It's not nuts to ban brownies in our schools: The rule might seem like health and safety gone mad – but it saves lives



21:10 GMT, 16 June 2012

Debates on the subject rage on internet forums. My patients – many aged under ten – have been bullied as a result of this increasingly common problem. What am I referring to Religion or racism No, I’m talking about nut allergy, and the lengths to which some schools now go to accommodate children who suffer the potentially deadly condition.

So-called allergy-prevention programmes – based on my own recommendations and research – are stringent. It’s not just about banning children from eating nuts.

Schools may have to radically alter their catering practices. And teachers, parents and relatives need educating about all the foods nuts are hidden in – baked goods, snacks and sweets, ready meals and sauces.

Banned: Brownies are among the snacks which may contain nuts that have been banned from schools amid fears they could trigger potential fatal allergic reactions from students

Banned: Brownies are among the snacks which may contain nuts that have been banned from schools amid fears they could trigger potential fatal allergic reactions from students

Other schools choose to minimise exposure. Children with nut allergies are put on separate tables, and all children have to wash their hands thoroughly after eating. Children who have had a peanut-butter sandwich may leave a smear on a door knob that can cause a reaction.

These measures are needed only if there is an allergic child, but most schools will have at least one. Nut allergies can kill within minutes.

Just last week it was reported that student Preethi Koshy, 22, nearly died after an allergic reaction to a cake that contained nuts, and spent three days on a life-support machine.

It might be a bore to adhere to fastidious rules, but imagine how you would feel if your child was inadvertently responsible for triggering a death.

Nut allergy is a relatively new condition. There were occasional cases until the mid-Nineties, then increasing numbers of children started to suffer. This resulted in deaths – and The Mail on Sunday was at the forefront of campaigning for better food labelling.

The allergy occurs when the immune system identifies proteins in a nut as a threat and produces antibodies. These cause cells to release a chemical called histamine, leading to physiological effects that result in rashes, swelling, severe breathing difficulty and loss of blood pressure, leading to collapse and loss of consciousness.

The spectrum is from mild to severe – ranging from a rash and itching to full-blown anaphylactic shock, where the patient is unable to breathe.

The allergy occurs in stages. First there is an initial exposure, when the body makes the antibodies. It is subsequent exposures that cause the sometimes dangerous allergic reaction. There is a slightly elevated risk through family history, but not much.

The exposure could be the child eating a nut. It could be through nut proteins in moisturisers – many contain aracus oil, a peanut derivative. It may also be introduced through breast milk.


Highly allergic: Izzy Mills, pictured with her mother Caroline, had bad reactions to nuts in food

Highly allergic: Izzy Mills, pictured with her mother Caroline, had bad reactions to nuts in food like brownies and cakes

One pupil to have benefited from a nut-free school policy is 11-year-old Izzy Mills.

‘Izzy suffered from eczema from a young age, so we were advised to avoid dishes containing nuts as it was thought there was a connection,’ says her mother, radiologist Caroline Allam. ‘When she was four, she ate a chocolate bar with almonds in it and then a carrot cake with walnuts in it. She developed an itchy tongue and throat.’

Izzy, who attends Channing School in North London, underwent skin tests and the results showed that her reaction to nuts was within normal limits.

In 2006, Izzy ate a chocolate that contained nuts and developed the same mild symptoms. But three years later, she had emergency treatment in hospital when her face and tongue began to swell. It transpired that her sister had been shelling nuts when Izzy was in the same room.

Caroline insisted Izzy’s school made changes. The school had already banned nuts but agreed to make its kitchen rules more stringent.

Since then, Izzy hasn’t suffered a reaction. ‘Being at a school that is free of nuts means I can relax and have fun,’ she says.

One child in 50 now suffers, and 30 per cent of those have serious reactions. Fortunately, deaths are rare, thanks to the EpiPen, a device that contains a shot of adrenaline to counter the worst symptoms of the reaction.

Children are being diagnosed with nut allergies, on average, at the age of two. Those with eczema are more likely to have a nut allergy, as are those with an egg allergy. The majority will be allergic for life.

Why are cases rising It could be down to our determination to lead a germ-free life, meaning that our immune system becomes under-stimulated and malfunctions by recognising non-harmful substances as dangerous. Others speculate that it is linked to over-consumption of antibiotics.

You find nut allergies only in Westernised countries

We believe it is a genetic condition triggered by specific environmental factors. You find nut allergies only in Westernised countries.

There is hope for the future. The work that my colleague Dr Andrew Clark and I are doing with our team will hopefully lead to a cure in the next few years.

In 2009, we were able to show that you could effectively retrain the immune system by giving 20 highly allergic children peanuts over six months.

The doses were initially smaller than the amount needed to trigger an allergic reaction – sometimes less than a 300th of a peanut. We increased them every two weeks. After four months, they were eating peanuts every day to maintain the desensitisation. The levels of the allergy antibody IgE had gone down. The allergy is switched off.

In the meantime, our best bet is to protect this vulnerable group.

On average, half of all children with a nut allergy will have at least one attack every year. For the children, this is incredibly distressing – and it places a huge burden on the NHS.

So if you’re about to bake cakes or biscuits for the school fete and are sighing over the nut ban, bear in mind that you could be saving a life.

■ The author is a consultant allergist at Addenbrooke’s Hospital, Cambridge, and founder of the National Allergy Strategy Group, advising the Government.