Four years ago, Keller mom Mary Havenstein made chocolate chip cookies with walnuts and offered one to her daughter Lindsey, then 2. Lindsey took one little taste and said she didn’t like it. “I thought she was being a typical 2-year-old, reluctant to try anything new,” Havenstein says. But then Lindsey started rubbing her eyes excessively and they swelled shut within minutes. Havenstein says that her daughter just wasn’t acting right, so she and her husband decided to take Lindsey to the hospital. But on the way, their daughter started to turn purple, went into anaphylactic shock, passed out and stopped breathing. Luckily, the family was passing a police/EMT station as this was happening. They pulled over, and the paramedics gave Lindsey epinephrine (EpiPen) and steroids.
Days later, after her release from the hospital, a skin and blood test at an allergist’s office confirmed Lindsey’s allergy to tree nuts.
Unfortunately, Lindsey’s diagnosis (and life-threatening reaction) is becoming more common. A 2013 study by the Centers for Disease Control and Prevention found that food allergies among children increased by 50 percent over the last decade, affecting 5.9 million kids in the United States. According to Food Allergy Research and Education (FARE), that means that 1 in 13 children has a food allergy. By these statistics, even if your child is food allergy free, there’s a likelihood that at least one kid in your child’s class is not.
To be diagnosed with a food allergy means that the child’s immune system reacts to the proteins in a harmless food as if they are threats and makes antibodies called immunoglobulin E (IgE) to fight them. Symptoms — which can start to occur within minutes but might take up to two hours — range from tingling in the mouth, sneezing and coughing to difficulty breathing, hives, eczema, vomiting, abdominal cramps, diarrhea and life-threatening anaphylaxis, like Lindsey experienced. Food sensitivities and intolerances are different, however. They occur when the body experiences trouble digesting a sugar, like lactose in milk, and can cause diarrhea, but they aren’t allergies, informs James R. Haden, M.D., of the Allergy and Asthma Clinic of Fort Worth.
Eight foods account for 90 percent of these allergic reactions in kids: milk, eggs, fish, shellfish, wheat, soy, peanuts and tree nuts (such as almonds, pecans, cashews and walnuts). Most food allergies manifest early, though food allergies can be triggered at any age, even if a food has been ingested reaction-free for years.
Flower Mound mom Meranda Cohn’s 7-year-old son Carter was actually diagnosed with three food allergies after he had a reaction to just one at 20 months old. He tasted a tiny bite of tilapia (no bigger than a pencil eraser) for the first time after Cohn made fish tacos for dinner. “He immediately spit it out and said hot, hot, hot.” She gave him milk that he guzzled down, and by the time he finished, his bottom lip had swelled and his chin and neck were turning red. “We didn’t know about Benadryl and antihistamines, so we called 911,” Cohn recalls. Carter was treated with epinephrine in the emergency room.
It was the skin and blood test in an allergist’s office days later that verified the allergy to fish and revealed that Carter was also allergic to peanuts and tree nuts, two things that even at 7 he’s never eaten. But he has had a reaction. Carter broke out in hives and his eyelids swelled shut when he was 3 after a child with peanut residue on his hands touched Carter’s face and the side of his neck at daycare.
Doctors don’t know why some allergic reactions are mild and others are life-threatening. Drew Bird, M.D., director of the Children’s Health Food Allergy Center, says that there are so many factors that may or may not contribute to the reaction, such as the type of allergen, the amount ingested, whether it was consumed on a full stomach, whether the child also has asthma or eczema, whether the child’s immune system was already compromised due to a cold or flu. “We just really don’t know,” he stresses.
What we do know is that food allergies run in the family. “There is a genetic predisposition for allergies,” Haden explains. A child is 35 percent more likely to develop a dietary allergy if one parent has allergies (not necessarily to food) and 50 to 70 percent more likely if both parents are allergic to something. “A parent might be allergic to dogs, grass and pollen, and their child is allergic to peanuts,” he says. “You don’t inherit the allergy; you inherit the propensity for allergies.”
The environment is also to blame, and it’s an area of intense research with a few working theories.
There’s the hygiene hypothesis that suggests the rise in allergies is due to the westernized environment. “I’m oversimplifying, but it basically states that we’re too clean,” says Haden. Things like cleaner water and fewer parasites have resulted in changes in our bodies, namely our immune systems. According to this theory, when our immune systems can’t find something destructive to fight, they busy themselves attacking things like harmless food proteins.
Another component to that theory is the overuse of antibacterial soap and antibiotics, which may kill off the good bacteria, called Clostridia, that protect against food allergies.
A second theory implicates a lack of vitamin D. Vitamin D aids in regulating the immune system, but today’s kids spend more time indoors and less time in the sun.
A third, less popular, theory suggests that genetically modified foods (GMOs) — and therefore a lack in dietary diversity — may have contributed to the rise in food allergies.
Obviously, sharing spit and sunbathing are not activities you’re going to encourage your child to do in an attempt to prevent food allergies.
Early recognition and diagnosis is key, offers Bird. Never diagnose your child with a food allergy without consulting a doctor, he says. That can lead to unnecessary dietary restrictions or inadequate nutrition. Seek evaluation and treatment from a board-certified allergist. They may perform a skin prick test, blood test, oral food challenge (feeding the child a measured dose of the suspected allergen), food elimination diet or a combination of these to diagnose the food allergy.
Five-year-old Madeline Michel was 10 months old when she was diagnosed with dairy, peanut and oat allergies, says mom Elizabeth Michel, who lives in McKinney. “I gave her a bite of my grilled cheese sandwich and instantaneously she broke out in hives around her mouth,” Michel says. A blood test came back positive for the dairy and peanut allergy. Oats were discovered when hives reappeared after Madeline tasted Cheerios for the first time.
Michel was given a prescription for an EpiPen and told to avoid all dairy, peanuts and oats when it came to Madeline’s diet. But it was a whole new world to navigate. “It changed everything,” she admits. Aside from reading food labels and carrying an EpiPen, Madeline’s diagnosis impacted Michel’s decision to have a second child. “I had always wanted a big family, but with Madeline’s food allergies and the difficulties that came with them, I waited five years before having a second baby,” she explains. And sadly, 7-month-old Avery already reacts to certain foods in Michel’s breastmilk so Michel avoids the top eight allergens.
Cohn reads labels and calls companies to ensure that products are made in facilities that do not also manufacture nuts, but the most difficult part for her now is explaining differences to her 7-year-old with food allergies. “Carter’s pretty good about asking before eating if there are nuts in something. But he’s also a kid, and he doesn’t necessarily understand why everyone in his class gets smoothies on a field trip and he doesn’t,” she says. “He just knows he’s not allergic to smoothies, so I have to explain that the equipment might also be used to whip up peanut butter shakes.” It’s hard when food allergies aren’t black and white, she adds.
Havenstein cleared her cupboards after Lindsey’s severe reaction, and she also calls the company behind any new product she buys to verify that nothing in the house was manufactured in a facility with nuts. In addition, she calls ahead to every restaurant to inquire about kitchen practices and menu options because most pizza parlors (serve pine nuts), Chinese restaurants (use one deep fryer for all foods) and bakeries (allow tree-nut baked goods on countertops) are off-limits. “We have to be able to live and show Lindsey that she can live, but we don’t want another reaction either,” she reasons.
As kids get older, living with their food allergies presumably gets easier. Kids with egg and milk allergies may even outgrow them (typically by age 6, according to Haden) as their immune systems mature. Other food allergies, like fish and nuts, tend to last for life.
Eleven-year-old Brooke Granado has been her own best no-nut advocate since she was 5, says her mom Vicki Anderson Granado, who lives in Dallas and runs Granado Communications Group. “She’s probably more diligent than my husband Robert and I are about reading labels at this point,” Granado admits. “But that can cause you to get complacent, which isn’t good.” And while they haven’t made a trip to the hospital since Brooke experienced her first allergic reaction (vomiting after eating a cashew at 3), Granado reveals that her daughter had a skin reaction to something in her office a couple of months ago. And while it only caused bumps and lots of scratching, “it was a wake-up call for me that I can’t let my guard down,” Granado shares.
So is this just how it is for families with kids with allergies: a lifetime of avoidance and worry?
Not necessarily. While there is no cure for food allergies and strict avoidance of the allergen is currently the only way to prevent a reaction, several promising strategies are under investigation in terms of treatments and cures for food allergies.
In countries like Korea, China and Israel, peanut allergies exist on a much smaller scale than in westernized countries. Haden explains that in China, for instance, peanuts are boiled and given to infants as young as 6 months. This practice of cooking the potential allergen has already been proven among some who suffer from dairy allergies. Heating the food to at least 350 degrees for 30 minutes, such as in a baked good, changes the allergenic protein, making it tolerable for some children with milk and egg allergies.
Because of this, Bird thinks we will see sweeping changes in the next three to five years to how and when we introduce certain known allergenic foods to children. “Down the road, we may actually be able to prevent a peanut allergy by introducing it earlier to infants who are at a higher risk (e.g., those with eczema) of developing food allergies,” he says.
Plano mom Kathleen Whitfield’s 19-year-old son Peter has been undergoing desensitization therapy using oral immunotherapy (OIT) for his peanut allergy for close to a year. And now the kid who went anaphylactic at age 8 after eating one bite of a peanut butter sandwich can successfully consume a handful of peanut M&M’s daily without a reaction, something he had to work up to. A doctor gave him carefully measured, almost microscopic amounts of the peanut protein in powder form, gradually increasing the dose. Such tiny doses reprogram the immune system by activating the cells that build a tolerance to the food while sneaking under the radar of the cells that trigger the reaction. Peter’s not cured of his peanut allergy, but his mom doesn’t have to worry about him accidentally ingesting something with trace amounts of peanuts and going into anaphylactic shock when he goes off to college.
Haden says this is just the beginning. He speculates that food allergies will be largely curable in this generation’s lifetime, “whether we’re genetically modifying allergens or giving allergy shots for foods,” he says.
Until there’s a cure, however, there are a number of resources for kids with food allergies and their parents too.
Bird started the Children’s Food Allergy camp in 2011. It’s a sleepaway camp in Gainesville, Texas, for kids ages 6 to 15 with food allergies. About 50 kids attend each year. Frisco mom Michelle Jernigan’s 15-year-old son Morgyn went for three years. “He’s been bullied because of his peanut and tree nut allergies, and he gets frustrated with his limitations because of them. But then he meets a kid at camp who has peanut, tree nut, milk and egg allergies and all of a sudden, things don’t seem so bad,” she says.
Another resource for kids (and their families) living with food allergies is the FARE Walk for Food Allergy, chaired by Jernigan. It’s a 5K fun walk that benefits Food Allergy Research and Education by raising awareness and funds for food allergy research (see sidebar for details on the FARE walk in Dallas this month). “We participated in the walk for the first time in 2005, and Morgyn was so excited because for the first time, he saw that he was a majority and not a minority,” Jernigan shares.
And where do these kids’ moms turn to on a day-to-day basis for answers? Online support groups, such as the Dallas Food Allergy Network (DFAN) on Facebook and the No Nuts Moms Group. “I trust the moms in my online support group more than I trust my doctor,” Michel says of the women in her No Nuts Moms Group. “What better place to get information and resources than from the moms who have been there and done that?”
Published October 2015