Asthma / Allergy

Avoiding Allergic Reactions To Foods In Restaurants

Transmitting Peanut Allergy Through Breast Milk

Avoiding Allergic Reactions To Foods In Restaurants

Patients who are known to have a serious allergy to particular foods, especially peanuts and tree nuts, have
to be extremely careful about accidentally being exposed to these foods, since they can cause life threatening and even fatal allergic reactions. One setting that can be especially difficult is a restaurant or other place where food is served. To learn more about this problem, researchers reviewed instances of these kinds of reactions that had been reported to the U.S. Peanut and Tree Nut Allergy Registry. They telephoned a sample of 129 adults and children, and interviewed them (or their parents) about the nature of the reaction and the circumstances in which it occurred.

Among food establishments, the most commonly reported ones were restaurants, and of these, the most common were Asian (Chinese) food restaurants; other establishments included ice cream shops and bakeries or doughnut shops. When food was ordered from a restaurant, only 45% of subjects had told the restaurant that they had an allergy. Examples of errors that led to reactions included nuts being "hidden" in a sauce, dressing, or egg roll, making it difficult to identify them, and in other cases ice cream equipment and cooking or serving supplies had been in contact with the allergenic food. A number of reactions occurred when the patient took foods from buffets or food bars, from the plate of a dining companion, or by skin contact or inhalation. In one case, a food was given directly to a child by bakery personnel as a free sample. (Furlong TJ et al: Journal of Allergy and Clinical Immunology, November, 2001, pp. 867-870)

COMMENT: It’s hard to know whether the experiences reported to this registry are typical of the wide range of reactions to foods in general or peanuts/tree nuts in particular, but these reports offer some important information on situations that lead to reactions in restaurants, doughnut shops, bakeries, and other food establishments. It’s both impressive and worrisome that almost half of the reactions in this registry seemed to occur because the patient or parent didn’t alert the restaurant staff to the fact that someone had a serious food allergy. Whether this is an oversight or done deliberately to avoid "making a fuss", patrons are left to guess whether what they ordered is really free of the allergens they fear.

So while we counsel parents of allergic children to be wary of buffets, samples handed out by well meaning staff, or the like, we should not forget the obvious—when ordering food for a child or any other person with severe food allergy, it’s critical to communicate to the restaurant staff that this person has a serious allergy to particular foods; handing the staff a note (perhaps one that is pre-printed) to bring to the cook might help to reinforce that potentially life saving communication.

Transmitting Peanut Allergy Through Breast Milk

Allergy to peanuts has become a larger problem in recent years, and in some children, even very small amounts of peanuts can trigger a potentially fatal allergic reaction. Why this allergy has been increasing isn’t clear. We do know that someone doesn’t get an allergic reaction the first time in their life that they eat peanuts; instead, the first time peanuts are eaten, they set up an allergic sensitivity in certain
people, and it is only when these people come into contact with peanuts again that they have an allergic reaction. Yet most peanut allergic people haven’t had any known exposure that would have made them sensitive. One explanation is that the first exposure might actually take place in the womb or through a mother’s breast milk. To see whether peanut can actually get into breast milk, researchers asked 23 healthy breastfeeding women to eat about 2 ounces of dry roasted peanuts; they then tested breast milk samples at hourly intervals.

Peanut protein was detected in 11 of the 23 women. The authors conclude that these data, together with earlier studies, suggest that peanut protein can be transferred to nursing infants through their mother’s breast milk, putting these infants at risk for sensitization to peanuts. (Vadas P et al: Journal of the American Medical Association, April 4, 2001; pp. 1746-1748)

COMMENT: Peanut allergy in children has become a real problem, not only because of the health hazard it obviously poses to the child, but also because schools and child care providers have to make sure that peanut allergic children won’t be exposed to foods containing peanuts that may be brought in by other children.

While we still don’t know why there’s been such a large increase in the number of affected children, this study adds further evidence that children may be at higher risk for peanut allergy if their mothers eat peanuts during pregnancy (perhaps exposing the infant to peanut allergen while in the womb) or if their breastfeeding mothers eat peanuts (exposing infants to peanut allergen that is contained in breast milk). For this reason, it’s no surprise that many experts suggest that pregnant and nursing mothers avoid eating peanuts.