Sharp increase in allergies

All three of Stacey Lavigne’s children have food allergies, but her 7-year-old son’s condition is severe.

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“He’s actually so severe he’s off the chart,” the Dudley mother said. “It posed some issues starting school.”

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Her son Will just started second grade, and his doctor prescribed extra EpiPens so he would always have access if the need arose. Will carries two EpiPens with him at all times, his teacher has one in a locked drawer and the school nurse also has one.

Allergies of all sorts, especially food allergies, are on the rise among school-age children. As a result, school nurses are being asked to manage greater numbers of epinephrine auto-injectors, known by the brand name EpiPens.

In addition to treating children with more specialized health needs, including children with diabetes and cancer, school nurses are responsible for keeping track of students with prescriptions for EpiPens, as well as other medications.

“This is a huge, huge issue because there are so many kids with allergies,” said Dr. Beverly Nazarian, a pediatric primary care physician at Worcester-based UMass Memorial Medical Center and the school physician consultant for the Worcester public schools. “For school nurses, EpiPens is one of the hottest issues out there.”

EpiPen and EpiPen Jr. auto-injectors, according to the manufacturer, Mylan Inc., are used for the injection of epinephrine, the first-line treatment for allergic emergencies (anaphylaxis). EpiPen auto-injectors are used to treat signs and symptoms of an allergic emergency, some of which include hives, redness of the skin, tightness in the throat, breathing problems and/or a decrease in blood pressure. Allergic emergencies can be caused by triggers such as food, stinging and biting insects, medicines, latex or even exercise.

“You want to have one everywhere the child needs it,” Dr. Nazarian said. “It’s really important that the school knows if a child has allergies or has EpiPens.”

When a child requires short-term or long-term medication during the school day, parents are required to contact the school nurse and provide a physician’s order, a parental consent form and the medication. At the start of the school year, nurses are busy collecting and updating students’ medical information.

“Absolutely, there’s an increase in allergies, the most common are peanut and nut allergies,” said Ellen Capstick, nurse at Sullivan Middle School in Worcester. She said the school is also noticing a rise of environmental allergies the past few years.

About 3 million American children are suffering from food allergies.

The number has increased 18 percent since 1997, according to a recent study for the U.S. Centers for Disease Control and Prevention. Students in Worcester brought 364 EpiPens to schools last year, and those were the ones that health officials were aware of in a student population of approximately 24,000.

“It’s old-school to think it’s Band-aids and ice packs,” Ms. Capstick said. Two nurses at Sullivan Middle School were responsible for 78 EpiPens last school year. Parents send their child’s EpiPen in a clear plastic bag with the child’s name clearly marked.

The EpiPens are stored in a large plastic bin in the nurses’ office.

“It’s important that they’re not locked — and accessible,” she said.

In addition, Ms. Capstick said schools stock an extra EpiPen and EpiPen Jr. in the event a child with unknown allergies has an allergic reaction.

According to the state Department of Public Health, 175 administrations of epinephrine for the treatment of allergic reactions in schools were reported during the 2008-2009 school year.

Of those, in 38 cases, or 22 percent, the student was not known to have an allergic condition at the time of the anaphylactic event.

In Fitchburg, Pamela Rivers, district nurse leader, reported an increase in allergies in children, and a corresponding increase in the number of EpiPens being brought to city schools.

She said the increase in allergies might be partially because of increased awareness and testing in children. In the past couple of years, there was an average of 90 EpiPens for a student population of 5,000 in Fitchburg.

Ms. Rivers said she has had to administer EpiPens twice, one to a child with a food allergy and one to a student allergic to an insect. If a child with an unknown allergy has his or her first allergic reaction in school, Ms. Rivers said, “The only person who can administer an EpiPen is the nurse.”

In the Northboro-Southboro regional school district, each of the schools has a nurse, and there are two nurses at the high school, according to Superintendent Charles E. Gobron. The school district sends out a complete description of the policy on the dispensation of medications at the beginning of the school year.

From January through July this year, approximately $224 million in single-shot epinephrine pens were sold, according to Danbury, Conn.-based IMS Health, a health care information company.

Donna M. Hoey, nurse and coordinator of nursing services for Worcester public schools, said school nurses review EpiPen training at the beginning of every school year.

“Sometimes nurses have a problem getting an updated EpiPen, or even an EpiPen from some families,” Ms. Hoey said. “They’re expensive.”

She said nurses also accompany students on field trips, or make sure another teacher or staff member is trained to administer an EpiPen.

Many students with known allergies carry their own EpiPens with proper permissions in place.

“For the younger children,” Ms. Hoey said, “we try to have the EpiPen follow them through the day. We try to pass them to whatever (gym or recess) teacher is in charge.”

If a child has an allergic reaction on a school bus, Ms. Hoey said drivers are instructed to safely pull over and call 911. That is the same procedure for other area school districts.

Spanishchef Safety Notes:

Indications

EpiPen® and EpiPen Jr® Auto-Injectors (0.3 and 0.15 mg epinephrine) are for the emergency treatment of severe allergic reactions (anaphylaxis) caused by allergens, exercise, or unknown triggers; and for patients who are at increased risk for these reactions.

EpiPen and EpiPen Jr Auto-Injectors are designed for you to use immediately in an emergency, to treat an allergic reaction fast and give you time to get to a hospital or medical center. EpiPen and EpiPen Jr Auto-Injectors are not a substitute for emergency medical treatment.

Important Safety Information

Each EpiPen Auto-Injector contains a single dose of a medicine called epinephrine, which you inject into your outer thigh. DO NOT INJECT INTRAVENOUSLY. DO NOT INJECT INTO YOUR BUTTOCK, as this may not be effective for a severe allergic reaction. In case of accidental injection, please seek immediate medical treatment.

Epinephrine should be used with caution if you have heart disease or are taking certain medicines that can cause heart-related (cardiac) symptoms.

Side effects may include an increase in heart rate, a stronger or irregular heartbeat, sweating, nausea and vomiting, difficulty breathing, paleness, dizziness, weakness or shakiness, headache, apprehension, nervousness, or anxiety. These side effects usually go away quickly, especially if you rest. If you have high blood pressure or an overactive thyroid, these side effects may be more severe or longer lasting. If you have heart disease, you could experience chest pain (angina). If you have diabetes, your blood sugar levels may increase after use. If you have Parkinson’s disease, your symptoms may temporarily get worse.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

For additional information please contact us at 800-395-3376.

Food Allergies with Bill & Sheila

Food allergies in children on the rise

Life threatening allergies can be something your child may have and you may not know until it is too late.

10-year-old Grace Holowczenko tries to describe how it feels when she eats one of the foods she’s allergic to.

“I get kind of itchy and I don’t know what to do,” Grace said.

Grace is among the 8 percent of children under the age of 18 living with a life threatening food allergy, according to the Journal of Pediatrics. Allergy and asthma specialist Dr. Thomas Harper says every year between 150 and 200 children die because of allergic reactions to certain types of food.

“We have seen an explosion of food allergies in the last 10 to 15 years,” Dr. Harper said. 

Dr. Harper says the top allergy prone foods are milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish.

“We discovered it on her first birthday. She had cake and ice cream and broke out in hives in about 15 or 20 minutes, “said mother Tracy Holowczenko.

Like anyone with a food allergy Grace can even have a reaction just by touching anything with dairy or peanuts in it.

“Sometimes when I sit down and people sit next to me ,I tell them, ‘You can’t sit next to me,’ and I feel really bad saying that but I have to do it to save my life,” Grace said.

Dr.Harper says although the cause of food allergies is unknown there are signs that your child may be allergic to a food item. Symptoms of a food allergy can include hives, swelling, wheezing, runny nose, vomiting, diarrhea, loss of consciousness and sometimes death. 

“Every time you give that child something with that food item in it you are playing Russian roulette, “Dr. Harper said.

Dr. Harper says for teens going off to college the threat of a life-threatening reaction can be even greater.

Dr. Harper says if you suspect your child may be allergic to a certain food item, it is important to have them tested by an allergist and to always have the proper life saving medication on hand in case of a life threatening reaction. 

Copyright WCSC 2011. All rights reserved.

Food Allergies with Bill & Sheila

Traveling with food allergies? There’s an app for that

A team of computer engineers has developed a new application that enables travelers with food allergies, health conditions and aversions to obtain instant translations of food menu items.

Developed by a team of researchers from Purdue University and announced last week, the app yields real-time translations — it takes on average 0.09 seconds — without the need for an internet connection or server, creators said.

Furthermore, once the name of a dish is entered, the system also has a warning system that red flags certain ingredients for those with dietary restrictions. For example, if a dish contain croutons — a gluten product that should be avoided by those with Celiac disease — the app will display a warning symbol and suggest questions and answers in both languages so that the user can discuss the dish with the waiter.

A sample sentence could read: “Excuse me sir, I have an allergy and was wondering if it’s possible to remove the croutons from the salad.”

Though designed to help take the fear and trepidation out of traveling for those with serious health conditions like diabetes and heart conditions, and food allergies like strawberries or nuts, it can also be a helpful tool for vegetarians and vegans or those with simple food aversions.

Before traveling, the user downloads a region- and language-specific database. From then on, the system can operate without a network connection. After typing in the desired dish, the text is translated and offers a list of best possible answers along with photos and other ingredients. It also suggests info and questions for the waiter if need be.

While Google — which requires an internet connection — yielded correct translations 73 percent of the time in their tests, their app improved that by 10 percent, with an average of 83 percent.

While it may not have the medical features of the Purdue app or the clout of university research, Foodictionary beat the researchers to the punch when it was released last year. The app offers 87,500 translations in seven languages: English, French, Spanish, German, Italian, Russian and Greek.

Gourmet Dictionary also has a repository of 40,000 translations in five languages.

The Purdue app is not yet available commercially.

Food Allergy with Bill & Sheila

Black race, African ancestry tied to food allergies

NEW YORK (Reuters Health) – In a new study of two-year-olds in Boston, black kids were twice as likely as white kids to have an immune response to foods such as peanuts, milk, and eggs, and almost four times as likely to have a “sensitization” to three or more foods.

While food sensitization doesn’t necessarily pose any danger on its own, kids who are sensitized to certain foods are more likely to develop full-blown allergies to them in the future.

“We know that sensitization is not the same thing as food allergy, but what they’re reporting does seem to be consistent with what has been seen in other populations,” said Christine Joseph, an allergy and asthma researcher from the Henry Ford Health System in Detroit who was not involved in the new study.

Other recent studies have hinted at higher rates of food sensitizations or allergies in blacks, she told Reuters Health.

Researchers also looked at the kids’ DNA and found that the more African ancestry it showed, the more likely a child was to have any type of food sensitization, especially to peanuts.

But it’s still unclear why that’s the case, they said. It could be that differences in genes make some kids more likely than others to get allergies, or it may have to do with their environment and what they’re exposed to early in life.

The study included about 1,100 kids, all born at Boston Medical Center. Between two and three years after birth, researchers led by Dr. Rajesh Kumar of Children’s Memorial Hospital in Chicago brought them in to test their immune responses to eight different types of foods that typically cause allergies: eggs, milk, peanuts, soy, shrimp, walnuts, wheat and cod.

Most kids in the study were from urban areas and many were from low-income families. About six in ten of them were identified as black by their moms.

In all, just over one-third of kids had an immune response to at least one of the foods, the researchers reported in Pediatrics.

About 38 percent of black kids had a food sensitization, compared to 22 percent of white kids. When the researchers took into account factors like whether or not kids were breastfed and if moms smoked while they were pregnant, the black two-year-olds were more than twice as likely to have a food sensitization.

They were also almost four times as likely to have a detectable immune-system response to three or more of the potential allergens.

Hispanic kids tended to have more food sensitizations than white kids, but statistics showed that finding could have been due to chance.

Food sensitizations were also more common in kids whose ancestors were mostly from Africa, compared to those of European descent, according to genetic tests.

There were some differences between kids whose moms reported their race as black and those who had more gene markers suggesting African descent. For example, African ancestry was linked to a greater chance of having a high immune response to peanuts, whereas black race was not.

That tells researchers that genetics may play a role in how likely kids are to have food sensitizations or allergies. Or, something about different ancestral environments may be playing a role, Kumar said — for example, people from Africa are known to have lower vitamin D levels early in life. Vitamin D has been linked to some aspects of immune function.

On another level, cultural factors such as what type of foods kids are exposed to when they’re young, or where they grow up, might trigger allergies, especially if there is already an underlying race-related genetic susceptibility, Joseph said.

More research is needed to better determine what’s behind these differences in risk, both by race and ancestry, they agreed.

For now, Kumar said, “we need to be aware that food allergy is a problem within urban populations.”

Pediatricians, he told Reuters Health, “should equally think of food allergy in their African American patients as they do in their white patients.”

SOURCE: http://bit.ly/ny7YDj Pediatrics, online September 5, 2011.

Mother’s Diet Can Positively Influence Infant Allergies

 

According to new research, pregnant women can reduce the chances of their babies developing food allergies by eating a diet rich in fish oil and nuts.

Researchers found that omega-3 fatty acids prompt the gut to develop in a way that boosts the immune system.

The team from France’s National Agricultural Research Institute (INRA) found that when pregnant women ate a diet high in a particular group of polyunsaturated fatty acids (PUFAs), the gut walls of their offspring were more permeable.

“There is intense research interest in maternal diet during pregnancy.

In the western diet, the group of polyunsaturated fatty acids that we have shown to help gut function are actually disappearing – our dietary intake of fish and nut oils is being replaced by corn oils which contain a different kind of fatty acid,” Dr Gaëlle Boudry, of the INRA research institute in Rennes, France, said in a press release.

“Our study identifies that a certain group of polyunsaturated fatty acids – known as n-3PUFAs – causes a change in how a baby’s gut develops, which in turn might change how the gut immune system develops. These changes are likely to reduce the risk of developing allergies in later life.”

The team said a more permeable gut enables bacteria and new substances to pass through the lining of the gut into the bloodstream more easily.  These new substances then trigger the baby’s immune response and the production of antibodies.

“The end result is that the baby’s immune system may develop and mature faster – leading to better immune function and less likelihood of suffering allergies,” Dr Boudry said.

The research backs up previous studies that have shown how an intake of n-3 PUFAs during pregnancy increases gestational length and maturation of the central nervous system of a baby.

“Other studies have found that a diet containing fish or walnut oil during pregnancy may make your baby smarter – our research adds to this, suggesting such supplements also accelerate the development of a healthy immune system to ward off food allergies.”

The study was published in September’s issue of the Journal of Physiology.

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On the Net:

• National Agricultural Research Institute
• Journal of Physiology

Diet and Weight loss with Bill & Sheila

Children’s allergies require schools, parents to remain alert

Amy Taylor does a lot of reading in the grocery store.

Since her young daughter, Maura, suffered a scary reaction to peanuts a few years ago, every box of cereal, pastries and snack food has to be looked over before it’s purchased.

“We don’t take chances,” says Taylor, 37, of Cranberry.

An estimated 11 million Americans are allergic to some kind of food. An increasing number of them are school-age children.

About 4 percent of the nation’s 62 million schoolchildren, to age 18, have some kind of food allergy, according to the National Center for Health Statistics. The number of reported food allergies among those younger than 18 increased 18 percent from 1997 to 2007, the agency reports.

As the condition has become more prevalent over the years, many parents have become more vocal with their school districts about setting up food-allergy emergency action plans to safeguard their children.

“There’s been a real increase out there,” says Dr. David Skoner, director of Asthma, Allergies and Immunology at Allegheny General Hospital, North Side. He says about one-third of his patients need help with allergies to food, compared with 5 percent when he began practicing medicine in Pittsburgh in the 1980s.

“With the rise in cases we’re seeing out there … schools simply can’t afford to not pay attention,” Skoner says. “They can’t afford to not look at it.”

Food allergies cause 30,000 cases of anaphylaxis — a whole-body allergic reaction — and are responsible for roughly 150 deaths each year. Eight foods account for 90 percent of all food-allergy reactions — cow’s milk, eggs, peanuts, fish, shellfish, soybeans, wheat and tree nuts (such as walnuts, pecans, almonds and cashews).

While most schools and school districts say they stay updated on food-allergy trends, there’s no one clear way to deal with them:

• Pittsburgh Public Schools’ Anaphylactic Allergy Action Plan requires students to disclose their allergy, whether they will provide their own lunches and whether they will be permitted to carry epinepherine to open airways.

• Bus drivers in Penn Hills are trained to recognize symptoms of an allergic attack and administer an injection if they have to.

• Officials at the Western Pennsylvania School for the Deaf, in Edgewood, are crafting a written policy concerning food allergies. Enrollment there has climbed since 2009, when state officials transferred ownership of the Scranton State School for the Deaf there.

“We’re not seeing so much an increase in (the volume of) allergies. What we’re seeing is a change in the severity,” says Gregg Bowers, the School for the Deaf’s chief operating officer. “We know we’re dealing with more severe cases because of what’s in their medical histories.”

Taylor and her husband, Ronald, meet each year with nurses and other officials at Maura’s school to make sure emergency-contact information is updated.

Maura, 9, was 15 months old when Taylor fed her a cracker with a small spread of peanut butter. Maura had earlier outgrown an allergy to coconut and sesame, and had eaten peanut butter before with no problem.

But this time was different. She broke out in hives and started to gasp as her airway began closing.

“It was horrible. I was terrified,” Taylor says. “I didn’t know what I was doing wrong. It’s the worst feeling in the world for any mother to have.”

Maura was rushed to the hospital and recovered after several doses of epinephrine. Since then, the family has tossed out everything peanut-based from the cupboards, and Taylor packs Maura’s lunch every morning.

Buying new packaged foods sometimes can mean calling manufacturers to make sure there’s nothing in them that can make Maura sick.

“We don’t have a treatment for it at this point, so avoidance is the best you can do,” says Dr. Todd Green, assistant professor of Pediatrics in the division of Allergy and Immunology at Children’s Hospital. “It’s a matter of being prepared and having (patients) steer clear of things and situations that will lead to a reaction.”

The National Association of School Nurses, in Silver Spring, Md., is days from releasing its Online Food Allergy Tool Kit that was funded jointly by the Centers for Disease Control and Prevention, the Food Allergy and Anaphylaxis Network and the National School Boards Association. The grant-funded report aims to be an aid for parents, schools and districts on the importance of being proactive with food allergies.

Its release also comes at a time when penny-pinching districts are strapped for cash and are weighing cutting faculty and staff that includes school nurses.

“Kids are coming into schools much more medically complex,” says Sally Schoessler, the association’s interim executive director. “There’s no question school nurses are vital to a district’s public safety and well-being.”

Watch for the National Association of School Nurses’ Online Food Allergy Tool Kit later this month. Details will be released on the association’s website at www.nasn.org.

If your child has food allergies

• Notify the school of what food(s) you child is/are allergic to.

• Provide written medical documentation, instructions and medications as directed by a physician.

• Provide properly labeled medications, and replace medications after use or upon expiration.

• Teach your child how to read food labels and when they’re supposed to tell an adult they might be having allergic problem.

The school’s responsibility

• Review any and all health records submitted by parents and physicians.

• Include food-allergic students in school activities. Students should not be excluded from school activities solely based on their food allergy.

• Set up a team made up of a school nurse, teacher, principal, school food service and nutrition manager, and counselor to work with parents and the student to establish a prevention plan.

• Ensure that all staff who regularly interact with students can recognize symptoms of an allergic reaction and know what to do in an emergency.

• Designate personnel who are trained properly to administer medications in accordance with the state Nursing and Good Samaritan Laws.

Source: Pennsylvania Department of Health

Food Allergies with Bill & Sheila

Living With Food Allergies

From peanuts to milk and even chocolate, people can be allergic to just about anything. Susan Gratza is raising two children with severe food allergies. She says getting proper treatment and knowing more about the condition has helped her to raise her children to live a normal life. Her children receive care from Penn State Hershey Medical Center and their Allergy and Immunology Department.

Below is information about some of the symptoms and treatment of allergies, from Penn State Hershey Medical Center:

Definition:
An allergy is an exaggerated immune response or reaction to substances that are generally not harmful.

Causes:
Allergies are relatively common. Both genetics and environmental factors play a role.

The immune system normally protects the body against harmful substances, such as bacteria and viruses. It also reacts to foreign substances called allergens, which are generally harmless and in most people do not cause a problem.

But in a person with allergies, the immune response is oversensitive. When it recognizes an allergen, it releases chemicals such as histamines. which fight off the allergen. This causes itching, swelling, mucus production, muscle spasms, hives, rashes, and other symptoms, which vary from person to person.

Common allergens include pollen, mold, pet dander, and dust. Food and drug allergies are common. Allergic reactions can also be caused by insect bites, jewelry, cosmetics, spices, and other substances.

Some people have allergy-like reactions to hot or cold temperatures, sunlight, or other environmental triggers. Sometimes, friction (rubbing or roughly stroking the skin) will cause symptoms.

A specific allergy is not usually passed down through families (inherited). However, if both your parents have allergies, you are likely to have allergies. The chance is greater if your mother has allergies.

Allergies may make certain medical conditions such as sinus problems, eczema, and asthma worse.

Symptoms:
Allergy symptoms vary, but may include:

Breathing problems (coughing, shortness of breath)
Burning, tearing, or itchy eyes
Conjunctivitis (red, swollen eyes)
Coughing
Diarrhea
Headache
Hives
Itching of the nose, mouth, throat, skin, or any other area
Runny nose
Skin rashes
Stomach cramps
Vomiting
Wheezing
What part of the body is contacted by the allergen plays a role in the symptoms you develop. For example:

Allergens that are breathed in often cause a stuffy nose, itchy nose and throat, mucus production, cough, or wheezing
Allergens that touch the eyes may cause itchy, watery, red, swollen eyes.
Eating something you are allergic to can cause nausea, vomiting, abdominal pain, cramping, diarrhea, or a severe, life-threatening reaction
Allergens that touch the skin can cause a skin rash, hives, itching, blisters, or even skin peeling
Drug allergies usually involve the whole body and can lead to a variety of symptoms
Exams and Tests
The health care provider will perform a physical exam and ask questions such as when the allergy occurs.

Allergy testing may be needed to determine if the symptoms are an actual allergy or caused by other problems. For example, eating contaminated food (food poisoning) may cause symptoms similar to food allergies. Some medications (such as aspirin and ampicillin) can produce non-allergic reactions, including rashes. A runny nose or cough may actually be due to an infection.

Skin testing is the most common method of allergy testing. One type of skin testing is the prick test. It involves placing a small amount of the suspected allergy-causing substances on the skin, and then slightly pricking the area so the substance moves under the skin. The skin is closely watched for signs of a reaction, which include swelling and redness. Skin testing may be an option for some young children and infants.

Other types of skin tests include patch testing and intradermal testing. For detailed information, see:Allergy testing

Blood tests can measure the levels of specific allergy-related substances, especially one called immunoglobulin E (IgE).

A complete blood count (CBC), specifically the eosinophil white blood cell count, may also help reveal allergies.

In some cases, the doctor may tell you to avoid certain items to see if you get better, or to use suspected items to see if you feel worse. This is called “use or elimination testing.” This is often used to check for food or medication allergies.

Food Allergies with Bill & Sheila

How schools can help kids with food allergies

When told the safest way to protect her children from allergic reactions from food during school lunch time would be to have them eat at a “peanut-free table,” Christina Robinson-Race initially worried that her children would feel like outcasts.

“I thought, ‘My kids are going to be those kids who are sitting at a table by themselves.’”

However, Colin Race, 7, and Anna Race, 9, both students at Iles School in Springfield, Ill., are allowed to invite a friend to join them for lunch. And Robinson-Race speaks highly of how the school district takes care of students who have severe allergic reactions to certain foods.

“It (has) meant so much to us that our kids are so protected,” she said. “I couldn’t feel more confident knowing how protective everyone is and how the kids look out for each other. District 186 (in Illinois) does an awesome job with allergy management.”

Of the roughly 15,000 students attending Springfield public schools, 460 are on record as having a diagnosed food allergy, said Barb Germann, health services coordinator for the district. That’s up from 194 who were listed during the 2001-02 school year, when enrollment was 15,037.

The Centers for Disease Control and Prevention reports the number of Americans under age 18 who reported a food allergy rose 18 percent from 1997 to 2007.

“We’re talking chocolate and oranges, peanuts and shellfish, ranch dressing, tomatoes, strawberries, blueberries and cinnamon,” Germann said. ” … There is one first-grader who is allergic to squash. I don’t think we serve that much.”

Dealing with food allergies covers more than just what’s on the menu when schools serve students lunch. Germann said the district addresses food allergies by teaching employees the proper administration of epinephrine and alerting them to students’ allergies.

Parents are told about foods that should be eliminated from class parties. In some cases, peanut-free cafeteria tables are provided for students who might have a severe allergic reaction.

Except for a couple of times a month when peanut butter sandwiches are on the menu, Robinson-Race’s children are able to eat the food served in the cafeteria, she said. But they miss out on classroom treats such as cupcakes purchased from a bakery because of the possibility of cross-contamination by baked goods, such as peanut butter cookies.

Robinson-Race said teachers are very conscientious about having students wash their hands to further protect her children from exposure to peanuts or peanut products that the students might have touched.

Managing food allergies

However, Dr. Jeff Lehman, an allergy/immunology specialist with Hospital Sisters Health System Medical Group in Springfield, Ill., is not an advocate of peanut-free tables because of the potential for children to be harmed socially.

“You know how mean kids can be in school,” he said. “I’ve had several (patients) have problems where they have had other kids make fun of them, and they feel different from the other kids … as long as you really educate them about not sharing food, they should be OK (sitting with other students).”

Every school district in Illinois was supposed to adopt a policy last year for managing life-threatening food allergies, based on guidelines established by the Illinois State Board of Education and the Illinois Department of Public Health, said Germann, who noted that the Springfield district complied with that mandate.

“It is actually a very excellent resource for schools to have on hand because it is user-friendly and provides the information you need and what you need to do for food allergies,” she said of the guidelines.

The reason for the increased focus on food allergies is because of a “tremendous increase in food allergies” in recent years, Lehman said, citing the “hygiene hypothesis” as the leading theory for that.

“We’re leading too clean of a lifestyle,” he explained. “We’re treating our cattle with antibiotics. Everybody has become more of a germaphobe. Kids are spending more time inside playing video games instead of playing outside in the dirt.”

Because of lack of exposure to germs and allergens, children do not build up tolerance to them, he said. And because the immune system does not have infections to fight, it attacks foods or environmental elements, instead.

“There are multiple studies to support this, especially with kids raised on farms,” Lehman said. “Allergies are much, much lower than in kids who were not raised on farms.”

Lifelong or short-term?

The American Academy of Pediatrics‘ guidelines are to wait until children are at least age 3 to give them peanuts, tree nuts, seafood and fish, but “there is absolutely zero scientific evidence to support this,” Lehman said. “I recommend that whatever you want to feed (them), as long as it isn’t a choking hazard after 4 to 6 months of age, go ahead. You might actually be doing more harm by withholding it.”

There is a chance that those children who do develop food allergies may outgrow them, Lehman said, adding that this applies primarily to milk, eggs, soy and wheat.

“Peanuts, tree nuts, fish and shellfish tend to be lifelong but can be outgrown,” he said. “It was thought that 20 to 30 percent of peanut-allergic patients can outgrow their allergies, but recent data suggests less than 10 percent will outgrow it. The caveat is that 20 to 30 percent of those patients that outgrow peanut allergy can become allergic again. Children can be re-tested to see if they have outgrown their food allergy about once every year.”

Researchers are working on “vaccines to desensitize peanut-allergic patients,” Lehman said. “Most of the work is being done with peanut since it has the biggest increase in incidence over the past 10 years.”

Dealing with allergic reactions

A new law in Illinois allows schools to keep a drug on hand to help students who have severe allergic reactions.

The law was passed on Aug. 15 at a Chicago school where a 13-year-old girl died after eating some Chinese takeout food. Katelyn Carlson had a fatal allergic reaction to the food, which contained peanut oil.

Illinois State Rep. Chris Nybo, the father of a 7-year-old son who has a food allergy, sponsored the bill, saying he saw an opportunity to “turn a very tragic and sad incident into something positive … and save lives down the road.”

The law allows Illinois schools to keep a supply of epinephrine to give to students suspected of having a serious allergic reaction to food and other allergens, such as bee stings.

This prescription medication is injected into the thigh muscle via a device called an EpiPen. It helps improve breathing, stimulates the heart, reverses hives and reduces swelling, said Dr. Jeff Lehman, an allergies / immunology specialist with Hospital Sisters Health System Medical Group in Springfield, Ill.

Before the legislation passed, students had to supply their own EpiPens for their own use, Nybo said.

“So, the schools always had their hands tied in terms of just keeping general epinephrine on hand,” he said.

Nybo said Katelyn did not have an EpiPen because her peanut allergies had previously seemed minor. He said the law also helps students who might have a first-time reaction to an undiagnosed allergen or who forgot to bring an EpiPen to school. Lehman recommends having two EpiPens handy in case the allergic reaction reoccurs.

Food Allergies with Bill & Sheila

On guard against allergies

Seth Davies’ son Will was just a few months old when he had his first allergic
reaction to baby formula containing whey or milk.

The Davies family later found out the list of no-nos for Will also included
cheese, eggs, strawberries and tree nuts.

If Will eats any of those foods, the reaction can range from skin rashes and
itching to difficulty breathing. Will, a 14-year-old student from Cumming at
Greater Atlanta Christian School, carries an EpiPen, a device to treat
allergic reactions, everywhere he goes. His mother keeps one in her purse,
and there’s always one in the car.

“We try to let him live a normal life, but he has to read labels, and there
are very few times he can eat in a restaurant,” said Seth Davies, managing
partner in an Alpharetta consulting firm. “The reality is you can’t let your
guard down.”

Recent incidents, such as the death of Jharell Dillard, underscore just how
cautious people with food allergies have to be.

Jharell, 15, died last week after eating chocolate chip cookies that contained
peanuts. Another student, Tyler Cody Davis of Marietta, died after a call
was placed to 911 from Kennesaw State University. An autopsy report has not
been released, but a note posted on the soccer website of Sprayberry High
School, where Davis was a 2009 graduate, said he died of an allergic
reaction.

“It’s a lack of awareness and education about food allergies that is leading
to these tragic events,” said Dr. Jon Stahlman, an allergy specialist and
president of the Georgia Allergy Society. “These are things that are
preventable.”

Simply put, Stahlman said, an allergy causes the body to overreact to a common
food or substance by releasing a series of chemicals into the body, the most
common being histamine.

“This creates a cascade of events that can affect any system adversely in the
body,” he said. “For example, it can cause rashes and swelling of the skin,
it can cause spasms and swelling of the airways and cause the cardiovascular
system to collapse.”

The Food Allergy and Anaphylaxis Network says most allergies are caused eight
foods: eggs, fish, milk, peanuts, shellfish, soy, tree nuts and wheat.

And experts say allergies are becoming more common.

Stahlman said about 3 million children younger than 18 have reported some form
of food allergy, and the incident of allergies increased 18 percent between
1997 and 2007.

“It’s important for patients to work with their doctors to determine whether
they are experiencing a food allergy or food intolerance,” Stahlman said.
“Allergies are due to the immune system overreacting, whereas intolerance
can involve many different things such as the inability to digest certain
proteins, such as lactose intolerance.”

Dr. Stanley Fineman, an allergist with the Atlanta Allergy Asthma
Clinic, said teens are at particular risk because “they don’t, as a group,
carry their epinephrine injectors.”

He said some people can outgrow certain food allergies, and other allergies
can develop later in life.

Most school districts have policies in place to ensure students’ safety.

Susan Hale, a spokeswoman for Fulton County Schools, said schools develop
“care plans” with parents and doctors so students’ allergy concerns are
identified. Food allergies and treatment options are detailed in one plan
while dietary concerns are addressed in another. Forms are shared with the
clinic assistant and the cafeteria manager so changes can be made to meals
and so they can be double-checked before being served.

Will Davies leads a life almost typical of young teens.

He’s active in sports and enjoys hanging out with friends. But when friends go
to restaurants, Will will drink and wait until he gets home to eat. When he
goes to a restaurant with his family, he makes sure the chef knows about his
allergies. He feels safe eating at McDonald’s and Wendy’s.

His last allergic reaction happened this year when he joined his family at a
Mexican restaurant.

“I think we got too comfortable eating out at places,” Will said. He ate some
tortilla chips and felt fine for a while. Later, he began to develop welts
and his tongue started to itch. He suspects the restaurant cooked the chips
in the same oil it used for fish or may have used peanut oil.

Country singer-songwriter Luke Pilgrim, 24, of Cleveland carries two EpiPens,
an inhaler and Benadryl at all times for a peanut allergy.

“I have to check what I eat,” he said, “and usually the people I surround
myself with are aware of the allergies.”

He had a close call a few years ago. For a high school graduation party, his
sister made an ice cream cake, one she had made several times before.

This time, though, she used a different ingredient not knowing that it
contained traces of nuts.

Before he finished the first bite he went into anaphylactic shock. His throat
began to itch, and he felt a severe pain in his chest. His lungs started to
collapse. His family quickly used Benadryl and an EpiPen and called 911. But
the ambulance had trouble finding their location, so a friend jumped on his
motorcycle to find it.

“I was just praying,” Pilgrim said. “I thought this was the end for sure.
You’re so scared. You’re hyperventilating and blacking out. I’ve heard
people get a sense of impending doom.”

——————–

FOOD ALLERGY TIPS AND RESOURCES

Take action

These severe symptoms require a shot of epinephrine or a trip to the
hospital:

– Shortness of breath, wheezing, repetitive coughing

– Weak pulse, dizziness, confusion

– Tight throat, hoarseness, trouble breathing or swallowing

– Swollen tongue and/or lips

– Hives, itchy rashes

– Vomiting, cramping

Managing food allergies

Always carry your medications. Many people with allergies carry an
epinephrine autoinjector (EpiPen, EpiPen Jr., Twinject). This device injects
a single dose of medication when pressed against the thigh.

Action plan

Create a food allergy action plan with your allergy specialist. A sample
action plan is available at foodallergy.com.

– Educate family members, teachers, caretakers and friends about your food
allergy. If you have been prescribed epinephrine, make sure the people
closest to you know how to administer the drug.

– Replace epinephrine before its expiration date.

Treatment

When to give over-the-counter or prescribed antihistamine (mild symptoms):

– Itchy mouth, few hives, mild itch

– Mild nausea

Resources

– Food Allergy Kids of Atlanta: www.foodallergy?kidsatl.org

– The Food Allergy Anaphylaxis Network: Foodallergy.org.

– Allergy and Asthma Center: www.allergyinatlanta.com

Sources: Dr. Jon Stahlman, Allergy and Asthma Center in Atlanta,
Lawrenceville and Conyers; the Food Allergy Anaphylaxis Network; the Mayo
Clinic

Food Allergy with Bill & Sheila

Study says 1 in 13 US children have food allergy

CHICAGO—Food allergies affect about one in 13 U.S. children, double the latest government estimate, a new study suggests.

The researchers say about 40 percent of them have severe reactions—a finding they hope will erase misconceptions that food allergies are just like hay fever and other seasonal allergies that are troublesome but not dangerous.

Overall, 8 percent of the children studied had food allergies; peanuts and milk were the most common sources. That translates to nearly 6 million U.S. children.

The most recent government estimate, from the Centers for Disease Control and Prevention, was based on in-home interviews and found that about 3 million children were affected, or about 4 percent. Other estimates based on different methods have ranged from 2 percent to 8 percent.

The new study, funded by an advocacy group, is based on online interviews with parents of kids younger than age 18 and involved 40,104 children. Research firm Knowledge Networks conducted the survey. Families were recruited through random telephone dialing.

Results were released online Monday in Pediatrics.

The findings suggest that food allergies affect two kids per classroom, said lead author Dr. Ruchi Gupta, a pediatrician and researcher with Chicago’s Children’s Memorial Hospital.

Dr. Calman Prussin, an investigator with the National Institute of Allergy and Infectious Diseases, said the study “confirms that food allergy is a substantial public

health problem.”

Prussin said differences in estimates are due to different survey methods and definitions of what constitutes a food allergy. He said the only way to know for sure how many kids are affected would be lab tests on scores of children, which isn’t practical.

Because the new figure is within the range of previous estimates, he said the study doesn’t mean prevalence has increased, although experts generally believe allergies including those to food are on the rise, Prussin noted.

He said some people mistake food intolerances for food allergies. For instance, many people are lactose intolerant, meaning they can’t properly digest milk. That can cause bloating and digestive problems, but not an allergic reaction.

Typical signs of a true food allergy include skin rashes, wheezing, tightness in the throat or difficulty breathing.

The new survey asked parents whether their children had those symptoms—a big strength of the study, Prussin said.

Many children outgrow allergies to some foods, including eggs and wheat, but they’re less likely to outgrow allergies to peanuts and other nuts.

The study was funded by the Food Allergy Initiative, a nonprofit advocacy group founded by parents of children with allergies.

Mary Jane Marchisotto, the group’s executive director, said the study “paints a more comprehensive picture” of food allergies, and should help raise awareness.

The group, funded privately but without industry money, is working with the CDC on national guidelines on how to manage food allergies in schools, she said.

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Online:

Pediatrics: http://www.pediatrics.org

Food Allergy Initiative: http://www.faiusa.org

————

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Food Allergy with Bill & Sheila