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Allergy anxiety Add to ...

The first time Angela Lehrer gave her 18-month-old son peanut butter, she brushed the tiniest bit on to his upper lip. It was early in the morning on a weekday, with plenty of time to rush Jacob to the doctor should signs of an allergic reaction arise.

"I was so nervous," says Ms. Lehrer. "I barely touched my finger to his lip."

Jill Kimmel recalls feeling "total anxiety" when she spotted her two-year-old son, Ethan, picking through a bowl of fancy nuts sitting on a coffee table at a party.

Neither of the Montreal mothers had a family history of food allergies, and both their boys were good, healthy eaters. But rising numbers of allergies have turned the once innocuous snack - peanuts - into a major stressor for parents across the country.

Some, like Sasha Haywood, a Toronto mother of two, have taken a more cautious approach - she's decided against giving her two-and-a-half-year-old son, Max, his first taste of peanut butter for now.

"I want to wait until he can communicate that there is something unusual going on with his body," she says.

Giving peanut butter and other common allergens such as shellfish and eggs to children for the first time has become a major milestone, with mothers swapping war stories at daycare and preschool with an intensity once reserved for accomplishments such as potty training or putting away the pacifier.

Bruce Mazer, head of allergy and immunology at Montreal Children's Hospital, says he increasingly gets calls from parents wanting young children tested at the hospital because they are too fearful to introduce the foods at home.

"I have families come in for skin testing without family history of allergy, asthma or eczema," he says.

Doctors are split over whether this kind of parental reaction is appropriately cautious or paranoid - largely because doctors still cannot say for sure whether introducing the suspect foods early predisposes children toward allergies or prevents them.

Dr. Mazer says parents are "wasting a lot of psychological energy," but he understands why they are concerned.

Some of the stress, he says, stems from schools and daycares banning all peanut snacks. Lambrick Park Preschool in Victoria, B.C., for example, recently banned all dairy and egg products in addition to peanuts, after children who were allergic to those foods starting attending the preschool. That means parents cannot send any baked goods containing egg or packaged goods containing dairy products in the seasonings with their kids to school.

Dr. Mazer says the bans are crucial to protect the well-being of a few severely allergic children - but have also had the unintended consequence of creating a stressful climate in which all children are presumed allergic until proven otherwise.

In fact, says Dr. Mazer, while the risk that children without a family history of allergies, asthma or eczema will develop an allergy has risen, it is still only 1 to 3 per cent. (Family history is defined as having an affected sibling or parent.) "It's about the same incidence as breaking a leg or getting hit by a car," he says.

Parents also say stress comes from the conflicting advice they receive from doctors about the best time to introduce the foods.

Until recently, doctors often told parents to wait until their child reached three years old before introducing potentially allergenic foods - the American Academy of Pediatrics even cautioned pregnant women against eating nuts.

But the AAP rescinded that recommendation in a paper released earlier this year, which also stated there was little evidence backing up the practice of delaying the introduction of certain foods to avoid allergies.

Dr. Mazer says doctors are increasingly starting to question the avoidance theory. In Britain, for example, where public health authorities have strongly cautioned against giving peanuts early, peanut allergies have doubled in the past decade.

In a study being followed by allergists around the globe, British physicians are investigating whether giving peanuts early to babies considered at risk for developing allergies has a protective effect.

However, other doctors say waiting is still the best line of defence.

Stan Szombathy, a pediatrician in Kelowna, B.C., says that although doctors are starting to "question these old beliefs ... there is no reassuring data yet that says we should abandon the old line of thinking."

He continues to advise parents to wait until a child is 18 months old before introducing eggs, two years old for fish, peanuts or tree nuts (such as almonds, cashews and pecans) and three years old for shellfish.

"I'm biased towards trying to prevent allergies," says Dr. Szombathy. "Once an allergy is diagnosed, there's a high chance the allergy will be there for life."

Dr. Szombathy recommends parents test for allergies by rubbing a bit of the food on the child's lip or forearm. A severe reaction would occur within the first 10 to 15 minutes, but if the child shows mild symptoms, such as excessive salivation, parents should inform their pediatrician.

As for Ms. Lehrer and Ms. Kimmel of Montreal, neither Jacob nor Ethan had an adverse reaction to eating nuts. "Jacob ended up loving peanut butter," says Ms. Lehrer of her son, who is now 2½. "It's his favourite snack."

 

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