Healthy Living: Allergic Reaction

 

A mother never forgets the first time.

“We discovered Savannah’s allergy when she was just about 2. She took a bite of a peanut butter and jelly sandwich and within minutes began to have a reaction,” remembers Kimberly Mather of Newtown. “She immediately hived, her face swelled, her eyes swelled nearly shut and her ears became so swollen that parts of her outer ear were purple.”

Luckily, Mather had heeded the advice of her pediatrician—Savannah has two older brothers—and kept Benadryl in the medicine cabinet. “I gave her a dose of Benadryl, called the pediatrician and then, as she was getting worse, called 911,” she says.

“At the ER the doctors monitored her vitals and we stayed there for four hours until she stabilized. We received a prescription for an Epi-pen and instructions to continue to give her Benadryl at regular intervals. We then followed up the next day with an allergist and her pediatrician.”

Now 11, Savannah has managed her allergy well. It has meant careful oversight of her diet (and of family menus) for her mother, but they know they’re not alone. While peanut allergies were scarcely heard of 20 years ago, today Savannah is in good company—witness the advent of the “peanut-free” table in school lunchrooms across the country.

“Food allergies have more than doubled in the last 20 to 30 years,” according to Dr. Kelly Stone, a specialist in the allergic diseases lab at the National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Md. And the jump in food-allergy cases among U.S. schoolchildren—18 percent over the last 15 years—has been especially significant, according to Dr. Jeffrey Factor of the New England Food Allergy Treatment Center in West Hartford. “We also know that in recent years, food allergies have become the most common cause of the most severe allergic reactions, such as anaphylaxis [an acute response that can lead to difficulty breathing, shock and even death], that present to emergency departments today, surpassing reactions from medications and insect stings,” says Factor. “Life-threatening reactions to peanuts and tree nuts are more common than in the past.”

While reactions to a wide array of offending foods—from peanuts, wheat and soy to milk and eggs—have seen the most notable increases, nasal allergies to everyday agents such as dust mites, animal dander and pollen are up as well, according to studies by the National Center for Health Statistics. An allergy is defined as an overreaction of the human immune system to a foreign substance, commonly known as an allergen, which can be eaten, breathed, injected or touched. Allergic reactions include, but are not limited to, coughing, sneezing and itchy eyes, rashes, hives and difficulty breathing.

Why the spike in kids’ allergies? “Some say there is merely a greater awareness—which there is,” says Stone of the NIAID, “but it’s more than that.”

Many point to the so-called “hygiene hypothesis,” which suggests that our immune systems have actually been compromised in recent years by too much cleanliness.

Dr. Jeffrey Miller, an allergist in Newtown, explains: “Today, increased sanitation has been of clear benefit in decreasing infectious disease, but there is reason to think that it has led to an increase in allergy. The immune system evolved in a world where there was constant exposure to infectious agents, and such exposure seems to be a requirement for the normal development of the immune system. In its absence, the immune system takes a wrong turn, and directs itself against otherwise harmless materials—allergens.”

In short, many believe that decreased exposure to infectious agents has put our bodies on the attack; formerly benign foods, pollens and animal dander have become the enemy.

Exposure to environmental pollutants is a factor as well; for example, says Stone, “There are more allergies found in developed countries than in developing countries.”

A recent study by the National Institute of Environmental Health Sciences (NIEHS) found that allergic rhinitis (AR), better known as hay fever, affects 40 percent of children in the U.S. Although “the environmental factors associated with the development of AR are not well understood,” according to the study, “children living near high-traffic areas experience higher symptoms of the disease.” While air pollution can aggravate existing allergies, the true cause of increased cases is not yet known. “That’s the honest answer,” says Stone.

 

So, what’s an allergic kid (and his or her parents) to do?

There is a standard of care in the treatment of nasal allergies, according to Stone. He advises that children whose allergies occur seasonally should avoid the outdoors as much as possible when offending grasses, molds and weeds are in full flower. When they are indoors, windows should be kept closed and the AC running. After they have been out, they should change clothes and take showers to remove traces of pollen, etc.

To minimize the ill effects of indoor allergens such as dust mites, a child’s bed should be outfitted with mattress, pillow and box spring encasings. Sheets should be washed frequently in hot water, and if allergies persist, parents should consider removing carpeting and stuffed animals from the child’s room.

Nasal allergies can be treated with antihistamines, prescription medicines (in spray or tablet form) or a course of allergy injections, known as immunotherapy. Allergy shots work by gradually exposing the patient to increasing amounts of an allergen, in order to decrease sensitivity to it. Immunotherapy can require a three-to-five-year regimen, and it is not effective for everyone. Still, says Miller, “Many people experience very significant benefit from that treatment, and it has been shown to decrease the likelihood that nasal allergies will progress to asthma.”

Where food allergies are concerned, early intervention may be in order.

For years, it has been the recommendation of many pediatricians to delay the introduction of highly allergenic foods (like eggs) until a child is 2 years old (or in the case of peanuts, 3 years old), but this “may not be the best advice,” says Factor. “Instead of allowing the immune system to mature, this practice may actually heighten the risk of becoming ‘sensitized’ and increase the number of children who develop food allergy.”

According to a study conducted by the NIH Food Allergy Initiative, infants who already have a milk or egg allergy are at risk for later developing a peanut allergy. Some researchers are testing the early-intervention theory by introducing peanuts earlier, to determine if a baby’s immune system might better tolerate allergens.

Once a food allergy has manifested itself, the best defense is strict avoidance. “After a diagnosis has been made,” Stone says, “we recommend that a child simply avoid the food he or she is allergic to—and carry emergency medicine” in the event it is inadvertently ingested.

While allergy shots are not typically administered to treat food allergies, says Stone, an experimental treatment called oral immunotherapy is showing promise. Although the treatment is not FDA-approved, it is being tested with some success by allergists, Factor among them.

“This process involves having the child with a food allergy—to peanuts, for example—ingest very minute amounts of that food [initially less than 1/1000 of a peanut],” says Factor. “We slowly increase the dose over time so they will become desensitized to that food. The goal of oral immunotherapy is not to cure the peanut allergy, but to raise the threshold amount necessary to cause a reaction.”

The results have been nothing short of amazing, says Kristin Barnhardt of Hartford, the mother of one of Factor’s patients. Her son Noah, now 9, has strictly avoided peanuts after he had a severe reaction at age 1, when he was given a Saltine with a thin layer of peanut butter on it. “Every year we’ve taken him to the allergist, and based on his skin-prick test and blood work, we’ve been told his allergy has actually gotten worse,” says Barnhardt. Last year, after Noah’s doctor told them that an oral immunotherapy study was being conducted nearby, they decided to go for it. Noah was the first patient to undergo treatment by Factor.

“It’s been a gradual, easy process,” says Barnhardt, and after only a few months, “he’s eating up to one peanut every day.” She’s thrilled. “I know the doctor’s goal is just to improve his quality of life, but we’re even more hopeful,” she says. “My hope is that one day Noah won’t have a food allergy at all.”

Healthy Living: Allergic Reaction

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