The all-time favorite sandwich of school lunches, peanut butter, sends children such as Andrew Graff, 6, into an allergic reaction so severe that it can swell shut eyelids and airways.
Peanuts and peanut butter have become an increasingly frequent food allergy that has doctors at Johns Hopkins Medical Institutions immersed in studying the ubiquitous legumes, and parents such as Christine Graff of Hampstead struggling to keep them away from their school-age children.
The anecdotal evidence at Andrew's school, Spring Garden Elementary in Hampstead, reflects the nationwide increase in peanut allergies.
"We used to have one or two. Now, we have six in the building," said Nancy Tutor, the school nurse.
Andrew and other students with severe allergies typically have a ready-to-use epinephrin syringe, called an EpiPen, in the school nurse's office, in case a reaction is so severe that it causes anaphylactic shock, a set of symptoms that can lead to death.
Andrew hasn't had to use one, and antihistamines have treated or prevented problems the four times he has been exposed to peanuts in kindergarten and first grade.
Those four incidents are too many, Graff said, and she has escalated her efforts to have staff members at the school, and in other schools, better educated about peanut allergies. She has sent letters to everyone from the school principal to President Clinton.
"Everybody has been good about it and I know accidents are going to happen, but they shouldn't happen this frequently," she said. "It was unintentional, but they need to be informed. I'm just afraid one of these days a slip-up could cost Andrew his life."
Graff said that while the school nurse has been helpful and knows what to do, she wants all teachers and staff members who have contact with children to be better informed. She is arranging for Andrew's allergist to visit the school and talk to the teachers at a meeting.
Also, the school has obtained a videotape that can be shown to children, featuring an elephant cartoon character who is allergic to peanuts.
The slip-ups that exposed Andrew to peanuts could have been prevented, Graff said, if staff and students were more aware that peanuts are hidden in foods, and that the allergy is so strong that even smelling peanuts can cause a reaction.
Brownies, bird feeder
A year ago, when Andrew was in kindergarten, a mother sent brownies for the class.
"He bit into it and realized there was peanut butter in it, so he took it to the teacher," Graff said. It caused him to vomit.
About a month later, Andrew had his worst reaction at school -- and all he did was smell peanut butter. The kindergartners were making bird feeders by spreading peanut butter on a pinecone and rolling it in birdseed.
His teacher knew he couldn't handle the peanut butter, so she kept him away from it and made a feeder for him. She sealed it in a plastic bag and put the plastic bag into a paper bag that she stapled shut. She told him not to open it but to give it to his mother. Curiosity got the better of him, and on his three-minute bus ride home, he opened the bag to see the feeder. Even though he said he didn't touch the feeder, by the time he got off the bus, his eyes were nearly swollen shut.
"Mommy," he said, "am I going to die?" Graff controlled his reaction with an antihistamine and constant telephone contact with his allergist.
This year, in first grade, Andrew has been exposed to peanuts twice. Last month, during math, another child passed out plain M&Ms to use for a counting lesson. Andrew was supposed to get Starburst candies because the teacher had read the back of the wrapper, which stated plain M&Ms may contain trace amounts of peanuts. But the child passing out the M&Ms gave some to Andrew, who ate them.
"These children are in first grade. You put M&Ms in front of a child, it's like an instinct to eat them. He never should have been given them," Graff said.
Andrew did not have a reaction, however, Graff said.
Later last month, a pinecone feeder was the culprit again. Andrew's occupational therapist knew he couldn't eat peanut butter but thought it was OK to let him make the feeder as long as he washed his hands thoroughly afterward. When Graff was notified, she went to the school to give him a dose of antihistamine, but he did not exhibit a reaction that time, she said.
"He's not to be exposed to it in any way, shape or form," his mother said.
Tutor, the school nurse, said a current issue of Principal magazine has an article on peanut and other food allergies. She agrees with the article that food bans are not a good idea, because they're hard to enforce and they pit parents against each other. The best way is to make staff members and students aware of the allergies, she said.
Students who are allergic also have to take some responsibility, and most do, she said.
Doctors aren't required to report food allergies, and no one has conducted a large study to document the prevalance of peanut reactions. The peanut's rising toll is based largely on the experiences of pediatricians, allergists and emergency-room physicians who are sure they are seeing more peanut reactions than ever.
Dr. Hugh Sampson has seen an increase among children treated at his Hopkins clinic for severe, allergic skin rashes. Peanuts were blamed in 16 percent of the rashes between 1981 and 1984, and in 31 percent between 1991 and 1994.
Attempts to create shots to desensitize children have been unsuccessful. The weakest dilutions of the peanut protein have caused reactions in children.
Pub Date: 11/17/97