Why peanuts might be added to the menu for our children
A new study suggests that the majority of peanut allergies can be prevented by feeding them to young children. Gabrielle Monaghan speaks to a mother who would never risk it after her beloved teenage daughter died from the condition
Caroline Sloan is still furious at the pharmacist who refused to give her a potentially life-saving adrenaline injection for her daughter Emma after the 14-year-old went into anaphylactic shock from eating a sauce containing peanuts.
Just minutes afterwards, Caroline's beautiful daughter collapsed on Dublin's O'Connell Street and died, surrounded by her helpless family.
Emma's trip to the city centre in December 2013 was meant to be a happy one. It was one week before Christmas, and the Sloans had gone to a Chinese buffet. But Emma mistakenly poured satay sauce on her plate, thinking it was curry.
The teenager did own an EpiPen, a disposable auto-injector used to treat severe allergic reactions, but didn't have it with her; Caroline had never been told Emma's condition could prove fatal. Because Caroline didn't have the EpiPen prescription with her, the pharmacist couldn't dispense the device. EpiPens can only be dispensed to people with a prescription signed by a doctor.
"I believe in my heart if Emma been given that pen, she would still be alive," says Caroline.
The only thing that gets Caroline out of bed each morning these days is her love for her two other daughters, Amy and Mia, and her tireless campaign to ensure no one else will die needlessly from a nut allergy.
She has since had three-year-old Mia tested for nut allergies. Even though the skin-prick test was negative, Caroline would never "take a chance" by feeding nuts to her youngest daughter.
Like Caroline, parents of children at risk of such allergies have gone to extremes to keep them away from peanut. But a major study published in the New England Journal of Medicine this week has turned this conventional wisdom on its head.
Researchers proved that the majority of peanut allergies can be prevented by feeding young children food containing peanuts right from infancy. The study was presented at the annual meeting of the American Academy of Allergy, Asthma and Immunology in Houston, Texas.
Professor Jonathan Hourihane from Cork University Hospital attended the conference. Hourihane, one of Ireland's leading specialists in paediatric food allergies, says: "We've long suspected that early introduction is better and this is the proof."
The study involved 640 infants aged four to 11 months old. It found fewer than 1pc of the children who were fed peanuts had developed an allergy by the age of five, compared to 17pc of the infants who avoided the food. An editorial in the New England Journal of Medicine said the findings were "so compelling" that guidelines on how to feed infants at risk of these allergies should be revised soon.
The American Academy of Pediatrics used to advise against giving children food containing peanuts before the age of three, but that recommendation was scrapped in 2008 due to lack of evidence that it was working.
Because of a dearth of guidelines since then, medical professionals like Hourihane have been waiting for the results of the trial on the early introduction of peanuts to children. He says parents are so tuned in to research like this that his clinic will see an upsurge in demand for testing to determine if they can start feeding peanuts to their offspring.
"Peanut allergies are the subject of dinner party conversation these days - every parent worries about it even when they don't need to," Hourihane says. "But they don't know that they don't have to worry because they can't get assessed."
Until recently, Hourihane was the only paediatric allergy specialist in the country. Another has since been appointed at Our Lady's Hospital in Crumlin. But waiting times for a routine appointment at the professor's allergy clinic in Cork are 14 months and parents have to wait three years to get their child a diagnostic food challenge.
On the back of Caroline's campaign, the Department of Health is considering a change in the law to make EpiPens more widely available.
"It would be Emma's legacy," Caroline says.
The fear of food allergies
One in five Irish families say they have a child with a food allergy, according to a survey of 1,000 mothers by Mummypages.ie. However, only half of those children had been medically tested by an allergy specialist.
The most common childhood food allergies are to eggs, milk and nuts, the poll showed. Peanut allergies are the most serious of all. Professor Jonathan Hourihane, a paediatric allergy specialist, says they affect about 2pc of the entire population but account for half of all fatal reactions to food.
These statistics need to be put in perspective, Hourihane says. There is a greater chance of being killed by lightning in Europe than dying from anaphylaxis due to eating peanuts.
Adults and children diagnosed with the allergy still need to carry adrenaline auto-pens because medical professionals can't predict who will potentially suffer anaphylactic shock or when it will happen.
The incidence of food allergies has surged in recent decades, with the number diagnosed with allergies to peanuts more than doubling in the last 10 years in the UK and North America. A review of allergy-related deaths in the UK and Ireland during the 1990s suggested only two children died after eating nuts.
Dr Gideon Lack, the allergy professor at King's College London who led the study into the benefits of early exposure to peanuts, says the surge in allergies can be partly attributed to parents withholding the food from babies.