University of North Carolina researchers compared data on the weight and body mass index of 245 food-allergic children between the ages of 1 and 11 years old against data on other children of the same age range. Data were also compared between the children with allergies and children with cystic fibrosis or celiac disease, two conditions which are also known to inhibit growth.

It was discovered that after 2 years of age, children with any food allergy had lower weight and BMI than those without allergies, regardless of whether they had celiac disease or cystic fibrosis. Researchers also discovered that having a milk allergy in particular meant even less weight gain, as did having multiple food allergies.

“The impact of food allergies was particularly pronounced when it involves cow’s milk or when it requires the elimination of more than two foods,” Dr. Brian Vickery, the study’s lead author, told a news conference. “Milk allergic children aged less than 2 were particularly vulnerable to growth restriction, with weight and BMI significantly lower than in those children with other types of food allergies,” he said.

Vickery said physicians need to do nutritional assessment with children in either of the two groups, and consider whether supplements are required. He also recommended nutrition counseling for those dealing with children with milk allergy or multiple food allergies.

“We feel that health providers should counsel patients and caregivers about the growth-related risks of the elimination diets that are used to treat food allergy, and ensure that families are excluding only the foods that are medically required,” he said.

See more news from the AAAAI 2013 conference here.

I can tell you exactly where I was when the field of allergy and immunology first stole my heart. I was in my first year of medical school sitting in an overly cool classroom taking notes as fast as any human hand could. My pathology lecture was just ending and immunology was up next. I rubbed my sore fingers and prepared to write down, verbatim, the next lecture.

But shortly after my professor started to speak, I realized that I had completely stopped taking notes. I had allowed myself to be drawn into the story that she was weaving, a story of T cells and B cells and their physical and chemical conversations with each other. It was amazing.

Little did I know that she was introducing me to a cast of cellular characters that would soon become not only important for me to pass my next immunology test, but also to complete my subsequent fellowship training and to my understanding of the mechanism of food allergy, an immunological disease that would affect three of my four children.

In 2005, after completing a pediatric residency, I started my fellowship in the field of allergy and immunology at the Children’s Memorial Hospital in Chicago. I had a 7-week-old baby boy at home so I was knee-deep in motherhood, but I was ready. I was excited to finally be seeing patients with the allergic and immunological disorders that I had been so interested in during medical school.

These diseases, including chronic sinusitis, seasonal allergies, and immune deficiencies, were all challenging and interesting, but what drew me in the most was food allergy. There was something so cruel and senseless about a disease that denies a child a bakery cookie – it made me want to break its code.

Patient Emotions
As fellows, we were taught to take a detailed history of the allergic reaction from the patient and the parent, paying exquisite attention to what food was ingested, the timing of the ingestion in relationship to the symptoms and what symptoms occurred.

Patient histories would often become complicated, a fusion of facts and feelings. We would then perform skin-prick testing with the suspected food protein and draw blood for the same allergen. Combining the history and the results of the testing, a diagnosis was made.

We would review an allergen avoidance sheet with the family, explaining the importance of reading food labels, and discuss an emergency health-care plan, teaching the families how to recognize and treat an allergic reaction. We provided them with a short list of support services and asked them to follow up in one year. It was a good system, at least as far as I knew.

By the end of my first year of fellowship, we had twin boys (yes, we had three boys in 13 months!) and one of them, Gino, literally had hives on his skin only a few days after he was born. He would soon be covered in itchy, bleeding eczema and more often than not, vomit, so I made an appointment with an allergist.

Next page: The diagnosis: a powerful blow

The family was waiting on Paige’s appointment with an allergist when 3-year-old Brooke also had a reaction, just days later. “We gave her one peanut, and she immediately dropped to her knees and started vomiting,” Wilson recalls. This was surprising: Brooke had eaten food containing traces of nuts before without incident. Wilson called her doctor back to say, “Now I need a referral for both kids.”

Today at the age of 6, Brooke is allergic to peanuts, and is avoiding all nuts on her allergist’s advice. Paige is allergic to milk, egg, chicken, is avoiding peanuts and tree nuts, and has eczema and several environmental allergies. Michelle and Eldon Wilson always knew their kids could be at risk for food allergies since Eldon is allergic to fish, tree nuts and eggs.

But in that one angst-ridden week, their lives changed forever. After Michelle realized a milk spill “was like a Level 4 biohazard,” the family eliminated allergens from the house. Soy milk became a major source of protein.

Allergists say more and more people like the Wilsons are walking into their offices with longer lists of foods suspected of causing reactions.

“The impression is that there are more people with food allergies, and there are more foods that they’re reactive to,” says Dr. Scott Sicherer, associate professor of pediatrics at the Mount Sinai School of Medicine’s Jaffe Food Allergy Institute. Sicherer, who is the author of Understanding and Managing Your Child’s Food Allergies, also notes that children aren’t outgrowing their food allergies at the same rate they were a few years ago.

In the days before his interview with Allergic Living, Sicherer did a tally of food allergic patients he saw in his New York office. Only three out of 21 were allergic to just one food. Similarly, a 1996 British study of 62 peanut- and tree nut-allergic people found that a quarter of them were allergic to another food, like milk, eggs, sesame or legumes.

But there aren’t many studies yet on the causes of multiple food allergies, as scientists are focused on trying to understand what genetic and environmental factors predispose a person to an individual allergy, like peanut or egg. Sicherer says the population in general is becoming more allergic, including more environmental allergies, eczema and asthma, so more food allergies are just part of that picture.

There is some evidence that multiple food allergies occur in patterns. Some can be explained: for example, someone who is allergic to several types of shellfish.

Other clusters are less obvious. Although peanut is a legume, not a nut, people with tree nut allergies are more likely to have a peanut allergy than the general population, and vice versa. A third of the 5,100 children and adults that the Virginia-based Food Allergy & Anaphylaxis Network has tracked in its tree nut and peanut allergy registry are also allergic to eggs, Sicherer says.

If a baby comes in with milk and egg allergies, “I start to think about peanuts,” Sicherer says. “There’s about a 20 to 25 per cent risk that the child is going to develop a peanut allergy. If that child is not already eating peanuts, I would want to evaluate them for that possibility.”

With the advent of more multiple allergies comes more challenges for allergic people and their families, says Dr. Peter Vadas, director of the division of Allergy and Clinical Immunology at St. Michael’s Hospital in Toronto. Not the least of these can be trying to convince other health professionals how allergic some people are to their grocery list of danger foods.

“I remember patients coming back and telling me their pediatrician was incredulous that the child had so many food allergies,” Vadas says.

Parents, too, can have a hard time grasping a diagnosis of multiple allergies. At first, Karen Eck and her husband Claude Beaucaire of Gatineau, Quebec, didn’t think much about their son Maxime’s troubles with food when he was an infant. Looking back, the boy had warning signs of allergy all along: he threw up frequently, refused to eat some foods, and occasionally got hives.

Eck’s “big wake-up call” was a massive reaction that Maxime had at daycare to green beans just before his second birthday.

But I’ve also learned how to stay healthy, and I want to help others with my story. So here it is.

My parents found out that I was allergic to nuts at the age of 2. I was still always feeling sick, so more tests were done when I was 8 years old. I was positive for fish, but my salmon allergy level was low. So later, at Toronto’s Sick Kids Hospital, I did an oral challenge for salmon, which is when you eat the food to see if you react. I felt fine afterward, and we went home.

In bed that night, I woke up feeling very itchy. Then suddenly I was burning on the inside. I walked into my parents’ room and as they switched on the lights, they saw large hives and swelling all over my body. It was a reaction to the salmon.

Ambulance Ride and Secondary Reaction

My mom ran for my EpiPen. I so was scared of the needle, but she told me it was important to have it. She gave me the shot while my dad held me. She called 911, and told me, “you are going to be OK, you’re very brave.” Soon we heard the sirens. The firemen got there first and gave me oxygen – and a teddy bear to keep me calm.

At the hospital, after the ambulance ride, I felt a blanket of relief fall over me. But soon I was feeling bad again. I was going back into anaphylactic shock, called a biphasic reaction. The doctor gave me another shot of epinephrine. Over the next days, I took a lot of prednisone and Benadryl. I didn’t feel great, but I was alive.

Mine was not a typical case. It’s unusual to have anaphylaxis so long after trying a food. After that reaction, it was hard for me to sleep. I’d have flashbacks, hearing the sirens and feeling like I couldn’t breathe. I’ve been told this is post-traumatic stress. I learned to try things to help me relax, like reading a funny book, listening to music or saying a prayer. I’d tell myself I would get through it.

Today, life comes with restrictions. My family doesn’t eat in restaurants – with so many allergies it’s hard to find a safe place. My mom does the cooking, and we eat a lot of fresh foods and nut-free products. And I can’t do everything other kids do because I have to be careful.

Avoiding all my allergy triggers can be challenging. In June of last year, I had another reaction – we don’t know to what. I was at school, and got hot and itchy and my face became covered in hives. Yet I was not positive it was anaphylaxis. I called my mom to take me home.

On the drive, I felt worse and told her I needed the auto-injector. I tried to stay calm and took deep breaths. By the time the ambulance got there, I was already starting to feel better. I learned from that day: I need to trust my instincts. I didn’t give myself the auto- injector at school. I should have – it makes you feel better right away.

Severe allergies can be scary at times, but by now I know what to do to keep safe. I always carry an auto-injector, wash my hands a lot, let other people know about my allergies, and I don’t take chances.

I used to think my allergies were a curse, but now I believe I have them for a reason: to help educate others. Some students make nasty remarks about my allergies. These bullies just do not understand that allergies can be deadly. I want to spend my life educating people about anaphylactic allergies, and I hope that I can help other allergic kids not to feel scared.

I’m working on a book about allergies and post-traumatic stress. I think the more we tell people about allergies, the more understanding will grow, and the stronger those of us with allergies will feel.

They are scary at times, but allergies don’t have to stop us from living and having fun. We just have to be careful.

Erika DaCunha lives in Brampton, Ont. To comment, write to: editor@allergicliving.com

First published in Allergic Living magazine, Winter 2009.
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