When treating food allergies, minutes matter

07/26/2014 7:27 PM

07/26/2014 7:29 PM

At 7 months, Tristan Knott reacted badly to the piece of egg his babysitter gave him for breakfast one morning.

His mother, Rossana Bizzio-Knott, a nurse anesthetist at Jackson Memorial Hospital, was at work when it happened. She rushed to her Homestead home when Tristan’s babysitter called. By the time she got there, Tristan’s face was blotchy, his body was covered in hives and his ears ballooned.

“He’s a beautiful kid, but he looked like a little monster,” said his mother.

Bizzio-Knott said it has been challenging to keep her son, now 3, on a restricted diet.

“It’s sad that you can’t let your kids try different foods because you’re so afraid,” she said. “I’m like a helicopter hovering over him all the time. ‘Don’t touch this, don’t eat that.’ ”

The Centers for Disease Control and Prevention estimated that approximately 6 percent of children under 18 in the United States suffered from food allergies in 2012. That’s about one in 17 children.

The incidence of food allergies in children has increased over the last decade and a half, but doctors don’t know why. A survey by the National Center for Health Statistics published last year shows the prevalence of food allergies increased from 3.4 percent in 1997-1999 to 5.1 percent in 2009-2011 among children ages 0-17. The same survey found that Hispanic children had lower rates of food allergies compared with children of other races or ethnicities, and that food allergies increased with higher income levels.

Peanuts, tree nuts, milk, eggs, soy, wheat and shellfish are some of the major food allergens for children. Hives, difficulty breathing, coughing, sneezing and swollen lips or eyes are the most apparent symptoms. But Dr. Shahnaz Fatteh, a consulting allergist at Joe DiMaggio Children’s Hospital in Broward County, said other symptoms might not seem as obvious.

“I think nausea, vomiting, diarrhea and stomach cramps are often overlooked,” said Fatteh.

The most severe reaction is anaphylaxis, a full-body allergic reaction that can occur within seconds or minutes of being exposed to an allergen. Anaphylaxis can result in a drop in blood pressure, which can lead to unconsciousness or death.

Epinephrine auto-injectors, often recognized by the brand names EpiPen or Auvi-Q, are a child’s best defense against food allergies. Epinephrine, also known as adrenaline, helps constrict blood vessels, which stops the drop in blood pressure and relaxes airways to facilitate breathing. It can also reduce the swelling and itchiness.

While there is no cure for food allergies, researchers are looking for new ways to treat food them, including a treatment called oral immunotherapy. The technique tries to build a child’s tolerance to a food allergen via oral exposure to the allergen. After several months, a child with a peanut allergy may be able to tolerate eating several peanuts without a violent allergic reaction.

But this is an experimental treatment and should be done only in a hospital setting under medical supervision.

“I think it’s really exciting and encouraging for parents who have kids who have been living in fear of allergen exposure and anaphylaxis,” Fatteh said. “We can look at what other tools we can implement for kids to get them back to less of a danger zone.”

Children can sometimes outgrow food allergies.

“If kids are going to outgrow a food allergy, they’re going to outgrow it in the first five years of life. However, in some kids it can be as late as 15,” said Dr. Vivian Hernandez-Trujillo, director of the division of allergy and immunology at Miami Children’s Hospital. “The thinking has changed. We used to think if you haven’t outgrown it by the age of 5, you’re never going to outgrow it.”

Milk and egg allergies can be outgrown as children get older; it is unlikely for peanut and shellfish allergies to be outgrown at any age, especially if it develops at an older age, said Hernandez-Trujillo.

Jonah Basi, 9, didn’t develop his allergy to tree nuts until he was about 5. At a neighborhood party, Jonah ate some M&Ms from a bowl of Trail Mix. On the walk back home, Jonah’s eyes became so watery he couldn’t see in front of him, and he started coughing and sneezing.

His family didn’t find out it was a nut allergy until after seeing an allergist. Even though Jonah didn’t eat the nuts, it was enough that the M&Ms were mixed with them.

Today, Jonah monitors his diet and sometimes keeps mom in check if she accidentally buys a food product that contains nuts.

“He’s a label reader,” said Jessica Basi, his mother. “He’s very good. When there’s a party at school and parents bring in cupcakes, he will not eat them. At least I know I don’t have to worry about that.”

Jonah has an epinephrine auto-injector at school in case of emergencies, and his mom keeps one in her purse. His teachers and friends know about his food allergy, and they all look out for him.

“One time my best friend had an almond cookie in his lunch, and he wouldn’t even sit by me that day just in case,” Jonah said.

Allergy experts stress the importance of parents communicating with others about their child’s food allergies, especially when they’re in school.

“I think of it as a team approach when kids are off to school — talking with physicians, completing school forms, determining an action plan,” Fatteh said. “Make schools aware before students come in what their food allergens are and what medications they need.”

In May 2013, Gov. Rick Scott signed a bill that allows Florida public and private schools to stock emergency supplies of epinephrine auto-injectors in case of an anaphylactic reaction. Participating school districts are required to adopt protocols developed by a licensed physician and train school personnel to recognize the signs of anaphylaxis and learn how to administer an epinephrine injection.

But schools need a medical director to order emergency supplies of medication. Neither Broward nor Miami-Dade County public schools has a medical director, which means there is no one to write prescriptions for medications to be stocked in case of emergencies.

Each school district allows children with food allergies to carry epinephrine auto-injectors. If the children are old enough to self-administer the injector, school nurses train them on how and when to use it. School nurses also help parents fill out treatment plans and arrange meetings with administrators and cafeteria staff to accommodate a child’s food allergies.

This works best for children who are aware of their food allergies. But some children aren’t aware, and others can spontaneously develop allergies to foods they were once able to tolerate. As a result, doctors say that stocking epinephrine auto-injectors in school is crucial.

“In the face of anaphylaxis, the correct treatment is auto-injectable epinephrine,” said Hernandez-Trujillo. “With anaphylaxis, minutes matter.”

Tatiana Ortiz, a clinical dietitian at Miami Children’s Hospital, helps parents find food alternatives. Ortiz said about 30 percent of her patients have food allergies.

A child with a milk allergy could be deficient in calcium, but, she advises, they can get calcium from dark leafy greens — spinach, kale, turnips and collard greens — in addition to soybeans and fortified almond milk, soymilk and orange juice.

“Children with multiple food allergies are one of the bigger concerns,” Ortiz said.

Hernandez-Trujillo has three daughters, all of whom have experienced food allergies, and her youngest is peanut anaphylactic. She never has nuts at home.

Dr. Zevy Landman, an allergist at the Florida Center for Allergy & Asthma Care, said parents should wait longer to introduce potentially allergenic foods to children. Kids are especially at risk of food allergies if either or both parents have a food allergy.

“Parents like to introduce real food early in life to kids,” said Landman. “We recommend not giving nuts to children until age 3, eggs until 15 to 18 months and regular milk until age 1.”

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