When good food goes bad: CDC study shows allergies on the rise

November 21, 12:11 PMLA Health and Beauty ExaminerSarah Torribio

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Allergies are on the rise, says the CDC.

Flickr photo/Bruce Tuten

A recent study found that 4 percent of children in the U.S. have food allergies, according to a Nov. 17 article in the L.A. Times. This appears to be a significant increase.

The CDC's National Center for Health Statistics came up with the stat—which was published in Pediatrics, the official Journal of the American Academy of Pediatrics—by analyzing four large national surveys.

The numbers of children and parents self-reporting sensitivities to various foods is up some 18 percent since 1997, according to the NCHS study. And between 1992 and 2006, medical visits for food allergies have trebled, reports Times writer Sheri Roan. 

THE FUSS ABOUT FOOD

Food allergies are the result of the body's mistaken idea that something harmless is dangerous. This misapprehension cues the immune system to create antibodies, called immunoglobulin E (IgE), tailored to combat the proteins contained in the offending food.

These antibodies try to fend off the "invasion" by releasing chemicals into the body, including histamine. Histomine can be bad news, causing one or more of an array of symptoms: swelling, hives, stomach pains, vomiting, diarrhea, wheezing or light-headedness.

The most intense kind of allergy is anaphylaxis, which, according to the U.S. National Library of Medicine, is a severe, whole-body allergic reaction. Some people are so allergic to certain foods (or drugs, or insect bites or stings) that within a few minutes or less, they require emergency medical attention to stave off extreme discomfort and even, in some cases, death.

Symptoms of an anaphylactic reaction, as elucidated by the National Library of Medicine, may include the following: abdominal pain or cramping, abnormal (high-pitched) breathing sounds, anxiety, confusion, cough, diarrhea, difficulty breathing, fainting/light-headedness/dizziness, hives/itchiness, nasal congestion, nausea, vomiting, heart palpitations, redness of the skin, slurred speech, and wheezing.

I'm not sure how signs are different from symptoms, but here are signs of an anaphylactic reaction listed by the NLM: abormal heart rhythm, fluid in the lungs, hives, low blood pressure, mental confusion, rapid pulse, skin that is blue from lack of oxygen or pale from shock, swelling in the throat that may be severe enough to block the airway, swelling of the eyes or face, weakness, and wheezing.

People with anaphylaxis are advised to carry an EpiPen (an auto-injecting device) with which to inject themselves with epinephren or adrenalin in order to stave off or treat anaphylactic shock. If a  child is too young to use the device, teachers and care providers should be instructed on how to use the EpiPen in case the child has a severe allergic reaction. When someone develops an anaphylactic episode, it's also important to immediately call 911.

Keep in mind that life-threatening allergies are the exception. The reported 4 percent is comprised of many, many children with much milder reactions.
 

THE USUAL SUSPECTS

What kinds of food are wreaking havoc? According to a May 2009 article in Medical News Today, just a handful of foods create 90 percent of all food allergies.

Here's the list of what the article refers to as "The Big 8": eggs, fish, milk, peanuts, soya, shellfish (crab, shrimp, lobster, mussels, etc.), tree nuts (almonds, walnuts, hazelnuts, Brazil nuts), and wheat.

Parents of kids with food allergies will be happy to hear that most children outgrow their food reactions after a few years. Some sensitivities that tend to last, however, include those to "peanuts, nuts, fish, shellfish, citrus fruit and wheat."

MASS HYSTERIA?

There are some who speculate that the seeming rise in food-allergic kids is due to greater awareness.

Others, like L.A. Times columnist Joel Stein, insist that it is due to hysteria. He wrote an opinion in January of 2009 called "Nut allergies--a Yuppie Invention,"  in which he posited that many so-called sufferers of peanut allergies are just the victims, or perpetrators, of a trend afflicting the too-much-time-and-money set. (Does that set even exist in the current economy?)

I take issue, big issue, with the glib and sarcastic tone of Stein's column ("Your kid doesn't have an allergy to nuts. Your kid has a parent who needs to feel special. Your kid also spends recess running and screaming, 'No! Stop! Don't rub my head with peanut butter!'")  I take allergies seriously because I was married to someone who has life-threatening sensitivities to tree nuts, shellfish and, to a lesser extent, niacin. These allergies arose in the absence of wealth and prior to the current "fad."

As someone who has seen a loved one gasping for air because he ate a few bites of the wrong food, I consider it careless in the extreme to minimize even potential risk.

On the other hand, a February 2009 article in the N.Y. Times called "Telling Food Allergies from False Alarms" gives some sage advice on ensuring that you are not restricing your child's diet unnecessarily. This includes making sure your kids are retested to find out if they have outgrown an allergy, and taking the results of blood tests with a grain of salt.

"Blood tests may be unreliable because they fail to distinguish between similar proteins in different foods," notes N.Y. Times reporter Tara Parker-Pope. "A child who is allergic to peanuts, for instance, might test positive for allergies to soy, green beans, peas and kidney beans. Children with milk allergies may test positive for beef allergy."

Food challenging, under the supervision of a qualified medical professional, is a better litmus test, according to that article, which quotes Dr. David Fleischer, assistant professor of pediatrics at National Jewish Health, as saying, “The only true test of whether you’re allergic to a food or not is whether you can eat it and not react to it.” 

As a parent of a picky eater, I can certainly understand why we don't want our kids living with unnecessary food restrictions. I let my 11-month-old eat grapes from time to time even though he develops a slight rash on his cheeks after ingesting a bunch, simply because the fruit is, ironically, his favorite food. I'll keep an eye on the situation, though.

Now that we've given the nod to the possibility of occasional overdiagnosis, let's return to the story about increased allergy rates.

Allergy alarmists are the exception, says Amy M. Branum, a statistician with the National Center for Health Statistics and lead author of the CDC study. Branum says all signs point to an actual surge in kids made ill by certain foods.

"To see almost a tripling of visits in a 13-year period is pretty good evidence that this isn't just parents hearing about food allergies on the news and then thinking their children have it," Branum said. "We used four different surveys, and to see an increase in food allergies in all of those surveys is very telling."

DIRT POOR

While no one is sure why food allergies seem to be on the rise, Branum notes "they hygiene hypothesis" as one potential cause.

'The hygiene hypothesis," explains the Times article, " is based on the notion that today's children are less exposed to germs and other disease-causing substances than were previous generations, preventing their immune systems from developing the same responses to protect against invaders. The immune system then overreacts to relatively harmless substances, causing allergies, eczema or asthma."

I checked out an article on the hygiene hypothesis, "Babies Know: A Little Dirt is Good for You," which was published in January 2009 in the New York Times.

According to the article, which points out that "multiple sclerosis, Type 1 diabetes, inflammatory bowel disease, asthma and allergies have risen significantly in the United States and other developed countries," some physicians and researchers believe that in our rush to keep our children clean, we've figuratively thrown the baby out with the bathwater.

Dr. Joel V. Weinstock, director of gastroenterology and hepatology at Tufts Medical Center in Boston, is one of the doctors quoted in the N.Y. Times article who believes that—within reason and moderation—exposure to certain microbial bacteria, viruses and especially worms help instruct a child's developing immune system. (Ugggh! I consider worms to be rather sickening teachers.)

Yes, some scientists believe that pinworm or whipworm infestations can actually benefit the immune system. Some research has indicated that a whipworm infection, for instance, may help the body combat flare-ups of multiple sclerosis and may have positive results when it comes to treating inflammatory bowel disorders like Chrohn's disease and ulcerative colitis, according to the NY Times article.

(Of course, if your child develops pinworms, a parasitic infection common in preschool and elementary school aged children, you'll want to make sure it is treated, as the condition causes uncomfortable itching and can make it hard for your child to get a good night's sleep.)

 Dr. Mary Ruebush, author of "Why Dirt Is Good," is another proponent of the hygenie hypothesis. She deplores, says the Los Angeles Times, "the current fetish for the hundreds of antibacterial products that convey a false sense of security and may actually foster the development of antibiotic-resistant, disease-causing bacteria."

THE DOPE ON SOAP

Instead, Ruebush advocates good old soap and water. Washing hands or using sanitizer does wonders in staving off bad germs like the flu, including the H1N1 virus (swine flu). According to a September 2009 article in the N.Y. Times, a recent study of four residence halls at the University of Colorado served to underline the importance of hand-washing. 

In two of the dorms, researchers installed hand sanitizer dispensers in each dorm room as well as in the dining commons and bathroom. The students were also given an instructional pep talk about why washing hands was important. The students in the two control dorm rooms were simply left to their own devices (no specially installed sanitizer dispensers and no special instruction.)

The result of the study? Rates of illness differed strikingly. Students living in the specially sanitized dorms  got sick 20 percent less than those in the control room—less coughs, fever and congestion. As a result, they missed 43 percent fewer days of school during the eight week duration of the study. Pretty impressive.

Okay, so where was I? As is the case with so many of my blogs, my research has led me on a circuitous path. To conclude: allergies seem to be on the rise, and over-obsessive cleanliness may be a factor in this increase.

Dr. Weinstock's suggestions, for the most part, seem sensible: ''Children should be allowed to go barefoot in the dirt, play in the dirt, and not have to wash their hands when they come in to eat.''  (I don't know about that last one.) 

I have been letting my learning-to-toddle son clamber around barefoot at our local park and have tried to be philosophical about his oral explorations of bits of sand and sticks—though I do monitor him to make sure he's not munching on any gross or easy-to-choke-on trash.

As far as determining whether your child has allergies, it seems that a little vigilance goes a long way. If your child appears to be allergic to food in a way that causes discomfort or danger, check it out. Check it out with someone good. Use your judgment to ensure that you've got a kid with a healthy range of food choices that make him or her feel great.

Looking for a good allergist or immunologist? Check out the Allergy Be Gone database of California allergy doctors.