By Henry Ehrlich
TV has “Are Your Smarter Than a 5th Grader?” Now, the Annals of Allergy, Asthma and Clinical Immunology has its own version. An article by Leon Kao, MD et al describes a survey of lay and medical people to distinguish peanuts and a variety of tree nuts from one another. As the authors point out, avoidance is a key strategy for dealing with food allergies, and as we all know, peanuts and tree nuts are one and two in the top eight food allergens.
The method was as follows: “A sealed and locked nut box was constructed, and samples of several common tree nuts and peanuts with and without shells were used. The box was covered with a clear plastic top for easy viewing and to prevent unintentional exposure to nuts. Included in the container were hazelnuts (filberts), shelled and unshelled peanuts, shelled and unshelled pistachios, Brazil nuts, cashews, almonds, walnuts, macadamia nuts, pecans, slivered almonds, sliced almonds, and pine nuts. Subjects were asked to identify each nut by writing the likely nut in a blank on a piece of paper corresponding to the labeled compartment on the nut box. The total score was measured by the total number of tree nuts and peanuts correctly identified, with a maximum score of 14.”
A total of 168 subjects completed the questionnaire, 66 of whom were guardians of children being treated for peanut and/or tree nuts, and 50 with other food allergies. “Most of these subjects were women (88%) and 40 years or younger.” The rest were allergists, some in private practice and some academics, some fellows in allergy and immunology, and the rest a smattering of dieticians, food scientists, medical residents, and “other”. They took the test at a meeting of the AAAAI.
The good news is that the professionals were better at it than the guardians of children. Allergy/immunology fellows did worse than those who had completed training. These results must be weighed against the small size of the sample. The bad news is that while all groups were better at identifying peanuts in and out of the shell, it wasn’t 100% for any group, including the doctors. (Brazil nuts were identified least by pros and non-pros alike.) Another issue is that many guardians didn’t think it made any difference because they avoid everything even if they aren’t allergic to some nuts, depriving their children of a potentially useful source of protein, although the authors speculate that many are motivated by an understandable fear of cross-contamination.
Finally, the authors suggest that more education of patients, families, AND providers is in order. Add that to the list, along with recognizing the signs of anaphylaxis, use of epinephrine, and how to manage the rest of the family.