Q: What do you think about using a peanut-sniffing dog for a severely peanut-allergic child?
Dr. Ehrlich replies:
This is a new wrinkle in discussion of what to do when children have life-threatening food allergies, which we write about in chapter 14 of Asthma Allergies Children: a parent’s guide. To summarize what we say there:
Cases where children are sensitive to fleeting exposure, not just ingestion, are extremely rare.
These dogs are really expensive, as are their inspiration—drug- and explosive-sniffing dogs–so it’s not for everyone because of basic economics. It’s not a particularly cost-effective use of the family health-care budget.
I have heard talk of a foundation to raise money to support this approach. I’m not one to question people’s philanthropic impulses–I would certainly donate for training seeing-eye dogs. However, peanut allergy is not blindness. I can think of many areas in the field of pediatric food allergy that will produce more bang for the tax-exempt buck, primarily because the dog approach projects a fundamental misunderstanding of the problem. The seminal study of peanut fatalities by Dr. Hugh Sampson shows that they happen when people are exposed to peanuts far from their normal surroundings and are exposed accidentally, such as mountain climbers whose climbing partners carry energy bars that contain peanuts.
Anyone who expects to encounter peanuts at school or the mall can prepare for it by carrying an epinephrine injector such as Epi-pen or Twinject at far less cost, which they should do even if they have a dog. Epinephrine is safe, even with repeat injections.
A family that expects a dog to create a peanut-free bubble is in for trouble because they will create a false sense of security. It’s not a peanut-free world. I agree with the Food Allergy and Anaphylaxis Network that even schools should not be peanut free. The children should understand their condition, never eat food that mom didn’t give them including birthday cupcakes, and their teachers and nurses ought to be trained to help in the event of anaphylaxis. Their classmates should be taught to respect those who have this condition.