Peanut Allergies at School: Is Banning the Answer?

The family meeting at my son's school last fall was fraught with tension: Peanut butter—all nuts, actually—had just been officially banned from school lunches. The school's director explained that one child had developed a peanut allergy, and no one wanted to risk a reaction.

One grandmother, apparently in charge of packing meals for her children's children, was upset. "I raised all my kids on peanut butter, and their kids, too. It's good, healthy food," she said. "That kid can just keep his hands to his own lunch." Many parents nodded in agreement, including myself.

But the mother of the child in question spoke up directly, forcefully, and more than a little tearfully: "My son is so allergic that coming into contact with a single atom could send him into anaphylactic shock!" she insisted. "He could die!"

And, indeed, deadly peanut allergies are real, if rare. Faced with such dire consequences, who wouldn't be willing to chuck PB&Js out of the lunch box? But I had to wonder: Was this really my problem? Was this lunch off the menu forever?

PEANUT-FREE ZONES

Protein, which comes packaged with nutritious unsaturated fats, is what makes peanuts (which are technically legumes) such a healthy food. It's also what causes allergic reactions in people whose bodies fail to recognize peanut proteins as nutrients and instead treat them as harmful invaders. A study from The Journal of Allergy and Clinical Immunology put the rate of peanut allergy in 2008 at 1.4%. That might not sound like much, but consider this: A decade earlier, the rate was only 0.4%. It has tripled, in other words.

That's bad news for parents who have to manage these allergies—which, at their worst, can be very dangerous. "There is a very real risk of a fatal anaphylactic reaction in children with severe peanut allergies," says Michael C. Young, MD, assistant professor of pediatrics at Harvard University and author of The Peanut Allergy Answer Book.

Between 150 and 200 fatal peanut reactions occur in the U.S. each year, according to the Centers for Disease Control and Prevention. As for the single-atom theory of airborne exposure, it's quite rare. As Young adds, "Most potentially fatal reactions come from ingestion, not casual contact." In a 2003 Mt. Sinai Medical Center study, pediatricians who examined the reactions of 30 children with severe pean ut allergies found that topical contact did not result in a reaction in which their airways constricted.

But, as any parent knows, hands, toys, and school supplies are only a small number of the items that might wind up in a young child's mouth. That has led educators to err on the side of caution. Many schools have instituted nut bans.

DO BANS ACTUALLY WORK?

Not all experts think outright bans are the best solution for every case. Maria Acebal is CEO of the Food Allergy and Anaphylaxis Network; as a toddler, her daughter Nina suffered a near-deadly reaction after a single bite of a peanut butter cracker. Still, Acebal does not insist on blanket school-wide bans, noting that a mix of caution and preparation can go a long way.

"The most important thing is having teachers and school staffers who are educated enough to know how to prevent a reaction and what to do if one should occur," Acebal says. Next on the priority list: ready access to an EpiPen, or epinephrine injector, which helps stop the immune-system reaction to allergens via a shot of the hormone epinephrine (aka adrenaline). "The kids themselves are also an important part of the equation," she adds. "Whatever approach a school chooses, kids know that they will have to manage what will likely be a lifelong problem in a world that is not peanut-free."

The legality of food bans has yet to be tested in court, although some suggest that the right to ban peanuts might be covered by the Americans with Disabilities Act. But what about kids with allergies to seafood, soy, or other foods? Can all of these foods be banned, too? Of course not, says Young, who recommends designated allergen-free safe zones for snacks and lunches, as well as hand wipes for younger children.

Since last fall, my child has transferred to a school that, though it also hosts an allergic child, requested caution rather than issuing a ban. For me, that made the switch from peanut to sunflower-seed butter easier to swallow.