Learning to Live with Food Allergies

On an average day in late September 2003, in Pembroke, Ontario, Sabrina Shannon, 13, sat down to lunch in her high school cafeteria. Within minutes she was in the throes of a severe anaphylactic reaction, and died before staff could retrieve her EpiPen from her locker. The cause of the reaction was something Sabrina couldn’t have been aware of – her fries had been served with tongs that had touched cheese. Highly allergic to dairy, that innocent mistake, if you can even call it that, was enough to raise the reaction.

The event became a rallying point. Sabrina’s family, along with many other parents and supporters, worked to bring the need for greater protections in the schools to public attention. The resulting provincial law was enacted on January 1, 2006, and it’s been literally saving lives ever since.

Yet, even with current protections like Sabrina’s Law, the fear of a similar event is one that many Canadians live with every day. Sarah VanderLelie, a mother of two in Burlington, Ontario, is one of them. Her daughter Ella, 4, has oral allergy syndrome, which means that much of the food that is fine for you and me is, for her, potentially deadly.

“You don’t really want your child to see that food allergies are scary,” says Sarah, “but at the same time you have to teach them that food can kill them.” Indeed, Ella’s allergies read like a shopping list: eggs, cantaloupe, peanuts, corn, milk, soy and seafood.

A severe allergy to any one of those things, let alone all seven, can make for a very exciting day. “Suppose a kid has a yogurt,” says Sarah, “if they come to school and touch Ella, she hives instantly.” When she was in day care, this was happening three and four times a day. Now in half-day junior kindergarten – a school day that doesn’t include lunch – she is reacting less, but the respite is temporary. Full-day kindergarten is just around the corner.

A GROWING CONCERN
For a growing number of Canadian children, severe reactions to food are simply a fact of life. Allergies have been creeping up on us, and if it seems like there are a lot more allergic people out there, that’s because there are. Experts estimate that the rate of food allergies has doubled in the past 10 years and that two percent of Canadians now live with potentially life-threatening food allergies. If Ella is unique, it’s only because she has allergies to so many things, not the fact that she is allergic.

You can be forgiven for thinking that this has come out of nowhere. If you are in your 30s, it’s safe to say that when you were in grade school there was, at most, one child in the entire school that had a severe sensitivity to food. Today it’s reasonable to expect that three or four children per classroom will have a food allergy. In Ella’s JK class, for example, she’s one of three who reacts to peanuts.

It’s a situation that has left researchers, doctors, and caregivers scrambling to find an appropriate response. Earlier this year, Canadian researchers began working to fill a very specific gap in our protection against food allergy: food labelling. In July, a partnership between AllerGen NCE Inc., the Allergy, Genes and Environment Network, and Health Canada announced a study that will allow us a better view of the prevalence of allergies in Canada, and hopefully give us a better sense of the effectiveness, or ineffectiveness, of the allergy warnings we see on the products that we buy.

“Right now, Canadian society isn’t clear how to respond to this apparent and unexplained increase in food allergy,” says Dr. Ann Clarke, an allergist Professor at McGill University and one of the principle investigators taking part in the study. “We have limited information regarding the number of Canadians afflicted, so it is difficult to know what an appropriate response from healthcare agencies or policy makers would be.” In studying samples of 9,000 people from across the country, researchers hope to enhance our understanding and our management of a problem that, in the minds of some, is reaching epidemic proportions.

WHAT WE KNOW; WHAT WE DON’T
Because it’s a situation so at odds with our experience, it can leave us scratching our heads, wondering where it all came from. It doesn’t help that, by and large, we simply don’t know. Food allergies have been described as, ‘vexing and poorly understood’, and, in almost every way, that’s an entirely accurate assessment. We don’t really know why some people get allergies while others don’t. We don’t accurately understand why some people suffer more than others, or why so many don’t suffer allergies at all. We know that many children will outgrow their childhood allergies, though most won’t, and the mechanics there are also a mystery. Therefore, when people are diagnosed with a food allergy there tends to be, understandably,
a lot of crossed fingers and wishful thinking.

The rise in the rate of allergy, some believe, may simply be a product of the way we live. “Part of the theory of why there is more allergy is because of the way we’ve changed our society,” says Ohayon. We’re eating differently, we live in cleaner, more energy efficient and therefore more tightly sealed homes, and we encourage our children to avoid many of the things that are known to aggravate or cause allergic reactions, and in so doing, have limited their ability to fight them.

The lack of any hard and fast answers hasn’t stopped us from making some informed guesses as to what is going on and, then, acting on them. If you have had a child in the last decade or so, you were likely advised to avoid peanuts during pregnancy, to limit the foods that you offer your child, and to delay the introduction to highly allergenic foods. That’s what we were told and that’s what most of us did.

Well, many now believe that what we’ve been doing has not only missed the mark, but may actually have made things worse. “Everything we’ve been taught over the last 10 to 20 years is all reversing,” says Ohayon, He says, for example, “In countries that expose their kids to food allergens early in life they appear to be very tolerant, and that is eye-opening to us in the West.” Indeed, many places in the world don’t limit foods at all, and are certainly none the worse for it. “Whether it’s Israel and peanuts, or Saudi Arabia and peanuts, rice in Japan, shellfish in Malaysia. These kids are fine. Elimination or avoidance has not translated into tolerance.

“It appears that timing of environmental exposures makes the difference.” This is because, contrary to what many of us believe, we aren’t born with allergies, but rather acquire them, are sensitized to them, often between one and two years of age. As such, the key to prevention may lie simply in earlier, rather than later, exposure to potential allergens, peanuts among them.

However, Ohayon also notes that, to be absolutely sure, we need to have solid evidence in hand, such as trials that follow a large sample of children from birth. Thankfully, that kind if information is on it’s way through studies like the AllerGen study, as well as others, including one in the UK aimed specifically at peanut allergy in children. The Learning Early About Peanut Allergy (LEAP) trial not only seeks to learn more about peanut allergies, in particular, but also to actually “determine the best strategy to prevent peanut allergy in young children.”

WHAT WE CAN DO ABOUT IT, AND WHAT WE CAN’T
Ultimately,
researchers believe that what we will find is that many of the things
that were common for our grandparents’ generation would benefit us
today. “More bugs are good, more sun is good, giving kids food early is
good,” says Ohayon. If you have had the long talk with your parents
about why you are limiting the food you offer your child, then you may
well be in a position to eat your words.

That, of course, doesn’t
change the fact that we live in one of the most highly allergic
populations in the world, and doesn’t offer any comfort to those, like
Ella, who live each day with food allergies. The protections we have put
in place – the no-nut rule prime among them – we are right to maintain.
What’s encouraging, however, is that what we are learning suggests
that, with a few changes here and there, the tide may be turning, and
that we may soon be able to reverse what is a very concerning trend.
Fingers crossed.

ALLERGY OR INTOLERANCE?

“If
a person reacts adversely to a food, frequently they rush to diagnose
it as a food allergy when they just have intolerance to a character of a
food,” says Dr. Jason Ohayon, an assistant
clinical professor of
allergy and immunology in the department of paediatrics at Hamilton’s
McMaster University. Although the two may seem related, the distinction
is actually quite vast,
though it does take a bit of explaining.

A person who is allergic has an antibody that is programmed to recognize a
specific protein. When activated, it stimulates the production of
histamine. We all produce histamine as part of a normal immune response
yet, in people with an allergy, the production is exaggerated and
therefore causes the symptoms we have come to expect from an allergy:
swelling, redness, and itch. “If [histamine] is released in the skin,”
says Ohayon, “we get a hive; if it’s released in the nose, we start to
sneeze and get hay fever; if it’s released in the eye, we get a
conjunctivitis and we get a red eye; it it’s released in the throat, our
throat can then threaten to close on us; if it’s released in the lungs,
we have an asthma attack.” Nice.