Bigger bite by food allergies

On a winter day in 2005, 3-month-old Ashton Girolet was covered in blisters from his toes to his eyelids.

“He could barely open his little eyes,” recalled his mother, Julie Girolet, of Ringgold, Ga.

After hurrying the baby to doctors for testing — first a dermatologist, then an allergist — Ashton’s parents watched as their son’s list of food allergies grew longer and longer.

Now at age 3, Ashton has been diagnosed with allergies to eggs, milk, peanuts, sweet peas, soy, tomatoes, corn, wheat, oats, rice, chicken and beef, making eating out and grocery shopping a near impossibility.

“It’s extremely stressful,” Mrs. Girolet said. “I cook all the time. I have to. When you start reading the food labels, just about everything has wheat, milk or soy in it.”

Today four out of every 100 U.S. children — about 3 million — have a food allergy, and the condition is becoming increasingly prevalent.

Food allergies among U.S. children grew 18 percent between 1997 and 2007, according to the U.S. Centers for Disease Control and Prevention.

Researchers and allergy specialists still are puzzled about the reasons.

“There’s a huge amount of gray areas when it comes to food allergies. At this point, there aren’t clear answers,” said Dr. Michael Pistiner, public education committee member for the American Academy of Allergy, Asthma and Immunology, a professional medical organization devoted to allergy and immunology.

Children with food allergies are more likely to have asthma or other allergic conditions, and recent CDC data show that hospitalizations of children related to food allergies are rising. Between 2004 and 2006, there were 9,537 hospitalizations related to food allergies, compared with 2,615 between 1998 and 2000.

A 2003 study also estimated that incidences of peanut allergy — the allergy most likely to cause death — doubled in just five years, between 1997 and 2002. The rate of peanut allergy still is small, about 0.8 percent of children in 2002, according to the study, published in the Journal of Allergy and Clinical Immunology.

“I think the biggest thing that parents are concerned about is their child dying,” said Dr. Susan Raschal, allergy specialist with Covenant Allergy and Asthma Care in Chattanooga. “The most important thing we can do is reassure them and empower them with the tools they need in case their child has a reaction.”

New awareness

The rise in allergies — particularly peanut allergy — has led to a hyperawareness in schools and day-care settings that was unheard of a generation ago, parents say.

“I knew of no one who had peanut allergies or milk allergies,” Mrs. Girolet said of her childhood. “My mom and dad were astounded” by their grandchild’s list of allergies.

The Hamilton County Schools system has reported a 168 percent increase in the number of students with food allergies between 2000 and 2007, from 189 to 507, according to Sheryl Rogers, director of the district’s school health program.

One of the most widespread theories explaining the rise in allergies is the “hygiene hypothesis,” which suggests that the lack of many germs, infections and parasites in industrialized countries may be doing a disservice to Americans’ immune systems.

“Early exposure to germs and infection is important in training the immune system to do what it’s supposed to, which is to protect us from foreign infiltrates,” said Dr. Marc Cromie, pediatric allergy specialist at the Chattanooga Allergy Clinic. Without that exposure, “there’s a shift in the balance to where we become overreactive to things that are harmless,” he said.

Peanut preparation

American food preparation also could play a role in the incidence of peanut allergy. For example, in the U.S. peanuts typically are roasted, which could enhance the food’s allergenic potential. In China, where peanuts are boiled, peanut allergy is much rarer, area allergy specialists said.

Another factor that may be contributing to the perception of more allergies is new ways of testing. More doctors are using a blood test that identifies antibodies that might indicate an allergic reaction, but that test alone does not confirm the presence of a true allergic reaction, Dr. Pistiner said.

“Just because somebody has an antibody, it doesn’t meant they’re actually having clinical symptoms,” he said. “Some children have been taken off diets that they’re tolerating just based on (that blood test) alone.”

Tests help

Further testing, such as a skin test or an “oral challenge” in which the patient is exposed to the food in a controlled setting, provides a more accurate diagnosis, allergists say.

Allergists also are questioning the role early introduction to peanuts plays in allergy development. A 2008 study in The Journal of Allergy and Clinical Immunology found that early exposure to peanuts appeared actually to lower allergy risk, going against previous recommendations from the American Academy of Pediatrics and the American Academy of Allergy, Asthma and Immunology.

The allergy, asthma and immunology academy is considering revising guidelines that recommend delaying exposure to peanuts and other highly allergenic food until children are older.

“There are brilliant people studying this, but still it’s a quagmire,” Dr. Cromie said. “Everything we believed through the last 50 years may not be the best recommendations.”

Parents of children with allergies need always to have on hand an EpiPen, an auto-injector that administers epinephrine and immediately can relieve life-threatening allergy symptoms, Dr. Raschal said.

Above all, Dr. Cromie said, an accurate diagnosis is crucial, so parents should get in touch with a board-certified allergy specialist if they suspect an allergy.