- The Washington Times - Monday, February 16, 2004

The first time Lisa Cole of Centreville gave baby biscuits to her daughter, Madeline, it took five minutes before the baby started screaming.

Mrs. Cole and her husband, Femi, rushed Madeline, then 9 months old, to the emergency room and, after consulting an allergist, discovered the problem: The baby was allergic to the wheat, eggs and milk in the biscuits. Additional testing showed the list of allergens for Madeline included 10 foods. Corn, tomatoes, beef, pork and blueberries give her hives, but eggs, milk, wheat, barley and peanuts cause her to go into anaphylactic shock: Her face and throat swell, and her blood pressure drops.

“It is fatal unless you use the EpiPen,” Mrs. Cole says about the shot of epinephrine she has on hand to stop symptoms of allergic reaction. “Until it hit home with me, I had no idea of the severity and risk of fatality involved. It’s startling when you first learn about it.”

The Coles limit Madeline’s interactions with other children and call ahead before they visit anyone. Mrs. Cole cannot return to work because she and her husband can’t find a day care facility that will guarantee the safety of their daughter, who now is 20 months old.

“It’s really stressful,” Mrs. Cole says. “You have to make the impression on people that it is serious. … I can’t take the risk she is going to pick up or share a cracker.”

Madeline is one of 6 million to 7 million Americans suffering from food allergies, or about 2 percent to 2.5 percent of the population, according to the Food Allergy & Anaphylaxis Network, a Fairfax-based nonprofit organization that provides educational materials, advocacy and research.

Food allergies occur when the immune system reacts to the protein in food as if it were a threatening foreign substance. Each time the food is eaten, the immune system releases antibodies and histamines that trigger allergic reactions. The reactions affect the respiratory system, cardiovascular system, gastrointestinal tract and the skin but do not get more severe with each exposure to the food. Instead, the amount of food eaten and how allergic someone is to that food determines the severity of the reaction.

Anne Munoz-Furlong, founder and chief executive of the Food Allergy & Anaphylaxis Network, says the most common allergy symptoms include hives, swelling, itching, difficulty breathing, abdominal cramping, vomiting and diarrhea, which typically occur from seconds up to two hours after food is ingested.

In a few cases, allergy symptoms result from coming in physical contact with the food, such as milk spilled on the skin or airborne particles inhaled as shrimp is frying. “The majority won’t have symptoms unless they ingest it,” Mrs. Munoz-Furlong says.

Eight foods trigger 90 percent of food allergies in American children: milk, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish, says Dr. Donna Schuster, allergist and owner of the Adult and Pediatric Allergy Center in Herndon. These foods and other substances contain proteins that are not broken down by cooking or by stomach acids and enzymes that digest food.

Children’s allergies to milk, soy, eggs and wheat can be outgrown. Eighty-five percent of children allergic to milk and soy, the first foods they typically eat, outgrow the allergy by their third or fourth birthday, says Isabel Maples, a registered dietitian and nutrition communicator for the Mid-Atlantic Dairy Association in Reston.

Children typically take longer to outgrow allergies to eggs and wheat, and some will not, a percentage research has not yet identified, Mrs. Maples says. By the time children reach middle school, the majority of their allergies are to peanuts and tree nuts. Likewise, allergy triggers for adults include peanuts, tree nuts, fish and shellfish, all of which can cause lifelong allergies.

Parents should work with an allergist and have the child tested before introducing any of the allergens or foods back into the child’s diet, Mrs. Munoz-Furlong says. Otherwise, introducing the foods may trigger an allergic reaction.

“Almost all childhood allergies are outgrown, particularly milk allergies,” Mrs. Maples says.

A milk allergy, which affects up to 5 percent of the population and is primarily seen in infants and young children, is an immunological response to the protein in cow’s milk. Alternatively, lactose intolerance, which is more common in adults, is a metabolic disorder and a response to the milk sugar or lactose in dairy products. The body does not produce enough lactase enzyme to break down lactose into sugars for digesting, limiting the amount of dairy products that can be ingested.

“With lactose intolerance, it’s not a matter of all or nothing. It’s a matter of degrees,” Mrs. Maples says.

Another food intolerance is caused by an immune-system response to gluten, a protein found in wheat, oats, barley and rye. Those with gluten-sensitivity enteropathy, or celiac disease, develop antibodies against gluten and can experience abdominal cramping and diarrhea and eventually damage to the small intestine. The symptoms typically appear within six to eight hours of ingesting gluten, whereas wheat allergy symptoms appear almost immediately and also include skin and respiratory symptoms.

“An allergy is different from an intolerance. When we’re talking about an allergy, you have to avoid the food,” Mrs. Munoz-Furlong says. “There are no little bits of the food you can eat. It’s strict avoidance.”

That’s the case for 13-year-old Nicole Ehrhardt of Reston, who is allergic to dairy products, eggs, peanuts, red meats and some vegetables. When she was 14 months old, she was taken off all foods so that foods could be introduced back into her diet one at a time, showing which ones caused her to have allergic reactions of eczema, runny nose and vomiting.

“We had to learn to reintroduce things, and we have to read labels,” says Nicole’s mother, Lisa Sechrest-Ehrhardt. “We prepare most of her foods, if not all of her foods.”

Despite her family’s efforts, at age 5, Nicole accidentally drank from the wrong cup of milk and stopped breathing.

“We saw what could happen,” Mrs. Sechrest-Ehrhardt says. “This is not an upset stomach from milk. This is life or death.”

“Once the patient has been diagnosed, they have to be prepared,” says Dr. Carol Jagdeo, an internist at the Washington Hospital Center in the District.

Patients can read ingredient labels, ask questions at restaurants and contact food companies with questions, along with purchasing allergy-free products at some grocery and health-food stores.

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