Food allergies like the one that almost killed Mount Pleasant girl affect millions

Hearing that a Mount Pleasant, South Carolina, girl with a peanut allergy almost died from it is sure to shake up other people and families dealing with food allergies. You can read Charlotte Whitley’s story here. 

So MUSC Children’s Health allergist Maria Streck, M.D., sat down to look at the scope of food allergies, why peanut allergies are on the rise, the effects food allergies can have, guidelines for families to follow if someone is exposed to a food they’re allergic to and possible treatments. 

She also said it’s important to point out that situations like Charlotte’s are rare, but when they happen, the consequences can be devastating.

Scope

Charlotte is one of an estimated 33 million Americans with food allergies: one in 10 adults and one in 13 children. About 50% of adults have had a severe reaction. More than 40% of kids have. 

According to the nonprofit Food Allergy Research and Education, teenagers and young adults are at highest risk for severe or deadly anaphylaxis caused by a food allergy. Black children are at least twice as likely as white kids to have a fatal allergic reaction to food. People with asthma as well as food allergies, which includes Charlotte, may run a higher risk for severe or fatal reactions.

Peanuts are among the nine major food allergens causing most serious food allergy reactions in the United States. The others are:

• Milk.
• Eggs.
• Tree nuts.
• Wheat.
• Soy.
• Fish.
• Crustacean shellfish.
• Sesame.

Peanut allergies on the rise

When it comes to peanut allergies, which almost killed Charlotte, the number of people affected has been rising for years. Streck, part of the Allergy and Immunology Team at MUSC Children’s Health, said it’s unclear why. “There's a lot of theories on it.”

 

One involves the way parents raise children, Streck said. “Way back, nobody worried about when to introduce a food to your kid. You just fed them, right? And then we made all these rules through the years of like, ‘Oh, don't give them certain foods.”

She said that likely backfired by preventing early exposure that could have been good for some children. 

A second theory that Streck said can’t be proved: “Our food sources have changed dramatically in the last couple decades – the way that our food is made and processed – but our bodies have not evolved that quickly.”

A third possibility involves changes in the environment kids grow up in. “There's something to that whole idea of living in a ‘dirty’ environment. Kids that grew up on farms have less allergies. Being exposed to some germs is good for you.” 

Effects of food allergies

The effects of food allergies, including peanut allergies, range from a few hives or stomach pain on the minor end to anaphylaxis, which can lead to low blood pressure and unconsciousness. Untreated anaphylaxis can be deadly.

Streck said nuts are the allergen mostly likely to cause anaphylaxis. But not everyone with a nut allergy runs a high risk. 

“There's this giant gray zone in the middle of the severity. There are a lot of kids that eat peanuts, and their mouths just get itchy. They just don't feel good. They get some hives, but no big deal. And they move on. They've had a bunch of accidental exposures, but they know that it's not going to turn into anything bad. But in other children, just one bite can be deadly." 

After exposure to a food allergen

If a person has had a severe reaction to an allergen in the past, Streck said, preparation for another possible exposure is important. “You have to treat it really hard from the get-go because we don't know where it's going to go. Epinephrine is your lifesaver and should be used at the onset of a reaction. Don't wait to use epinephrine.”

What does a severe reaction look like? Streck’s team tells parents to watch for the following:

• Shortness of breath, wheezing or coughing.
• Pale or bluish skin.
• Weak pulse.
• Fainting.
• Dizziness.
• Tight or hoarse throat.
• Trouble swallowing.
• Swelling of lips or tongue.
• Vomiting or diarrhea (if severe or combined with other symptoms).
• Hives or redness.
• Feeling of doom, confusion or agitation.

If a child has any of those symptoms after exposure to a food they’re allergic to, Streck said they need to take epinephrine immediately and get immediate emergency care.

Milder symptoms include an itchy nose, sneezing, an itchy mouth, a few hives and/or mild nausea. Streck recommends watching children with those symptoms closely, giving an antihistamine and if they're at school or daycare, notifying parents and the family doctor.

Children can also have a Food Allergy Action Plan. “The point is to make it foolproof. It’s not open to interpretation. This is what you do. If you think this child is having a reaction, you just activate this protocol and follow it.”

Treatments

As of now, there is no cure for food allergies, but there are treatments that work for some people. “Avoiding the food that a person is allergic to and being prepared to treat a reaction is key,” Streck said. 

Treatment options include: 

• Xolair (omalizumab), an injectable medication that blocks the IgE allergy antibody and prevents anaphylaxis.
• Oral immunotherapy, which involves intentional exposure to a very small amount of the food allergen, which is slowly increased over time.