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The Truth About Food Allergies

Jarvis Oxley

Yes, they're afflicting more kids than ever—but our awareness and treatment options have also leaped exponentially in recent years. See how far we've come, and how the latest therapies are helping children beat their allergies at last.

Five years ago, Noah Schaffer's food allergies were so severe that even one tenth of a peanut could endanger his life. His parents worried about unseen peanut slivers making their way into snacks at friends' houses or restaurant meals. "You're in constant fear when your child is in someone else's care that they'll accidentally give him peanuts and not know what to do," says his mom, Robyn Smith, of Cary, NC.

But last summer, for the first time in his life, Noah ate a peanut butter and jelly sandwich. The now 10-year-old has become one of only a handful of kids to be successfully treated—experts still hesitate to say cured—for his food allergies, thanks to a promising experimental trial his parents enrolled him in at Duke University Medical Center. At the end, the sandwich—eaten in the company of nervous parents and nurses at the ready—was given to him as a test to see whether his allergies had truly been tamed. His only reaction? He despised—really despised—the taste and feel of peanut butter in his mouth. But his immune system remained calm. His parents were elated. "So much burden has been lifted from me and the family," says Smith. Her son even goes to summer camp now without his EpiPen—the injection of epinephrine that can rescue him from a life-threatening reaction.

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Noah is a success story, but most allergic kids live like Jimmy Francis. The Dallas 5-year-old cannot tolerate even the smallest trace of eggs or nuts. His mom, Kathryn, studies food labels like her son's life depends on it—because it truly might. "When we go to birthday parties, I bring lollipops," she says, because Jimmy can't have the cake or ice cream. He and his family have learned to cope, but the threat of anaphylaxis—Jimmy going into shock and his airway closing off—remains an undercurrent in their otherwise ordinary lives.

Yet Francis and other allergy-anxious parents see signs that, one day soon, more kids will join the ranks of Noah: able to eat, play, and walk through the school cafeteria without the cloud of their disease hanging over them. The research in recent years has exploded. Never in the history of the field has so much progress been made toward understanding the causes of food allergies, and developing treatments. "The scientific revolution is giving us abilities we never dreamed of," says Andrew Saxon, M.D., head of the allergy division at the University of California, Los Angeles School of Medicine. Take a look at what's changed—and what the future may hold:

THEN: Food allergies were virtually off the cultural radar.

In fact, the issue was so publicly ignored that some emergency medical technicians weren't always equipped to handle a reaction, according to Chris Weiss, Ph.D., vice president of advocacy for the Food Allergy and Anaphylaxis Network. "Ten years ago, there was a chance that if you called 911, the EMTs would either not have epinephrine on hand to administer or have it and not be able to use it," he says. Allergic kids even tried to "forget" their problem. "They would actually get teased," says Dr. Saxon. "They were different. So they wouldn't talk about their allergies, which, of course, put them at higher risk."

NOW: We are allergy savvyand accepting.

Since 2001, more than 40 states have passed laws requiring EMTs to always carry epinephrine. Most states now allow children to carry their own EpiPens to school, as well. And while allergic kids may realize they are different, it's no longer holding them back. A recent study found that children with food allergies don't feel any higher levels of social stress than their non-allergic peers. These days, the issue also takes center stage in schools, among policy makers, and in the media. Food allergies even appear in movies and TV shows. "There's an acceptance of this as a real disease," says Dr. Saxon.

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This about-face is partly due to the fact that food allergies have become so common. According to the Centers for Disease Control and Prevention, their prevalence rose nearly 20 percent between 1997 and 2007, and it now strikes up to 8 percent of children under the age of 4. (The numbers are greatest among young kids, since allergies are often outgrown.) That means your children are more likely than you were to have classmates with allergies—or to have one themselves.

Food allergies have become such a public issue that parents sometimes feel a backlash when schools and daycares declare themselves "nut-free." (Nut allergies are particularly feared because they tend to produce the most life-threatening reactions.) A doctor from Harvard Medical School touched a nerve in 2008 when he wrote a medical-journal article titled "This Allergies Hysteria Is Just Nuts," after a school bus was evacuated because someone spotted a peanut on the floor. "I understand the world can't necessarily revolve around kids who have allergies," says mom Kathryn Francis. "But if any parent sat down long enough to think 'What if that were my child?' I think they would understand why schools at least need to have a discussion about this."

THEN: Parents were warned to hold off on introducing certain foods.

To help prevent allergies, pediatricians used to advise families with a history of them to delay giving their children eggs until age 2—and to avoid peanuts, tree nuts, and fish until their kids turned 3. The thinking was that a child's immune system needed to be more mature before dealing with allergy-prone foods.

NOW: That advice is gone.

In 2008, the American Academy of Pediatrics withdrew its recommendation to delay these foods. "The change was based on a lack of evidence that waiting for these long periods protects against allergies," says Scott Sicherer, M.D., a professor of pediatrics at Mount Sinai School of Medicine's Jaffe Food Allergy Institute, in New York City.

Some experts believe that withholding allergenic foods may make children more likely to develop adverse reactions.

In fact, some experts believe that withholding allergenic foods may make children more likely to develop adverse reactions. A study that compared the prevalence of allergies among Jewish children in Great Britain (where peanuts are rarely given to infants) to children in Israel (who tend to eat them before their first birthday) found that the Israeli kids had about one tenth the risk as their nut-averse counterparts. Other research has bolstered the idea that early exposure may reduce a kid's odds of becoming allergic. Experts aren't sure why, but some evidence suggests there may be a time in a child's life—not too early, not too late—when the immune system best tolerates certain foods.

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If you're concerned about your little one, talk to your child's doctor. It may be okay to introduce milk, eggs, nuts, and other foods earlier than you think. The timing should be based on your family history, whether your child has other signs of allergy (such as eczema), and when you feel comfortable offering the foods. And if you have a newborn and are thinking way in advance, research suggests that breastfeeding for at least four months may lower the risk of allergies.

THEN: The cause of allergies was a mystery.

NOW: Science is closing in on answers. One of the most prevalent beliefs is the "hygiene hypothesis": the idea that modern kids are exposed to so many fewer germs and allergens that their immune systems don't get "trained" to deal with them as young children (a point underscored in many of the nut studies). Another theory points to recent changes in the food industry. The number of highly processed foods on the market has skyrocketed—and children are eating more of them than ever before, which may affect the immune system's ability to accept them, says Wesley Burks, M.D., an allergy expert at Duke University Medical Center. (An allergic reaction occurs in response to the basic proteins in a food. During the refining process, those proteins get altered, which may trigger the body to rebel against this unidentifiable substance.)

THEN: Treatment was not an option. The only way to manage a food allergy was to avoid the trigger.

NOW: "Curing" allergies looks possible. Several promising strategies are under investigation, including the one that worked for Noah. Doctors gave him small amounts of peanut powder, gradually increasing the dose. The approach seems simple, but, in fact, it's exceedingly complex and not something to be attempted independently. (Repeat: Don't try this at home!) The children who have been treated so far began with carefully measured, almost microscopic doses of the food they were allergic to. The goal is to reprogram the immune system by activating the cells that build a tolerance to the food while sneaking under the radar of the ones that set off a response.

Other experimental treatments being studied include a Chinese herbal remedy called FAFH-2-a medicine derived from nine herbs that has shown encouraging results in animal studies—and vaccines that, like the oral treatments, are designed to deliver allergenic foods in a way that can desensitize a child's body.

"I believe that in the next few years, the first generation of treatment will be out," says Dr. Burks, although he notes that it's too soon to predict exactly which type of therapy it might be. Future treatments may not totally cure an allergy, he adds, but could raise the threshold of how much of a food a kid could safely eat. "I'm hopeful," says Jenn Williamson of San Diego, whose family rarely takes vacations or eats out because of her daughter Kyla's nut allergies. "I feel like she's missing out on a lot now—and like any parent, I don't want my child to feel excluded." If things keep progressing at the same rapid pace, her wish—and that of millions of other parents—could soon become a reality.

Plus:
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Is it really an allergy?

Many people who think they have a food allergy—or believe their child does—actually suffer from a food intolerance. Unlike an allergic reaction, an intolerance doesn't involve the immune system and can have several causes. People with lactose intolerance, for example, lack or have less of a digestive enzyme needed to properly break down dairy products. Here, some ways to tell the difference:

Signs your child likely has a food intolerance

  1. She can eat small amounts of the worrisome food without much problem.

  2. Symptoms usually include nausea, belly pain, bloating, and diarrhea.

  3. The reaction causes temporary discomfort.

Signs she may have a true allergy

  1. Often, even a small amount of the food can cause a reaction.

  2. Symptoms include hives, swelling of the lips and face, difficulty breathing, and a severe drop in blood pressure.

  3. The reaction can progress rapidly and be life-threatening.

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