The Peanut Allergy Epidemic, Third Edition

What's Causing It and How to Stop It

Heather Fraser

• Publisher: Skyhorse
• Year: 2017
• ISBN:
  9781510726321
• Topic: Medizin
• Subtopic: Krankheiten & Allergien

Essential reading for every parent of a child with peanut allergies—third edition with a foreword by Robert F. Kennedy, Jr. Why is the peanut allergy an epidemic that only seems to be found in western cultures? More than four million people in the United States alone are affected by peanut allergies, while there are few reported cases in India, a country where peanut is the primary ingredient in many baby food products. Where did this allergy come from, and does medicine play any kind of role in the phenomenon? After her own child had an anaphylactic reaction to peanut butter, historian Heather Fraser decided to discover the answers to these questions.In The Peanut Allergy Epidemic, Fraser delves into the history of this allergy, trying to understand why it largely develops in children and studying its relationship with social, medical, political, and economic factors. In an international overview of the subject, she compares the epidemic in the United States to sixteen other geographical locations; she finds that in addition to the United States in countries such as Canada, the United Kingdom, Australia, and Sweden, there is a one in fifty chance that a child, especially a male, will develop a peanut allergy. Fraser also highlights alternative medicines and explores issues of vaccine safety and other food allergies.This third edition features a foreword from Robert F. Kennedy, Jr. and a new chapter on promising leads for cures to peanut allergies. The Peanut Allergy Epidemic is a must read for every parent, teacher, and health professional.

Part 1

THE MYSTERY OF THE PEANUT ALLERGY EPIDEMIC

Chapter 1

FROM IDIOSYNCRASY TO MULTIBILLION-DOLLAR INDUSTRY

Thirty-year-old Dr. Walter Teller disembarked from the Holland American liner Maasdam at New York City in December 1954. Traveling from Germany, the young doctor had accepted a position at Mercy Hospital in Altoona, Pennsylvania, and was greeted by his new colleagues at the pier. The men went to dinner in midtown. Five hours later, Dr. Teller was “nearly strangled” when his esophagus closed. He had eaten peanuts for the first time.

While a contemporary account of this event—possibly the first peanut reaction to be reported in the popular media—would reflect drama, fear, and worry that a doctor could be so blithe about peanuts, at the time it was barely newsworthy. To the reporter who covered the story in five paragraphs, the allergic reaction was about as interesting as the doctor’s car that, coincidentally, had been vandalized during that very dinner. Dr. Teller’s unusual first evening in New York City was buried on page 31 in the Books section of The New York Times.1

Until the last decade of the twentieth century, the US press typically met the rare and curious reactions to peanut with surprise and a shrug of the shoulders. It was just too hard to imagine that a common food could really be that dangerous even to the obvious victim. A rare feature on allergy in Harper’s Magazine in 1939 delved into the defensive nature of these strange “food idiosyncrasies” that could cause swelling, sneezing, headaches, itching, and rash, but not death it seemed.2 In fact, allergy had a lighter side. A young woman’s allergy helped her prove that a platinum necklace from her fickle sweetheart was actually nickel when she broke out in an allergic rash. And a restaurant patron proved by virtue of his swollen ankles that the economic waiter had merely scraped the anchovies off his eggs before re-serving them.

At this time, however, there was one exception to the anomalous nature of food allergies. Starting in the late 1930s, there was a small but troubling outbreak of anaphylaxis to just one food—cottonseed oil. The outbreak startled doctors, government agencies, and the food industry but, again, was not newsworthy. In the few reports about allergy at this time, cottonseed oil was mentioned as just one among many foods that could cause reactions.3

In an investigation, however, the Food and Drug Administration (FDA) found that sloppy cottonseed-crushing protocols had led to the contamination of many other oils subsequently used in processed foods. While this discovery explained how people were exposed unknowingly to the oil, it did not explain how so many had suddenly become sensitized to it. They had been consuming this oil for decades in the United States without apparent problem. Doctors responded to the outbreak with a flurry of analyses and opinions none of which managed to unearth the functional cause of this mass sensitization.4

The rising prevalence of cottonseed allergy, however, resolved as quickly and as mysteriously as it had arrived.5 Intense scrutiny in medical literature of this outbreak peaked during the late 1940s and sharply declined during the 1950s. This short-lived medical crisis was never fully investigated.

As reports of cottonseed allergy fell, peanut allergy emerged in US medical literature. Prevalence of this allergy, however, grew more slowly.

In 1941, well-known allergist Warren Vaughan, in his book Strange Malady, had dismissed peanut from his considerable list of potential food allergens. In his medical practice, Vaughan had seen allergies to milk, egg, corn, soybean, cottonseed, shrimp, tomato, cabbage, cherry, chocolate, strawberries, and many more foods. Significantly, however, the doctor did not consider there to be any allergic concern about peanut. In fact, in the book he mentioned crushed peanuts as a food topping without further comment. And yet, by 1948, peanut sensitivity had become a serious obstacle in studies involving children and penicillin that contained a peanut oil additive.6

Medical articles published in 1956, 1961, and 1963 reveal a growing interest in the increasingly common allergy to peanuts.7 Peanut and other severe food allergies soon affected so many people that with the peanut allergy death in 1972 of a ten-year-old Boston boy, Michael Grzybinski, there was a public outcry for proper food-container labeling.

The media coverage of this tragedy revealed a far greater sympathy for food-allergic people than had been exhibited in the 1950s over Dr. Teller’s near-death experience. The death of a child who had eaten “ice cream with peanut butter whipped into it” might have been prevented if the container had had its ingredients listed on the side, exclaimed a very upset Dr. Jean Mayer, professor of nutrition at Harvard University. The doctor wrote the following: “We think food manufacturers should no more be allowed to hide behind ‘the need to protect recipe secrets’ than drug manufacturers are. In both cases, lack of information can be not only unhealthy, but even deadly.”8

The doctor’s anger in albeit the limited press coverage is matched only by the sadness of the parents who, in an open letter, demanded that the FDA implement labeling laws. A deepening awareness of peanut as a deadly problem for a slim minority of children and adults found more room in newspapers from that moment on. Yet, the allergy was still not taken seriously. Throughout the 1970s, peanut allergy in the media was isolated to festive occasions like Christmas. Newspaper food section articles alerted the conscientious hostess to the potential of food allergy among her holiday guests. Peanut allergy was not a cause for widespread alarm.

And yet, doctors knew it was on the rise.

In 1973, the first formal US study of peanut allergy was launched by S. A. Bock who followed 114 children for twelve years, concluding that none had outgrown his or her reactivity.9 The report underlined the fact that children were developing food anaphylaxis at an unusual rate and that peanut had emerged as a dangerous food that should be watched.10 And so doctors watched the allergy, none publicly posing the obvious question—like the cottonseed oil mystery, what was causing people to become sensitized to this one food? An additional and surprising question this time, however, was why the allergy appeared to have an increased impact on children.

But rather than unearth the root cause of this mounting concern, doctors in 1980 chose instead to address the allergy after it had been established. In that year, medical researchers isolated the proteins that trigger the peanut reaction—Ara h 1 and 2. This was valuable information in the manufacturing of vaccines and other allergy treatments. The growing problem of peanut and other food allergies was a market opportunity for pharmaceutical companies.

In 1980, the EpiPen was introduced to allergists who prescribed them for patients. The EpiPen is a portable emergency autoinjection of epinephrine. Epinephrine temporarily relaxes muscles and slows the allergic reaction. The EpiPen automatic syringe was licensed to Center Laboratories, New York, from manufacturer Survival Technology Inc. (STI) owned by physician Stanley J. Sarnoff. STI and inventor Shel Kaplan had patented the hypodermic injection device in 1977. The syringe was originally designed for the US military to supplement STI’s other autoinjector that was used to administer a nerve gas antidote during battle.11

Commercial interests led the way in allergy management while social, legal, and political initiatives lagged. Poor food labeling, again, was blamed for another death in 1980 of a seventeen-year-old boy. He had eaten a candy bar that contained peanuts.12

A turning point in media sympathy for peanut-allergic children was marked by the death of an eighteen-year-old US national squash champion in 1986.13 This tragedy was followed by a new tone of sober inquiry into what the media perceived to be a serious and growing threat to children. A healthy and accomplished teenager had died after eating a spoonful of chili thickened with peanut butter. Headlines reflected new vigor in bringing information to the public, including population studies and a review of emergency measures.

The media challenged restaurants to list ingredients and airlines to consider in-flight peanut restrictions.14 Of new import for the first time was interest in an explanation for this child-specific allergy—thoughts turned naturally to mothers’ diets while pregnant and breastfeeding. In 1941, allergist Warren Vaughan had already fingered the “abnormal food cravings”15 of pregnant women as the source of allergens to which children often become sensitized. But this educated guesswork did not explain the rising prevalence of allergy to peanuts when this dietary staple had been consumed for decades without obvious problem—in fact, again, Vaughan had outright dismissed peanut from his list of food allergens. By 1987, however, one reporter looked fearfully to an allergy-filled future following the death of an eleven-year-old asthmatic boy who had eaten peanut-contaminated cake: “Every week brings reports of new dangers, a death from allergy.”16

Refreshed marketing efforts for EpiPens in 1988 introduced the word anaphylaxis to the mainstream media. News reports for the lifesaving emergency device exploited the story of the 1986 death from peanut butter–“laced” chili. An EpiPen might have saved the teen’s life. An article to this effect ran in the newspapers of six US cities in the summer of 1988.17

Starting around 1990, the media buzzed about EpiPens, new allergy guides, cookbooks, labeling concerns, holiday season dangers, and the biology of “when your immune system panics.”18 People began to question if the allergy could be passed via organ transplant, and even whether the allergy was an overdiagnosed malady,19 when the prevalence of peanut allergy in children suddenly accelerated. Unnoticed by the public, hospital emergency room (ER) records in Australia, the United Kingdom, and the United States documented the upward momentum of food anaphylaxis admissions for children under five.

In the United States, ER records showed a steady and rapid increase in anaphylaxis discharges between 1992 and 1994 from 467 per 100,000 to 671. This number jumped to 876 in 1995. In three years from 1992–95 the numbers nearly doubled. A 1991 US study determined that 90% of all food allergy fatalities were due to ingestion of peanut/tree nuts.20

In the Australian Capital Territory (ACT), a fourfold increase in hospital admission rates for food allergy was observed from 1993 through 2004–5. ACT is a self-governing state within New South Wales with the highest density population and smallest area at 910 square miles. Within it is the national capital of Canberra. A twelve-year study of allergy services in ACT showed a 400% increase for this period for children under five. During the course of the study, birth rates actually fell 10%. One allergist in Australia referred to this trend in allergy in children as an epidemic.21

In hindsight, what was called the tip of the iceberg22 by University of Edinburgh allergist Aziz Sheikh in a 2006 lecture, the discharge rates for system allergic disorder in England increased between 1990 and 2001 from 1,960 admissions for allergic conditions to 6,752. This threefold jump in just eleven years indicated “a highly significant increase” in admissions for severe allergy.

The timing of this acceleration was confirmed by a UK peanut allergy study. A retrospective cohort analysis of children born between January 1989 and February 1990 on the Isle of Wight revealed a shocking statistic: by ages four and five in 1994, 0.5% of these children were anaphylactic to peanut and 1.1% showed sensitivity to it.23

This news made riveting headlines. Not only were 40,000 UK children under four years of age “in peril from peanuts,” but they could also react as one child did, to just its vapor.24 A 1997 issue of London’s Sunday Times Magazine sensationalized the sudden new threat to children in “One Bite and He Dies.”25

A second cohort analysis from the Isle of Wight provided an even bigger shock. An analysis of children born in the same region between September 1, 1994, and August 31, 1996, and tested at ages three and four, revealed that twice as many children we...