Another day, another article about why food allergies -- and the fear of peanut allergies in particular -- are overblown as a public health concern. This time it's in web magazine Salon (see "The Fear About Peanut Allergies is Nuts" -- if you're not a member, you'll probably need to watch an ad to see the full article.)
The points in the article are very similar to those made in two recent articles, Meredith Broussard's "Everyone's Gone Nuts" (which discusses the same statistics from the Food Allergy and Anaphylaxis Network that Dr. Parikh discusses in the Salon article) and Nicholas Christakis's BMJ article about peanut allergies as epidemic hysteria.
I'd just like to make a few points about the current article and let y'all discuss:
- The Salon article is misleading about the AAP's current policy on delaying introduction of peanuts and other potentially allergenic foods. The first page of the article makes it look like the policy is still to delay likely allergens until age two or three. It's true that this used to be the policy of the AAP, but that recommendation was changed over a year ago (not nearly as recently as the article implies) because the science simply didn't support it -- there wasn't evidence that infants whose parents delayed introduction of these foods past the time the digestive tract was mature enough to handle food proteins had better outcomes in terms of developing allergies.
- It's true -- and it's been true for a long time -- that many people who believe they have food allergies don't. Some have food intolerances and some have other conditions that can be confused with food allergies. Some have been diagnosed via questionable allergy tests. Does that really equal "hysteria" about allergies?
- Finally, parents and practitioners may be in a difficult situation when a RAST test shows a probable allergy to peanuts, tree nuts, or shellfish. While these tests aren't close to 100% accurate, performing a far more accurate food challenge may be considered risky if the chance of anaphylaxis is high, as it is with these three foods. Does this mean that some children avoid peanuts unnecessarily? Almost certainly. But that's on the basis of a risk-benefit analysis between patient and doctor.
Usually, too, RAST tests aren't done as part of, say, a three-year-old well visit -- a child may have had a reaction to dairy or eggs and have peanut antibodies unexpectedly show up on a RAST test. Or food allergy testing may be part of screening for another persistent allergic condition, like eczema. In other words, a small subset of high-risk kids are getting these tests -- not just children whose classmates at preschool have peanut allergy and whose parents are "hysterical."
Are parents at large more aware of -- and worried about -- food allergies? Almost certainly. But I think the argument that awareness is a bad thing is suspect at best.