Food allergies in children have risen 50 percent since the late 1990s, with Maryland and D.C. having some of the highest rates in the country. And no one knows why.
To combat the rise, the Centers for Disease Control, which reported the 50 percent increase in a 2013 study, recently released a 108-page comprehensive guide to assist schools. The “Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs” meticulously documents procedures and policies regarding the disease.
The guidelines label symptoms of an allergy attack, including how a child would articulate such symptoms, like, “my mouth feels funny” or “my tongue feels like there is a hair on it.”
A delay in treatment, typically epinephrine, can result in death in as little as 30 minutes.
Epinephrine, commonly administered through an auto-injector called an EpiPen, is essentially adrenaline. When injected into the outer thigh, the hormone will open airways that constrict during an allergy attack.
The guidelines also expound on how to explain allergies to children, how to keep children’s lunches separate and how to create a positive psychosocial climate in the classroom.
Kaylin Bugos, a senior at the University of Maryland, has known she’s been extremely allergic to peanuts and tree nuts ever since her uncle innocently fed her a Reese’s Peanut Butter Cup when she was 3.
She was immediately rushed to the hospital. She and her family have been vigilant ever since.
“My teachers in elementary school had always been understanding,” said Bugos. “But my parents put a high premium on me knowing what to do in any situation. They taught my friends how to use EpiPens. If they were overprotective, I can’t really blame them for it. I could easily die from it.”
Although rates have been rising all over the United States, Dr. Ruchi Gupta, a health services researcher at Northwestern University’s Feinberg School of Medicine/Lurie Children’s Hospital in Chicago, put Maryland and D.C., as well as Delaware, New Jersey, Florida, Nevada, Georgia and Alaska, as areas with the highest rates of food allergies.
The study, the first to map the disease by zip code, found that children in large urban areas are twice as likely to have peanut allergies as children in rural areas.
“We don’t really understand why it looks like this,” said Gupta. “Urban centers have higher rates while in rural areas it decreased.”
The most common food allergies, such as nuts, milk and shellfish, affect roughly 4 percent to 6 percent of children, according to the CDC.
The Food Allergy Research and Education organization puts the number higher, at 8 percent. An estimated 5.9 million children or two per every classroom in the United States suffers to some degree from food allergies.
As for why cities produce more children with allergies, Gupta said that is the focus of the next study.
“There are a lot of theories. It could be what we’re eating, a lot of pesticides and GMOs (genetically modified organism) There’s also a hygiene hypothesis. Another common theory is exposure. Children on farms are exposed to animals, we see less allergies, asthma, eczema there,” said Gupta.
FARE, a not-for-profit, non-government entity, took a leadership role on the CDC’s guidelines. FARE is the front line right now for developing cures for food allergies, said CEO John Lehr.
“What’s clear is that there’s some combination of environmental and genetic factors that’s driving the numbers up,” said Lehr. “This national guide represents the gold standard, the best practices and additional things to make sure kids are safe.”
Now FARE is funding therapies that could strengthen immune systems in children. One is oral immunotherapy, a process of administering the food allergen mixed with another food in progressively higher and higher doses until the body is used to it. Another therapy currently being tested is using Chinese herbs to prevent anaphylactic reactions.
Before the CDC report, it was up to states to come up with their own policies and procedures regarding allergies. Roughly 15 states had some laws concerning the disease.
Since 2009, the Maryland State Department of Education, in conjunction with the Maryland Department of Health and Mental Hygiene, has made available guidelines for school nurses, which dictate management of students at risk for an allergy attack.
However, the Maryland guidelines mandate that each jurisdiction have a procedure in the event that a child having an attack does not have an epinephrine auto-injector. While most children with a prescription for an EpiPen usually have it on them at all times, 25 percent of potentially life-threatening anaphylactic reactions happen with children with no previous history of food allergies, according to the CDC.
The School Access to Emergency Epinephrine Act, a bill signed into law recently by President Barack Obama, will provide incentives for every public school in America to stock epinephrine, as well as to train other school officials besides nurses to administer it.
The bill, introduced by Sens. Dick Durbin, D-Ill., and Mark Kirk, R-Ill., is a bipartisan measure to give grants to public schools to provide resources for those who suffer from allergies.
According to the American Academy of Emergency Medicine, a study from 2001 showed that in 28 percent of cases where a child died from an anaphylactic attack, epinephrine was either not administered or was not administered fast enough.
“If schools can take that one step to have EpiPens, it could make a huge difference,” said Bugos. “For kids having allergic reactions, epinephrine can give you 15 extra minutes. And those 15 extra minutes can be the difference between life and death.