Thank you for your letter.
I clearly understand your position, and from reading your e-mail, I also feel that you have become familiar with the position of experts in this field who have not advised the banning of peanuts. Some of the opinions you expressed make me realize that you are already aware of the rationales that have been employed to justify the opinion that banning peanuts in schools would be inadvisable. This is an issue which has been debated almost endlessly, and there are proponents of both sides of the argument. Both sides are sometimes strongly invested in their own views of this issue, as I can tell you are. Both sides can be argued vigorously.
We have many issues in anaphylaxis that fit into the same category. The reason for the debate is that such issues cannot be answered on the basis of controlled trials, and therefore we have no true definitive supporting evidence for either side of the issue.
One such issue, for example, revolves around when to administer epinephrine in a potential case of anaphylaxis. This occurs when a child, thought to be allergic to a food, ingests the food, but has no symptoms after the ingestion. There are proponents of administering epinephrine immediately and there are other proponents who state that the child should be watched and administered epinephrine only if symptoms occur. There are no clear-cut data to support either side. We will never be able to attain these data because we cannot do controlled trials.
We have no controlled trials to compare outcomes in schools where peanuts are banned versus schools where they are not. I do not think this study will ever be done, in part because of the emotional investment in the issue.
So, I do not think it would do a great deal of good to become, on this website, involved in these polemics. However, we are placing your letter online so it can be reviewed by our readers, many of whom are experts and publish in this area.
Thank you again for your interest in our website, and for the expression of your opinion.
Phil Lieberman, M.D.