Life or death

Children with food allergies face a world full of threats

Braxton Peel, shown here getting help with her algebra homework from her mother, Andrea Peel, always has close at hand the medications that could save her life in the event of an allergic reaction.
Braxton Peel, shown here getting help with her algebra homework from her mother, Andrea Peel, always has close at hand the medications that could save her life in the event of an allergic reaction.

Braxton Peel was 2 ½ when residue from a handful of peanuts her grandmother had eaten hours earlier sent her body into a severe allergic reaction.

Braxton’s mom, Andrea Peel of Little Rock, was at work when she answered a call from her mother-in-law.

Braxton was throwing up violently. The Benadryl that had calmed a puzzling but mild reaction earlier was no longer working, and a bath was doing little to ease her all-over itching.

“By the time I got there, she honestly did not look like my child,” says Peel, who had jumped in her car right away. “She was so swollen, so scratched - she had been scratching herself because everything itched - and at that point, she was wheezing and I could tell she was starting to have trouble breathing.”

Peel scooped up her daughter and jumped into the backseat of her car, her father-in-law at the wheel. They took Braxton to the after-hours clinic at Arkansas Children’s Hospital. When the medical staff got her breathing under control they sent her for a blood test that revealed levels of immunoglobulin E - the antibodies that suggest an allergic reaction - among the highest her doctor had ever seen.

The number of U.S. children reported to have food allergies similar to Braxton’s increased by 18 percent between 1997 and 2007, in preschool and school-age children, according to the Centers for Disease Control and Prevention, which defines food allergies as “a potentially serious immune response to eating specific foods or food additives.”

The report also found that between 2004 and 2006, there were approximately 9,500 hospital discharges per year with a diagnosis related to food allergy among children under age 18.

Eight types of food - milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat - account for 90 percent of allergic reactions.

The reason for the increase is something of a mystery, says Dr. Amy Scurlock, associate professor of pediatrics at the University of Arkansas for Medical Sciences’ College of Medicine and a researcher at Arkansas Children’s Hospital Research Institute.

“That’s the million-dollar question in our field,” she says. “There are a lot of theories.”

The “hygiene theory” hypothesizes that children aren’t exposed to enough microorganisms and parasites and that their immune systems are under-stimulated because of it.

“There are some interesting questions about timing of introduction of foods. Most people don’t give their kids peanuts until they’re older because of choking reasons, so is that delayed introduction causing a problem?” Scurlock says.

“There’s also some question [whether] the way we prepare our foods and process our foods is a contributing factor,” she says. For example, in the United States peanuts are most often roasted, which can actually enhance some changes that make them more allergenic.

In some other countries where allergy rates seem to be lower, they tend to boil their peanuts, she said.

While researchers work to determine how to slow the development of allergies, affected children and their parents and caregivers struggle to cope.

“Everyone thinks parents of food-allergic children are a little hysterical but they’re not.

They’re just trying to figure it out,” Scurlock says. “It’s like you’re sending your child out into a world filled with land mines, so there’s reason to be very concerned.”

DUE DILIGENCE

Jennifer Beranek of Little Rock made sure her now 8-year-old son, Joseph, was in the habit of asking grownups to check the labels or ingredient lists to ensure anything they gave him was free of eggs or nuts as soon as he was old enough to talk clearly.

“We don’t do it for him. We make him do it so he’ll be able to do it when we’re not there,” she says. “We want him to be as independent as possible.”

The first indication that Joseph had a food allergy was the eczema that plagued him for the first year of his life.

“I kept those little mitts on him but he was constantly scratching,” Beranek says. She didn’t realize that eczema and food allergies were connected, and her pediatrician never mentioned the possibility.

“Baby food, formula, most all of that, has eggs in it, and I was feeding it to him, and that was causing the eczema,” she says. “I went to a dermatologist and that helped relieve some of the itching and clear up his skin some.”

He was diagnosed after a severe reaction to pudding made with eggs at his grandparents’ home, and after that his large extended family made sure gatherings included “Joe Cakes” - egg-free, Joe-friendly snacks.

According to a 2013 study by the Ann & Robert H. Lurie Children’s Hospital and Northwestern University Feinberg School of Medicine in Chicago, one in four children outgrew allergies to milk, eggs and soy by age 5 ½. The study showed that children allergic to shellfish, peanuts and tree nuts were less likely to outgrow those allergies.

Joseph outgrew his egg allergy a couple of years ago, and celebrated with a party including “real” birthday cake. His peanut allergy remains, though, and his doctors don’t believe he will outgrow it.

He remains diligent about making sure the foods he is offered don’t have nuts. There are some instances where the most he can do isn’t enough. For example, bits of nuts sometimes end up in ice cream ordered from restaurants, some restaurants cook with peanut oil, and peanut candies like Reese’s Pieces can be easily mistaken for chocolate M&Ms.

A BIT LESS CAUTIOUS

Braxton’s teachers have been prudent. Those who don’t come into contact with severely allergic children every day may be a bit less cautious, Peel says.

She recalls with horror the time Braxton bit into a peanut butter cookie at an awards assembly in elementary school, having been told it was a safe sugar cookie. She realized immediately that it was peanut butter, not only by the taste but by the itching and bumps in her throat and around her mouth that signal a dangerous response.

“I said, ‘Spit it out!’ She said, ‘But it’ll be on the floor.’ I said, ‘I don’t care - spit it out,’” Peel says. “She spit it out and immediately started having a really bad reaction.”

Braxton knows how eating peanut butter could affect her but in that moment, her fear was overridden by worries of getting in trouble for making a mess on the floor, her mom laments.

Braxton’s reactions have so far been quelled by Benadryl, as have Joseph Beranek’s. But every reaction is different, and although one may be mild and manageable, the next could be severe and life-threatening.

All parents of allergic children have heard the worst-case scenarios - such as what happened to Natalie Giorgi, the 13-year-old California girl, ever cautious about checking food labels, who died in July minutes after biting into and spitting out a Rice Krispies treat made with peanuts.

Most of those parents are diligent about making sure whoever is caring for their children has an EpiPen, the most well-known doctor-prescribed brand of automatic injector. The “pens” are filled with life-saving doses of epinephrine that may stem a potentially deadly anaphylactic reaction, involving airway constriction, skin and intestinal irritation, and altered heart rhythms. Anaphylaxis can occur within a couple of minutes of exposure to an allergy, leaving not nearly enough time to get to a hospital.

For someone like 13-yearold Cameron Espinosa of Corpus Christi, Texas, with an undiagnosed allergy - and thus no prescribed EpiPen to provide to school staff - that can be tragic. Cameron died last month after being stung by ants while he huddled on the sidelines with his football teammates.

Arkansas Act 1437, passed in the last regular legislative session and set to go into effect in January, will allow schools to stock epinephrine not prescribed to an individual student and will allow a trained school employee to administer that drug to any student believed to be having a life-threatening anaphylactic reaction.

Some schools and other organizations have policies in place to help protect children with severe allergies.

“I think clear communication and the school’s being very proactive about setting up policies about parties and bringing treats to classes is key,” Scurlock says. “One approach that some schools have taken is that if you bring a food product it has to be prepackaged and have the food ingredient label on it and that way they can read the label and if it has milk or peanut or whatever.”

Some schools within the Little Rock School District designate tables in their cafeterias for students who have food allergies and dictate that food may not be shared among students.

Conversely, the Viola School District requires that students who bring nut products to school sit at a special table in the cafeteria.

One public school in the Fayetteville School District, Asbell Elementary, is designated as a nut-free school.

Arkansas River Valley Montessori in Little Rock also prohibits all nut products, and even bans foods like sesame butter that may resemble a nut product.

Critics of nut-free schools argue that people who suffer from nut allergies shouldn’t be sheltered in locations without allergens, but should instead learn to cope within their environments.

Peel has mixed feelings.

Because peanut residue is airborne, Braxton does not have to ingest nuts to have a reaction. She has had reactions at sporting events when fans sitting several seats away have opened bags of peanuts.

When the family travels, they request peanut-free flights and have to wipe down airplane trays, seat backs and armrests. But she can still react to peanuts served on prior flights.

Peel says she guesses having a nut-free school might eliminate some problems. “But I’m also very mindful of kids who love peanut butter sandwiches. There are some kids that the parents know that’s the one thing they can get them to eat. It’s an easy thing to send for lunch, it has protein, it’s a good snack. I understand how for some parents it’s not very convenient if a school is ruled to be a peanut-free school.

“But as the mother of a child that can die - I’m not going to lie, it’s scary.”

Family, Pages 34 on 10/09/2013

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