Thursday, March 24, 2011

To Eat or Not to Eat: The Puzzle of Peanuts and Allergies

200 people die a year from food allergies.
11 people die a year from food allergies.

Big difference. So which is it?

Meredith Broussard, a journalist hot on the trail of the peanut puzzle since her controversial Harper's article a couple years back, thinks the actual annual number of food allergy deaths is considerably smaller than the oft-quoted 150 to 200.  Back in 2008 in a Huffington Post piece she reported the CDC listed only 11 deaths related to food-induced anaphylaxis in 2005.  There were 12 in 2004 according to a 2008 New York Times article.

Why the larger estimate? Here's Broussard's answer:
The 150-200 death estimate comes from the media resource kit of the Food Allergy and Anaphylaxis Network, a lobbying and educational group headed by a former marketing executive at Dey Pharmaceuticals, the maker of the EpiPen adrenaline injector (which is prescribed to millions of food-allergic patients).
From The Food Allergy and Analphylaxis Network.   OF COURSE.  An organization devoted to spreading the word about food allergies, that yes, can be life-threatening but that rarely kill anyone despite the considerable hype.  They help a lot of families but I see no reason why they shouldn't try to get the numbers correct.  Unless of course they enjoy freaking out parents and children - come on,  ANAPHYLAXIS in the title, really? 

Fearmongering aside, where did FAAN get the numbers?

From one measly 1999 study from Olmstead county in Minnesota.  A retrospective study tracking anaphylaxis - of all sorts, not just food-related - among its citizenry.  How many people died? One. One death that wasn't related to food.  A man's throat swelled up while exercising.  Not eating.

The authors concluded "the incidence of anaphylaxis is less than 1%, and death rarely occurs."  Less than 1%.  DUH.  The rate for food-induced death?  Way lower than 1%.   

Yes it's just one study, it could be larger.  But it's ONE study.  ONE tiny study does not yield a solid estimate. 

So if extrapolated to the larger population it would still be less than 1%.  So how that became like 200 annual deaths is entirely unclear.  If the CDC is correct,the actual number is really too small to even quantify in a meaningful way.  That said, it's still possible the rate is higher.  But surely the symptoms of food-induced analphylactic death are difficult to miss or confuse with another condition. 

Why pick on peanut allergies? 

Some very smart professionals like noted Harvard Ph.D. and M.D. Nicholas Christakis worry that we're getting carried away with peanut-free environments to some not inconsequential consequences, like perhaps, more allergies.  Oh yeah, there's some intriguing and troubling new evidence that early avoidance (no nuts during pregnancy, breast-feeding, or first three years of life) might not only be ineffective but harmful.  Actually promoting more allergies.  Even the American Academy of Pediatrics revised it's no-nuts recommendation recently. 

If you're interested in the evolution of the new evidence and the no-nuts recommendation, check out my recent scoop on Parent Dish - Peanut Allergies: Snack with a Side of Drama.  It's a drama alright.

Great article about it in the New Yorker too (The Peanut Puzzle:Could the conventional wisdom on children and allergies be wrong?).  Yes the New Yorker. Not kidding.  It's rather pathetic parents have to track down a hard copy of a literary magazine to find out what's really going on.  If you have a subscription to it already what are you doing slumming it here?  Although I might need a subscription too if they continue to cover these kinds of health/parenting stories.

Is there a Food Allergy Curse?  Kind of like the King Tut curse that afflicts those who touch the royal tomb.  Just realized the red licorice I'd been nibbling on from Whole Foods (an infrequent treat, the shop not candy) - has "natural strawberry flavoring."  Uggh.  I'm allergic to strawberries - it's near the bottom ingredients so I shouldn't be wheezing as I've already dosed up for the day.  Who flavors licorice with strawberry? Isn't red suppose to be cherry????   Last time I wrote about food allergies my son's face swelled up.  Time before, I got a rash.   I'm not superstitious but....

9 comments:

TherExtras said...

Polly, you ARE my favorite statistical sleuth! I'm glad you are over at P Dish.

I can leave this comment with the confidence that you are not in for an anaphylactic event after the strawberry flavored candy. I mean, the chances are low. *wink*

While I cannot quietly digest dairy products on the rare occasions that cheese passes my lips I have been known to reassure others with: I won't go into anaphylactic shock.
Barbara

Mother Against Distorted Data said...

Barbara, howdy, missed you! Always happy to hear your clever take. Sorry to hear about the food issues, dairy's a hard one but I'm confident you've never let a little lactose rattle you.

P.S. Thanks for the idea - I'm gonna have to borrow "statistical sleuth" for my resume. Is that too cheeky even for the twenty-somethings seemingly in charge of the world (i.e. social media)?

Polly Palumbo, Ph.D. said...

That was me above, new layout changed "my identity".....

Kristin said...

Polly, great post! I've been finding lots of interesting science and healthcare articles in the New Yorker lately - I do suggestion a subscription or browsing the webpage once in a while!

Polly Palumbo, Ph.D. said...

Hi Kristin! Thanks for the lead - now I will have to browse the magazine. What were some of the articles?

Anonymous said...

As a mom with a daughter with peanut allergy, albeit not severe, I read THE PEANUT ALLERGY ANSWER BOOK. I found that there are no answers and even the top physicians in the field don't have answers. Contemporary parents feel like there is an answer or solution to everything today. If they do this and that then their child will be as close to “perfect” as possible or they can control what happens to their child. In some ways I am glad there aren’t answers – people need to stop looking at their children as something they manage.
I am also glad you are discussing all the misconceptions about how food allergies develop and that it isn’t cut and dry b/c many new parents think it is – believe me, I have been told “well if you didn’t do this maybe she wouldn’t have the peanut allergy.”

Polly Palumbo, Ph.D. said...

Hey Anony! I am sure you have heard just about everything from doctors, relatives, teachers, other parents!!!

Thanks for reading and commenting - I love to hear from parents who've deal with allergies in real life. I also love that you have not only taken matters into your own hands and read up on food allergies - but you remind us that parents can't and shouldn't micro-manage every day/hour/meal of a child's life. And that kids aren't little science experiments or projects that we must try to perfect! So wise, and a much-needed perspective.

Dawnmarie said...

I went into anaphylactic shock in 1992. Within 30 minutes, I was non responsive. I actually stopped breathing. If I hadn't been at the hospital at that point, I would have died. The problem with stats on deaths from this cause, is that most of the time, like in mine, they can't say for sure what caused it. We believe mine was caused by overexposure to mold. Yeah, you heard right. Mold spores are in food and they're airborne. My reaction was probably caused by exposure to both. We also learned that my doctor had been misdiagnosing allergic reactions as stress. This incident might have been avoided if I had been better treated for my allergies. Since then, I've never gotten close to such a reaction again. I recognize the warning signs that my allergies are flaring out of control. For me, it's not one simple item, it's the combination of all together.

Someone with sever allergies needs to be aware of what can cause a life threatening flare up, and they need to exercise proper caution for themselves in avoiding those items.

You're spot on in that most attacks don't actually end in death, a lot move slowly enough to get treatment. Mine moved quickly and if I hadn't started treatment at home and rushed to the hospital the outcome might have been much different. From what doctors told me, my case is not the norm.

Correct information rather than fear is the most effective way to educate people. I wish public health groups would realize that. Allergies can be deadly, but they don't have to be. Better education instead of fear mongering would save more lives.

Polly Palumbo, Ph.D. said...

Thanks, Dawn Marie. Glad you're well. I happen to be very allergic to mold too, could be my most severe allergy. But I never worried about it that much until I read something about mold on food, had associated it with mold outside the house, the basement, etc. Not so much eating it.