By Emily Bazelon, Posted Thursday, July 27, 2006, at 2:22 PM ET.
Earlier this month, the city of Milford, Conn., agreed to cut down three 60-feet-high hickory trees because of a 3-year-old's nut allergy. The trees rise over the backyard and swimming pool of the child's grandmother, who helps take care of him. According to the New York Times, he once had to go to the hospital after touching a bowl of cashews. If the trees don't come out, he could die, his family told the town. Neighbors, however, are skeptical: They say the grandmother tried to have one of the trees removed before and is now using the allergy to her advantage.
Who is crazy here—the family that wants the trees felled or the residents who seem willing to put a child at risk? It's hard to tell. That's the dilemma of nut allergies. There are cases of real danger and real death. And then there's the huge circle of caution that often gets drawn around children when, rationally speaking, more modest precautions might do. If every school is already a nut-free zone, the felling of the Milford trees suggests that every block might become one, too. Is this a smart way to marshal our resources to avoid risk, even risk to children?
Some kids' food allergies are their family's business: If a child can't tolerate milk, parents don't order pizza with cheese. But these parents don't tell you that if you have dairy in your house, their kid can't come over. For the rare few, however, sensitivity is really that extreme. Airborne food particles could trigger an allergic reaction. Food essentially becomes a version of secondhand smoke: It has harmful effects for people who aren't ingesting it. The difference, of course, is that secondhand smoke hurts most of us, while airborne food particles are a hazard only for a minority: An estimated 3 percent of elementary-school-age children and 2 percent of adults have food allergies, and the number who are radically sensitive is a sliver of those groups.
Taking precautions for the radically sensitive, however, means asking a lot of people to change their behavior. Peanuts are among the most lethal allergens, and since the mid-1990s, serious reactions to them have been rising. There are several theories as to why. (My favorite is that we've created a too-antiseptic world—in other words, children need dirt!) But the result is that while most adults can probably remember bringing a peanut-butter sandwich to school for lunch, most kids probably can't. My children, who are 3 and 6, have somehow conditioned themselves to eat soy butter—it smells pretty vile to me, but they wolf it down and ask for more.
Peanuts are legumes, but they often get lumped in, allergy-wise, with tree nuts like pecans, cashews, and hickory nuts. Some unlucky people develop many different and unrelated allergies; others experience cross-reactivity, where an allergy to one kind of nut triggers a reaction to another. Both kinds of multiple allergies are relatively easy to test for. You go to an allergist and get a blood test to show whether you produce specific anti-cashew or anti-peanut or anti-pecan IgE, the allergy-specific class of antibodies. The risk that a minor reaction could balloon into a major one is a little harder to determine, since you need to recheck the patient after each exposure.
It is possible that the 3-year-old boy in Milford who reacted to cashew nuts had such a test for a reaction to hickory nuts. But it's also possible that his allergist, or his pediatrician, issued a blanket precaution: Since he's allergic to one kind of nut, he should stay away from all of them. Highly allergic people may well have multiple allergies; combine that with a parent's fear of failing to do his or her utmost to protect a child, and you've got three felled hickory trees. (Hickory nuts, despite being tree nuts, aren't closely related to cashews.) The mayor of Milford, James Richetelli Jr., said that the city decided to cut down the trees after the child's family produced a letter from a pediatrician. "Once we were put on notice of the allergy by the pediatrician, we didn't ask for any specific testing. We didn't think we had a right to. We took their word for it," he said.
In legal terms, solutions like this one are called "overbroad." A town that passed a law banning Internet use to protect children from X-rated content on the Web would be rebuked by the courts for banning far too much permissible speech. It's pretty easy to see the costs in the speech arena. But when what's at stake is a child's safety and comfort, it gets harder to say that the cost of erring on the safe side, by banning more foods than may be necessary, is too high.
At the risk of sounding heartless and bratty, though, let me try to make the case for better-calibrated, more-moderated responses to nut allergies. Parents who ask for more accommodation than their kids really need do a disservice, I think, by making the rest of us unsure of when we need to strictly comply. It's a form of crying wolf. Or at least that's how it has felt to me on occasion. One summer, my older son Eli, then 4, got sent home from preschool with a stern note, because the granola bar I'd given him for a snack was made at a factory that processed other products that contain tree nuts. The next day I sent Eli with a plastic baggie full of cheese crackers made by Annie's, the organic pasta company. Their factory stamped out organic macaroni and crackers, I thought—no nuts.
But the father of the boy in the class with the nut allergy wasn't so sure. He asked me to take the crackers home. I'm sure this seemed like a minor concession to him. But to me, it seemed unfair and a little ridiculous. My son and his son didn't sit at the same snack table. They'd never shared food. His son's allergy had never been triggered by airborne particles, and it was no longer particularly serious. And if I couldn't give Eli his crackers, then he wouldn't have a snack. For the second day in a row. So, there was a cost, however small, for doing as asked.
I left the crackers with Eli. They provoked no allergic reaction in his preschool classmate. When I got home that night, I checked the Annie's box. There was the telltale warning: "Produced in a facility that also manufactures products containing peanuts and tree nuts." So, what's the moral of this story—that I'm inconsiderate, or a reasonable risk-taker?
It's hard to justify potentially jeopardizing the health of someone else's child (even if it means your own kid goes a bit hungry). But it would be a lot easier to accommodate allergies graciously if I felt like I could tell the rationally neurotic parent with the extremely allergic kid from the crazy neurotic parent with the slightly allergic one. And I can't. As Susan Dominus wrote in a 2001 New York Times Magazine article on food allergies, quoting Dr. Hugh Sampson, the chief of the division of pediatric allergy and immunology at Mount Sinai Medical Center, "Hypochondria is a big problem in this area."
Sampson said he'd heard of kids who ended up malnourished because their parents have restricted their food intake to protect them from nonexistent allergies. That's got to be rare. But in the end, so is death by food allergy: Dominus reports 150 to 200 a year. It's never appealing to minimize mortality figures or contemplate a choice between a child and a tree. But if we can agree on that, can we also agree that doctors shouldn't issue overbroad precautions, that parents of food-allergic kids shouldn't exaggerate risk, and that cities shouldn't cut down trees without asking hard-nosed questions? We need to bend to accommodate allergies, for sure. But sometimes the trees can win.
Addendum, July 28, 2006: In my piece, I originally linked to a story about the death of a 15-year-old girl that was thought to have been caused by her exposure to peanut butter via a kiss she received from a boy who'd eaten some nine hours earlier. Several readers have alerted me (thank you) that the coroner in the case has since ruled that the girl's death was not caused by the kiss.