Doc Diagnoses Our Nut-Phobic Society With Mass Hysteria

By Eliza Strickland | December 10, 2008 4:56 pm

nutsThe fear surrounding nut allergies among children has gotten so out of control, one doctor says, that it could be considered an outbreak of mass psychogenic illness (MPI), more informally known as mass hysteria. Writing in the British Medical Journal, medical sociologist Nicholas Christakis argues that a tiny fraction of hospital admissions and deaths are due to allergic reactions to nuts yet ever more draconian measures are being brought in to prevent any child coming into contact with nuts [Telegraph]. Those draconian measures fuel parents’ anxieties, Christakis says, in what he calls a “cycle of over-reaction.”

Christakis cites the extreme example of when a potentially fatal peanut was “spotted on the floor of a school bus, whereupon the bus was evacuated and cleaned (I am tempted to say decontaminated), even though it was full of 10-year-olds who, unlike two-year-olds, could actually be told not to eat food off the floor” [The Register]. He also mentions some school policies of banning all nuts, peanut butter, and even baked goods that may have come into contact with nuts. While he acknowledges that nut allergies can be serious and even deadly, Christakis says that reasonable preventative measures could protect vulnerable children without scaring the bejesus out of everyone else.

In his article, Christakis argues that the response to nut allergies is drastically out of proportion to the true threat they pose. He notes that many more children are allergic to other foods like shellfish, wheat, or milk, and that the combined toll of all food allergies is not extraordinarily high. In the US, serious allergic reactions to foods cause just 2,000 of more than 30 million hospitalisations a year and comparatively few deaths – 150 a year from all food allergies combined [BBC News]. He compares this to the 45,000 people killed every year in car crashes, and the roughly 1,300 children who die from gun accidents.

Allergies are an increasingly hot topic because the number of people affected is skyrocketing; the Centers for Disease Control recently announced that the number of children and teenagers with food allergies increased 18 percent between 1997 and 2007. Nobody knows why the number is growing, but some researchers speculate that as other threats to the human immune system are removed from the playing field by antibacterial soap and other modern techniques, the immune system needs something to do, so it attacks the offbeat proteins in peanuts and other foods that many people are known to be sensitive to [LiveScience]. If this “hygiene hypothesis” is correct, it’s possible that sheltered children who avoid nuts will be even more sensitized to the nut allergens when they eventually encounter them.

Related Content:
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DISCOVER: Is Dirt the New Prozac? explores the hygiene hypothesis
DISCOVER: Burning Down the House describes the “malevolent kingpin of allergic reactions”

Image: flickr / viZZZual.com

CATEGORIZED UNDER: Health & Medicine, Mind & Brain
  • bigjohn756

    “He compares this to the 45,000 people killed every year in car crashes, and the roughly 1,300 children who die from gun accidents.”

    What a strange comparison.

  • GAC

    My sister has a very real, very serious allergy to peanuts, soybeans, and chicpeas (started with peanuts and broadened), and sometimes, yes, draconian measures can be necessary. But I wouldn’t accept the kind of restrictions we take when she visits into a public place. Maybe it would be safer for a few, but it would be impossible to enforce.

  • Jim

    As the father of a girl with a strong peanut allergy, all I can say is that I hope this happens to someone this so-called doctor loves. What a j*rk, and an irresponsible one at that. May he knows anaphylaxis in his own flesh one day.

  • Esther

    So nice of you to wish that upon someone, Jim.

  • Len

    “What a strange comparison.”

    It’s not a strange comparison at all. The author’s point is that we don’t freak out about driving cars or making it ever easier in the United States to obtain a gun, even though both practices carry far bigger risks in terms of annual death count than the threat of peanut allergies.

    As for Jim: You’re letting your emotions overrule your reason. I feel sorry for your daughter (and I was a sufferer of food allergies in my youth, incidentally), but given the limited societal risk, there’s no reason to lose our collective heads over peanut allergies. Has anybody out there actually read this article and–gasp!–gotten the point?

  • Bob

    Aside from Len, I wonder how the others did on the reading comprehension part of the SAT. It’s almost as if people read 3 sentences and head straight for the comment section ready to state their uninformed opinion with unwavering vehemence.

  • Mike

    It’s like the hysterical over-reaction to childhood immunisation. A small sector think that the tiny number of deaths each year due to reactions in these programs outweighs the hundreds of millions of live saved.

    Being someone who has nearly gone into anaphylaxis from an injection in an allergy immunization program, I’m quite happy to support both the principle of preventive measures AND a measured response to environmental threats.

  • Chris

    I expected more from this article, it assumes I know about some recent incident involving nuts.

    Jim tried to spice it up, but mostly just made himself look bad. Good thing the internet is anonymous, mostly.

  • http://debralegg.com/ Debra

    It looks like I have another new job description. Last week, I added Peanut-Allergy Nazi to my resume when a business magazine blasted parents concerned about their children’s exposure at school. This week, I’m fueling mass hysteria. It’s good to keep busy, I suppose.

    Yes, I’ve read the article, and I get its point: That the percentage of true peanut-allergic people is small. I did quite well on the reading comprehension portion of the SAT, too. I don’t recall the exact score, but it was high enough to land several scholarships.

    I would like the author to get this point, though: Allergic reactions to peanuts tend to escalate much more rapidly than reactions to other substances. While it is indeed true that more people are allergic to shellfish, wheat and milk, it’s also true that I’ve never had an allergic reaction from milk spashing on me. I do, however, have to wear gloves when preparing shrimp for others and iodine use is out of the question.

    My 5-year-old son, though, has had an allergic reaction from touching an object that had been touched by a classmate who had touched peanut butter. That’s not hysteria. That’s not over-reaction. It’s real. It happened. He’s also had reactions from consuming food contaminated with peanut during manufacturing. The product was not labeled for peanut. I supposed the shift supervisor that day also was among the set who believes that because not THAT many people die from peanut allergies, a little bit would be OK.

    The article says that 10-year-olds should be able to grasp that you shouldn’t eat a peanut off a bus floor, and I agree. I also believe that 10-year-olds should be able to grasp that you don’t rub a peanut-butter sandwich all over a severely allergic classmate, yet that very thing happened at my son’s school a few years ago.

    My son’s classroom at his school is peanut-free, which I think is reasonable given that he is confirmed to be contact allergic. He sits at a designated peanut-free table at lunch, and that arrangement, too, is acceptable.

    But the first time a classmate thinks it’s cute to rub him with something that can kill him, you better believe I’m going to turn into a Peanut-Allergy Nazi faster than you can say “anaphylaxis.” Because at that point, lunch literally will have become the loaded gun. I see nothing hysterical about that reaction.

  • Dr.G

    As a medical doctor who has a food allery to nuts himself — this guy has missed the point. To we few who suffer from the risk of death with microscopic levels of allergen–we do need to warn the public to protect kids. If we seem like we are over the top at times–it’s only because we live in fear of those people who downplay our risk.

  • JudyS

    As one who is new to the issue (and openly admitting my ignorance): Why wasn’t this an issue when I was growing up (I’m 48)? Back then, peanut butter was a staple in every kid’s diet. I don’t get it. I’m not a parent, so I haven’t had to deal with the “no peanut zone” thing. I do sympathize with parents who must be hyper-vigilent, but where did this all come from?

  • Sponzy

    I am a recent high school grad and am in college now. We had several kids with peanut allergies in high school and obviously all of the restrictions that were described. But these very same kids (one of whom is a good friend of mine) go to college and there are none of these dietary nazi measures taken. And my friend is fine I would like to point out.

  • parent of elem child with life threatening allergies

    School attendance is mandatory, for young children. These children are not capable of reading labels themselves and calling manufacturers to better undersand cross contamination risks. These young children, some FIVE years old in the school system, must rely on teachers and school staff to keep them safe. There is no reason to have peanut butter in a classroom when a child has a life threatening allergy to it. Peanut butter is sticky and can remain on surfaces for a long time if not properly cleaned.

    Restrictions in schools are usually at the elementary grades. The simple fact is — children HAVE died in schools due to lack of training in proper precautions for children with life threatening food allergies.

    This “doctor” is way off the mark. He is just trying to get a rise out of readers, obviously. He is not a board certified speicalist in Allergy/Immunology — he is a “medical sociologist”. I doubt he’s ever seen a small child in anaphylactic shock.

    No child should have a severe reaction or die at school. Life threatenig food allergies are very real– perhaps you’d feel differently if you’ve stood over your own child for 24 hrs in the hospital after an anapylactic reaction and near death.

    Not every “medical mystery” is solved yet. There are many theories behind the increase in food allergies — the hygeine hypothesis, the way we are affecting the immune system (vaccination schedule, GMO’s), environmental causes. Also, in many food allergy deaths, asthma is also a factor and the death is often classified as asthma.

    Sponzy, your friend is in COLLEGE, not elementary school. Young children with life threatening allergies do need traning and measures in place to attend school safely. There is tons of food served in elementary school classrooms and peer pressure to fit in and teachers that, without proper planning, would not be equipped to handle a life threatening food allergy reaction, when there can just be minutes to implement effective treatment with the Epipen.

  • Smart Parent

    First, just to answer the question, — Almost perfect verbal and math SAT and GMATs, and graduate degree from Ivy league school, thankyouverymuch.
    Jim is right…many of us are also wishing first hand experience on this Medical *Sociologist* because we have seen near-death in our own child. Jim was just willing to say it. This type of publicity from Christakis is not helpful.

    If nothing else, I’m sure others would not want to have their child witness a classmate in anaphylactic shock at school. That would be traumatic for everyone. It did happen in our school years ago, and the Girl Scout parents (who blew off the “Nut free classroom” sign since it was after school) and kids are still affected. You see, they did a “peanut butter birdfeeder” project in a kindergarten class after school one day when they used the K classroom. The next day, a peanut allergic girl attended kindergarten and had an anaphylactic reaction at school due to an invisible amount of residue on the table. The Girl Scout leaders and the girls in that troop still feel terrible…it was very scary for a bunch of 5-6yr olds to see their friend blue and struggling to breathe, taken away in an ambulance from Kindergarten class.

    So, why are projects like this necessary in school when it’s a no brainer not to use a child’s life threatening allergens in a classroom? These aren’t college kids who know how to avoid allergens themselves, these are little kids who need appropriate precautions in place.

  • Smart Parent

    This unintelligent article is a bad reflection on Harvard Medical School.
    Note – this guy has no clinical experience with children with Life Threatening Food Allergies. He is just stirring up controversy to make a name for himself as a “medical sociologist”.

    Children with life threatening food allergies deserve to be safe in school. Our school has done an excellent job and it is not a big deal if handled properly. Luckily we have a principal who “gets it”, and a nurse who has seen anaphylaxis first hand.

    It’s about reducing the risk and educating people. Sounds like Christakis needs some educating himself.

  • Zirantonus

    “…some researchers speculate that as other threats to the human immune system are removed from the playing field by antibacterial soap and other modern techniques, the immune system needs something to do, so it attacks the offbeat proteins in peanuts and other foods that many people are known to be sensitive to..” Please tell me this is not the reasoning to which science subscribes.

  • let’s be realistic

    I hate to say it, but at the end of the day you have to consider the number of people affected by each side of the coin. Suppose you have one or two children with a peanut allergy at an elementary school. You could make a rule that no material can be on the campus (no bringing nut-related items to school and no nut residues on surfaces, etc), or you could do nothing. In the first case, you restrict the diets and in some cases, the creativity (reference to the peanut butter bird food that someone mentioned) of 500-1000 children and the parents who worry about packing their lunches. You also have to have special training for the teachers and all kinds of infrastructure should anything go wrong.

    On the other hand, if you do nothing, there are two possibilities. One is that the children stay in school and are possibly exposed to something that may kill them. The other is that they are home-schooled or go to a special private school that addresses their needs.

    I’m not being insensitive to these children. Really, I’m not. …but to suggest that an entire community change the way it works, restricting what their kids can eat and do for such a small segment of the population is ridiculous. Parents with children with other special needs bear the responsibility of taking proper care of those children. Yes, this often times means spending more money and changing your life, but it’s what parents of mentally challenged, palsied, physically deformed, etc, children have to do.

    It’s not a matter of discrimination or anything along those lines (that would be restricting rights). These children have the right to attend school, but it’s up to the parents to take the responsibility for their safety if extraordinary measures are required. This is a matter of NOT taking extraordinary precautions to protect a very small number of people at the expense of everyone else.

    PS the immune system forms during infancy and much of the information points to a number of things to the rise in allergies in children. Among them is the lack of breast feeding in current culture (mother’s milk contains antibodies that are passed on to the baby – formula doesn’t have this). Additionally, children are nowadays spending much more time indoors during this time in their lives, and they aren’t exposed to numerous natural compounds that, when exposed to later in life, could result in an allergic reaction.

  • Bystander

    Why do special needs parents desire that everyone feel for and pay for their problems? We have schools for the blind, schools for the deaf, schools for the mentally challenged, so why not a school for the.. peanut intolerant? Then the majority of the population doesn’t have to alter their eating and personal habits for a few parents who don’t want to take responsibility for their own shortcomings and innocent girl scouts don’t have to be traumatized over the carelessness of school janitors lack of superb cleaning rituals.

  • Concerned Doc

    The original article by Dr. Christakis, who is both a physician and a sociologist, is available here:

    http://christakis.med.harvard.edu/pdfs/BMJ_081213_Nuts.pdf

  • Notthebigdealyouremaking

    First of all, most schools only restrict peanuts/nuts in the CLASSROOM, not the entire school. In most schools, chidlren can bring whatever they want for lunch. There are other things not allowed in the classroom as well, such as soda, candy, and gum. Eating snack in the classroom each day is a priviledge. Some schools don’t allow it at all.

    There is no reason these children can’t attend regular public schools. Anything else IS discrimination and would be funded by taxpayers.

    The restrictions are minor. Most of the risk reduction measures are regarding school readiness for anaphylaxis, such as Epipen training and accessibility. Anaphylaxis happens quickly, and children have died in schools where proper training and protocols were not in place.

  • Not A Fan of this Guy

    Christakis is not considering the innocent young Kindergartner with a severe peanut allergy. In his “non-hysterical” model, the school staff is probably untrained (as mine would have been, had I not had to be the “hysterical” mom insisting the Epipen be available and staff be trained)…

    And in his model, the nut-free classroom is unnecessary right? So some mom brings in peanut butter cookies to a party, or some chocolate chip cookie with tiny nuts in the batter, and the child eats the cookie offered by his teacher or a volunteer parent (because no one is educated in his model which relies 100% on the 5yo to save his life) and goes into anaphylaxis but the Epipen isn’t available…no one recognizes the reaction since training hasn’t taken place at this laid back school…the child is lucky to survive that party.

    Make no mistake, all those things have happened in my district before the district issued a food allergy policy. There have been allergic reactions including anaphylaxis to baked goods at class parties…the school stafF (and taxpayers) are darn lucky the children survived.

    Life threatening food allergies are very real, and schools must be prepared. Sometimes that may mean not allowing the life threatening allergens of a small child in a classroom. We are not talking about high school kids here — Christakis’ article speaks of elementary school. I would hate to be at his school as a parent of a young child with life threatening nut allergies.

    And notice — this guy is not a board-certified Allergist. He is a sociologist looking to get a rise out of people.

    So what if Christakis had to pick up mixed nuts at a loading dock at school? Was he soooooo inconvenienced? And so what if the bus was cleaned after a peanut was found on the floor? Most districts have a “no food on the bus” rule anyway…and the 10yr olds can be reminded of the rule. I am just not seeing how this is any huge inconvenience to this guy or anyone else. The fact is, children have been bullied with peanut butter in many places, and the bus is a likely lcoation for this, the bus driver is usually unequipped to handle anaphylaxis resulting in delay of care which can have deathly results.

  • alan

    The same schools that create peanut free zones to protect the one or two children that might have a reaction to peanuts still allow kids to play on the jungle gym at recess, where the risk of a fall and attendant serious injury or death far outweighs the risk of injury or death due to a peanut allergy. Yet where is the clamor for removal of the jungle gyms or elimination of recess? And where is our common sense while we’re at it? No doubt peanut hysteria mom drove her oh so vulnerable child to school in a peanut free car, exposing her oh so vulnerable child to a much higher risk of death and injury due to the car ride than due to any peanut the child might come across. We’ve become such pansies…

  • Doug

    To those with severely allergic children, I sympathize. Packing an epi-pen everywhere you go isn’t fun. This advice is too late for those who already have confirmed peanut allergies, but to new and expecting parents, there’s a bit in this article that’s being overlooked in the angry back and forth: Let your kids get dirty.

    “some researchers speculate that as other threats to the human immune system are removed from the playing field by antibacterial soap and other modern techniques, the immune system needs something to do, so it attacks the offbeat proteins in peanuts and other foods that many people are known to be sensitive to.”

    The human immune system possesses a cumulative knowledge, in that, as it is exposed to new pathogens/irritants/yucky stuffs, it learns to deal with them more effectively. This is why parents used to send their kids to the house of the friend who had chicken pox, why vaccines work, and why in another 80 beats post today a study links sterile upbringing with greater C-reactive Protein levels. Our bodies need to learn what the truly bad stuff is so they can fight it off, and it would appear that denying our immune systems that input causes those systems to go a bit haywire from boredom.

    To finish with an unscientific anecdote, I have a 3 year old. She was raised with pets in the house, goes to group care, lives outside with dirty hands for 7 months out of the year, and hand sanitizer does not exist in our house. She washes her hands regularly with antibacterial soap, but that’s mainly because you practically can’t get non-antibacterial soap any more. She got sick at an acceptable rate for the first two years, mainly colds, ear infections and the like. I know karma’s gonna bite me for saying this, but for the last year and a half she’s been damn near bulletproof. Colds, strep, the flu (not h1n1, she’s vaccinated there) have all run through her care center, and she keeps smiling and playing. I’m not saying to give your 6-month old peanut butter, but I am saying to let their immune systems learn what the enemy looks like, and you will be thankful for it in the future.

  • Angie

    I guess I should remain quiet, as I have no children of my own, but for some reason I believe that every child and in general every human being matters. At the same time I understand, that those doctors were trying to make a point about letting people eat nuts, if they are not allergic against them. I dare say there is a link to your soul when it comes to what you are allergic against. I was allergic against certain rings, when I figured out I had enough of a certain relationship in my life. I believe, that you can develop an allergic reaction against something you are afraid of. So I fully agree with those who claim, that people might be frightened of nuts when you teach them to be scared of nuts.

  • Angie

    A Dad displayed his anger towards doctors. I think more women should do that more often. It would be good for our health. No kidding! Let your anger out and you are far less likely to develop any kind of cancer. At least, that´s what I read somewhere some time ago. So why scold angry Dads, who are being unfriendly to doctors? Join them! Have some fun!

  • Wendy Clarke

    Make sure your ready for any Anaphylaxis emergency!
    Healthcorp Australia have an Anaphylaxis Epipen training course available
    Australia wide. Check out the details at http://www.healthcorp.com.au/epi-pen-anaphylaxis-training.html

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