By Lorrie Baumann
Food allergy is a growing public health concern in the United States. Food allergies are responsible for 100 to 200 deaths a year in the United States, and many studies have found that the prevalence of food allergies is on the rise for both children and adults over the past 10 to 20 years, although the reasons for this are not clear.
Food allergies affect 15 million Americans, including 1 in 13 children, roughly two in every classroom. Nearly 40 percent of children with food allergies have experienced a severe or life-threatening reaction, such as anaphylaxis, which is a severe, potentially fatal allergic reaction.
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Many Americans really don’t understand that food allergies are a serious, life-threatening issue for many people, especially children. This is according to Debbi Beauvais, a registered dietician and the District Supervisor of School Nutrition for schools in Rochester, N.Y. Beauvais spends a great deal of her time training the foodservice workers in her school district on how to prevent allergic reactions among students and how to recognize and respond to them if they occur. “When I talk to people about allergies in general, there’s a misperception of the definition of an allergy,” she says. “There are allergies, intolerances and people who say they have an allergy when they mean they don’t like the food.”
“A lot of people don’t realize that a food allergy can cause a severe medical event,” Beauvais continues. “It’s not as simple as that they just don’t like that food.”
According to Food Allergy Research and Education, a nonprofit organization that works on behalf of the 15 million Americans with food allergies, a food allergy is a reaction of the body’s immune system to a protein in a food. There is no cure for food allergies. Strict avoidance of allergens and early recognition and management of allergic reactions are key to preventing serious health consequences. Other food reactions and sensitivities to food are called food intolerances. Food intolerances are reactions that are generally localized, temporary and rarely life-threatening. The most common of these is lactose intolerance. Gluten intolerance is another.
The national school lunch program has very specific requirements for how to deal with students who have food allergies, and those have just been supplemented by the Centers for Disease Control and Prevention with the October 2013 release of Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. The guidelines were issued in compliance with the FDA Food Safety Modernization Act passed by Congress in 2011 to shift the focus on food safety from response to prevention.
“The new guidelines are significantly broader and address issues that haven’t had that level of structured attention: food in the classroom, the broader school day beyond what happens at lunchtimes,” says Diane Pratt-Heavner, Director of Media Relations for the School Nutrition Association. “It really makes sense for those children who have life-threatening allergies. Unfortunately, food is all around … Kids can encounter the item on the school bus, after class, in a party or at a bake sale, so it is important to bring everyone into the mix to make sure those children are in a safe environment.”
The guidelines note that children with food allergies may face health challenges that affect their ability to learn and their social and emotional development, and that food allergies may even pose a daily threat to allergic children’s ability to live productive lives. CDC studies show that 16 to 18 percent of children with food allergies have had a reaction from accidentally consuming food allergens while at school and that one in four of the severe and potentially life-threatening incident of anaphylaxis reported at schools happened to children with no previous diagnosis of food allergy. While milk is the single most common food allergen, fatalities associated with food-induced anaphylaxis are most commonly associated with peanut or tree nut ingestion. Eight foods account for more than 90 percent of all food allergies in the United States: milk, eggs, peanuts, tree nuts, wheat, soy, fish and shellfish.
Debra Bloom is a mom who wishes that more Americans understood the potential danger of exposure to a food allergen. Her daughter Elisabeth was diagnosed with allergies to peanuts and eggs when she was just a year old. Elisabeth’s first really noticeable allergic reaction happened on the third time she ate egg, Bloom recalls. “I was getting her something to drink, and when I turned back to the high chair, she had hives all over the side of her face and all over her neck,” she says. “She started rubbing her eyes, which were swelling.” Bloom called her pediatrician immediately and was advised to administer Benadryl, which brought the reaction under control. “The swelling went down, and the hives went away, and she was fine.”
While her daughter was fine, Bloom herself was scared. She made an appointment with an allergist and had Elisabeth tested. “She came up positive for egg and for peanuts. I wasn’t surprised about the egg, but the peanuts results really threw me,” she says. “I had heard many stories about reactions that were far worse than what Elisabeth had experienced, with children suffering full-blown anaphylaxis and not able to breathe. When that happens, you need to rush your child to the hospital. We were lucky.”
A diagnosis of food allergy is a life-altering event, as patients and those who care for them come to grips with the realization that allergic reactions to food are unpredictable and can be deadly. Just because a food caused only a minor allergic reaction once doesn’t mean that the reaction won’t be much more severe the next time it happens. “You have to take every case seriously,” Beauvais says. “You can’t assume that if you only got hives this time, you know how your body will react the next time.”
According to the CDC, food allergen avoidance and the risk of severe allergic reactions can have substantial daily consequences for both allergic children and their caregivers. Caregivers, especially mothers, can experience anxiety, stress and diminished quality of life, and a study of children with peanut allergies found that those kids had significantly poorer quality of life than their siblings as well as greater separation anxiety. A 2012 study found that more than a third of children and teens with food allergies reported having been bullied specifically because of their food allergy, often by being threatened with exposure to an allergen. Some parents even choose to home school their children because of food allergies. In addition, parents with allergic children report that the food allergy significantly affects meal preparation and often family social activities.
When it came time for Elisabeth to head off to school the first time, Bloom found that while the faculty and staff understood how serious was the need to protect her and other children with food allergies, other students’ parents were not so understanding. That created conflicts almost as soon as Elisabeth went to kindergarten. “The kindergarten class had a lot of parties. I wanted to have a say in what they were having, to keep my daughter safe. It was something I had to do,” she says. “At the first meeting to plan the class party, I felt like I was the subject of a witch hunt. We were talking about snacks for the party. I offered to bake 80 cupcakes for the entire kindergarten because I felt that if I baked all the cupcakes, I could ensure her safety.” The other parents in the party-planning group revolted, and Bloom was accused of trying to deprive the other children in the class of their treats.
Bloom left the meeting, went to the supermarket and started reading labels, making a list of safe snacks that all the kids could enjoy. Then she went back to the other mothers to assure them that no one was going to be deprived because her daughter needed to be protected from exposure to peanuts and eggs. “There are a lot of treats in the market that are safe for everyone,” she assured them.
Eventually, that list turned into the Safe Snack Guide, a resource schools and parents around the country use to screen the snack foods brought into their classrooms and offered to their children. Listing a qualifying product is free for the manufacturer, and more than 500 schools are on record as recommending her site, www.snacksafely.com, to their parents.
Elisabeth is in seventh grade now, and Bloom is finding that greater awareness of the potential consequences of food allergies is helping to diminish the intolerance she hears from other parents. Her daughter has joined the ranks of older children and adults who have learned to monitor their own potential exposures and to advocate for themselves to make sure that they are not exposed. That does not mean that Bloom is less vigilant on behalf of her daughter and other children with food allergies. “As far as being nervous, that will never go away unless a cure is found. Food is everywhere. It’s such a part of life,” she says.
“What every mom wants for their child is to be safe, to be included and to be well adjusted. So many people take safety for granted,” she continues. “You send your kid off to school, and you don’t know if they’re going to be exposed to someone else’s snack, or eat something dangerous that’s offered to them. You put your child’s life in other people’s hands all the time.”