Pediatricians knowledge of peanut allergies

Posted on: Wed, 05/19/1999 - 4:39am
susan's picture
Joined: 05/19/1999 - 09:00

In March when my son had turned 15 mos. and had his 15 month doctor visit I was told that I needed to get him to eat more table foods. so I decided to try a ritz bit peanut butter cracker because he didn't like any meats and I wanted to give him some protein amid all of the carbo's he enjoyed so much(cheerios, toast, etc.) At the time I offered the peanut butter, the baby was on antibiotics for an ear infection. He ate the cracker and reached for a second bite. That was when he began to cry and vomit. The vomiting lasted for about 5 minutes. My first thought was that the ear infection or his medication was making him sick, but it was so immediate I wondered if it was the peanut butter. when he stopped vommiting I put him in his crib and went to get a towel to clean him. I returned to find one of his eyes had become swollen and very red...just like mine around cats. That reinforced my thoughts about this being an allergic reaction, but I had no idea what that meant. His eye looked clear and he seemed fine within an hour of the episode. I called the doctor who agreed that he was probably allergic and told me that I might want to give him some benedryl if I had it. He didn't recommend that I get him tested...
2 days later I took him to our Nurse P to recheck the ears. I told her about the episode and she told me to get to an allergist immediately to check this out and that it was life threatening...Hello! What was the pediatrician thinking? In fact, why didn't our pediatrician recommend that we avoid introducing highly allergenic foods to our toddler until his immune system had a chance to mature? Are your pediatricians asking you if either parent has a history of allergies before they recommend toddler diets? Wish mine had..
Anyway, our baby is a class 4 for peanut allergy. We have 2 epipens to carry with us. He is also allergic to egg whites and beef. (My doctor also told me to try him on eggs at 10 mos.) Not sure how he was sensitized to the peanuts unless in utero since I didn't breastfeed.

I am switching to a pediatrician that has a background in allergy. I am still new to this and somewhat freaked out by the lack of knowledge in the pediatric community....any thoughts?


Posted on: Wed, 05/19/1999 - 9:46am
armiger's picture
Joined: 05/15/1999 - 09:00

Our pediatrician jumped right on the peanut allergy as serious (when I was still thinking it was no big deal...just a few hives!). However, Brady is allergic to dairy products too and the ped isn't concerned at all. I am amazed at all of you moms who have had there very small children allergy tested..noone here will do it until they are at least three. If I had known she was allergic to begin with, I would have never given her a peanut! It seems logical to me..but not to these doctors! At least I have epi-pens now so I know I can handle any other allergy that she may have lurking..just waiting to be discovered!! [img][/img] Tammy

Posted on: Wed, 05/19/1999 - 10:01am
dhumphries's picture
Joined: 02/02/1999 - 09:00

Hi Susan,
I wanted to relate my experience with my pediatrician and my son's first and only reaction. I would call this reaction full blown anaphylactic, as within five minutes of ingestion he had difficulty breathing, vomiting, intense sneezing, and hives. I called my pediatrician immediately, and he didn't even come to the phone. His nurse, who is only an LVN, said just to give him a 1/2 tsp of benadryl, and he would be ok! My maternal instincts didn't trust this opinion, and I immediately took him to a doctors clinic within a couple of minutes of my home. The doctor on call there realized the seriousness of this, and immediately took him in to an exam room, where he received two epinephrine injections and two doses of benadryl in about a two hour time frame. This same doctor gave me a prescription for an epi-pen and advised me to see my doctor. When I visited my pediatrician, he again said that I probably didn't need to worry, and advised me to wait until my son was five to see an allergist! Again, I didn't take his advice and saw an allergist, who reiiterated the seriousness of this allergy. Thank goodness I didn't heed my pediatrician's advice!
Good luck and Stay Safe,, Debbie

Posted on: Wed, 05/19/1999 - 12:24pm
susan's picture
Joined: 05/19/1999 - 09:00

Did either of your pediatricians ask about family history of allergies at the one year or subsequent visit when discussing foods for the baby?

Posted on: Wed, 05/19/1999 - 11:19pm
Shan's picture
Joined: 04/05/1999 - 09:00

I can totally relate Susan. Please read my post under this main discussion board titled Should I vent...I had alot of replies and good advice from everyone on here. It is amazing the amount of peds out there who don't have a clue. It just reinforces the fact we have to take matters into our own hands to keep our little ones safe. I wish you the best of luck. I'm even starting to question our allergist now. My dd's peanut skin test came back negative even though she had hives and swelling in her face for days within minutes after eating peant butter. He wants to do an oral challenge and I'm starting to wonder now if a RAST would be more in order. Keep us updated! Shan

Posted on: Thu, 05/20/1999 - 2:46am
Greg's picture
Joined: 01/16/1999 - 09:00

Just a quick note to let everyone know that at a forum held here in NY yesterday, that included a number of top figures in the food/peanut allergy field, one of the main topics brought up for discussion was indeed the fact that pediatrician's handling of food allergies appears to vary widely from one to another. It certainly seems some sort of uniform food allergy education needs to be offered.

Posted on: Thu, 05/20/1999 - 1:44pm
tracy's picture
Joined: 02/03/1999 - 09:00

I had a similar experience. When my son turned 1 year old, we asked the pediatrician what we needed to be concerned about when feeding our son -- should we avoid any foods? He said, no, that we could feed him anything. We had informed him of our family history of allergies when we interviewed him before I gave birth, so he was aware of that.
6 weeks later my husband gave my son a peanut butter cookie and 30 minutes later he vomited and his faced swelled up. The nurse on call told me to give him benedryl and that he'd be okay. I decided to take matters into my own hands, so I took him to an allergist. I didn't like the way this guy treated us, so I asked around and got recommendations for another person. I was prepared to pay for everything myself if I had to -- I didn't want to let the insurance companies dictate anything.
My son tested a 5 on the RAST test. That was 4 months ago and he hasn't had a reaction since, but we are careful about what he eats.
We still go to the same pediatrician, but I do my homework. I go in with a piece of paper that has questions and concerns and I don't let him leave the room until we've covered everything and I feel comfortable with his responses. I do this with every doctor I see. I also have realized that it sometimes doesn't matter how prepared and how much homework you do, you can't control everything. I feel confident that based on the knowledge I, and all the professionals I consulted had, we did the best we could. I have also tried to educate these professionals. My lactation consultant now lets all her clients know about the link between family history of allergies and potential food allergies. My ob/gyn was respectful when I told him what happened, but isn't changing the way he consels his patients about diet (his office still recommends peanut butter as a good source of protein for pregnant and lactating mothers). But our pediatrician is a bit wiser.
I also feel confident that the information about this problem will become more prevalent and people will become more understanding and careful. It will take some time, though.

Posted on: Mon, 05/24/1999 - 10:53am
Becky's picture
Joined: 03/05/1999 - 09:00

I had the same reaction from my ped. At 12 months I handed my son a ritz cracker with a small amount of PB on it. As soon as he touched it he started breaking out in hives and his eyes went red. I grabbed it and washed his hands, and called the ped. (I never heard about PB allergies before so I wasnt sure what was happening or how severe this was) I called the ped and said my son ytouched PB and he has hives what do I do? They replied someone will call you back!!! I called back in 10 minutes and demanded to talk to someone and they told me give him a tsp of Benedryl he will be fine. (Looking back on this now I am thankful he didnt take a bite of that cracker most likely he would have been dead. The ped never mentioned the severety of his allergy at his next well check up when I reminded him of the episode. Another doctor in my group I went to see a few weeks after I saw my normal ped my son was sick and he was going to prescribe a prescription and asked if he has any allergies I said just to PB, he said do you have an epipen? I said no, and he explained the severity!!
We went to the CT conference and DR Sampson talked about ped not being taught ANY COURSES on allergies. Also he showed us a study that showed the ped didnt know how to use an epipen, the parents scored higher when they ran a random test. Pretty Bad!!

Posted on: Thu, 06/17/1999 - 12:07am
LouiseLarsen's picture
Joined: 06/07/1999 - 09:00

I wholeheartedly agree that the medical community is frighteningly ill-informed about Peanut-Allergies.
I am shocked at how little they know about the phenomena of anaphylaxis due to peanuts.
The "starting solid foods" guidelines are all over the map in regard to peanuts.
I mean, I was pregnant from March '96 - Dec. '96 and read everything I could get my hands on about babies, etc...(As I'm sure everyone does when they're pregnant for the first time.)
I never read one thing that warned me about peanut allergies from those books. The "What To Expect" books especially appalled me; after my daughter almost died at 15 mos. from severe anaphylaxis from one bite of peanut butter, I reviewed my books. I couldn't believe I could have been so careless to miss the warnings that surely had to be in the books.
Well, there really was no warning. Just a vague reference that a peanut allergy is "extrememly rare"...It was even rather dismissed...AND, in their "Best Odds Diet for Toddlers", they have recipes for "Peanut-Butter Balls."
The "What To Expect"...books are like a bible for most women, they probably purchase one the day they have a positive pregnancy test....How can these writers not feel an obligation to update their books on a yearly basis in order to keep up with all the medical discoveries that are made all the time? I think it is beyond foolish, after all, the authors would get more money each time it was revised! I think somebody somewhere should be held accountable for failing to warn parents about the possibility of a fatal disease as a result of food eatten by mother or child.
This is simply unacceptable and mothers should not have to find out the "hard way"...The information DOES exist. Let's get it out to the public!

Posted on: Thu, 06/17/1999 - 4:29am
kellyh's picture
Joined: 05/27/1999 - 09:00

Hi Louise. I too had those books and considered them my "bible". I just want to say, that I too read everything there was to read on pregnancy. I had heard of peanut allergies and so I know if I had seen a warning, I would have not eaten the amount of peanutbutter that I had. I was reading the other day "What to expect with Toddlers" and came across a section that stated children under 3 should not eat peanuts. Ok, then why do they give receipes like you mentioned. It was only one line and I find it so hard to believe they didn't take it seriously. I have been told by researchers at John Hopkins, that there is no "proof" of giving this allergy to your child while being pregnant. BUT, the doctor did stress that not eating it was a good idea. She says I probably sensitized my daughter while breastfeeding. I believe if alcohol can get to the fetus, then so can everything else. She did say that if anyone in your family has allergies, you can pass it to your child and it can come out as any type of allergy. Unfortunately, my husband has asthma, hayfever and I am lactose intolerant(except while I was pregnant) and allergic to wheat. No one ever told me to alter my diet at all. I ate alot of peanutbutter ( I remember my husband giving me peanutbutter sandwiches while I was literally breastfeeding my daughter- yikes!!), milk, and eggs. I thought I was doing everything right. But as that doctor told me, sometimes it just doesn't matter. I will always be peanut free for my daughter's sake, but I think before I get pregnant again, I will check out Canada's and the UK's guidelines. I always assumed the US was "on top of all research" What a shock. Also, I did look up a site (not sure of the address) but it was about the peanut farmers etc. There was a section on peanut allergies and I was surprised at how informed it was. They actually suggested children under 7 should not eat peanuts. I just wish I had gotten all this info and then I could have made my own decisions. I know my child still could have gotten allergies, but maybe it wouldn't have been this bad. So now we deal with it and pray they come up with a vaccine. I just pray my future children will be alot luckier. Kelly

Posted on: Thu, 06/17/1999 - 11:38am
dhumphries's picture
Joined: 02/02/1999 - 09:00

Hi Kelly,
I just wanted to mention that I read that the reason books warn against children under three not eating peanuts is due to the choking hazard, and not the potential allergic reaction. That is probably why you see that warning, but then see recipes with pb in the same book.
I agree that we need to get these authors more informed about pa. I would be willing to bet that just as many individuals die from the reaction as they do from choking on pnts.
Stay Safe, Debbie

Posted on: Wed, 06/23/1999 - 5:03am
SteveW's picture
Joined: 04/08/1999 - 09:00

Our pediatrician has been very good about our son's peanut allergy. His first reaction was very mild - he threw up and had hives on his face that disappeared so quickly that we weren't sure we ever saw them (he was also sick at the time and had thrown-up the night before). We decided not to give him peanut butter again and talked to the pediatrician about this at his next checkup (a week later). The pediatrician was surprised that he had had a reaction the first time he ate peanut butter (he was probably sensitized through nursing), but did recommend that he not eat peanuts again until he was at least three.
His second reaction was at day care where he was accidentlly fed peanut butter. This time he threw up again and had severe facial swelling (you couldn't tell what color his eyes were because the area around them was so swollen). Luckily, he had no trouble with his breathing. When my wife called the pediatrician's office, she spoke to the nurse whose daughter has a walnut allergy and was very understanding and very helpful. Because she couldn't see the reaction, she had day care call the office and talk to the nurse she had spoken to and the pediatrician also came to the phone. Since he wasn't having breathing trouble, they asked me to bring him to the office as soon as we could get him there. They observed him for almost two hours. The pediatrician ordered a CAP-RAST (done later the same day) and said he would refer us to an allergist depending on the results. When the results came back we had a prescription for Epi-pens and a referral to an allergist.
The allergist told us at the first appointment that this would go more quickly than usual because the pediatrician had taken care of the preliminaries for us. The only difference they had was that the allergist
read the RAST test differently with respect to eggs. The pediatrician thought the eggs were a false positive and the allergist wants our son to strictly avoid them as a precaution.

Posted on: Wed, 06/23/1999 - 6:30am
brenda's picture
Joined: 01/22/1999 - 09:00

As many of you, I too have been bothered by the lack of allergy knowledge that most peds have and have wondered why they are not more informed. The explaination to this came up at the Stamford FAN conference. Dr. Sampson said peds get very little or no allergy training during their whole medical training (at most they get 1- 2 hours)!!!! Dr. Sampson said the only way to change this is through a public outcry to the boards (ie, write letters to the exam and pediatric boards). It is terrible that peds have no training for allergies during med. school, BUT it is still no excuse for them not to at least educate themselves thru medical journals, internet, and FAN about such an important and common childrens' health issue (just as we have all educated ourselves). The well informed peds that some of you write about are probably the ones who have done this. It certainly explains why there is such different handling of the allergy amongst all our peds.

Posted on: Wed, 06/23/1999 - 6:31am
brenda's picture
Joined: 01/22/1999 - 09:00

[This message has been edited by brenda (edited June 23, 1999).]

Posted on: Wed, 06/23/1999 - 8:33am
SteveW's picture
Joined: 04/08/1999 - 09:00

There are two distinct topics being addressed on this thread. First, the pediatricians level of knowledge once someone has a reaction. This varies greatly. From my very unscientific sample, the younger ones appear to have greater knowledge of food allergies.
Second, the guidance in the "What To Expect" books are just that. I'll probably take some major heat for this but, I find it extremely unproductive to make statements such as "I think somebody somewhere should be held accountable for failing to warn parents about the possibility of a fatal disease as a result of food eaten by mother or child."
1. There is no definitive proof (although suspected) that early exposure will increase the probability of having a reaction.
2. There is no definitive causal link between mothers eating peanuts during pregnancy and an increased probability of developing PA. This link has only VERY recently (British Medical Journal, June 27th, 1998 published a letter entitled "Women warned to avoid peanuts during pregnancy and lactation.") been suspected. People at high risk should certainly avoid it (my wife certainly will). Some researchers feel that in utero sensitization may actually reduce the body's rejection of pn proteins (as happens with transplants). Indirect data suggest that lactation is a more likely route of primary sensitization, but this point remains to be established.
That said, I think there should be greater awareness of the possible PA links so that expectant mothers (especially high risk ones) can make informed decisions.

Posted on: Thu, 06/24/1999 - 3:55am
EILEEN's picture
Joined: 04/06/1999 - 09:00

Steve W.
I think the British government may be taking the view that it can't do any harm for women to avoid peanut while pregnant and that it may help to curb what they perceive to be a growing epidemic.
As I've said on these boards before the rest of the world was putting babies to sleep on their backs to reduce the risk of SIDS (sudden infant death syndrome or cot-deaths) long before it was adopted in the US (and how many lives would have be saved iif it had been introduced earlier?). We can't easily dismiss what the rest of the world is doing.
Could you please post citations to the work you describe about researches thinking that in utero sensitization could reduce the body's reactions to peanuts. I have not come across this in any of my literature searches. Also immunological responses are very much affected by the nature of the antigen. These are very different in transplant rejection (the foreign antigen is on the cell-surface) and to peanut ( a soluble protein) and I am not sure the same events take place to produce "tolerance".
If you haven't seen them already, you may find these limks of interest, I had previously posted them under research.
"Reduced exposure might increases allergic sensitisation" BMJ 1996;313:300
Selective expansion of T cells expressing V beta 2 in peanut allergy. Pediatr Allergy Immunol, 1995; 6: 95. T
[This message has been edited by EILEEN (edited June 24, 1999).]

Posted on: Fri, 06/25/1999 - 2:23pm
tracy's picture
Joined: 02/03/1999 - 09:00

Steve W.,
Our son had a very similar reaction to your son's... he also threw up and had some hives, in addition to some mild swelling in his face. When we gave him Benadryl, it all went away quickly. We took him to an allergist as soon as we could and the allergist told us that our son's reaction was not mild -- it was anaphylactic. When I said I thought it was a good sign that our son threw up (because I thought he was getting rid of the peanuts), the allergist said he threw up because of the amount of histamine his system produced in reaction to the peanut cookie he ate -- his stomach couldn't tolerate it.
Anyway, I originally thought our son's reaction was mild (because he didn't have breathing problems either), but the allergist's explanation of his reaction has made me much more concerned.
Eileen understands the terminology better than I do, so she can correct me if I'm wrong in any of my explanations here. (Thanks Eileen.)

Posted on: Mon, 06/28/1999 - 8:48pm
Ilene Clayman's picture
Joined: 06/19/1999 - 09:00

My son has multiple food allergies including nuts and peanuts. I feel that pediatricians are not properly trained about food allergies. Yesterday my friend's daughter ate peanuts and had what appears to be a reaction (hives all over). She called the doctor and got a nurse practitioner on the phone. The nurse told her it could be an allergic reaction. The nurse said you could either take her to the allergist soon or wait a month and and give her a small amount of peanuts by herself and have benadryl in case of a reaction. Things like this infuriate me. As you all know the next reaction could require epinephrine and without it the child could be in very bad shape. My friend is going to stay away from peanuts until she gets to an allergist.

Posted on: Tue, 06/29/1999 - 11:42am
Kelly Morse's picture
Joined: 03/13/1999 - 09:00

Hi everyone! I don't think it is only pediatricians who have a lack of knowledge in this area. Our allergist refused to listen to Spencers chest, check his ears or throat (wanted us to see the pediatrican for that). He was much more interested in taking notes concerning the last two reactions. Unfortunately had he taken an interest in what was happening yesterday we may have avoid the ER this morning! Needless to say we are immediately switching allergist.
Kelly M
Another Mom in Michigan

Posted on: Wed, 06/30/1999 - 8:01am
MaryLynn's picture
Joined: 06/25/1999 - 09:00

My first pediatrician who was suposed to also have a specialty in allergies told me that a 2 yearold can't have allergies, the throwing up after tasting and spitting out the peanut butter candy was an intolerance and to keep reintroducing it every month or so. He did not even suggest Benadryl! At three, when I had daughter try again, again she spit out the candy and then threw up. This time he suggested that I "might want to start watching what she eats". Luckily for all of us I had been watching what she had been eating carefully, because the second ped I took her to immeciately sent her for RAST testing and personally called me to inform me that she scored 46,000 well over the category 6. The ped also asked for my pharmacy phone number, so she could call in an Epi-pen prescription and referred us to an allergist who specailizes in food allergies. We have since been to the ER twice, but these doctors have worked with us and continue to do so. I am glad to say there a few really good ones out there. You just have to look hard!

Posted on: Sun, 07/04/1999 - 10:19pm
SquirrellyMom's picture
Joined: 06/29/1999 - 09:00

This is so interesting. I have been very concerned about the lack of knowledge our family doctor seemed to have about food allergies!!
Like most of the others who have posted, I read everything I could find about introducing foods to a young child. I read a lot about the dangers of giving a child under 1 year honey - BUT, never have I read anything about peanut products!!!!
My 3rd child - now 9 years old - was given his 1st taste of peanut butter when he was 9 - 10 months old - We gave him a peanut butter cookie. He would throw-up & he became quite lethargic. This went on - off & on - for weeks!!!!! He would eat a cookie & become very sick. I took this child to our family practitioner EVERY OTHER DAY for almost 2 weeks. She could not figure out what was wrong!!!!! We never discussed possible food allergy! Josh was dehydrating & a nurse in our Dr.'s office actually told me that they were very worried because THEY THOUGHT THEY WERE GOING TO LOSE HIM and they didn't know what was making him so sick!
This doctor consulted with a partner in the same office & after he looked at Josh we were advised that he had "possibly" had some kind of allergy and that we should visit an ear, nose & throat specialist to see if he was experiencing "sinus problems". Lucky for us, the ENT Dr. said that something was causing an allergic reaction & that we should see an allergist and have tests done. I still am quite concerned with the "lack of information" I receive. At about 1 year of age, Josh was given the RAST test. He showed up mildly allergic to peas and eggs and VERY allergic to peanuts. The allergist did not advise me to carry an epi or even what reactions I could expect if Josh came in contact with peanuts! Our family doctor just "laughingly" told me to "keep him away from peanuts.
For the next 2 years Josh was exposed to peanut butter (usually in a cookie) and would throw-up and act very sick for a number of hours (sometimes a day or two). My DOCTORS, including the allergist, never even told me to give him benedryl!!!!
His worst reaction came when he was 3-1/2 and my mother accidentally gave him a mini snickers bar. She totally forgot that he had a problem with peanuts because we didn't realize how severe it COULD be. Josh threw-up & started swelling. His eyes were glassey & he had some difficulty breathing. I called the allergist because I became very scared when I looked at his reaction. The allergist told me to give him benedryl & to watch him for a while. I told him that Josh was throwing-up a lot - and the allergist said, "that's good, at least he's getting it out of his system".
Our next scare was when he was 6 and he ate some nuts from a bowl of mixed nuts when we were at a school play. He actually came and told me that he "thought" he had eaten a peanut & that nothing was happening so he was sure he wasn't allergic anymore. I took one look at him & I could see the hives beginning to come out. I threw him in the car & drove to the nearest emergency room (about a 20 min drive away) By the time I got there he was throwing-up & told me his throat felt like it had a plate in it. The emergency room staff were not helpful & made us wait in the waiting room area for over 30-45 minutes. The hives grew worse & worse and my son rolled in the floor and cried the entire time. I almost left to go to a drug store to get benedryl to try and help him - but I was afraid because it seemed to be getting worse & worse and I didn't want to leave the "safety" of the hospital. Finally a Dr. saw us & gave him the adrenalin shot with immediate relief for Josh. I shook for the rest of the night and I vowed to never go through that experience again. I've been through febral convulsions with another child & this was worse!!!!
Anyway, I made an appt. with another allergist & he not only had him skin tested for other allergies (Dust & Dogs came out very high) but he gave me a letter to carry with me about his peanut allergy & what to do if he was exposed to peanuts, he also told me to always carry an epi pen & he explained to me the seriousness of the peanut allergy (SOMETHING NO OTHER DOCTOR HAD EVER DONE!!!DUH?) After that episode, I have read up on the peanut allergy & I now pay special attention to everything in the media about it. I still don't think some of our relatives take it serious enough!! The really frightening thing for me was that it started out with throwing-up & has now moved to throwing-up, severe hives & swelling & difficulty breathing. I don't want there to be another episode!!!! BUT, with tests, doctor visits, even an allergist, NOT ONE of these made an impression on me as to how serious a food allergy could be. I have had to see it for myself, educate myself & look for a doctor I could trust. Our new allergist even told me that I should not put up with any delay in an emergency room. He was quite upset at the length of time we had to wait when we had our last reaction. He told me to always carry my letter, benedry & epi with me & to demand that they call him if I had to go in again and I was told to "wait". It makes me wonder how many people have life threatening reactions to foods & it is unrecognized!!! I trusted my doctors to know about these things - AND BELIEVE ME - THEY DID'NT!!!!!!!!!!!

Posted on: Wed, 05/08/2002 - 10:56pm
smack's picture
Joined: 11/14/2001 - 09:00

I want to bring this up to the top.
Why, I have been reading a lot of articles lately on Peanut allergies and these articles are saying that "Hives" are a sign of a mild allergy.
Note: What dhumphries story says.
Just goes to show you where are these people getting their information on Peanut Allergies before they write their articles?

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Peanuts cause more severe food allergic reactions than other foods, followed by shellfish, fish, tree nuts and eggs. Although there is only a...