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.”