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Not Easy to Digest

The phone rang. It was the nursery school. Something bad was happening to Delia Chiaramonte's 4-year-old daughter.

Marina was itching all over. She had a rash. Her throat felt funny. She was sneezing uncontrollably and her face was swollen. Dr. Chiaramonte, a family physician, ordered school officials to call 911. She rushed to the school.

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What triggered the sudden emergency? Craft time at school. Marina had made a bird feeder out of birdseed and peanut butter. Somehow, that minor contact had triggered a full-blown allergic reaction.

"She recovered, but I knew what it meant," says Chiaramonte. "It scared me to death."

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Marina's experience has grown increasingly common. Roughly 7 percent of children younger than 3 years old experience a documented allergic reaction to food. Peanuts, eggs, milk, wheat and soy are the most likely culprits.

It's not just a matter of more doctors diagnosing food allergies either (although other types of adverse food reactions often get misdiagnosed as allergies, too). Researchers believe food allergies -- like allergies generally -- have become increasingly prevalent worldwide.

No one is certain why this is happening, but a leading theory is that modern hygiene has left immune systems with less to do. Instead of routing out harmful invaders, an infant or toddler's germ-fighting mechanisms mistakenly identify certain kinds of food proteins as a threat to the body and create specific antibodies to fight them.

Once that sensitivity is set in place (usually in the first year of life), the immune system is locked in -- whenever the body comes in contact with that food, the allergic reaction can be immediate and powerful.

Unfortunately, many food allergies aren't diagnosed. Nor are parents always prepared to cope with its consequences. An allergic reaction can cause a variety of symptoms from a mild rash to projectile vomiting, and in its worst cases, anaphylaxis -- an acute condition that causes labored breathing, a drop in blood pressure and, in rare cases, even death.

"A reaction can be immediate and severe -- between 30 seconds and 30 minutes," says Dr. Robert A. Wood, director of the pediatric allergy center at Johns Hopkins Children's Center.

Limit exposure

Wood suspects his fellow physicians need to learn more about how to diagnose a food allergy. Last month, the American Academy of Pediatrics published a 90-page supplement to its journal Pediatrics reviewing current research in food allergies and reviewing their proper diagnosis and management.

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"There are doctors who don't realize how common food allergies are," says Anne Munoz-Furlong, founder and head of The Food Allergy & Anaphylaxis Network, a non-profit advocacy group that co-sponsored the report. "Babies can develop symptoms, too."

That's exactly what happened to Marina Chiaramonte. As a 1-month-old, she had persistent eczema, and would cry inconsolably during breastfeeding. Her pediatrician was stumped by the symptoms. It was a lactation consultant who first suggested the possibility of an allergy -- a diagnosis later confirmed by an allergist.

"We took milk out of her diet and she got better immediately," recalls Chiaramonte, who lives in Homeland and is a married mother of two.

Once an allergy is suspected, a pediatrician normally refers the youngster to an allergist. A test, either by pin prick (where tiny drops of allergens are inserted in the skin) or with a blood sample (to look for certain antibodies), will confirm an allergy.

There is no cure for a food allergy, although children will grow out of most food allergies by the time they are in grade school. Most, but not all. Peanut allergies are likely to last a lifetime. Shellfish allergies may not develop until adulthood.

Most food allergies can be prevented by limiting a baby's exposure to certain foods. If, for instance, a baby is never exposed to peanuts, the child can't develop a peanut allergy.

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But that can be tricky. A breast-feeding mother exposes her infant to peanuts, for instance, merely by eating foods with peanuts herself -- even minute amounts. Some canned products, for instance, have a small amount of a peanut-derived thickener in them.

"If you come from a family where there are allergies, you shouldn't even introduce peanuts in the diet until the third birthday," says Munoz-Furlong.

The only proven treatment for an allergy is to avoid the wrong foods, but that's easier said than done. It can put a tremendous burden on parents to stay constantly vigilant and become knowledgeable in such arcane subjects as food labeling and restaurant preparation.

"We tell parents that you have to assume an adverse reaction is going to happen and be equipped to deal with it," Wood says.

For instance, a food that has "casein" has a milk product in it. One with "albumen" could trigger an egg allergy. A trip to the bakery is not advised for a peanut allergy because of possible cross-contamination -- a spatula that scooped peanut butter cookies might be used on other things. Same thing for Chinese restaurants where peanuts and peanut oil are commonly used.

Even certain medications can be dangerous to anyone with an allergy. A vaccine commonly used for the flu and yellow fever contains enough egg protein to trigger a reaction in some people.

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Challenge for parents

"Parents come to us and they are overwhelmed," says Megean Garvin, 30, founder of the Harford County Food Allergy Support Group in Belair. "Everywhere there's food in our society -- which is pretty much everywhere -- they have to be on guard. It can be high stress."

Garvin's 4-year-old daughter Emily has allergies to peanuts and certain other nuts. Wherever she goes, Garvin brings along emergency first aid -- an inhaler, a bottle of antihistamine and a syringe filled with epinephrine called an EpiPen to manage a severe reaction.

Bringing along medicines is one thing, but explaining why a 4-year-old can't get ice cream from the neighborhood ice cream truck is a tougher challenge for a parent. "That's the hardest part for me," says Garvin, 30, who also has a 2-year-old son who shows no signs of allergies. "Even though we had ice cream at home, it wasn't the same. She couldn't be with her friends. She was in tears."

Still, even lingering food allergies can be managed, and there has been some recent progress in medical research. At least two anti-allergy drugs in development, Xolair and TNX-901, may help prevent the worst allergic reactions to food. In the long term, there's also hope that injections might be developed to desensitize people to certain foods -- similar to the ones currently offered for other types of allergies.

The public has become better informed about allergies in recent years, and sufferers are more likely to be accommodated. Grade schools are willing to establish peanut-free tables in their cafeterias, for instance, to reduce the danger of inadvertent problems.

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Congress is also expected to soon take up legislation to improve food labeling, a measure that has bipartisan support.

In the meantime, there are support groups like Garvin's and Web sites where parents can share their frustrations and offer each other practical tips.

"What I've learned from this as a physician is that doctors under-appreciate how severe this is and don't always give as complete advice as they could," says Chiaramonte, who teaches family medicine at Franklin Square Hospital in Rosedale. "It's extraordinarily difficult to be the parent of a child with a food allergy. I was surprised at how difficult it is."

Resources

The Food Allergy & Anaphylaxis Network 800-929-4040 www.foodallergy.org

American College of Allergy, Asthma & Immunology 800-842-7777 www.allergy.mcg.edu

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American Academy of Allergy, Asthma & Immunology 800-822-2762 www.aaaai.org

American Academy of Pediatrics 800-433-9016 www.aap.org

Asthma and Allergy Foundation of America 800-7-ASTHMA www.aafa.org

The National Institute of Allergy and Infectious Diseases www.niaid.nih.gov

FDA Center for Food Safety and Applied Nutrition www.cfsan.fda.gov

Support Groups for Food Allergy Awareness in Central Maryland:

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Baltimore / Baltimore County Nancy Holle at 410-377-8551 holle@comcast.net

Harford County Megean Garvin at 410-836-8835 foodallergysupport@ comcast.net

Howard County Tammy Bowers at 410-465-9669 nutmom3@comcast.net

Common childhood food allergies

* milk

* eggs

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* peanut

* soy

* wheat

* "tree nuts" such as

almonds and pecans

* fish and shellfish

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Food allergy symptoms

* A tingling in the mouth

* Swelling of the tongue and throat

* Rash

* Eczema

* Hives and swelling

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* Vomiting

* Abdominal cramps

* Diarrhea

* Wheezing

* Difficulty breathing

* Drop in blood pressure

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* Loss of consciousness

SOURCE: AMERICAN COLLEGE OF ALLERGY, ASTHMA & IMMUNOLOGY


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