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May 16, 2006

When dogs fly

It is now official that Christina Desforges died from an asthma attack, not from a "nutty kiss". Thanks to a loquacious doctor, piss-poor reporting and the activist zeal of shadowy "allergy groups" in search of a poster child, the intimate details of Christina's final hours are now public domain. We know that her fatal attack was brought on by a combination of second-hand cigarette smoke, first-hand marijuana smoke, and, er, "'physical exertion' with her boyfriend," who had been drinking, at three o'clock in the morning. These are not the worst things of which 15-year-olds are capable, but I don't imagine we'll see Christina's face on any asthma awareness campaigns. A poster child should be asleep at 3am, unless her affliction is keeping her up.

It's unclear how peanuts even became associated with the story. Perhaps her friends knew of her allergy and told 911 or paramedics that's what the problem might be, and this got passed on to reporters. Still, the attending allergist properly refused to confirm that diagnosis. Here's how she appeared in the Canadian Press article of November 25, 2005:

Dr. Nina Verreault, an allergist at the Chicoutimi Hospital in Saguenay, did not want to comment on the case but said peanut allergies are seldom fatal.

The Hamilton Spectator's headline was "Kiss deadly for teen girl with allergy"; the Vancouver Sun's was "Teen dies after peanut-butter kiss." Ridiculous.

Dr Verreault does come off much worse, and much more to blame for the ensuing worldwide sensation, in La Presse:

Interrogée hier, la nouvelle allergologue de l'Hôpital de Chicoutimi, le Dr Nina Verreault, n'a pas voulu se prononcer sur le dossier de l'adolescente, mais a accepté d'expliquer les cas d'allergie.

Car il n'est pas facile ni évident non plus de savoir si un enfant vient au monde avec une allergie. Cette information n'est indiquée nulle part. Que ce soit les allergies aux arachides ou aux fruits de mer.

Une allergie comme celle aux arachides ou aux noix n'est détectable que lorsque la personne a une réaction. Habituellement, la première fois, c'est plutôt léger, mais assez pour que les gens s'en rendent compte. Lors d'un deuxième ou d'un troisième contact, le choc est plus grand.

Il est très rare qu'une personne vienne à mourir des réactions à une allergie. Mais cela peut se produire, explique le Dr Verreault.

Il est par contre faux de dire que les réactions sont plus importantes à l'adolescence ou à l'âge adulte. Il ne s'agirait que de mauvaises perceptions.

L'allergologue ajoute que lors de la réaction, les muscles se contractent et la personne a notamment des maux de ventre. De plus, elle va voir sa gorge enflée, aura des démangeaisons et fera de l'urticaire.

Ceux et celles qui sont au courant ont habituellement un auto-injecteur d'adrénaline, dont l'effet est de contrecarrer les réactions à l'allergie.

L'adrénaline ainsi administrée va faire en sorte de fouetter les vaisseaux sanguins pour les ressaisir et les amener à être plus détendus, note-t-elle.

Le Dr Nina Verreault espère être en mesure de sensibiliser toute la population, plus particulièrement les adolescents, une clientèle à risque, car souvent ils se sentent invincibles.

Il ne faut pas avoir peur de dire à son entourage qu'on souffre d'une allergie
et même d'expliquer la façon de se servir de l'auto-injecteur.

Pour en savoir davantage sur les allergies et leurs risques, mais aussi pour savoir quoi faire lorsque vous êtes témoin d'une réaction virulente, consulter le site Internet: www.aqaa.qc.ca.

Roughly: Dr Verreault did not want to comment on the case specifically, but agreed to comment on allergies in general. And comment she did, boy howdy. Deaths from peanut allergies are rare, she told La Presse, but they happen. Just generally speaking, you understand — nothing to do with this as yet unnamed girl you're asking about. As if any doubt remained of her diagnosis, Verreault's medical opinion then gives way to a public service announcement: Young people needn't be afraid to tell their friends that they have an allergy, she said. To learn more about allergies, consult the Internet! The more you know…

I suspect Verreault won't be quite so forthcoming the next time she's approached by a journalist. It's just unfortunate that in her November 24 keynote address she didn't take on the million dollar question: What the hell is going on with peanut allergies right now?

You'll find this little nugget on the American Academy of Allergy Asthma & Immunology's website, for instance:

Peanut allergies in children increased two-fold over a five-year period from 1997 to 2002.

That is impossible to believe. Either it isn't what it seems to be or it must be one of the greatest medical mysteries of all time. There are the usual explanations for such anomalies, of course: heightened awareness leads to more accurate diagnoses. But I will admit to wondering if some children claiming to have such allergies aren't victims of parental misdiagnosis, which is facilitated by peanut-free schools and the ever-increasing incidence and acceptance of such allergies. (I avoid bananas because they almost invariably give me the shits, but I wouldn't claim to be allergic to them.)

Duke's Dr Wesley Burks validates that suspicion to some extent:

"A lot more people think they're allergic to foods than actually are," he says. "The public perception is that about 30 percent of the population has a food allergy. But the scientific reality is about 6 to 8 percent of children and 3 to 4 percent of adults are allergic. I think what happens is that people eat all kinds of foods, and if they have a reaction-perhaps viral gastroenteritis or food poisoning-they happen to associate it with one of the foods they've eaten." So, a detailed clinical history is a must, says Burks.

"You need to find out the timing of the ingestion and the clinical symptoms," he says. "Reactions to an allergen such as peanuts occur literally within minutes, not more than an hour or two, after ingestion. So, if the patient ate the food four hours ago and they're having symptoms now, then it's probably not an allergy."

(Conversely, one often hears people claiming that "food poisoning" has them running for the can mere minutes after eating something that disagrees with them.) Chiefly, I'd say the allergy mystery suffers from a dire lack of statistical evidence. We have little idea how many Canadians even die of food-related anaphylaxis, let alone how many are at risk. Self-reporting really isn't good enough here. It's not relevant if people think they're allergic to peanuts — which, naturally, is what that 100 percent increase in five years was measuring. It was a telephone survey, for heaven's sake.

There are several theories for the rise in allergies, but the "hygiene hypothesis" is my favourite — a beautifully ironic expression of the law of unintended consequences. Basically, our increasingly antiseptic environment has reduced the number of things young immune systems are exposed to, and consequently the number they develop resistance to. Thus, well-meaning household fastidiousness may actually contribute to the onset of allergies and asthma by exposing children to fewer germs, bacteria, and other invisible nasties. A fascinating Swiss study published in the New England Journal of Medicine found that tolerance to allergens was markedly higher among children who grew up with a dog in the house — a shit-eating, face-licking dog, of all things.

In other news, the drive to sterilize has now reached cruising altitude — Air Canada has decided to ban pets from its passenger cabins, meeting the approval of the Canadian Allergy, Asthma and Immunology Foundation's Dr. Donald Stark. (I was surprised to learn they weren't banned already. Evacuating a smoldering Airbus is hard enough without panicky Weimaraners running around or someone's cat digging its claws into your eyelids.)

Guide dogs are exempted from this policy, obviously. Well, obviously to me anyway, but why are the allergy groups not complaining? A golden lab's dander is not rendered hypoallergenic by its guide dog training. It's the same reason pets are absolutely forbidden from entering food-preparing premises unless they are guide dogs, in which case they are expressly welcomed. In the pursuit of inclusiveness, a sort of victim hierarchy emerges, and mostly it makes sense. Blindness trumps the potential for gastrointestinal distress (in the case of restaurants) and allergies (in the case of airplanes), and why shouldn't it? Allergies don't trump much of anything, which is why allergy-themed advocacy groups were so eager to believe in the Nutty Kiss Theory.

As previously and quite passionately discussed on Tart Cider, people with violent allergies have reasonably lobbied for exhaustive food labelling, and for restaurants to affirm that a certain dish is free of a certain ingredient. Having achieved that, their lot in life consists of not being able to eat certain foods, asking more questions of servers than other people, and removing themselves from situations that are too saturated with the allergen in question for comfort. Even though the risk is much greater, this doesn't even approach blindness or confinement to a wheelchair on the inconvenience scale.

It's a sense of scale that advocacy groups inevitably lose as they gain traction. Already a single organization has gone on record against peanuts in schools and dogs on planes, which is absurd. One is a life-threatening condition, while the other is potentially frightening. An advocacy group for the allergic makes no more sense than one for the sick — dog allergies have about as much to do with severe peanut allergies as carpal tunnel syndrome does with Lou Gehrig's disease. Trying to make victims out of the moderately inconvenienced is not going to help those with life-threatening allergies.

Posted by Chris Selley at May 16, 2006 11:26 PM

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Comments

"I avoid bananas because they almost invariably give me the shits, but I wouldn't claim to be allergic to them."

Yes. Well, I'll just put that in the "more than I ever wanted to know" file, shall I?

"I think what happens is that people eat all kinds of foods, and if they have a reaction-perhaps viral gastroenteritis or food poisoning-they happen to associate it with one of the foods they've eaten."

My Dad went to work in a camp (logging camp or such-like) when he was 16, in the 'dirty thirties.' Sometime in his first week there they had steak for dinner, with fried mushrooms. Having worked like a Trojan for a couple of days, he was hungry - he ate everything put in front of him. That night, it turned out, was "drinking night" - and as a 16 year old in 1935, Dad was not an experienced drinker. A couple or three beer, and he was pretty woozy. A couple more, and he was legless. A couple more, and the steak and mushrooms and potatoes and everthing else were making a bid for freedom.

He always insisted that he was allergic to mushrooms.

Posted by: DCardno at May 16, 2006 11:43 PM

"...the activist zeal of shadowy 'allergy groups'"? Please. You make them sound like Opus Dei.

While I am also very curious as to how this story got started in the first place, I am uncertain why this arouses such passion in you beyond an understandable irritation with shoddy, sensationalistic journalism.

Allergy groups heard about the story (now shown to be incorrect), were sad that a girl had died from kissing her boyfriend, and set about to use the tragedy to educate allergic teenagers about: a) making sure they were carrying their epipens at all times, and b) making sure their friends know about their allergies and what to do in case of an attack. How sinister!

Anyway, just wanted to say, chillax. The allergy groups aren't out to getcha...

In other news, I had the first granola bar of my life this week. Quaker Oats just opened a peanut-free factory... Turns out I wasn't missing much.

Posted by: Anonymous at May 17, 2006 12:15 AM

P.S. Anonymnous is me J. Kelly. I forgot to fill in the fields...

By the way, I think I speak for all food allergy sufferers when I say that I also CAN'T STAND people who dislike a food and pretend they have an allergy to it. It makes people associate "allergy" with "dislike" and take the seriousness of food allergies less seriously...

Posted by: JKelly at May 17, 2006 12:21 AM

You know, you really hit the nail on the head with "making victims of the moderately inconvenienced" (I may be paraphrasing there). The clamour to claim "victim" status is what really bugs me about the whole allergy lobby - they're hardly victims at all. Terrific piece, as always.

Posted by: Jason at May 17, 2006 03:35 PM

I am aware that I appear moderately obsessed with this. You shan't read about it here again until the shadowy allergy groups arm themselves and surround my house.

Posted by: Chris Selley at May 17, 2006 06:22 PM

"80 per cent of therapy dogs are carrying zoonotic diseases that can potentially pass from animals to people"
http://www.mathstat.uoguelph.ca/?action=news&view=669

Posted by: EarlWer at May 18, 2006 12:28 PM

The allergy folks, between perfume and peanuts, are guilty of the sort of advocacy overreach which passes for health policy making these days. but they still have not touched the overall lunacy of diagnosing one little boy in eight with ADHD. (http://www.cpa-apc.org/Publications/Archives/CJP/2001/December/study.asp)

And then pumping them full of drugs.

Sigh.

Posted by: Jay Currie at May 18, 2006 04:00 PM

On many of these items I agree, but I have to disagree with you regarding the pets on planes agrument. They belong in the cargo hold. The comfort of passengers with allergies outweighs the comfort of a dog or cat anyday.

Posted by: Gareth at May 18, 2006 05:52 PM

Food allergies can be fatal and debilitating. It's jerks like you that don't take it seriously that put those in danger who can die from the slightest exposure. I highly doubt you understand the immune system or anything having to do with medicine at all. Did you know some asthmatics can die from being in close quarters with animal dander? Of course you didn't. You have your head to far up your ass to even begin to comprehend anything beyond your limited scope of vision. Get a life.

Posted by: Jamie at May 29, 2006 07:37 PM