By Dr. Larry Chiaramonte
Periodically, questions pop up about possible exposures to food allergens by means other than actual eating. For example, people whose children are allergic to tree nuts wonder about buying a house that has walnut paneling, or about their neighbors who use walnut shells for mulch around their rhododendrons. Others worry about their egg-allergic child painting Easter eggs. Yet another arose with a family that took a beach vacation: their shellfish-allergic child was fascinated by horseshoe crabs, mussels, and whelks that inhabited the shore and insisted on touching them.
I have found over the years that risk management is rarely a matter of a “never” or “always” but there are instances where I am 99% sure, and advise my patients and their parents accordingly. Controlling a chronic condition like asthma or diabetes is a matter of managing risk rather than outright cure. By a combination of medicine and behavior we can tilt the odds away from bad outcomes. Diabetics can lose weight, exercise, and change their diets as well as use their insulin. Asthmatics can avoid their triggers, monitor their breathing, and use their control medication as directed by a qualified allergist.
Food allergies are more of a wild card because there has been little recourse besides avoiding the offending foods and carrying epinephrine. Widespread cross-contamination of food forces us to be on high alert. Confirmation that there are in fact instances of serious reactions to airborne food allergens and to skin contact contributes to levels of concern. These examples make it more important to understand other theoretical risks and seek relief from anxiety where it can be found.
The first thing to consider is how likely it is that kids will try to eat the furniture or put mulch in their mouths and swallow it. Probability low.
Easter eggs are riskier because the problematic food is actually present, but if they are hard-boiled, it is unlikely that the protein in the egg white will touch the child’s fingers or end up in little mouths. I have never seen children paint uncooked Easter eggs, and in any case, this is invariably an activity with lots of parental supervision, so this risk can be reduced accordingly. If a shell cracks, get rid of it.
As for the budding marine biologist the parents decided to let him indulge his curiosity, to his great pleasure, with no ill effects.
So looking at the risks that you might have to assess in your lives, are there any takeaways from these examples?
Indeed. Consider that most allergens have something in common. The allergenic proteins are there for a reason—to propagate, gestate, and sustain the next generation of the species—whether the offending item is normally eaten as a nut, a seed, or an omelet. This is also the case with environmental allergens like pollens. These proteins are dense with genetic information and nourishment to make sure that babies can get their start, whether they are saplings or chicks.
Woods and shells—animal or vegetable—serve different functions, and Mother Nature doesn’t waste these valuable proteins on them. Wood is mainly made of cellulose, which appears in the human diet as fiber. You can carve your sweetheart’s name in the living cambium layer and it won’t kill the tree. Eggshells, nutshells, and seashells are there to shelter the organism within. They are made from sturdy, expendable, and largely inert materials such as, again, cellulose, or calcium carbonate.
None of this detracts from the possible dangers to a shellfish-allergic patient who wanders through a market where shrimp and lobster are being boiled in massive qualities. Cooking can aerosolize the proteins in quantities large enough to possibly trigger an allergic reaction. Peanut-free seating at the ballgame and precautions on airplanes are sensible measures. In our book we admonish parents not to worry about appearing to be too careful.
Risks can and should be managed with precision, however. You can be allergic to walnuts and not to almonds, so blanket “tree nut” avoidance is an expedient limitation on a patient’s diet. You can be allergic to milk by the glass but possibly not to milk that has been cooked. This is why I never get tired of recommending the services of a board-certified allergist who can help you dig deeply into the nature of your child’s allergy. You can learn the rules of blackjack in two minutes, but if you want to beat the house, you have to learn to count cards.
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