Danger: Food Present

It was a cautionary tale for the epinephrine age: A 15-year-old Canadian girl died last year after kissing her boyfriend, who’d eaten peanut butter hours earlier—imperceptible residue from the snack had triggered a severe allergic reaction, news reports trumpeted. “Kiss of Death for Nut Allergy Girl,” proclaimed the (London) Telegraph.

Turns out peanuts had nothing to do with Christina Desforges’s death—an asthma attack killed her—but that was beside the point. The incident crystallized a growing anxiety over food allergies. It’s come to clutch a special handful of our fear receptors: In an era of orange alerts and bird-borne pandemic, the most mundane of human activities—chewing, swallowing—can produce the most horrific results.

With the emergence of a popular food consciousness in recent years (where do my eggs come from?) has come something of a diner consciousness: Can Billy eat those eggs? Increasingly, he can’t. Hysteria aside, this much is true: The number of food-allergy sufferers in America has risen from 7 million to 12 million over the last five years, according to the nonprofit Food Allergy Initiative. As with many medical statistics, there’s some debate over how much this increase simply reflects a growing ability to spot the problem. Still, researchers at the Mount Sinai School of Medicine found that 1 in 250 preschoolers suffered from peanut allergy—the most dangerous variety—in 1997; five years later, that number had jumped to 1 in 125.

“It really does seem to be on the rise,” says Dr. Scott H. Sicherer, assistant professor of pediatrics at Mount Sinai and author of Understanding and Managing Your Child’s Food Allergies. “Asthma, hay fever, and other allergic diseases are also increasing, so it’s no surprise that food allergies would be, too. They’re all related. Just walk into any school. If the nurse has been there over five or ten years, they’ll say, ‘Oh yeah, there are many more kids with food allergies these days.’”

While food allergies now lead to 30,000 emergency-room visits a year in this country, the number of fatalities is relatively low—between 150 and 200 annually. A horse is likelier to kill you in the United States than all the peanuts, shrimp, and gluten combined. So why the alarm? No doubt the vivid particulars of a serious allergic reaction—constricted airways, rapid pulse, and loss of consciousness—grip our imagination. What’s more, the triggers seem ubiquitous. Severe anaphylactic shock can be brought on by shared utensils at a buffet, a single careless waiter, residue on a doorknob, trace amounts of peanut dust in a ventilation system, and, yes, kissing.

“It’s like living in a minefield,” says Lauren Lemke of the nonprofit Food Allergy and Anaphylaxis Network (FAAN), which lobbies for legislation and promotes food-allergy awareness.

What Is It and Why Does It Happen?

With all the alarm over food allergies—the most typical cases are nuts, wheat, seafood, milk, gluten, sesame, citrus, and soy—there is the nagging question: What, exactly, are they? Allergies involve a programming error on the part of the immune system. Perceiving the offending substance (whether it’s hayseed or peanuts) to be an unwanted foreign agent, the body responds by releasing histamine, a defensive chemical whose unfortunate side effects include narrowing of the bronchi. That EpiPen you see people carrying contains a shot of epinephrine, which dilates the airways. (Best to carry more than one if you’re allergic—a single injection will last just 15 to 20 minutes.) Complicating matters further is the far-more-common food intolerance, often confused with food allergy, and just as often dismissed as pickiness. Intolerance comes from difficulty metabolizing certain foods and doesn’t involve the immune system.

As for why a person develops food allergies—and why it’s happening more in North America than in less-developed countries—scientists aren’t sure. Some babies are born with a greater genetic predisposition. Pollution, preservatives, pesticides, and other hallmarks of industrialization are believed to be contributing. Conversely, one prominent theory blames the West’s excessive hygiene. In ridding the typical household of microbes and dirt, industrialized nations have perhaps jeopardized kids’ chances for developing a resistance to allergens.

“Our immune systems are not getting exercise,” Sicherer says. “Without parasites around, the immune systems react to the food, instead.”

But why certain food? Why eggs and not, say, cauliflower? “These allergens are more resistant to digestion, so they get deeper into our systems,” Sicherer explains. “Still, nobody knows why one person has a severe reaction and another has only a mild reaction. It’s a mystery.”

Sweeping the Halls for Peanut Residue

If dodging invisible food particles and jabbing oneself repeatedly with an EpiPen sounds grim, growing awareness of the subject has also led to a variety of promising—and effective—efforts. Schools have begun declaring their cafeterias peanut free; several lawsuits were filed against McDonald’s earlier this year after inconsistency in the chain’s disclosure of gluten in its french fries; in August, the Massachusetts Senate approved a bill to improve allergy training at restaurants; and, thanks in part to protest from allergy sufferers, the Transportation Security Administration recently relaxed its ban on in-flight liquids, making room for potentially lifesaving medication. Meanwhile, groups like Food Allergy Survivors Together provide support and information for what’s often a solitary slog.

Most dramatic of all, however, was a recent announcement from allergen researchers at the University of Amsterdam. Through the development of immunotherapies, Dr. Ronald van Ree told the media earlier this month, the treatment of food allergies might move beyond stopgap measures—and soon. Such therapies work by reducing sensitivities to allergens. “The one thing we really need for food allergy patients is a treatment that can cure the disease,” van Ree said. “I’m pretty confident this will come about within ten years.”

In the meantime, parents of children with food allergies can take mild comfort in a few reassuring statistics. About 85 percent of young children outgrow their milk, egg, wheat, or soy allergies by age five. In contrast, Sicherer points out, only 20 percent outgrow a peanut allergy during that time. He says that breastfeeding is recommended “for reducing allergic diseases, owing to certain cells and chemicals found naturally in the milk.”

Lemke, for her part, mentions a different kind of measure she hopes to see more of: allergy-awareness campaigns within restaurants. Given the great potential for confusion between the table and the kitchen, FAAN is working to educate restaurant staffs about the dangers of food allergies. There are encouraging signs. Celebrity chef Ming Tsai, of Blue Ginger in Wellesley, Massachusetts, has a son with serious food allergies and has made public his efforts to create a worry-free dining experience at his restaurant.

The rise of food allergies has, naturally, presented broader issues to ponder. In the first decade of the 21st century, Americans find themselves not luxuriating in medical bliss but struggling to account for environmental sickness, rising cancer rates, and mounting autism. If food allergies are particularly haunting, it might be that we’ve perceived yet another health issue gathering steam in a post-industrial society meant to be beyond such things. A dawning dread seems to accompany our growing suspicion of the nearest ingredients list. Modern civilization, and the modern kitchen, has the power to sicken as well as to heal.

Which is nothing to sneeze at.