A peanut butter and jelly sandwich in the lunchbox may not be such a good idea for some kids. My 8-year-old daughter has peanut allergies. So when I send her off to school every morning, not only am I worried about her school—“Did she do her homework? Is she doing ok in reading and math? Is there any friend drama?” I’m also worried about her food allergy—“Does she know how to avoid peanuts at school? Will the school know what to do if she has a severe reaction? Does the school have her Epi-Pens?”
I am not alone. Many families deal with peanut allergies on a daily basis. Peanut allergy is one of the most common food allergies and is seen more often in children with other allergic diseases like asthma, hay fever, or eczema. About 2 to 5% of children in the United States are allergic to peanuts, and the number has continued to rise exponentially over the last two decades. The reason for this is not entirely known. Some state the hygiene hypothesis, that perhaps we live in too clean of an environment and our immune system doesn’t need to fight infectious agents and instead reacts to foods and other harmless allergens. Others postulate genetically-modified foods as a factor in the rise of food allergies. There are many theories but no one really knows for sure. What we do know is that in food allergic children the immune system goes haywire and reacts to the proteins found in peanuts. Interestingly, roasted peanuts are more allergenic than boiled peanuts, since roasting alters the peanut protein and makes it more allergenic. Symptoms of peanut allergy can range from itchy mouth, lip or tongue swelling, hives, shortness of breath, wheezing, vomiting, abdominal pain to a severe reaction (or anaphylaxis) which can be life-threatening. Reactions typically occur within minutes after ingestion of peanuts. If you suspect peanut allergies in you or your child, speak to an allergist. Diagnosis of peanut allergy can be established by an allergist through a skin test or a blood test.
Thankfully, advancements in managing peanut allergies offer hope and additional layers of protection. Avoidance remains the cornerstone of management, involving careful label reading, educating the child about safe foods, and creating a peanut-free zone at home. However, in addition to avoidance, new treatment options have recently emerged to reduce the chance of severe, potentially life-threatening reactions, in the case of accidental exposure to food allergens. Oral Immunotherapy (OIT) for food allergies involves gradually introducing increasing amounts of the allergen under strict medical supervision. The goal is to desensitize the immune system, making reactions less severe or even preventing them altogether. Xolair (omalizumab), an injectable biologic medication traditionally used for other allergic diseases such as asthma and hives, has also shown promise in food allergy management. It works by blocking IgE antibodies, which are responsible for allergic reactions, helping to facilitate desensitization and reduce the severity of reactions. While these management options are not a cure, they can significantly improve a child’s quality of life by reducing the fear of accidental exposure.
Beyond these long-term strategies, advancements in emergency treatment are also providing more options. While epinephrine auto-injectors have been the standard for immediate severe allergic reactions, the development of needle-free options like Neffy (epinephrine nasal spray) is a welcome innovation. Neffy offers a less intimidating and easier-to-administer option for parents, caregivers, and even children themselves in an emergency, helping to reduce the anxiety associated with administering a traditional auto-injector.
Navigating the back-to-school season with a child who has a peanut allergy requires a collaborative and proactive approach from parents, school staff, and the wider community. By focusing on a combination of strict avoidance strategies, exploring newer treatment options like Oral Immunotherapy and Xolair, and having readily available emergency medications such as epinephrine auto-injectors or the innovative Neffy nasal spray, parents can create a safer and more inclusive environment. While the challenges are significant, these medical advancements, along with open communication and a commitment to awareness, offer hope and a pathway for children with peanut allergies to enjoy a successful and worry-free school year.
