Despite the small numbers of those who have them, more attention is being paid to food allergies. In November 2013, President Barack Obama signed the first federal law that encourages schools to stock epinephrine injectors for use in allergic emergencies. Epinephrine works by relaxing the muscles in the airways and tightening the blood vessels, which helps to counteract an allergic response. Epinephrine comes in a prefilled automatic injector, which typically is a spring-loaded syringe that the patient or another person can inject at the first signs of a severe allergic reaction, such as hives, swelling or wheezing. The law provides financial incentives to states if schools stockpile epinephrine and train school personnel in how to use it.
MILK MISERY. Allergic reactions to milk are among the most common among children who live in the United States.
“The passage of the federal bill was terrific,” says Dr. Lynda Schneider, who is the director of the allergy program at Boston Children’s Hospital. She says about 20 percent of children who have an allergic reaction in school don’t know that they have a food allergy, so having epinephrine available could be lifesaving.
People who have food allergies who are prescribed epinephrine injectors should carry them at all times, says Dr. Anna Nowak-Wegrzyn, who is an associate professor of pediatrics at Icahn School of Medicine and Jaffe Food Allergy Institute. This is important, because even if a previous allergic reaction was mild, no guarantee exists that your next reaction to a food won’t lead to anaphylaxis.
According to Food Allergy Research & Education (FARE), nine states have laws that require schools to stock epinephrine injectors, another 37 have legislation introduced or pending in 2014 to stock epinephrine injectors at schools. Four states—Delaware, Mississippi, New Hampshire and Rhode Island—have neither.
For people who are nervous about using an automatic injector on themselves or on others, a new type of automatic injector was introduced in 2013. The Auvi-Q, which is about the size and shape of a cellphone, has voice prompts. The prompts take a user through all of the required steps, such as removing the safety cover, positioning the device and counting down the 5 seconds that it takes to complete an injection.
However, it’s more expensive than are conventional automatic injectors—about $360, compared with $210–$325. Further, some insurance companies won’t cover the Auvi-Q, Schneider says, while conventional automatic injectors have widespread coverage.
Another move toward better food-allergy education came in October 2013 when CDC released “Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Centers.” Fifteen states have their own guidelines, Giles says, but national guidelines were nonexistent. The national guidelines can be found at foodallergy.org/cdc.
Until CDC’s publication, many school administrators had no guidelines on how to take care of children who have a food allergy, says Dr. Ashis Barad, who is a pediatric gastroenterologist. The publication, he says, legitimizes that food allergies are “real and need to be taken care of.” He says guidelines might eliminate a lot of common food-related activities in school, such as craft projects that involve food.
Further, in January 2014, FARE launched a program to help colleges and universities to understand the potential dangers of food allergies. Representatives from at least 30 colleges and universities, food-allergy experts and food-industry groups attended the launch meeting. FARE says the goal for the College Food Allergy Program in 2014 is to create guidelines and develop resources, such as training programs for college food services and resident advisers and educational materials for students and their families.
Food Allergies: The Big Eight
Still, more training is needed in schools and restaurants, says John Lehr, who is the chief executive officer of FARE. He says the program’s goal is to raise public awareness about food that can cause allergic reactions as well as educate workers on the steps to take if a child experiences a food allergy and anaphylaxis.
DIAGNOSIS DOUBTS. Given the potential danger of an allergic reaction, it’s unfortunate that diagnosis of food allergies isn’t a simple process. Allergic reactions to food are wide-ranging, Nowak-Wegrzyn says, which means that you might not have the same symptoms as someone else who has the same allergy. Symptoms include difficulty breathing, hives, nausea, swelling of the face and other body parts and vomiting. These can appear within seconds of exposure or take hours to appear.
Dr. Marty Hartz, who is a clinical pediatric allergist at Mayo Clinic, says a food-allergy diagnosis is made on two factors—a history of symptoms and the presence in the patient of a specific antibody. That antibody, which is called immunoglobulin E (IgE), triggers the immune response and can be detected by skin tests or blood tests, she says. Unfortunately, she says, even those methods aren’t foolproof. Sometimes people who don’t have food-allergy symptoms test positive for the antibody, she says, and sometimes people who have food-allergy symptoms test negative.