Clinic, parents adjust to allergies

By Tanner Kent
The Free Press

MANKATO November 12, 2007 11:20 pm

— Salmon meat is among the healthiest in the world.
Rich in vitamins A and D and an excellent source of fish oil and polyunsaturated fats — the good kind of fat — salmon is recommended by a wide variety of public health agencies as a healthy protein source.
Unfortunately, salmon is also a food that prompts 8-year-old Duncan Cook of North Mankato to suffer severe allergic reactions the moment it hits his tongue.
“I grew up in Florida,” said his mother, Amy Edelstein. “I love fish. But we can’t eat it at home.”
Duncan was just a little younger than 2 when his mother fed him his first bite of salmon. Expecting her child to lick his lips in delight, Edelstein was terrified when Duncan immediately vomited and broke out in hives.
Weeks later, before Edelstein could get her son in to see a specialist, Duncan had the same reaction when he accidentally ate a bite of steak that had merely shared a plate with a grilled salmon fillet.
“It was scary,” Edelstein said. “Very scary. But when those kinds of things happen, you just have to educate yourself.”
And millions of other parents are having to educate themselves as well.
According to a 2006 survey by the International Study of Asthma and Allergies in Childhood that looked at more than 700,000 children in 56 countries since 1991, allergies are on the rise all over the world. A 2003 Mount Sinai School of Medicine study reported peanut allergies in kids younger than 5 have doubled. And the Food Allergy and Anaphylaxis Network says one out of every 17 kids younger than 3 years old has a food allergy.
At home, those numbers had much to do with the Mankato Clinic’s recent hire of its first full-time allergist, Dr. Srinivasan Ramanuja. The clinic’s allergy department is the first of its kind in the area and, Ramanuja said, will supply a growing demand.
“It’s important to have a service like this, especially in a growing community,” Ramanuja said. “The incidence of allergies has definitely been increasing over the last decade.”
But even though Ramanuja and much of the medical community seem in agreement that allergies are becoming more prevalent, the causes of such an increase are obscure.
Some posit the “hygiene hypothesis” that says children in developed countries — where clean water, antibiotics and vaccines are the norm — have immune systems that don’t encounter toxins often enough to build immunities. A 2003 study published by the Journal of Allergy and Clinical Immunology reported the nation’s increase in Caesarean section births is correlated to the increase in food allergies because those babies are not exposed to the healthy bacteria found inside the birth canal.
“Allergies are being diagnosed more,” Ramanuja said. “I really think people are just becoming more aware of them.”
After Duncan’s second allergic reaction, he underwent allergy skin tests. The results showed Duncan was also allergic to nuts and that he would react most severely to fish — especially cod and salmon. And while Duncan’s allergy diagnosis was not exactly life threatening, that’s not the case with all allergies.
The most severe reactions can cause airways to shut down and blood pressure to drop, leading to anaphylactic shock and possible death. Since a dose of epinephrine can open breathing passages and increase heart function, those with severe allergies often carry EpiPens — basically, a syringe filled with epinephrine — in case of emergency.
Duncan’s parents and school have EpiPens on hand for safety purposes, but he’s never needed to use one. In fact, Edelstein said everyone’s been so careful about avoiding foods allergic to Duncan, she’s not even sure how allergic he still is.
Ramanuja said 20 percent of young children grow out of peanut allergies while most allergies to eggs, wheat and soy disappear before kindergarten. But Duncan and his family still take precautions.
“He’s never eaten school lunch,” Edelstein said. “And since he knows what his medications are for, we’ll get to a restaurant and he’ll ask, ‘Did you bring my meds?’”
Edelstein said she and her family have had to get more proficient at reading food labels — noticing, for instance, that Worcestershire sauce contains anchovy paste, a food that could possibly trigger Duncan’s allergies.
If anyone comes into contact with a food Duncan is allergic to, they have to wash their hands. If anyone eats a food Duncan is allergic to, they can’t share a drink or silverware with him. Duncan also wears a medical bracelet and has been well-coached to notify adults of his allergies during birthday parties and play dates.
“There’s an adjustment, but you adapt,” Edelstein said. “And you have to educate yourself. There are so many resources.”
Ramanuja said allergies are highly individual and are sometimes difficult to diagnose without a clear patient history. To ensure thorough diagnosis, Ramanuja said skin or blood testing is almost always required to separate true allergies from cases of food poisoning or lactose intolerance. If uncertainty still remains, a doctor may prescribe a food challenge in which increasing amounts of a potential allergen are eaten — either under the watch of a physician or at home.
As for infants, Ramanuja said he recommends parents do not give their children cow’s milk until age 1, eggs until age 2 and peanuts or seafood until 3.
“Duncan has gotten hives about six times when we weren’t sure why,” Edelstein said. “So, we’re probably hyper-vigilant. But you have to be.”
Cafeterias pose challenges for students with allergies
A school cafeteria should be a place of respite.
A place for students to take a quick break between morning reading and afternoon math. A place to visit with friends and refuel a hungry mind.
But for parents and children with severe allergies, a lunchroom can be a medical minefield.
“I see the struggle on parents’ faces,” said Erin Jaskulke, a registered dietitian for Mankato Area Public Schools. “Not only are they worried about what they’re feeding the kids but also what the school is feeding their kids.”
With all kinds of allergies — and especially peanut allergies — on the rise, school districts have had to become extra vigilant when it comes to food safety.
Bridges student Duncan Cook, 8, is allergic to peanuts and fish. To prevent any reactions at school, Duncan’s family met with school nurses and health-care workers to determine what precautions to take. They decided his allergies are severe enough that although he keeps medications in the nurse’s office, he would bring his own lunch.
But for kids who can’t bring their own lunch, food safety is harder to ensure.
For Mankato, that means coming up with individualized health-care plans for every student with an allergy. Because allergies vary so much from individual to individual, Jaskulke said, it is very difficult for a school district to have uniform policies or procedures for allergies. She said it is up to the student and his or her family to notify the school and devise a health plan.
Jaskulke, who splits her time between the Mankato School District and the Mankato Clinic, said each school has its own procedure for handling allergies and that, often, a principal decides the best plan of action.
“We just have to find the best approach we can,” Jaskulke said. “There are a lot of different stages and tolerances of allergies.”
Jaskulke said the main concern for allergic students is cross-contamination. A student allergic to peanuts, for instance, can have a reaction from food simply coming into contact with peanuts. That means silverware and kitchen utensils cannot be used for more than one purpose and must be thoroughly washed after every use. That means food service personnel must know exactly what ingredients are in every food and whether it was processed with machinery that also processes peanuts.
Sometimes, more drastic measures need to be taken. Ron Schirmers, Mankato Area Schools’ food service director, said one student a few years ago required a peanut-free zone in the cafeteria.
“You have to do what’s necessary,” Schirmers said. “You can’t risk the health of a student for peanut butter.”
Jaskulke said to be completely safe in the cafeteria, students should not share or trade food and should check with an adult if they are unsure about a particular food.
She also advised parents to check food labels thoroughly and regularly — they could change at any time — and call the food manufacturer if there are any questions or concerns.

Copyright © 1999-2008 cnhi, inc.