When she was a toddler, Giulia Gallo suffered a food allergy attack so severe that the plane in which she was flying was forced to make an emergency landing. By the time she was 12, the episode was a distant memory; even her parents had let their guard down. So while out to dinner with her family, she ordered a veggie wrap that, unbeknownst to her, included peanut sauce, setting off an anaphylactic reaction that went unrecognized until it was almost too late.
It began with a stomach ache after the meal, followed by an inability to feel her feet touch the ground or to move her fingers as her body went into shock. She had trouble breathing. As she walked to her family’s car, a passerby tapped her on the shoulder and asked if she was okay, noting that her lips were blue. By the time the ambulance arrived, she had temporarily lost her eyesight and hearing. Eventually, she passed out.
“It was really scary. They thought I was going into cardiac arrest,” says Gallo, now 20 and a junior at New York University. “It really traumatized me and sent me into a state of depression for about four years. It completely changed my life.”
Life is more manageable now for the Franklin Township resident, who is allergic to tree nuts, shellfish, soy and peanuts; the latter sensitivity is so extreme she reacts to airborne particles. She’s come a long way since her Catholic school days, when skeptical nuns thought the solution at lunchtime was to seat her next to those who weren’t eating peanut butter. Today Gallo carries an arsenal of EpiPens, used to treat anaphylaxis in emergencies, and has a close group of friends and family who watch out for her. Comfort also comes in knowing she is not alone.
An estimated 9 million American adults and 5.9 million children suffer from food allergies. From 1997 to 2007, the number of children with food allergies grew by 18 percent, according to the Centers for Disease Control, which reported that one in every 25 children had a food allergy. Today the figure is one in 13 children, according to a nationwide survey of 38,465 families, conducted by Northwestern University’s Feinberg School of Medicine. The survey also found that 39 percent of those affected have severe or life-threatening food allergies, and that more than 30 percent of those with allergies are allergic to more than one food. Urban areas showed higher incidences of food allergies than rural areas, as did a handful of states, including New Jersey.
The growth in numbers has spurred a greater understanding of and response to the problem, including tougher legislation, prominent food labeling, better training for food professionals and school personnel, and new research that offers the promise of better treatments and, possibly, a cure.
Although nearly 200 foods have been found to cause allergic reactions, about 90 percent are connected to “the big eight”—milk, eggs, peanuts, tree nuts, shellfish, fish, soy and wheat. Since 2006, food manufacturers using any of those ingredients in a product has had to list them in clear language on the label. Several food allergies are eventually outgrown, but more slowly than in the past, allergists say—although the reason is unclear. Among children allergic to cow’s milk and eggs—2.5 percent and 1.5 percent of all American kids, respectively—80 percent will outgrow these allergies by age 12. Peanut allergies, one of the most dangerous, are more intractable, with only 20 percent of children outgrowing the allergic reaction. Shellfish allergies are generally not outgrown—and affect 2 percent of all adults.
While those with food allergies tend to have a genetic predisposition and frequently suffer from non-food allergies, several environmental factors may explain the growth in the United States of food allergies. Most commonly cited is the hygiene hypothesis, which suggests that an obsession with cleanliness hampers our immune systems from developing defenses against potential allergens. Some experts say our increased reliance on processed foods, food additives and foods cooked in peanut oils may contribute to more people finding they are allergic simply because they are getting exposed—often unknowingly—to ingredients that are potential allergens.
On the other hand, controlling the way we are introduced to potential allergens is no longer seen as a way to limit allergies, according to Dr. Catherine Monteleone, an allergist at the Robert Wood Johnson Medical School. In the past, expectant mothers were told to avoid allergen-potential foods during pregnancy and nursing, and to avoid introducing their babies to these foods until two or three years of age. In 2008, the American Academy of Pediatrics reversed its position.
“They found it doesn’t make any difference,” says Monteleone. “Now, when you start giving them solid foods, they say give them everything. If they’re going to have an allergic reaction, they’re going to have it either way.”
Food allergies—which occur when the immune system perceives food protein as a threat and attacks it—manifest themselves in a variety of ways: gastrointestinally (cramps, diarrhea or vomiting); epidurally (rashes, itching or swelling); and bronchially (asthma and trouble breathing). The most extreme reaction is anaphylaxis, which can be fatal. The CDC reports that food allergies account for more than 300,000 emergency room visits each year, and as many as 150 to 200 deaths annually, depending on whose data you look at.
Diagnosing food allergies typically involves a skin-prick test or a blood test, looking for the presence of immunoglobulin E (or IgE) antibodies. The skin test exposes the subject to a tiny amount of the suspected allergen, and therefore is not used on those who are believed to be highly allergic. Dr. Hemant Kesarwala prefers blood tests. “They provide a more objective machine reading and are less traumatic to the child,” says the Kendall Park pediatric allergist. However, he warns that “a positive test doesn’t make a diagnosis. You need the patient’s personal history as well.”
Most allergists will also conduct oral food challenges, placing small samples of a known allergen under the tongue of a patient to determine if the allergy still exists. Such microsampling has led researchers to examine the potential of immunotherapy for treating food allergies. In the research, those with mild to moderate allergies are repeatedly exposed to the relevant allergen over a period of time to test whether they can build up an immunity to the substance. This practice has proven successful for those allergic to dust, pollen and animals.
In July, the New England Journal of Medicine reported on the most comprehensive immunotherapy study to date. Doctors at five research centers tested 55 children allergic to eggs over a period of two years. Forty children received small doses of egg-white powder on a regular basis, while 15 were given placebos. Allergic reactions were measured at 12, 22 and 24 months. By the end of the study, 28 percent of those in the group that received the egg powder no longer showed allergic reactions.
“This is changing the landscape of food allergies, which is extremely exciting,” says Dr. Neeta Ogden, an allergist in Closter and spokesperson for the American College of Allergy, Asthma and Immunology.
Smaller desensitization experiments have been done with peanuts and milk, but the results were not conclusive. Without definitive proof—and given the potentially serious consequences of food allergies—the medical community has been hesitant to embrace immunotherapy. Dr. John Oppenheimer of Summit was the lead researcher in such a study 23 years ago in Denver when a 15-year-old died of anaphylaxis after being given a small dose of peanuts.
“It really sobered us up,” says Oppenheimer. “It’s a very exciting field of research, but you should only do it at a research center under strict controls. It’s by no means ready for prime time.”
Oppenheimer and allergist Dr. David K. Brown agree that sustained desensitization has yet to be proven. While Ogden predicts that in 10 to 15 years allergists will be able to prescribe treatments for food-allergic patients, Brown worries about the legal risks of administering such treatments.
“If a doctor prescribes something and the patient doesn’t take it properly and something bad happens, we’re held accountable,” he says. “I’m not sure we’re going to prescribe that therapy.”
For now, the only option for those allergic to certain foods is to avoid them, a tall order for even the most vigilant consumer. From restaurants to schools to social gatherings, the potential for accidental encounters seems endless.
Restaurants are involved in nearly half of all food-allergy emergencies and fatalities, according to a 2007 study published in the Journal of Allergy and Clinical Immunology. Many restaurants now post allergy alerts in the kitchen and provide staff with training in food-allergy procedures, such as wearing gloves when preparing food for allergic customers and avoiding cross-contamination of cookware and utensils. Still, many problems linger, from lax safety standards to a failure to communicate with customers or take their issues seriously.
Jim McGrady, executive chef and managing partner at Maggiano’s Little Italy in Bridgewater, has made it his mission to address food-safety issues since joining the restaurant chain five years ago. In the kitchen, utensils and cookware are continually sanitized to avoid cross-contamination. Servers are trained to ask diners if they have any dietary restrictions and if so, a chef comes out to discuss food options, which the kitchen is always willing to accommodate. McGrady says he and his staff make approximately 10,000 table visits a year.
“Back in the day, upscale places would refuse to make alterations to their perfect dish. That’s pretty pompous and not very realistic today,” says McGrady, who frequently lectures on the subject. “One person with an allergy can change where a party of 10 goes for dinner. If you shun them, you’re losing a good portion of business.”
With a growing number of gluten-intolerant customers, Pasquale Masters, chef and part owner of Pasta Pomodoro in Voorhees, offers glutened and gluten-free versions of all his pastas, breads and fried foods, and will try to omit or substitute certain ingredients for food-allergic customers. “I emphasize to my staff that it’s not that the customer is trying to give you a hard time,” says the father of a 7-year-old with multiple food allergies. “You have to treat everyone seriously, because if you don’t, it could kill someone.”
Schools, too, have become more attuned to the problem. Since 2007, public and private schools in New Jersey must have a staff member who is able to administer the epinephrine/EpiPens. The school is not obligated to provide the drug, though some schools do keep it on hand. Most school systems, camps and youth organizations have been diligent about reducing or eliminating peanuts from cafeteria foods and in snacks supplied by parents. The stigmas once associated with food-allergic children are lessening as more are being diagnosed.
Allison Inserro’s 9-year-old son Colin wears a fanny pack containing antihistamines, two EpiPens and an inhaler for his multiple food allergies. His Cub-Scout troop plans to make “Colin-friendly oatmeal cookies,” which are gluten, dairy and egg free, his mother says. The upside to her son’s condition: Colin has never eaten processed foods, and his classmates have been very supportive.
“It’s a great way to teach kindness and compassion to your children,” says the Metuchen mother, who heads the Allergy and Asthma Support Group of Central New Jersey. “It’s no longer acceptable to tease kids in a wheelchair, because that’s something you can see. This is an invisible illness, and until something happens, you don’t know it’s there.”
For the last 21 years, Leslie Shaw’s three daughters have been treated for food allergies. Every stage has presented a different challenge.
“When you’re little, you can’t self administer,” the Boonton Township mother says. “When you’re in high school, nobody wants to be different, so the kids just avoid eating. In college, they’re wanting to live as full a life as possible but still be safe.”
Susan Kraus, a dietician with the Center for Allergy, Asthma and Immune Disorders at Hackensack University Medical Center, says a big challenge is filling the nutritional void. “My job is making sure there are enough alternatives to ensure the person is getting the nutrition they need,” she says. For someone allergic to cow’s milk, for example, she might recommend coconut, hemp, rice or oat milk.
“It has taken a huge amount of emotional energy to always be strategically thinking about where you’re going to be and what you’re going to be eating,” says Shaw about her three daughters. “It can be very fatiguing.”
She is proud of her three girls, who have gone to college, studied abroad and found great friends. She admires their emotional health, especially considering their many emergency-room visits. She tries to follow their lead in not letting their condition define them.
“You can run away with fear and try to control too much,” she says. “But my belief is you have to live in the world, and that world is not going to accommodate you. You have to figure out how to manage it and shape your own life.”
Jill P. Capuzzo is a frequent contributor to New Jersey Monthly, writing restaurant reviews and feature articles, many pertaining to food.
Click here to read more Top Doctors stories.
By submitting comments you grant permission for all or part of those comments to appear in the print edition of New Jersey Monthly.