HUNTSVILLE, Ala. - Milk, eggs, wheat bread and peanut butter are common grocery items for many families. But for others, especially a growing number of children, these are foods that can kill.
Doctors will tell you, food allergies are more than just a fad. Reactions occur within minutes. Untreated, they can result in anaphylactic shock -- a tightening of the airways and drop in blood pressure -- even death.
OUR FAMILY'S STORY:
For our family, this is a personal issue. When our son was 18 months old, we gave him a mini peanut butter cracker.
It was Sam's first time to have peanut butter. We were aware of food allergies and although there was no family history, we had decided to delay introducing peanuts or tree nuts -- some of the most highly allergenic foods for children.
But that delay did not protect him.
Within minutes, Sam's hands, arms and chest were covered with hives -- angry, red splotches, spreading up his neck toward his face.
We rushed him to the pediatric ER.
Tests later confirmed Sam is one of the several million children in the U.S. with a life-threatening food allergy. A number that continues to grow.
One CDC report found food allergies rose 50 percent between 1997 and 2011. Current research shows 4 percent of adults and 8 percent of children are allergic to one or more foods. This means, the average U.S. classroom now has two students with a food allergy.
And, it's not a problem restricted to the U.S. Europe has seen similar increases in recent decades.
But why? And what can we do about it? WHNT News is Taking Action in the food allergy fight.
A DOCTOR'S PERSPECTIVE:
We met with Dr. Shashi Kumar of the Alabama Asthma, Allergy & Immunology Center in Huntsville. A former pediatrician, Dr. Kumar has spent the last 20 years as a board-certified allergist and immunologist.
He told us research shows food allergies have indeed risen in the U.S. in the last ten to 20 years.
"Especially for peanuts and tree nuts and especially in children. We don't know exactly why but we are getting closer to the answers," Dr. Kumar says.
One possible answer can be traced back to the American Academy of Pediatric's 2000 guidelines, which recommended avoiding highly-allergenic foods for the first two to three years of life.
It was suggested that parents avoiding giving children eggs until age two and avoid fish, peanuts or tree nuts until age three.
"Now, we realize that avoiding the highly-allergenic food early in life, it actually increases the chances of developing an allergy. The opposite of what we were thinking," Dr. Kumar says.
The AAP revised its stance in 2008, saying there was insufficient evidence to support delayed introduction, but did not issue any recommendations on how or when to introduce the most highly-allergenic foods.
These foods, which are responsible for 90% of cases, include:
- Cow's milk
- Tree nuts
Finally in 2013, the American Academy of Allergy, Asthma and Immunology did provide specific guidelines.
These represented a complete change from the previous wisdom, suggesting parents could safely begin feeding their babies these foods (with the exception of cow's milk which is not recommended until one year) as early as 4-6 months.
Dr. Kumar points to a landmark study released in Europe last year, called the LEAP (Learning Early About Peanut Allergy) study. For five years, researchers followed children at high-risk of developing food allergies.
Children with a family history of food allergies are considered high-risk. Eczema is another risk factor.
Under careful supervision, one group was given two grams of peanuts, three times a week. The other group practiced complete avoidance of the food.
The results showed the children who ate peanuts reduced their risk of developing the allergy by 80 to to 90 percent.
"This goes to show that early introduction is important," said Dr. Kumar.
If you believe your child may have a food allergy, Dr. Kumar says skin or blood tests will be used to confirm the diagnosis.
As for treatment, there currently is none. Only complete avoidance of the allergenic food. As families with food allergies can attest, this requires careful reading of all nutritional labels and asking a lot of questions at restaurants.
However, even that isn't always enough. For those with severe food allergies, cross-contamination is always a concern.
SURVIVING AND THRIVING WITH FOOD ALLERGIES:
Isaac Allen, 11, is athletic and outgoing -- a regular kid. But wherever he goes, whether to the ball field or to school, his EpiPen goes with him. It's an epinephrine auto-injector, ready to help him if he suffers a reaction.
"When I was about 1 year old my mom was eating a peanut butter sandwich and I wanted some. She gave me it, and then, I had a reaction," said Isaac.
"I gave him one little piece and he got a hive on his lip," said his mother, Sue Allen.
Despite the family's constant vigilance, Isaac has twice experienced anaphylactic shock.
He was 6 years old the first time it happened.
"His ears turned bright red. His lips were swelling," said Sue. Then, Isaac's airway began to close.
"He said it felt like there was a shell in his throat and it just got tighter and tighter and tighter."
Sue Allen immediately dosed Isaac with Benadryl and called 911.
This past Halloween brought the most recent -- and most severe -- reaction. Isaac had gone trick or treating and gotten an individual-sized bag of sour candy. There were no allergy warnings on the bag. It was a hard candy. The Allens thought it was safe.
"That night, he came to me, covered in hives, I mean hives this big," said Sue, as she held her hands in a circle. "I was scared to give him the EpiPen. We gave him Benadryl, took him to the emergency room, they released him."
Twelve hours later, the hives came back.
That night, Sue Allen knew her son's life might hinge on his EpiPen.
"I said, Isaac, it's time," as her voice shook. "I took him in the living room. I gave him the EpiPen and he immediately, by the time I got to the phone to call 911 he said - 'I feel so much better.'"
The family later learned the large bag of candy - which contained the individual-sized packages - did carry a warning that the candy was made on shared equipment. In other words, although the candy itself did not contain peanuts, it may have become contaminated during manufacturing.
Sue Allen has learned a lot about food allergies in the last 10 years and there are a few other things she'd like to share with any family walking the same road.
First -- as she learned -- don't be afraid to use the EpiPen, if needed.
Dr. Kumar confirms, "epinephrine is safe to use. It does cause tremors and heart racing but it doesn't cause any severe reactions."
In fact, he recommends his patients receive the epinephrine as soon as they begin showing hives, even if their breathing is fine.
Outside the medical issues involved with food allergies, the Allens have learned some other lessons. Hard ones.
Sue Allen acknowledges Isaac is sometimes left out.
"Socially, it's hard. He started a new school this year and some of the parents maybe don't want Isaac to sleep over because they're afraid. They don't know what's safe."
One the other hand, "some parents are amazing. They ask lots of questions," she adds.
Her message is simple: Don't be afraid.
Trust that the children and their parents are taking steps to guard against the food allergy. Work with these families to include -- rather than exclude -- the child.
Also, know that school policies -- banning certain foods in lunchrooms -- aren't intended to punish but protect.
"There are definitely people out there that think we are exaggerating and think that it is just like hay fever and there are people who will say -- well, my child will only eat peanut butter sandwiches. Well, your peanut butter could kill my son," said Allen.
THE SCHOOL PERSPECTIVE:
As part of this story, we contacted Huntsville City, Madison City and Madison County Schools to learn their policies.
There are no laws regulating how school systems handle food allergies. Some ban products altogether.
As any parent knows, it's almost impossible to keep children, especially young children, from making a mess. All it takes is an allergic child to touch a peanut butter smear or a bit of dropped food, then bite his fingernail or rub his eyes.
That's why other schools set out separate "allergy tables," where children with food allergies eat together.
Decisions are made on a system by system -- and in some cases, school by school -- basis.
In Madison City, none of the elementary schools serve meals with nuts. The decision that was made about 8 to 10 years ago.
As far as separate tables, spokesman John Peck says, "that decision is made on a school by school basis. Teachers are made aware by a school nurse of sensitivities from being in the vicinity of certain foods."
He adds, "secondary schools don't have a nut-ban per se but generally have a wider variety of food items that give students more choices. However, there are provisions that can be made for the safety of students with food allergies."
Those provisions include a database that allows the Child Nutrition department to input any food allergy into the system under the student's ID.
Parents report the allergy information and if the student tries to purchase a food he or she is allergic to, the database flags the system -- allowing the cashier to stop the sale.
Menus are also posted online and the system also provides an online form that allows parents to detail any special dietary needs, as dictated by a doctor.
Madison County Schools Child Nutrition Program Supervisor Barbara Haugtvedt says some of their schools, "particularly elementary schools have enacted a peanut-free preference in their lunchrooms." She adds that all students with diagnosed milk allergies, have the option to receive soy milk.
The system also takes the following steps:
- Cafeteria managers receive copies of each student's diet order forms or doctor's statement, to verify food allergies
- Cafeteria managers, guided by the school nurse and/or CNP director, demonstrate they understand the dietary needs
- Care is taken to avoid cross-contamination by utensils during food preparation and service
- Appropriate substitutions are made for students with food allergies
- Child nutrition staff also complete annual training on preventing exposure, recognizing allergic reactions, using EpiPens, dealing with bullying involving food allergies and more.
Huntsville City Schools provided this link to the system's Special Dietary Needs guidelines.
The website also states: "We understand that certain children have special dietary needs and we will do our best to accommodate those needs. For a student with a chronic medical condition such as diabetes, cystic fibrosis, or a non-life threatening food allergy, a diet prescription signed by a licensed physician, nurse, registered dietitian, or physician assistant is required. A student with a disability or life threatening food allergy must have a diet prescription signed by a licensed physician."
As for Isaac, he's doing his part in the food allergy fight. He was recently appointed to the Teen Advisory Group for the Food Allergy Research and Education (FARE) organization. The work will include peer counseling and advocacy.
It's a big job but as Isaac explains, "it can help other people and inspire people."
Dr. Kumar is also looking to the future. He says there are some promising new treatments on the horizon. One uses a patch, similar to a nicotine patch, to expose the immune system to peanuts through the skin.
While not yet approved for general use, Dr. Kumar says, "the early trials are very encouraging and we may have that as an option in the next year or two."
Until then, the best defense is awareness.
If you'd like to learn more, we've included some resource links below.
And in the meantime, to everyone who is helping keep our children safe -- thank you.
- Food Allergy Research and Education
- Kids with Food Allergies
- American Academy of Allergy, Asthma and Immunology
- American Academy of Pediatrics