Should schools ban peanut butter?

Richard C. Loria, M.D. Adult and Pediatric Allergist, Allergy and Asthma Associates, P.C., McLean, Va.       YES Along with tree nuts, peanuts are the leading cause of fatal and near-fatal anaphylaxis induced by food, and the incidence is rising. A report in the British Medical Journal found that peanut and nut allergies account for over half of all allergies seen by age 2, and 92% seen by age 7.   A handgun is potentially lethal, and we don’t allow a child to carry one into the classroom. For the child with peanut allergy, peanut products are potentially lethal. Schools aren’t prepared to deal with life-threatening anaphylaxis. Most lack personnel trained in resuscitation.   Schools already control entry of drugs onto school property. Every year, in my practice, we fill out countless forms for drugs so that students who need them can bring them to school. There is ample reason to include peanut products in this category of restricted substances. The hypotension-inducing, bronchoconstricting ingredient in peanuts is far more dangerous than most of the drugs kids need in school.   It’s important to weigh the costs and benefits of any policy. Peanut butter is easily fungible in the diets of schoolchildren. Would a school prefer to risk peanut-butter exposure and deal with the consequences of a fatal reaction? Allowing peanut butter around the peanut-allergic child is like allowing smoking at the gas pump. It’s a formula for disaster.   Sure, people with allergies need to learn to deal with day-to-day risks. But young children with peanut allergies cannot be expected to bear this kind of responsibility on their own. There’ve been cases in schools where peanut butter has been waved in the face of a peanut-allergic child.   The nonallergic population needs to recognize the severity of this issue.

Scott Sicherer, M.D. Assistant Professor of Pediatrics and Researcher, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York       NO A ban could create a false sense of security. Early signs of a reaction may be discounted long enough to delay treatment, leading to worse outcomes.   Moreover, a complete ban is impractical and technically almost impossible. Cross-contamination with peanuts can occur during manufacture, in restaurants, and in the home. Sometimes the same machinery is used for making peanut and non-peanut-containing products. At home, chocolate-chip cookies might be baked with the same utensils used earlier with peanut butter.   It’s too much to expect parents of a nonallergic child to guard against cross-contamination of every food item their child brings to school. Bans could lead to lawsuits by parents of allergic children against parents whose children accidentally bring a cross-contaminated item to school.   We have seen accidents occur even among children whose families were educated about avoidance. We published a study in Pediatrics in which 55% of 102 peanut-allergic children over a 5 1/2-year period had reactions from accidental ingestion of peanuts.   Then there is the slippery slope of other allergies. Significant allergies to milk, egg, wheat, soy, tree nuts, and fish are not uncommon. Are we going to ban these, too?   It’s probably appropriate to exclude peanut products from day care and the youngest age groups since eating may include drooling on one another, and sucking shared toys.   For most settings, though, providing a safe environment includes education of all parties about the allergy, instruction on the indications and technique for injecting epinephrine, having an emergency plan in writing, enforcing a strict “no-food sharing” policy, washing hands and tables, and having a supervised “allergy” lunch table.