Associated PressAn EpiPen is often used when a person has a severe allergic reaction to foods such as peanuts, tree nuts or shellfish.
CLEVELAND, Ohio — Cookies alerted Dr. Reshma Shah to the possibility that her young son had food allergies.
“He broke out in hives,” the Shaker Heights pediatrician recalled of the event in 2006 when her son Owen was just 2 years old. Tests eventually revealed that Owen was allergic to peanuts and tree nuts.
“We came home and we cleared out the entire pantry,” Shah said. “For the first few weeks after the diagnosis, I wasn’t a pediatrician, I was a worried mom.”
Now, whenever Owen goes to school, camp or even a friend’s house, Shah lets the adults in charge know about his allergies and what needs to be done in an emergency.
It’s a routine being embraced by more and more families across the country who are seeing signs of childhood food allergies.
Eight percent of U.S. children 18 years and younger — about 6 million — have food allergies, according to a study published June 20 in the journal Pediatrics with lead author Dr. Ruchi Gupta of Northwestern University.
That’s twice as many children as previously reported.
A 2009 study by the National Center for Health Statistics published in the journal Pediatrics found 3.9 percent of children in this age range reported food allergies.
Staying on top of allergies
eight foods account for 90 percent of Americans’ food allergies: milk, eggs, peanuts, tree nuts, fish, shellfish, wheat and soy.
Experts say that a range of reactions occur, including respiratory (allergic asthma to ear infections), digestive (diarrhea to colic), cerebral (headaches to depression), skin-related (rash to eczema) and other body systems (diabetes to arthritis). Anaphylaxis is the most extreme, with symptoms including swollen throat, shock, drop in blood pressure, rapid pulse and dizziness.
• Children allergic to milk or eggs usually outgrow these allergies. Symptoms generally include hives, itching, wheezing, gastrointestinal reactions or, in extreme cases, respiratory issues.
• About 25 percent of children in a recent survey reported a peanut allergy. Peanuts, which are legumes, are among the leading causes of fatal and near-fatal food allergies.
Allergic reactions include hives, itching, swelling of throat or an anaphylaxis reaction.
• About 1.8 million Americans have an allergy to tree nuts. This also is considered one of the leading causes of fatal and near-fatal food reactions. Tree nuts include, but are not limited to, walnuts, almonds, hazelnuts, coconuts, cashews, pistachios and Brazil nuts. they should not be confused with peanuts (a legume) or seeds (such as sesame or sunflower).
Reactions range from hives, itching, swelling of mouth or throat, digestive discomfort, wheezing to anaphylaxis reaction.
• About 2.3 percent of Americans report allergies to seafood, including fish and shellfish. Salmon, tuna and halibut are the most common types that cause allergic reactions.
Fish allergies are usually lifelong. About 60 percent first experience reactions to fish as adults. Reactions could include hives; itching; swelling of lips, face, tongue or throat; wheezing; diarrhea; vomiting; dizziness and sometimes anaphylaxis.
• an allergy to wheat is primarily found in children and usually is outgrown. Reactions include swelling, itching, hives, rash, nasal congestion, difficulty breathing, cramps, diarrhea and sometimes anaphylaxis.
Don’t confuse this with celiac disease, a digestive disorder that makes individuals unable to eat gluten found in wheat, rye, barley and sometimes oats.
• Soybean allergy is one of the more common, especially among babies and children. Children usually outgrow this allergy. Reactions include hives or itching in the mouth and, in rare cases, anaphylaxis. Soy is found in many processed foods.
Source: Ohio Department of Health.
Heightened awareness and better diagnoses by doctors are the likely reasons for the jump in reported cases, experts explain.
Gupta’s study had one of the largest samplings of previously published studies with data from a random, cross-section of families representing 38,480 U.S. children 18 years and younger. Data were collected from June 2009 to February 2010.
About 25 percent of children surveyed reported a peanut allergy, followed by milk at 21 percent, and shellfish at 17 percent. Kids with peanut and tree nut allergies had the most severe reactions with symptoms of anaphylaxis, wheezing or low blood pressure, according to the study. of the children reporting allergies, 38 percent had histories of severe reactions and 30 percent had multiple food allergies.
The study also noted that adolescents are at a greater risk than other children since the chance of a severe food allergy increases with age peaking at 14 to 17 years old.
Shah said teaching her son about his allergies — what he can eat and how to make that decision — has been crucial.
“Children are better at navigating their allergies if they know they have to ask questions about foods being offered,” Shah said. “We as parents have to give them the words and show them how to do this.”
Being cautious about food can be difficult especially for younger children who may feel self-conscious about questioning adults or being different from their peers.
Shah knew she had made progress when at the age of 3 Owen asked his friend what was in the muffins on the treat table at preschool. The friend shrugged. “Then my son said: ‘That means I can’t eat it because I don’t know the ingredients, either.’ ”
Children with allergies ultimately are in the care of other adults during school or other group activities. Informing principals, teachers, school nurses and coaches of a child’s allergies is essential.
The Americans with Disabilities Act specifies that no individual with a disability — including chronic conditions such as asthma, allergies and diabetes — can be excluded for federally funded programs. that includes elementary, secondary and postsecondary schooling.
Parents of children with severe allergies can request a 504 plan — named for the section in the federal Rehabilitation Act of 1973 — be developed with school officials.
“This allergy action plan outlines the condition, limitations, classroom management and what needs to be done should the child have an allergic reaction,” said Ann M. Connelly, supervisor of the Ohio Department of Health’s school nursing program.
Parents need to spell out possible reactions their child might have, whether it could be life threatening due to peanut exposure or sensitivities to airborne substance like perfume, Connelly said.
Ohio law allows students to carry an epinephrine pen, but the school must have a copy of the prescription, doctor’s orders and a backup injector pen stored in the building, Connelly said.
“There are different sizes of Epi-Pens. They’re not interchangeable, so you need the right one for an individual student,” Connelly said.
Schools without a nurse or a full-time nurse need to train staff members on what to do in the event a student has a reaction, Connelly said.
Prescriptions, doctor’s orders and other necessary paperwork should be updated by parents at the start of each academic year. Parents also might check the school’s state-mandated written policy on safeguarding students with peanut and other allergies.
Connelly said it’s unrealistic to have a peanut-free school. “It lulls the children into a false sense of security.” but schools need to take steps such as having peanut-free areas for children to eat and reducing exposure of students to latex, perfumes or other allergens, she said.
Plain Dealer filePeanuts are among the foods that can cause an acute allergic reaction in some people. eight foods account for 90 percent of Americans food allergies, including soy, wheat, fish, shellfish, tree nuts, peanuts, eggs and milk.
Shah said communication has been key. When Owen started school, she drafted a letter to parents telling them of his allergies and requesting that no nuts be used in snacks or birthday treats given out in class. If this wasn’t possible, Shah requested that the parents inform her or the teacher so Owen, now 6, could be told not to eat the snack. Shah makes sure Owen’s teachers have a supply of safe snacks so he won’t be left out of any celebrations.
Instead of putting Owen’s medications in a plastic bag — as is done by many families — Shah developed a plastic box with a photo of her son and special labels giving caregivers an action plan as well as emergency phone numbers and instructions on how to administer medications inside the box in the event of an allergic reaction. Shah is making this customized box available to other parents (mymedpax.com) for $22.95. once received, parents place the prescription medications inside.
Her website also includes a blog with information about allergies, suggestions in drafting letters to distribute in school and tips on how to talk to your children about food allergies.
“I found that once I explained things, parents and teachers have been a lot more comfortable,” Shah said.