A Milk By Any Other Name....The Problem Of Misdiagnosing Your Problem
A Nut by Any Other Name
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I was just diagnosed with peanut allergies, and I have two questions. One, I've heard there are other things besides peanuts and peanut oil that could trigger an attack. What other words do I have to watch out for on food labels? Second, do I need to let my ex-husband know about the allergy since he has custody of our two children? Am I at risk if they come to my house smelling of peanut butter sandwiches?
— Melissa, New York
Let me address your questions one at a time. In terms of other foods to avoid, peanut-allergic people are often told to avoid tree nuts as well. This is not because a peanut-allergic person will automatically react to tree nuts (only about a third will also be allergic to tree nuts) but because so many commercially prepared foods are made using machinery and in factories that process both peanuts and tree nuts. This creates a high risk of cross-contact between peanuts and tree nuts, so it's safer to avoid both.
As far as labeling of packaged foods, a law went into effect in January 2006 that mandates all foods that contain any of the major food allergens must be labeled using simple words. These allergens include peanuts, tree nuts, eggs, cow's milk, wheat, soy, fish, and crustaceans. This is a big step forward for food-allergic people because previously, labels could list ingredients using ambiguous terms such as "natural flavors." It was up to the consumer to call the manufacturer to find out what those terms meant.
Despite this new legislation, you still need to know all the terms that can be used for peanuts since stores still carry foods that were packaged before January 2006. These terms include: nutmeat, arachis, ground nuts, goobers, monkey nuts, beer nuts, artificial nuts, and mandelonas. Also, foods such as marzipan, mole sauce, and nougat often have peanut as an ingredient, though it may not be listed.
Most peanut-allergic people can tolerate peanut oil because it contains very little protein, which is the part of the peanut that is allergenic. The exceptions are expelled, cold-pressed, and extruded peanut oils, which are more likely to contain offending protein.
Anyone with a food allergy has to readalllabels on packaged foods,allthe time. Peanut can be added to unexpected items, especially sauces and dressings. The term "may contain" is used at a manufacturer's discretion to indicate that the food doesn't have peanut as an ingredient, but could have come into contact with something else containing peanut, despite the producer's best efforts. For example, cookies and candy without nuts may be labeled as "may contain" peanuts, because the machinery is used some of the time to make peanut-containing cookies or candy, and the first batch of nonpeanut product may have trace amounts of the last batter in it, despite proper cleaning. Most allergists tell their patients to avoid "may contain" foods too.
Certain types of restaurants are particularly high risk for people allergic to peanuts, such as Asian (Chinese, Thai, etc.), African, and Mexican. This is because these types of food often contain peanut and also mix ingredients extensively (high risk for cross-contact). Finally, avoid buffets, as the serving spoons often get mixed up.
As far as your exposure to other people who have been eating peanut, there are a few general guidelines that will be sufficient for all but those rare, exquisitely sensitive people. If you can smell peanut butter on your children or anyone else, simply ask them to wash their hands and faces thoroughly after they arrive at your house. That should be enough. Just smelling peanuts doesn't cause reactions. You may need to be a little more careful with a significant other, however, or someone with whom you might kiss passionately. If a person has just eaten peanuts, then their saliva will have peanut protein in it for some time after. Studies have shown that waiting a few hours, or waitingandeating something else (without peanuts) is more effective than brushing teeth or chewing gum right after eating.
The other thing that would be very helpful is to join the The Web site is: Food Allergy & Anaphylaxis Network. It is a nonphysician organization for people with food allergies, which publishes a variety of information, both on the Internet and in print. All of the Network's information is reviewed by expert physicians, and it offers a variety of networking options for members. The Network also posts notifications regarding changes in ingredients of well-known products, food recalls, and information about various manufactured foods. It has programs that can be used to train teachers and childcare providers about food allergies. The Network is probably the best resource for food-allergic people to become and remain informed — or even get involved in advocacy.
Finally, you may be wondering if your children are at risk for developing food allergies, as you did. They are at a somewhat higher risk than children whose parents do not have allergies, but that is all I can say definitively. Allergic conditions do run in families, but not everyone is affected.
Hope all of this helps.
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