The childhood food allergy mystery

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[url="http://www.newsday.com/news/health/ny-hscov4634528feb21,0,4166591.story?coll=ny-leadhealthnews-headlines"]http://www.newsday.com/news/health/ny-hs...hnews-headlines[/url] The childhood food allergy mystery Cases are on the rise, and no one knows why BY ELLEN MITCHELL SPECIAL TO NEWSDAY

February 21, 2006

Recently, Christopher Duffy's fourth-grade class celebrated a special occasion with ice cream sandwiches. Everybody that is ... except Christopher.

"I was irritated about that ice cream sandwich," he confided in rather grown-up terms.

But, then, the 10-year-old from Massapequa long ago developed a mature attitude over the fact that he often cannot eat what his peers are enjoying.

Christopher is among an estimated 2 percent to 4 percent of the overall U.S. population with a potentially life-threatening food allergy. The number of those younger than 3 with severe food allergies is greater - as much as 6 percent to 8 percent - but the percentage decreases as children often outgrow their allergies.

We hear a great deal about food allergies in kids these days, particularly about the great peanut butter battle being waged in the schools over how best to deal with those children who are allergic to peanut butter.

Peanut butter is No. 1 on every list of food culprits. The experts know that the number of children allergic to peanuts and other major food allergens is climbing. What they don't know is why.

Dr. Hugh A. Sampson, the chief of pediatric allergy and immunology at Mount Sinai School of Medicine in Manhattan, is one of the country's best-known pediatric allergists.

Peanut allergy doubling

"Everybody is quite perplexed about it," Sampson said. Aside from peanuts, he said the other seven major food allergens are milk, eggs, tree nuts, wheat, soy, fish and shellfish.

"We did a peanut allergy survey in 1997 and repeated it in 2002. We found that in children under the age of 5 there was a doubling of numbers," Sampson said.

Why?

"That's what everybody is quite perplexed about," Sampson said.

Genetically, we are producing populations of people who are generally more allergic, according to Sampson and Dr. Bruce Edwards, an allergy specialist in Plainview. Both doctors also cite "the hygiene hypothesis" as an unproven, but a plausible possibility.

The hygiene hypothesis results from observations of children in Scandinavia and Europe who grew up on farms under less than "sterile" conditions and have been found to be less allergic than U.S. kids, Edwards said.

The theory is that because U.S. children "use antibacterial soap, get antibiotics at the first sign of a runny nose and are vaccinated for every potential thing out there," their immune systems do not spend time producing anti-infectious responses to all the diseases they will never get. Instead, their immune systems may be "shunting their responses to produce things [anti-infectious responses] which are more allergic in nature," Edwards said.

Nor is there any preventive medicine. The only surefire advice the medical community can offer a person with food allergies is to strictly avoid offending foods.

Sampson and his colleagues are working to produce a vaccine they hope will turn off a person's allergic response to peanuts. So far, the vaccine has shown promise in animals; the next steps will involve lengthy trials with humans. If those are successful, Sampson said, his research team may eventually be able to produce similar vaccines to protect against other major food allergens. But any such vaccines are still a long way off.

A challenge to control

Meanwhile, having a child with a food allergy is a challenge, said Mary Ellen Grimes of Massapequa.

Grimes' son Brendan, who is 10, began vomiting for no obvious reason when he was a baby. Grimes, a nutritionist, had been breast-feeding him. Tests showed him to be allergic to peanuts, tree nuts, soy, milk, bananas, melons and oranges. Grimes had occasionally eaten peanuts while breast-feeding. While the data does not provide proof positive, most American allergists advise that breast-feeding moms try to avoid the major food allergens.

In fact, Sampson tells of a breast-fed baby who several times broke out in hives, had difficulty breathing and turned blue. The cause turned out to be seafood allergy and before each attack the breast-feeding mother had eaten salmon.

Neither Brendan nor Christopher has ever gone into allergy-induced anaphylactic shock, in which the body reacts so violently to the allergen that unless the person is treated immediately, death can result. They have, however, experienced breathing difficulty and swelling in the mouth and throat. If their blood pressure had dropped precipitously, they could have gone into shock.

Antidote kept handy

Both families are never without an emergency supply of EpiPens, syringes preloaded with epinephrine (adrenaline), to counteract the adverse effects of shock. The epinephrine shot is given intramuscularly, and then the victim should be transported to the hospital.

It's estimated that U.S. hospital emergency rooms treat 30,000 anaphylactic food reactions a year and that food allergies cause 150 to 200 deaths annually.

Grimes worries that the time is not far off when Brendan will grow beyond her watchful control. He will have to learn to self-inject with the EpiPen, as well as to check food labels for hidden contents that could set off an allergic reaction.

At both boys' schools, the school nurses are supplied with EpiPens, which are to be administered immediately if needed. At times when the nurse is not in the building, such as when Christopher is attending extracurricular activities, his mother, Christine Duffy, goes to his school and waits just in case her son should have an attack and need an injection.

The peanut butter controversy swirls around how schools handle the issue. According to the New York State School Boards Association, each district makes its own policy. Some schools provide a "peanut-free table" for allergic children, others try to ban peanut butter completely, which, as Edwards pointed out, is virtually impossible to enforce "without peanut police at the door."

Ingestion, not inhalation

Even though her son Brendan is allergic to peanuts, Grimes called it an overreaction to ban them from schools. And the medical experts agree that just the scent of the peanut is not enough to produce an allergic reaction. Edwards and Sampson said in general the offending food has to be ingested, not merely inhaled, to cause a problem.

"Some parents become frantic. I think a lot of the phobias kids have about eating are related to the fear the parents put in them," Grimes said.

According to Edwards, children who've had it ingrained in them that certain foods "are poison" will refuse to eat that food even if they eventually outgrow the allergy. The potential, he said, is for these children to develop eating disorders.

But Duffy said oftentimes parents whose children have no allergies, and sometimes even school personnel, do not take the allergy issue seriously enough. Consequently, her son, Christopher, is not allowed to eat any food at school unless he brings it from home.

"You're dealing with a lot of ignorance from those who think you are making too much of it and that you are overreacting. Maybe I would have thought that, too, if I hadn't seen what happened to Christopher when he was a baby and had a tiny bit of peanut butter on a cracker," Duffy said.

"He had white spots all over his face," she said. "They were hives, but they looked like white spots because his whole face was so swollen that his eyes were swollen shut."

On Feb 21, 2006

Ok what bugs me:

(((("Ingestion, not inhalation

Even though her son Brendan is allergic to peanuts, Grimes called it an overreaction to ban them from schools. And the medical experts agree that just the scent of the peanut is not enough to produce an allergic reaction. Edwards and Sampson said in general the offending food has to be ingested, not merely inhaled, to cause a problem.

"Some parents become frantic. I think a lot of the phobias kids have about eating are related to the fear the parents put in them," Grimes said."))))

We all may have different opinions of bans, but to call those of us WHO do have children that are that SENSITIVE, "Frantic", it burns me! It's not bad enough we have to convince all the schools, get heat from other parents, etc. etc, but to have "one of us" call us that! I'm not impressed! Her son might be ok to be around some one eating and not break out. It doesn't work that way for one of my PA children! My child does break out from it being in the air! My brother does have inhalation to foods being cooked and so does one of my children!! Why can she not think outside the box? And the medical experts said in general, so not saying that in some rare cases it can happen! They will be getting a well thought out letter with links to some of those stories of contact and inhalation! Sorry for the vent!!!

On Feb 21, 2006

Ugh! Another perfectly good article ruined by the denial of airborne reactions. I've seen them enough times with my own son to know better. And every time I see an "expert" deny their existence I just want to scream.

Amy

On Feb 21, 2006

My thoughts exactly...I couldn't agree more with the last 2 posts!!!

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