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Managing peanut residue at schools

Question:

3/22/2017
My question involves hand washing for peanut residue at schools. I have a severely peanut-allergic patient whose mother insisted the school purchase Wet Ones wipes for the classes to use once to twice daily. This has cost the school district $30,000 yearly and they are looking for an alternative. She is adamant that only this product be used due to the 2004 JACI article by Perry T., et al., Distribution of peanut allergen in the environment. The active ingredient is benzethonium chloride, an antibacterial agent and not found in any other products.

My question relates to the fact that it is unlikely an antibacterial ingredient is responsible for effectively removing the allergen, but instead is due to surfactants and other oil/lipid-related residue removers. Are there any other ingredients or products that could be recommended? I have not been able to find new literature on this. I looked into waterless grease removers, used in the automotive industry, but would like your opinion.

Answer:

We asked for an expert response from Dr. Robert Wood, who authored the referenced article. His response is below.

"The answer comes in two parts:
1. There is nothing special about the wipes or the chemical contained in them. The main point of the paper we wrote was that any cleaning works, whether it be the wipes or soap and water. However, we also found that antibacterial gels are less likely to work, and should not be relied upon for allergen removal.

2. The other big question is whether any of these precautions are needed. There is no evidence that hand washing helps prevent reactions in schools, or that the lack of hand washing increases the risk of reactions. From a clinical standpoint, washing or wipes may have some value in young children (e.g. preschool age), but we do not recommend it as necessary or beneficial for elementary school children."

Hope this helps.
Patricia McNally, MD, FAAAAI