When 4-year-old Leah Austin sees an ice cream truck, she turns to her mother and asks for a safe treat, knowing that the truck’s delectable contents could cause an allergic reaction. After experiencing several life-threatening allergic reactions from a kiss on the cheek by relatives who had eaten an allergenic food, Austin understands the importance of complete avoidance.

“Leah has always been very good with understanding and accepting ‘no’ for safety reasons,” says her mother, Katie Austin, of Philadelphia. “A few times she has cried and it just broke my heart. We learned to look out for potential problems like the ice cream truck and avoid them.”

The Austin family participated in the October 8th “Doylestown Walk for Food Allergy: Moving Towards a Cure,” which benefits the Food Allergy and Anaphylaxis Network (FAAN), the nation’s leading nonprofit, patient advocacy organization increasing awareness, providing education and advancing research on behalf of those affected by food allergies and anaphylaxis. More than 800 participants attended this year’s walk, raising an unofficial total of $82,000 dollars for FAAN’s work in education and research towards a cure.

Food allergies affect everyone – the allergic individuals, friends, family and classmates. Although no cure for food allergies currently exists, strict avoidance of allergic foods is essential. In addition, according to the American Academy of Allergy, Asthma and Immunology, peanut allergies in children increased two-fold from 1997-2002; a decade ago only 1 percent of the population was believed to have food allergies.

One of 18 nationwide events in 2006, the Doylestown Walk for a Cure was designed to raise community awareness about the prevalence and severity of food allergies. For many people, even those whose family members manage food allergies, the number of people with life-threatening allergies and the gravity of allergic reactions are surprising.

Leah Austin’s aunt, Judy Hogman, who also attended the walk, says that although she was familiar with her niece’s allergies, she didn’t expect the huge turnout. “It was great to see people support people with food allergies and help to raise awareness because I didn’t realize that so many people had allergies.”

The Food Allergy Increase

Food allergy affects about 6 percent of children under three years of age and roughly 2 percent to 3 percent of adults. The most common food allergies in infancy and childhood are milk, egg, soy, wheat and peanut.

However, it is not uncommon to encounter children in the ICU after severe allergic reactions to foods previously considered benign, such as rice, according to Children’s Hospital of Philadelphia allergist Terri Brown, MD. “As one gets older, the most common foods also include shellfish, tree nuts. Food allergies are one of the most common causes of anaphylaxis being brought to the emergency room [others include venom or drugs],” she explains.

An Immune System Reaction

The physical process of an allergic reaction is complex, ranging from mild hives and worsening eczema, to cardiac collapse following an anaphylactic reaction.

Brown explains, “Bottom line is that the food protein typically needs to be ingested. [However, the] caveat to that is if [for instance,] someone is cooking shellfish and the fumes from the shellfish are brought in through the respiratory tract [or] aerosolized in an allergic person, this could lead to symptoms of anaphylaxis.” 

During an allergic reaction, protein from the food binds to specific IgE receptors on mast and basophils cells, leading them to degranulate and release mediators that cause the reaction. “These mediators are sometimes preformed or made so that there is an initial immediate reaction followed by potential somewhat delayed reaction. Hives, bronchoconstriction, hypotension, etc. are some of the reactions noted to occur,” Brown says.

Allergy or Intolerance?

There is a difference between food intolerances, which are non-immune mediated responses, and a true food allergy. According to Brown, “Patients with food intolerances may have a toxic reaction to food [for example, a normal, healthy, non-allergic patient who ingests fish that has ‘scromboid’ develops a reaction similar to an allergic reaction.] The patient is not allergic to fish per say, just the scromboid. Or, a person with lactose intolerance experiences abdominal pain; this is an enzyme issue not an immune reaction to the milk protein itself.” 

IgE-mediated food allergies can affect many areas of the body: the skin, the respiratory system, the gastrointestinal system, the pulmonary system and the neurological system. Reactions can range from mild symptoms, such as mild hives, mild swelling and worsening of eczema, to more significant wheezing, throat closing, coughing, feelings of impending doom, projectile vomiting, diarrhea, hypotension and cardiovascular collapse.

A patient experiencing mild symptoms should be given an antihistamine, such as Benadryl™, while someone displaying anaphylactic symptoms should be treated with epinephrine and immediately transported to the emergency room, preferably in an ambulance. “Epinephrine does wear off and you want to be in capable hands,” says Brown.

The Psychosocial Aspects

Growing up with food allergies not only affects grocery shopping and meal preparation, but it also it presents a challenge as children age and begin eating school lunches with peers.

Educating children about their food allergies, teaching them to protect themselves and say, “No thank you, I’m allergic” is one tool that does not require a prescription. In addition, educating the school board, teachers, peers and other parents about not sharing food and hand washing is essential.

“We want all children with food allergies to grow up ‘normally,’” Brown says. “They just need to be careful about what they eat. Everyone is different in different ways and that is what we need to teach our children, families, etc. Just because you are milk or peanut allergic does not mean that you cannot play baseball, it just may mean that you will have a different snack when the game is over. “

Oftentimes, families of children with food allergies receive the label of ‘overprotective’ or are described as ‘overreacting’ by extended family and friends who may not understand the severity of their child’s ailments.

Now that Leah Austin is older and an expert in her own food allergies, the Austin’s feel more comfortable attending social engagements focused on food because Leah is old enough to refuse allergenic food and because their family and friends have become much more understanding.

Katie Austin explains, “Since we limited social interactions for safety reasons, other parents thought we were weird and overprotective. There was a social stigma attached to us, as well. Even when we went to a party, one of us was always with Leah so we weren’t always able to sit and talk with other people. Again, despite us explaining the reasons for this, people made their judgments, usually that we were far too protective.”

That social stigma is just a fact of life for patient’s with food allergies, as safety is the No.1 concern. With continued efforts to raise awareness, Austin hopes the stigma will begin to decrease.

Brown explains, “You may have to ask your friend to wash his [or] her hands and brush teeth after eating ice cream, [or other nut-containing products]. If they’re your friends, it shouldn’t matter. Not all people agree or deal with food allergies in this manner, but if you don’t it will control you as opposed to the other way.”

The psychosocial challenges of recovering from a severe allergic reaction and overcoming the fear of returning to normal work and school situations may take time.

Collaboration between therapists, however, helps patients to recover from the experience and return to regular life activities, without pushing themselves too far. For example, Brown explains, “Infants [and] toddlers with food allergies may develop food aversions, texture issues, etc., and that is where a feeding team specialist is often helpful … the earlier the better.”

When every meal and every snack presents a potential danger to a child’s health, “Eating times at those homes can be stressful, and quick recognition of the problem and then getting help is key,” Brown says. “Parents can get frustrated, things escalate, and often another [therapist] can help determine the problems and then the solution.”

The Research

Advancements in food allergy research point towards possible treatments for food allergy, which researchers say may be available within the next decade.

Researchers at Baltimore-based Johns Hopkins University are investigating the possibility of a peanut vaccine that has the potential to, if not eliminate the allergy, lower the allergy threshold and/or the severity of reactions in peanut allergic individuals.

Scientists are also working to better understanding the way the body breaks down and uses food protein in non food-allergic individuals; this, according to Brown, is key to fully understanding the cause of food allergy.

Researchers at Durham N.C.-based Duke University and New York City-based Mt. Sinai Hospital are also working on developing modified food protein for allergy immunotherapy. According to Brown, researchers hope to “understand at the molecular level what part of the food protein makes it allergenic and [determine] if there is a way to alter the food protein outside of body, administer it and [“trick”] the body so that if one ingests it, there is not a problem.”

While many more strides need to be made to raise public awareness, for the Austin family, knowing that they are not alone in their struggle and that organizations, such as FAAN, are working towards a cure “was validation that so many other people were living with the same issues as we were and that it was important to address,” says Austin. “It gave me [an] incredible sense of hope and promise that a great deal of time and effort was going to be put forth to help my daughter.”

After years of struggling to explain the gravity of her daughter’s allergies to family and friends, Austin says, “I felt a sense of relief that people were taking food allergies seriously and that money had been raised to help research a cure and educate schools and the community so our family [and many others] wouldn’t have to live with such fear and trepidation outside of our safe homes.”

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Kate DeBevois is the staff writer for Therapy Times. Questions or comments can be directed to editorial@TherapyTimes.com.