Anaphylaxis Legislation gets Presidential Seal of Approval

HowtoUseYourEpiPen644x356-process-sc644x356-t1338817363SRxA is delighted to announce that earlier this week President Obama signed into law the School Access to Emergency Epinephrine Act.  During a week in which Obama and his new healthcare.gov website have made headlines for all the wrong reasons, we thought it only fair to commend him on this important anaphylaxis initiative.

The School Access to Emergency Epinephrine Act is legislation that will help to protect schoolchildren who experience life-threatening anaphylaxis.

This legislation is a significant milestone for food, venom and latex allergy safety in our nation’s schools,” says Tonya Winders, chief operating officer of Allergy & Asthma Network Mothers of Asthmatics (AANMA). “It will help save lives of children who experience an anaphylactic reaction for the first time or don’t have epinephrine auto-injectors readily available when anaphylaxis occurs.”

Think Fast Allergy Symptoms PicThe measure provides a funding incentive to states that enact laws allowing school personnel to stock and administer emergency supplies of epinephrine auto-injectors. Epinephrine is the first line of treatment for anaphylaxis.

The School Access to Emergency Epinephrine Act was bipartisan legislation, first passing the U.S. House of Representatives on July 30, 2013, and then the U.S. Senate on Oct. 31, 2013, before heading to the President’s desk.

Allergic reactions to foods are the most common cause of anaphylaxis in community settings, according to the U.S. Centers for Disease Control and Prevention (CDC). Studies show that 16-18% of schoolchildren with food allergies have had a reaction from accidentally ingesting food allergens. In addition, 25% of anaphylaxis cases reported at schools happened in children with no prior history of food allergy.

USAnaphylaxis_10_14_13As of today, 28 states have passed emergency stock epinephrine legislation and six have bills pending.  Let’s hope this legislation will spur the remaining states to follow as soon as possible.

Green states that have passed stock epinephrine laws or regulations:

AlaskaArkansasArizonaCaliforniaColoradoFloridaGeorgiaIllinoisKansasKentuckyLouisiana,MarylandMassachusettsMinnesotaMissouriMontanaNebraskaNevadaNorth DakotaOklahoma,OregonSouth CarolinaTennesseeUtahVirginiaVermontWashington, and West Virginia

Yellow states have pending stock epinephrine bills:
MichiganNew JerseyNew YorkNorth CarolinaOhio and Pennsylvania

Red states that have no stock epinephrine bills: 
AlabamaConnecticutDelawareHawaiiIdahoIndianaIowaMaineMississippiNew HampshireNew MexicoRhode IslandSouth DakotaTexasWisconsin, and Wyoming

To find out more about anaphylaxis in schools please visit http://www.epipen4schools.com/ and https://www.anaphylaxis101.com/Resource-Library/Anaphylaxis-in-Schools.asp

SRxA-logo for web

Protecting Kids with temporary tattoos

food allergiesParents of the three million or so kids in the US who have been diagnosed with food allergies whose kids have severe food allergies know they can’t be too careful. One bite of the food they are allergic to could be deadly. Indeed, according to the CDS, more than 200 people with food allergies die every year as a result of anaphylaxis.

Now, Michele Walsh, a mother of three from Baltimore, has created SafetyTat  to help remind teachers, classmates and babysitters to be extra careful.

temp tattooThe safety tats are brightly colored temporary tattoos or long-lasting write-on stickers that can be placed prominently on a child’s arm, with information such as “ALERT: NUT ALLERGY” or other critical information.

When you leave a child in someone else’s care at school or camp, “no matter how many times you fill out the forms, you’re still taking a leap of faith,” Walsh says. “This is like my voice with my son when I’m not there. It’s almost like teaching them ‘stop, drop and roll…’ They know exactly what to do.”

Another company –  Allermates offers allergy education tools, stickers, alert bracelets and other products for kids. Allermates was created by Iris Shamus, inspired by her son’s multiple allergies and an incident at school. “When you have a child with a food allergy, you’re always worried. It’s just part of your life,” she says. “I wanted to have something a little more personalized for him to remind teachers and babysitters.”

allermatesIt began with a fun necklace, then a wristband and a large selection of products accompanied by cartoon characters such as Nutso, a charming peanut, to help her son understand, remember and confidently discuss his allergies.

It makes me feel so much more secure,” she says. “I know you can’t be there all the time when you’re a mom, and this gives you peace of mind.”

Anything that can help educate the patient about their problem and continue to make them aware about it is helpful whether it’s a temporary tattoo or a warning bracelet,” says Stan Fineman MD, immediate past president of the American College of Allergy, Asthma and Immunology.  “The important thing is for people to accurately find out what they’re allergic to and then make sure to take the appropriate precautions,” Fineman says. He says parents of kids with severe allergies should keep EpiPens on hand, check school policies, talk to school officials and bring in treats their kids can eat for special events.

allermates 2Betsy Shea of Chicago says both of her boys, 4-year-old Colin and 2-year-old Emmet, have nut allergies, and Colin wears Allermates’ green snap-on wristband featuring Nutso. She’s thinking about trying temporary tattoos for Emmet.

Having allergies herself, she remembers having to wear the traditional metal medical alert band, which made her feel different and self-conscious. But Colin “loves that band. He wears it with pride and thinks it’s just so cool. We couldn’t get him to take it off for a while,” she says.

We thinks it’s pretty cool too!

SRxA-logo for web

Welcome to World Allergy Week

WAWlogo_clearToday marks the start of the World Allergy Organization’s (WAO) annual World Allergy Week.

During the 2013 event, WAO together with its 93 national Member Societies, will be addressing the topic of “Food Allergy – A Rising Global Health Problem,” and its growing burden on children.

Globally, it’s estimated that as many as 220-250 million people suffer from food allergy.  And the incidence is on the rise in both developed and developing countries, especially in children.

During World Allergy Week WAO plans to highlight the need for greater awareness and understanding of food allergy as well as the exchange of ideas and collaboration in order to address a variety of safety and quality-of-life issues related to the care of patients with food sensitivity.

According to Professor Ruby Pawankar, President of the World Allergy Organization, “There are problems that need to be addressed in many countries throughout the world such as the lack of awareness of food allergies, lack of standardized national anaphylaxis action plans for food allergy, limited or no access to epinephrine auto-injectors, and the lack of food labeling laws. Moreover, some countries have standardized action plans but no ready access to auto-injectors; while others have auto-injectors but no standardized action plans.”

An important part of the initiative of World Allergy Week 2013 is to advocate for the safety and quality of life of patients who suffer from food hypersensitivity. WAO has also produced a list of online food allergy resources for healthcare professionals and patients / caregivers, which we have reproduced below.

HEALTHCARE RESOURCES

Kids Teased about Food Allergies No Laughing Matter

Access the article

WAO White Book on Allergy

Access the book

Food Allergy: Pathogenesis and Prevention
World Allergy Forum, December 2012, Orlando, Florida, USA
Access the presentations

Food Allergy
Cassim Motala, Joaquín Sastre, Dolores Ibáñez
WAO Global Resources in Allergy (GLORIA™), 2009, updated 2011
Access slide deck

Cow’s Milk Allergy in Children
Access the summary

Anaphylaxis
Richard F. Lockey, September 2012, updated Disease Summary

Access the summary

WAO Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines
Access the article

ICON: Food Allergy
The Journal of Allergy and Clinical Immunology, 2012; 129(4): 906-920
Access the article

World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis
World Allergy Organization Journal, 4:13-37, February 2011
Access the article

PATIENT / CAREGIVER RESOURCES

PrintFood Allergy Research & Education (FARE)

The FARE website has an abundant source of valuable resources specifically for patients suffering from food allergies and the people who care for them, including:


anaphylaxis-campaignAnaphylaxis Campaign

The Anaphylaxis Campaign is a UK charity catering exclusively to the needs of people at risk from anaphylaxis by providing information and support relating to foods and other triggers such as latex, drugs and insect stings.
The AllergyWise online programs provide training for families, carers and individuals as well as health professionals. General information on Anaphylaxis and Severe Allergy

SRxA-logo for web

Allergic to Bullying?

foodallergybullying1As if having a food allergy wasn’t bad enough, one in three children who do, also experience bullying. Worse still, nearly half of parents surveyed (47.9%) were not aware of the bullying.

Almost 8% of children in the U.S. are allergic to foods such as peanuts, tree nuts, milk, eggs, and shellfish.

The study, “Child and Parental Reports of Bullying in a Consecutive Sample of Children with Food Allergy,” was published on Christmas Eve in the online issue of Pediatrics.  Led by Eyal Shemesh, MD, Associate Professor of Pediatrics and Psychiatry at Mount Sinai, researchers surveyed 251 pairs of parents and children. The patient and parent pairs were consecutively recruited during allergy clinic visits.  Patients and parents independently answered questions about bullying due to food allergy or for any cause, and quality of life. Distress in both the child and parent were also evaluated.

child eating food aloneOf 251 families who completed the surveys, more than 45% of the children and 36% of their parents indicated that the child had been bullied or harassed for any reason, and 31.5% of the children and 24.7% of the parents reported bullying specifically due to food allergy.

The bullies were usually classmates and bullying frequently involved threats with the foods the child was allergic to. Not surprisingly, bullying was significantly associated with decreased Quality of Life and increased distress in parents and children.

Parents and pediatricians should routinely ask children with food allergy about bullying,” said Dr. Shemesh. “Finding out about the child’s experience might allow targeted interventions, and would be expected to reduce additional stress and improve quality of life for these children trying to manage their food allergies.”

kids-with-food-allergies-targets-for-bullies-webmdThe study also showed that when parents were aware of the bullying, the child’s Quality of Life was better. “Our results should raise awareness for parents, school personnel, and physicians to proactively identify and address bullying in this population,” says Scott Sicherer, MD, Professor of Pediatrics, and Chief of Pediatric Allergy at Mount Sinai Medical Center, NY.

Have you or your child experienced bullying as a result of a food allergy? Share your stories with us to help shed more light on this worrying trend.

SRxA-logo for web

Avoiding Anaphylaxis this Advent

christmas-partyChristmas parties, meals out with friends and family, stockings full of candy, chestnuts roasting on the open fire…

While all this sounds like great fun, there’s a risk that more people than usual will be accidentally exposed to foods they are allergic too. Food allergies are common. An estimated 9 million, or 4%, of adults and nearly 6 million or 8% of children have food allergies with young children being those most affected.

Although childhood allergies to milk, egg, wheat and soy generally resolve in childhood, they appear to be resolving more slowly than in previous decades, with many children still allergic beyond age 5 years. And allergies to peanuts, tree nuts, fish, or shellfish are generally lifelong.

If you’re one of those affected by food allergy, what can you do to avoid accidental exposure this holiday season?

Remind people! Sure you might once have told your hosts that you have an allergy, but a gentle reminder is always helpful, especially at Christmas when things get busy and the alcohol starts flowing!

PeanutButterAllergyJust say ‘no’ – if you don’t know what’s in it, don’t eat it. And even if you do, can you really be sure there was no cross-contamination in the kitchen.

Bring snacks, rather than rely on your hosts to have food you can eat…or

Stay home. Host the party yourself – then you know it’s safe.

Bring your epinephrine auto-injector with you –and keep it close to hand! Make sure somebody else at the party knows you have food allergies, where your auto-injector is and how to use it.

Know the Symptoms – within minutes, an allergic reaction may turn into a life-threatening severe allergic reaction. Sometimes the reaction can occur in two phases, with another reaction occurring up to 48 hours after the initial reaction.

Use epinephrine immediately after you have been exposed to your allergy trigger – it may prove to be life-saving.  If you are even thinking should I give myself epinephrine, the answer is almost certainly yes!

epipen jpegAfter giving epinephrine, seek emergency medical attention – call or have someone else call 9-1-1 or your local emergency medical services.  In most individuals, epinephrine is effective after one injection. However, symptoms may recur and further injections may be required to control the reaction. Epinephrine can be re-injected every 5 to 15 minutes until the severe allergic reaction stops completely.

Do you have your anaphylaxis Action Plan ready?  If not, make it part of your holiday preparations. It could be the best Christmas present you give yourself this year.

SRxA-logo for web

Doctors Deficient in Anaphylaxis Care

Having just returned from the American College of Allergy, Asthma and Immunology (ACAAI) annual meeting, we’re spoiled for choice of news. But among all the science there was one stand out shocker.  In a session on Sunday, physicians presented the results of a survey, sponsored by the Asthma and Allergy Foundation of America (AAFA). During this, they revealed that a disturbingly high proportion of primary care and emergency physicians don’t know how to treat anaphylaxis.

Interviews with 318 physicians indicated that:

  • substantial numbers do not always provide epinephrine to patients – even those  they believe are having anaphylactic reactions
  • they often fail to refer anaphylaxis patients for follow-up care
  • they believe incorrectly that some patients should not receive epinephrine auto-injectors

Myron Zitt, MD, says the results reveal “likely deficiencies in physician knowledge,” and corroborate results from earlier chart review studies.

In the telephone-based survey, researchers conducted interviews lasting an average of 19 minutes with approximately 100 emergency room physicians, 100 allergists, 50 adult primary care physicians, and 50 pediatricians.

82% to 99% of respondents in each group said they had treated at least one anaphylaxis case.

Although epinephrine is supposed to be given to all patients having such reactions, about 10% of emergency room physicians and 20% of primary care and pediatric physicians said they had done something else.  These “something else’s” included prescribed another drug, sending the patient to a hospital, or an “other” action.

Prescribing of auto-injectors for patients to take home also was far from universal. Barely 60% of emergency room physicians said they did. In fact, emergency physicians were generally bad at all phases of follow-up care. They rarely referred patients for diagnostic tests, they almost never demonstrated use of an auto-injector, and seldom explained that auto-injectors have an expiration date.

Another disturbing finding from the survey, Zitt said, was that many physicians of all types – even the allergists – mistakenly believed that some patients should never receive epinephrine.

In the same session, Akhil Chouksey, MD, reported that anaphylaxis care in a major teaching hospital usually failed to meet guidelines established by a consortium of allergy societies including the ACAAI.  In a 10-year review of anaphylaxis cases only 15% met the standards of care recommendations i.e. that epinephrine be administered within 30 minutes of triage, that auto-injectors be prescribed at discharge, and that patients be referred to an allergist or immunologist for follow-up investigations and treatment.

The review also found that in 26% of cases in which anaphylaxis was definitively confirmed, the patients never received epinephrine.  Antihistamines, such as benadryl (diphenhydramine), were given in nearly all cases but epinephrine was omitted in one-quarter. In fact, epinephrine was only the third most commonly administered medication, with corticosteroids such as methylprednisolone, taking the second spot after antihistamines.

During the question-and-answer period, an audience member suggested that, when patients present with relatively mild symptoms, the treating physicians may decide that epinephrine isn’t needed at that point.  Zitt countered, that this was a very dangerous approach.

The national guidelines state explicitly that there are no absolute contraindications to epinephrine. Nevertheless, 16% of the pediatric allergists and 32% of the other allergists said there were such contraindications, as did 38% of adult primary care and emergency physicians.

Also common were beliefs that schools, restaurants, and ambulances always stock epinephrine. In fact, Zitt said, there are no general requirements for schools or restaurants to do so, and approximately half of all ambulances do not have epinephrine on hand.

Clearly there is much work still to be done in terms of education.  SRxA’s Word on Health suggests a first step would be to instill a healthy fear of anaphylaxis into doctors and the general public while simultaneously removing the fear of epinephrine.

Or as Dr Zitt says, “Give epinephrine first, ask questions later.”

Modern Family’s Emmy winning actress takes on the most important role of her life

Actress Julie Bowen, recently awarded her second Emmy for her role in the hit TV comedy “Modern Family,” started a more serious role last week: raising awareness about life-threatening childhood allergies and anaphylaxis.

The two-time best supporting actress in a comedy series and mother of three knows firsthand about potentially fatal allergic reactions. Her oldest son, Oliver, was 2 years old when he developed anaphylaxis as a result of a double-whammy exposure to a bee sting coupled with a bit of peanut butter.

“We had no reason to suspect we might have a problem. He had had peanuts before. And he had always been fine,” explained Bowen. “But then one day we found out that, no, he’s not.”

Almost immediately, Oliver’s face swelled dramatically. Other symptoms of anaphylaxis include chest pain; hives; breathing difficulties; tightening of the throat; lip and tongue swelling; nausea; dizziness and fainting.

Bowen’s husband, who was at home with the toddler, was terrified. “He knew it was bad.” Oliver was rushed to the hospital and immediately given an injection of epinephrine – the drug used for the emergency treatment of anaphylactic reactions that can follow exposure to allergens such as peanuts, walnuts, shellfish, bee stings, medications and/or latex.

Although any child can develop an allergy, or abnormal immune response, they are more likely to occur in people whose family members also have allergies.

Bowen now is spearheading the nationwide awareness campaign with the help of Mylan Specialty L.P., the pharmaceutical company that makes EpiPen®.

The goal is education,” said Bowen. “We, as parents, can’t always be with our children all day, every day. So we want the people around them to be educated.”

Thankfully, Oliver made a full and quick recovery. “Once he had the proper medicine, it was a very quick process,” she noted. “But today we always carry epinephrine with us wherever we go.”

Food allergies are the leading cause of anaphylaxis. The U.S. Centers for Disease Control and Prevention (CDC) estimates that food allergies in children have increased 18% since 1997. More than 9,000 children are hospitalized because of severe food allergies each year.

Many allergic reactions occur when children accidentally consume foods they’re allergic to at school. According to the CDC as many as one-quarter of anaphylaxis happens in students with no history of food allergies.

Parents and school employees shouldn’t dismiss a child’s complaints, Bowen says, “We want parents and teachers to know the signs, so that if you see them coughing, scratching at their throat some, or that they’ve got some rash, that you go ahead and look into it further.”

If you suspect your child may have an allergic reaction to anything, get it checked out. Call 911 and get medical attention immediately because there’s no way to guarantee that your child is never going to have an anaphylactic reaction.

The odds are not insignificant. “One to two children in each classroom could potentially be at risk for a serious food allergy,” says Dr. Carla Davis, an assistant professor of pediatrics in the section of immunology, allergy and rheumatology at Texas Children’s Hospital in Houston.  Of those, 30-40% would be at risk for life-threatening anaphylaxis.

Epinephrine is the first-line treatment, and caregivers must act quickly in order to treat effectively.  How quickly? Ideally, within minutes of the child developing a reaction.

For more information on anaphylaxis, visit the Food Allergy & Anaphylaxis Network.

Back-to-school lesson on food allergies

According to the Food Allergy & Anaphylaxis Network (FAAN), nearly six million children across the United States suffer from food allergies. Of those, more than 300,000 were admitted to hospital in the last year alone. To help ensure your food allergic child doesn’t suffer the same fate, SRxA’s Word on Health offers some simple Back-to-School tips for parents. The key to preventing allergic reactions and anaphylaxisis preparation:

  • Contact the school well in advance of the first day of class and let your child’s teachers, coaches and school nurse know about their allergies
  • Provider the school with a copy of your Child’s Anaphylaxis Action Plan
  • Find out about field trips, parties, and special events such as Halloween or Valentine’s to ensure that allergens don’t sneak in along with other treats
  • Meet with key personnel that will take care of your child if a reaction occurs
  • Find out what plans are already in place for children with food allergies and what steps will be taken if an allergic reaction occurs at school
  • Ensure that any medication, such as an EpiPen, on that plan has a physician’s order to cover it at school and that medication is readily available to personnel if it needs to be administered
  • Teach your child what foods are off limits
  • Teach your child to recognize symptoms and let an adult know immediately if they think they might be suffering an allergic reaction.
  • Make sure your child understands not to trade food with others or eat anything with unknown ingredients.

Schools and teachers can also prepare themselves for the food allergic children in their class.  FAAN produces some excellent resources as part of its Safe@School campaign. For example, they offer expert in-service training to school districts to prepare staff to confidently CARE™ for students with food allergies by teaching them how to: In addition, FAAN provides training presentations, suitable for elementary and secondary schools as well as colleges and universities. So whether you’re a child, parent or teacher dealing with food allergies, be prepared, be safe and CARE this back-to-school season.

Some VERY strange allergies

According to the Centers for Disease Control and Prevention (CDC), 90% of all food related allergies are caused by milk, eggs, peanuts, tree nuts, shellfish, fish, soy and wheat.

While these are the most common, there are other allergy triggers you may not be so familiar with.

How about water?  Yes, it is possible to be allergic to one of the most abundant substances in the world, including the water in our own bodies. People with this condition, properly known as aquagenic urticaria, can experience severe itching and hives within five minutes of coming into contact with water, regardless of its source or temperature.

This condition is rare – only around 30 cases have been reported in the literature and the reason for it isn’t known. Worse still for those affected, histamine levels — the usual allergy culprit — don’t actually increase in these patients, meaning that traditional antihistamines don’t work.

While it might be hard to envision a life without water, spare a thought for women who are allergic to their own female hormones.  Although it’s not uncommon for women to suffer from acne, water retention and premenstrual syndrome (PMS) at certain times their cycle, a small number of women suffer from a condition called autoimmune progesterone dermatitis (APD). This skin disorder is triggered by progesterone hypersensitivity after ovulation.

And speaking of women’s problems – just imagine if you were allergic to semen.  While it’s more common in women, we need to point out that it’s also possible for men to be allergic to their own sperm.

Dutch researchers recently reported 45 cases of post-orgasmic illness syndrome. In both cases, the men experienced allergic symptoms around their eyes and nose, and transient flu-like symptoms within seconds, minutes or hours after sex, masturbation or spontaneous ejaculation. Yikes!

As if life without water or sex is difficult to contemplate, imagine if you were allergic to the weather.  In some people, a drop in the temperature can set off an inflammatory disorder known as cold urticaria.  Patients with the condition can experience redness, itching, swelling, hives and, in rare cases, death when they come in contact with cold air, cold water or even cold drinks. For others it’s the sun that’s the problem. Solar urticaria, can cause similar symptoms within minutes of exposure, in affected individuals.

And if all of this has left you feeling a little faint, be careful where you lie down! Although as we told you earlier soybeans are a common food allergen, and sufferers need to omit soy products from their diet, soybean allergies can be triggered by beanbags. According to a case study reported in the Annals of Allergy, Asthma & Immunology, a 6-year-old boy experienced respiratory distress while playing at school. His reaction was apparently triggered by dust from the dry soybeans in the beanbag.

Are you allergic to anything strange?  Share your stories and suffering with us!

Peanuts and Pregnancy

As we’ve discussed before, peanut allergies are on the rise. One study showed that the incidence of peanut allergy in children doubled between 1997 and 2002. Now, it seems researchers have discovered one of the reasons why.

A study of almost 62,000 mothers showed that the children of those who ate peanuts and tree nuts while pregnant were less likely to develop asthma or allergies than the kids whose mothers shunned nuts.

The results support the recent withdrawal of recommendations in both the US and the UK that pregnant women should avoid nuts because they might raise a child’s risk for allergies to the nuts.

There is little research on peanut eating during pregnancy and the subsequent risk for peanut allergy in her children yet the fear continues to lead many expectant mothers to steer clear of nuts.

So, researchers at the Centre for Fetal Programming at Statens Serum Institut in Copenhagen, wanted to take a more extensive look at nut exposure and the possible health outcomes in kids.

The mothers provided information about how often they ate peanuts and tree nuts, such as almonds and walnuts, during pregnancy.

At age 18 months, the researchers found, the kids whose mothers ate peanuts were less likely to have asthma.

Fifteen percent of kids whose moms ate peanuts more than once a week, had asthma compared to more than 17 percent of kids whose moms never ate peanuts.

When other asthma risk factors were taken into account, the researchers concluded that kids whose mothers ate peanuts regularly were 21% less likely to develop asthma.

At seven years old, this same group of kids was 34% less likely to have a diagnosis of asthma than kids whose moms had abstained from peanuts.

Similarly, mothers who ate tree nuts more than once a week had 18-month-olds who were 25% less likely to have asthma than the moms who avoided the nuts, although this difference appeared to fade as the kids reached seven years old.

Peanuts appeared to have no effect on whether kids developed nasal allergies, and the children of moms who frequently ate tree nuts were 20% less likely to have allergies.

Lead author, Ekaterina Maslova said the findings are further reassurance that moms-to-be don’t need to avoid peanuts and tree nuts, although the study doesn’t prove that nuts are actually protective against asthma and allergies.

Mahr, who is also chair of the section on allergy and immunology at the American Academy of Pediatrics, noted that interviewing people about what they eat can introduce some accuracy issues, but the findings are still interesting.

SRxA Advisor Todd Mahr, a pediatric allergist at Gundersen Lutheran Medical Center in La Crosse, Wisconsin, who was not involved in the study said “A take home from this would be if there’s no food allergy in your family, but there’s an asthma history in your family, maybe you might not want to avoid peanuts specifically.”

All of which is good news for moms with peanut butter cravings.