By Dr. Larry Chiaramonte
After more than 30 years of clinical and academic experience with food allergies, no one welcomes the publication of the new NIAID guidelines more than I do, although as a professional I do have some nuanced thoughts of my own about them. As chapter 5 of Asthma Allergies Children: a parent’s guide makes clear, the field of food allergies is subject to stubborn misconceptions, and even knowledgeable people make mistakes.
This was dramatized for me the week the guidelines came out when our editor showed me a long post by an allergy-blogger mom.
Briefly, the mom asks if it is possible for her son to be allergic to peanuts after being negative on a double blind placebo controlled food challenge [DPPCFC] Let me summarize the facts as I understand them (the original is much more entertaining, but I want to be concise).
1. The child has proven a DBPCFC positive to wheat or at least an anaphylactic reaction
2. He was slightly RAST test positive to peanut to peanuts without a reaction on ingestion
3. The mom claims he had never eaten peanut
4. At five years of age he was negative on DBPCFC to peanut and still had no reactions to peanut
5. He does not like to eat peanut containing foods
6. The household is on peanut alert
While I can’t say anything definitive for a patient I haven’t seen, my reactions are as follows:
1. The child has a true clinical allergy to wheat. But like most true food-allergy parents, Mom fears that more foods may be involved than truly are; peanut is a common cause of serious reactions so it is a likely candidate to fear.
2. A positive skin or blood test just means the child reacted to peanut exposure by creating some allergic antibody. This does not mean he is clinically allergic to peanuts.
3. Mom claims the boy has never eaten peanuts, but he has to have ingested some peanut however a small amount or hidden as an component to react to peanut.
4. A negative reaction to a DBPCFC means he was not clinically allergic to peanut at that time.
5. Food preference is not related to allergy, although I feel all the angst over peanut allergy may have influenced his preference.
6. From what I understand, the child never had a clinical reaction to peanuts, and is DBPCFC negative to peanuts. If that is true HE IS NOT ALLERGIC TO PEANUTS.
Living with food allergies is hard enough. One of the best things you and your doctor can do for your children is to make sure that you don’t make their diets more restrictive than they have to be.