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Doing the Right Thing At Fenway Park

Originally Posted: June 20, 2011

Dr. Paul E. Kelly, M.D.

A ballgame is supposed to be a carefree experience, where a kid has nothing more to worry about than his home team. (Courtesy Photo: thesunblog.com)

Amagansett - It pains me to say this, but as a life-long Yankee fan I have to admit that Boston Red Sox management has finally done something else I appreciate (the last time, of course, was when they sold Babe Ruth to "us"). They have set aside a section of Fenway Park as a peanut-free zone. To my knowledge, this is something the Yankees don't do.

A ballgame is supposed to be a carefree experience, where a kid has nothing more to worry about than his home team winning or losing, his favorite player's performance, and whether his team stands a chance in the pennant race. Come to think of it, that's actually quite a lot to worry about, especially if you're a Yankee or Sox fan. But the same point pertains: a kid with peanut allergies shouldn't have to worry about inhaling peanut dust from the bag being devoured in the seat next to him. According to boston.com, the typical Sox game sees sales of 3,000 bags of peanuts and half a ton of shells. That's a lot of stray allergen. Then there are the Cracker Jacks; the prizes do not include EpiPens.

The epidemic of peanut allergy has garnered a great deal of attention in recent months, including accounts of near riots in a Florida school over attempts to accommodate a six-year old girl, and a lengthy article in The New Yorker called "The Peanut Puzzle" which featured Dr. Hugh Sampson, head of the Jaffe Food Allergy Institute at Mount Sinai. The most comprehensive study of allergies in the United States, done by Quest Diagnostics using state-of-the-art allergy testing technology from Phadia, Inc., said this:

"Peanuts were the most common source of food sensitization in children six to 18 years of age, affecting nearly one in four school-aged children tested. Yet, peanut sensitization is even more prevalent in children five years of age and younger, affecting about 30 percent of children in this age group. Our data suggest peanut allergies remain an important source of concern in children."

I must point out that sensitivity and allergy are not the same thing. While the incidence of peanut allergies is growing, if 30 percent of children had true clinical allergy, we wouldn't be having a debate in this country about peanuts in the schools, and companies like Smuckers and Planters would have to find other revenue streams. Sensitization and allergy are not the same. As the full report says, a clinical diagnosis is more involved than any test, and a thorough history by an allergist is a must. One of the traps physicians and parents fall into is to equate ambiguous test results with the nightmare of anaphylaxis. As we say in our book, feeding a child a nutritious diet is hard enough without excluding any food unnecessarily. So before you restrict foods, make sure your child really has an allergy.

The challenge of managing food allergies changes as a child ages. When I speak to parents who have six-month old children with allergies, I am quick to point out that until the child walks and is able to grab for foods, I don't worry too much. Once the child becomes a toddler who can run, grab for foods in an instant and not be able to distinguish between what he should and should not eat, the problem emerges.

The three-year old can be told what to do and will listen. The next big concern comes when the child first attends school where there is food outside the accepted diet. In most cases, with the child trained, knowledgeable teachers and administrators, and up-to-date paperwork, things seem to do along smoothly until adolescence when many children push the envelope.

During all of these times the parents and their children must be re-examined, the doctor must reinforce the importance of carrying and being prepared to use the necessary medications, prescription EpiPens and the OTC antihistamine Benadryl.

I tell parents never to depend on anyone - restaurants, friends, grandparents - anyone, without constantly reminding them of the consequences if the "rules" are not followed. One thing I stress is that parents themselves and all caregivers should gain comfort in using injectable medication like the EpiPen. Inhibition about injecting a child is common, and even understandable, but weighed against the consequences of not giving it, there is no contest. It can't hurt. It saves lives.

If the child is in school, reminders take on a special meaning because of food, snacks, birthday parties and trips to restaurants. But unless you can be sure of the source of each food, trust no one. If I had my way, food in the classroom would be kept to a bare minimum. There is a danger that trace amounts of peanut residue from one child's hands could end up on the hands of an allergic child and then find its way into the mouth where if would be capable of causing a serious reaction.

To me, the crucial element is that our food allergy families have to be prepared. That is why I have run a support group for 30 years in which experienced food allergy parents share what they know with one another and with newcomers. We always have a demonstration of epinephrine injection for the new parents, and the most important lesson is: Never Be Afraid To Use The Medication.

As for the problem implied by the new peanut-free gallery at Fenway, inhaling someone else's peanut dust, the best study of contact with peanuts through touch or inhalation that I know of gave little support to the idea that this represents a threat of anaphylaxis. I am not aware of any anaphylactic reaction ever being triggered at the ballgame, but worrying about it shouldn't stand in the way of enjoying the game. Yogi Berra is famous for having said, "Ninety percent of this game is half mental." That goes for fans, too.

Dr. Kelly, MD is a facial plastic surgeon certified by the American Board of Facial Plastic and Reconstructive Surgery. Dr. Kelley currently practices with ENT Allergy Associates. www.peconic-faces.com

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