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Given the uncertainty in the medical world, it's easy to understand the frenzy outside the doctor's office. Too often parents of newly diagnosed children aren't given enough information about when and even how to inject the lifesaving epinephrine. "Our allergist said, 'Here you go. Here's a prescription and see you in a year,' " says Dena Friedel, an Ohio mom whose daughter was diagnosed with a peanut allergy when she was 2. When her daughter had a reaction several months later, Friedel didn't know when to use the syringe and called 911 instead. The EMT told her she had made the right decision, but when they reached the hospital, "the doctor yelled at me and said I should have used the EpiPen," she says. "I was so confused and overwhelmed." (See the most common hospital mishaps.)
Reports in 2005 of a peanut-allergic girl who died from anaphylactic shock after kissing her boyfriend, who had eaten some peanut butter hours beforehand, raised alarms that the slightest exposure could prove fatal. It turned out that the girl also had asthma, a dangerous combination, since the lungs of asthmatics are more prone to swelling and shutting down when aggravated. Contact — in kissing, for example — through mucous membranes can also heighten the chances of an attack. For the most part, touching a food allergen is not a problem unless you then rub your eyes or stick your fingers into your mouth — both of which young children are fond of doing. Even so, parents' worries about the mere possibility of inhaling peanut dust prompted airlines to stop serving the popular flight snack. There has been no such treatment for passengers with milk or egg allergies, which are more common but also more likely to be outgrown. Moreover, smaller amounts of peanut protein can trigger allergic reactions in those who are sensitive, and peanuts are also more likely to result in fatalities than are other food allergens.
Still, very few people with a peanut allergy die from it. In fact, a 2003 study led by Dr. Scott Sicherer, a Mount Sinai pediatrician, showed that 90% of peanut-allergic children who got peanut butter on their skin developed nothing more than a red rash; none developed a systemic reaction in which their airways swelled up. The same went for smelling peanuts. Thirty peanut-allergic children were asked to sniff peanut butter and a placebo paste for 10 minutes each, and none developed a reaction to the peanut butter. Only one child had difficulty breathing — and that was after sniffing the fake peanut butter.
Such studies are starting to suggest a more nuanced way of handling the peanut problem in schools and other places. "You are probably better off teaching the faculty how to manage food allergies than making the classroom or school a peanut-free zone," says Dr. Sean McGhee, a pediatrician at Mattel Children's Hospital at UCLA. "To my knowledge, there aren't any studies where peanut-free zones decrease the incidence of anaphylaxis."
In some instances, peanut-free zones seem downright silly. Upon request, Delta and Northwest airlines will set up a peanut-free buffer zone spanning three rows in front of and behind an allergic passenger. (Why three rows instead of four or five?) Foodmakers have also gone a little overboard. In 2006 a federal law started requiring companies to use plain language to note the presence in their products of any of eight major allergens: milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybeans. But concern about liability claims led manufacturers to voluntarily supplement these labels with alerts on products that were made in the same facility or on the same machinery as food containing any of the eight allergens. The result is ubiquitous warnings about possible cross-contamination, which have made the labels essentially useless.