Childhood food allergies increasing, fearful parents 'live a life of preparedness'

They often can’t pick up fast food. They may have to send their children off to school with a lunch they’ve carefully packed themselves, even if there’s a cafeteria on campus. They can’t just swing by a restaurant and grab dinner on the way home.

Parents of children with food allergies are constantly on alert.

“Anyone with a food allergy has to be treated as though they have the potential to have a life-threatening reaction,” says Dr. Meredith Moore, an allergist and immunologist at Charleston Allergy and Asthma. “Reactions can occur very quickly, within minutes of eating. Families with children with food allergies, they have to live a life of preparedness.”

At their most mild, food allergies can cause hives, itching, tingling and eczema. At their most severe, food allergies can be deadly. Severe reactions can include swelling of the eyes, lips and throat and inflammation of the respiratory tract that hinders breathing. Some reactions even impact the heart and make it difficult to get oxygen to other parts of the body.

At home and at school, knowledge and communication are vital. Especially for younger children, caregivers need to know not only what type of food a child may be allergic to, but what triggers that allergy — sometimes, touch is enough — and how the allergy typically manifests itself. At school, nurses, teachers and cafeteria personnel need to familiarize themselves with allergies and action plans. An epinephrine auto-injector needs to be kept in a secure, known location so it can be retrieved quickly in case of an emergency.

“The kids are very smart. Even the little ones in kindergarten and preschool are able to tell you what they’re allergic to, and know to ask questions if they don’t know what’s in the food,” says Dr. Maria Streck, an allergist and immunologist at MUSC. “But at the same time, mistakes can happen. They’re young, they can’t read labels yet. They need to trust that the adults are providing a safe environment for them.”

‘That’s your lifesaver’

Food allergies affect an estimated 4 percent to 6 percent of U.S. children, according to the Centers for Disease Control and Prevention, and Moore says she spends roughly a third of her clinical day attending to those suffering from the condition. Food allergy cases increased 50 percent in the U.S. between 1997 and 2011, according to the CDC, although no one is quite certain why; theories involve overuse of antibiotics, Moore says, or less exposure to dirt and manure as populations have gravitated more toward urban areas.

Testing for food allergies is done via blood or skin, Moore says, with the pin prick skin test being more reliable, delivering a quicker result, and providing a clearer indication of how the allergy will manifest itself. According to the CDC, 90 percent of food allergies involve eight food types: milk, eggs, peanuts, tree nuts (like pecans and walnuts), fish, shellfish, soy and wheat. Peanuts, tree nuts, fish and shellfish typically bring about the most severe reactions.

About 20 percent of affected children outgrow allergies by their teenage years. But the rest do not, with more severe allergies potentially lingering into adulthood. “They all have the potential to cause life-threatening reactions,” Moore says.

For parents of children with food allergies, the great fear is anaphylaxis, a severe and potentially life-threatening condition that can strike within seconds or minutes of exposure to an allergen. According to the Mayo Clinic, the condition causes the body to go into shock, with blood pressure dropping and airways narrowing to restrict breathing. In such cases, the vital tool to have nearby is an epinephrine auto-injector, of which the EpiPen is the most well-known brand.

“Epinephrine is the first treatment to go to,” Streck says. “That’s your lifesaver.”

Allergists recommend children with food allergies have two of them, kept in a secured place where they’re easily accessible. At a daycare, that typically means an office. For younger school-age children, they’re usually kept by the school nurse. From middle school on, the children can carry them if they know how to administer them and both parents and physician sign off.

“When there’s a reaction, everyone is trained the same way,” says Bobbi Handy, nurse coordinator for Dorchester County School District 2. “They notify the nurse, who brings the EpiPen and administers it. But there are times when the students have to have it on them, say in middle school when they’re playing sports outside. If the child is carrying, they have to be able to administer it themselves, and both parent and physician have to agree. But that’s not something we see for younger kids.”

Stress at school

At one school in Dorchester District 2, there are 170 students with food allergies ranging from jalapenos to peanuts to peaches, Handy says. At the beginning of each school year, the district sends out health information cards on which parents list any types of allergies and what to do in case the child has a reaction. The allergy information is logged into a computer system and attached to each student’s profile, so even the cafeteria manager knows what type of foods the student can or can’t purchase.

Other school districts in the Lowcountry have similar policies, Handy says, with nurse coordinators meeting monthly to discuss which approaches work best. While some schools have peanut-free tables, or even peanut-free areas, as students get older those delineations become tougher to enforce.

Streck says some schools will seat kids with food allergies closer to teachers at lunch, so any emergency can be responded to more quickly. Children with severe food allergies often bring their own food from home, though that doesn’t eliminate the chance they might try something out of a friend’s lunch box.

Moore recommends parents of children with food allergies write a letter to parents of the other students in class, explaining the risks of and reactions to the allergy, and potentially lowering the chances their child will be bullied, which is a real concern for food allergy suffers, about 30 percent of which are bullied, she adds.

At any grade, sending a child to school and relinquishing control of their food allergy can be a stressful experience for a parent.

“I can imagine how scary it must be, especially when they’re so young, to send them in (to school) and not have that control,” Handy says. “The biggest thing I can pass on is communication. (Parents) have to communicate with nurses, teachers and the staff there. We can notify teachers and cafeteria staff, develop emergency action plans and at the elementary level have peanut-free tables. We can put all those things in place, but we have to know.”

Reassuring research

Food allergies in children aren’t only more common than they once were, they’re being diagnosed at a younger age. While doctors once recommended that children not be exposed to peanuts until at least 3 years old, the push now is to introduce potential allergens before the first birthday, Moore says. That not only allows parents to discover allergies earlier, but helps the child build up a tolerance to potentially allergy-inducing foods.

Allergies to foods like wheat, eggs and milk are most likely to be outgrown. Milk and eggs served in a baked form have also been shown to reduce how allergenic those foods are to children with allergies, Moore adds.

Exposing children to the foods they’re allergic to is one common approach to potentially reducing the severity of those injuries. Charleston Allergy and Asthma is among the practices that offers oral immunotherapy to peanut and tree nut patients, feeding patients small amounts of nuts in a controlled environment over a long period of time — months to a year — with the goal of training their bodies to not have a life-threatening reaction.

“You build up to eight to 12 peanuts a day, taking them just as you would take a vitamin,” Moore says. “As long as you continue to eat them every day, the body will become more tolerant. What we don’t know is if they stop, will (the allergy) come back. Research is looking into that.”

Another potential therapy being researched is a desensitization patch for peanuts, Streck says, one the allergy sufferer would wear just as someone trying to quit smoking would wear a nicotine patch. “The next couple of years, there will be more things available,” she adds. Specifically in the area of peanut allergies, “there are a lot of studies on the horizon that look very reassuring.”

A 2017 study published in The Lancet tested the effectiveness of a combination treatment involving a probiotic and peanut protein on children with peanut allergies. It’s been viewed as a substantial step toward a cure. In the meantime, with no cures for food allergies available, the recommended approach is to be proactive and prepared: Alert school officials to the child’s allergy and reaction, keep epinephrine auto-injectors in a secure and available location, have a detailed action plan in case of an emergency and wash hands thoroughly with soap and water after every meal.

“Reactions can start within minutes of eating the food,” Moore says, “so it’s so important to be prepared to treat a reaction all the time.”