Recently, while registering my soon-to-be preschooler, the administrators asked me a question that I struggled to answer: “how severe is your son’s peanut allergy”? This innocent question that I get all the time from my friends and family brought back memorizes of when I first found out that my son had an allergy. It was 2009 and we were at a children’s birthday party. When I had turned for a moment my one year old son started eating a cookie that was on a table. Nothing happened at first but within minutes he started breaking-out in hives and vomiting. In a panic, we rushed him to the emergency room and luckily everything was fine, however the doctor recommended that I make an appointment ASAP to see an allergist.
The next day the first question I asked the allergist was “how severe is my son’s allergy?” I was expecting him to reply with either “severe”, “moderate” or (hopefully) “not too severe”….and was bracing for the bad news. His answer surprised me though as he mentioned that unfortunately there is no “right” answer. As I learned, reactions are completely unpredictable, as someone can have a minor reaction one time but then suffer a severe reaction (like anaphylaxis) the next time. It is true that some people show obvious signs of what is classified as a severe reaction (such as in inhalation exposure), but others just haven’t had that severe reaction yet. Severity of reaction is unfortunately a roll of the dice and is not necessarily dependent upon previous reactions or allergy testing results.
Allergists typically measure an allergy by the CAP-RAST, which tests the IgE antibodies to a particular allergen, the skin prick test and a rating scale, which is based upon previous reactions. According to FAAN, “overall, fewer than half of individuals with a positive skin test to a food will develop allergic symptoms if they eat that food”.
These tests do not need to correlate positively with each other either, actually often they don’t. My son has a high rating scale number of three (based upon a rating scale from 1 to 4), a positive skin prick test, yet his IgE antibodies were very low. His allergist informed us that this doesn’t predict a future reaction’s severity in any size or form, but only that he is allergic to peanuts. These are significant discrepancies that need yet to be explained.
Case in point, reactions are difficult to predict and test results can be confusing and misleading. Precaution, due diligence regarding label reading, and always being prepared with Epi Pen and a medical plan, are the only ways to effectively treat those with a diagnosis of food allergy. Each and every person with a food allergy should be given equal treatment of their food allergy regardless of their food allergy testing results and previous reactions.
So, going back to the question raised by the school administrator….how should I answer? What is the best approach to both educate a person on this topic without coming across as preachy or lecturing? I decided that being honest and direct with them took priority over how I may be perceived. Keeping the conversation light, but still educational, we ended-up having a great talk that ended with the administrator thanking me tremendously (she even invited me to speak in a class on the topic!).
While I’m still learning and am far from an expert, I feel passionately about the health and well-being of the food allergy community. Everyone deserves the basic feeling of safety and security at home, in school and in any public setting. This is one of the reasons why I have started a site that offers hard-to-find foods, snacks and treats that are peanut-free, nut-free and mostly allergen-free. It has given my family and me the comfort in knowing that foods which often contain peanuts can be found without any and eaten safely and happily. Come and visit us at http://www.peanutfreesweettooth.com and let me know your thoughts and in what other ways this site might be helpful.