mean that most playgroups, classes, schools, camps, teams and other groups that contain kids need to take steps to create a safe and inclusive environment.

With allergies INCREASING IN GENERAL, why is there MORE of a focus on peanut and tree nut allergies?

There are a few reasons why these allergies have gained so much attention as of late. First, peanut and tree nut allergies make up about 38% of food allergies, making them the most prevalent, and the rate of growth has been and continues to be truly extraordinary.

Second, each patient has their own unique sensitivity to nuts, with all patients susceptible to a life-threatening reaction called Anaphylaxis. This means that even if the allergy manifests itself in a certain patient 999 times as an annoying but benign rash, that patient could still have an anaphylactic response on the next exposure. This random-occurrence nature of anaphylaxis is why the protocol is for every person with these allergies to have a prescription for an EpiPen, and to know how to use it or a similar device. Sitting with a doctor learning how to use an epi-pen is a scary and surreal experience that millions of families have gone through.

The sheer number of people (and especially kids) with the allergy has caused families, schools, communities and institutions to rethink how they create a safe environment. This is why many schools have gone entirely nut-free and President Obama has signed national legislation regarding funding for epi-pens and training on how to use them.

Finally, the vast majority of children with peanut and tree nut allergies will never outgrow their condition. This is uncommon in milk and egg allergies, or intolerances like gluten, which often in late childhood. This difficulty is increased because many foods (both staples and treats) that characterize childhood are particularly dangerous to those with nut allergies.

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