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How Peanuts Became Public Health Enemy #1

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Peanut allergies affect only one percent of the U.S. population—so how did they become an 'epidemic'?

Researchers aren't sure why, but over the past several years, the number of children reported to have allergies has doubled, to 5 percent of children in the United States. Yet at the same time, in schools and elsewhere, allergies have drawn what some see as an oversized amount of attention. A new paper out of Princeton University explores why that may have happened.

Allergy attacks are awful. I've been there plenty of times. Eyes swollen shut, coughing, hacking, sneezing—and that's just garden-variety pollen. But severe allergic reactions, also known as anaphylaxia, can cause death, even for the constantly vigilant. That's why the U.S. House of Representatives voted unanimously last week in favor of a bill that would incentivize states, through a pre-existing grant program, to make sure their schools have a supply of epinephrine (usually an EpiPen) on hand, as well as staff members trained in using it.

The de facto allergen mascot, the peanut, has been at the forefront of anti-allergy crusades. Several schools have banned peanuts, sports arenas have set up "peanut-free" zones, and pretzels long ago committed a coup d'état against their salty brethren aboard airlines. The public response and media coverage at times suggests an epidemic.

So then, how many people have a peanut allergy, that which has become the focus of so much epidemiological study and public attention? Look here:

Despite only affecting one percent of the U.S. population, peanuts have caused a strong response from the public health community.

One percent. That's it. One estimate pegs it closer to 1.4 percent for children, but only .6 percent for adults. Either way, it's small. Not all of those affected are seriously allergic, either. One percent isn't nothing, but it's not the kind of number that would suggest a strong cultural reaction, either.

Why, then, have peanut allergies become such a well-known public health menace? Maybe it's partly from the mystery surrounding all allergies; scientists don't know why allergies exist and why some people grow out of them. It's also not clear how much an allergy attack may be exacerbated by asthma; the two often go hand in hand.

That allergies carry even some of the same the notoriety of a true epidemic, like typhoid, AIDS, or smallpox, intrigued Princeton University researcher Miranda R. Waggoner.

In a paper set to be published in the August 2013 edition of the journal Social Science & Medicine, Waggoner explores the momentum behind society's Planters paranoia.

Medical journals first discussed peanut-based anaphylaxia in the late 1980s, while more and more parents separately but simultaneously started banding together to promote allergen awareness, assisted by speculation within the press about a new, interesting, and potentially hazardous health problem.

"The discourse reverberating within and beyond media reports of peanut allergies was filled with anxiety and fear, and this coexisted with the activities of parent groups and the percolation of medical studies documenting the rise of the problem," Waggoner writes.

It's not hard to envision. Remember 2001, for instance, when a summer shark attack set off a panic that evolved into "Summer of the Shark," even though shark attacks overall were down from the year before.* Sometimes, major attention is warranted, like during the height of the 2009 swine flu pandemic. Sometimes, it's not. The line between the two can be tricky and difficult to see without the benefit of hindsight.

But attention came. Massachusetts published a set of recommendations in 2002 entitled "Managing Life Threatening Food Allergies in Schools," becoming the first state to set guidelines for peanut-free zones in schools.

In 2004, Congress passed the Food Allergen Labeling and Consumer Protection Act, which mandated labeling food that might contain the most common allergens: Milk, eggs, fish, shellfish, tree nuts, wheat, soybeans, and peanuts.

The ensuing years caused a headache for places like public schools, left to grapple with the balance between offering foods people like and ensuring the safety of those with allergies. Some parents have brought lawsuits to exile the nearly ubiquitous peanuts from their child's school.

While the peanut industry has tried to intervene, and show that it cares, it has done so to limited effect.

"[W]hile airlines and schools, nudged by fearful parents, scrambled for new policies regarding peanuts in public spaces, corporations downplayed popular perceptions of risk," the Princeton paper says. "By 2010, the purported epidemic and its responses seemed out of proportion, as experts reined in the population definition and prevalence numbers of all food allergies."

Again: only 1 percent of the U.S. population has a peanut allergy. Twice as many people have a seafood allergy.

Peanuts, however, are a ubiquitous if not integral part of American culture—you won't hear "Buy me some tuna and Cracker Jacks" at a Washington Nationals game. And anaphylactic episodes caused by peanuts can be among the most dangerous of any food allergy. Stories about children killed by peanut allergies are scary, like that of 13-year-old Natalie Giorgi, who died even after being treated with three EpiPens. And they are especially frustrating because such severe attacks can usually be prevented.

This explains, in part, why the number of self-reported allergies has increased, either through heightened public awareness or as part of an understandable panic, and how peanut allergies became the focal point.

"More than a story of panicked parents and sensationalist media, peanut allergy discourse was co-constructed by multiple actors and institutions over time, with a range of social consequences," Waggoner concludes.

Waggoner by no means dismisses peanut allergies as a reason to be concerned, but rather looks at peanuts as providing a useful case study to understand public health scares. The outcomes of such incidents aren't wholly bad; if public alarm causes schools to have both a supply of epinephrine and staff members trained to administer it, excellent—anaphylaxia is a mostly preventable situation that still catches many off guard. More people have probably been prepared for anaphylaxia over the last two decades than they otherwise might have been in part because of peanuts' notoriety, and if so, then it's hard to say the ends don't justify the means.

The difficulty, though, is in the legacy peanut allergies have created, about understanding a health problem before reacting to it and creating reasonable expectations for how institutions like schools ought to respond to such a threat. Know thy enemy, yes; but don't panic before it.

*The media nevertheless failed to give due coverage to the impending threat of Sharknadoes.

Top image: Wikimedia Commons/Ross Brenneman

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