Summer 2007
NIAID Discovery News
Life Is No Picnic for Food Allergy Sufferers
For sisters Laura and Anna Parisi, life has always required them to avoid certain foods. Laura, 11, is allergic to dairy foods and peanuts. Anna, 9, is allergic to dairy, peanuts, and eggs.
“Although living with severe food allergies is a daily challenge, they’ve only known this way of life. This is normal to them,” says their mom, Gretchen Parisi, of Kennett Square, PA, who reads labels and checks ingredient listings on each shopping trip to ensure the foods her children eat are safe for them.
Food allergy is a life-threatening condition that affects 6 to 8 percent of children under 4 years of age in the United States and roughly 4 percent of adults, and its prevalence appears to be increasing. Each year, 100 to 200 people die in the United States from severe food allergy-related reactions.
Other types of allergies, such as hay fever or allergic rhinitis, can be controlled through medications, so-called allergy shots—otherwise known as allergen immunotherapy—and avoidance of allergy-causing irritants. The only ways to manage food allergies, however, are to avoid the foods that cause reactions and to treat the allergic reactions caused by food exposure.
Fortunately for the Parisi family, neither girl has experienced anything more serious than a case of hives in response to allergy-triggering foods, but they are always prepared for an emergency. Wherever they go to school, to soccer practice, or on sleepovers, both girls carry Benadryl and a set of EpiPens, spring-loaded needles for self-administering epinephrine in the event of food-induced anaphylactic shock. Epinephrine is the “fight or flight” hormone that boosts the supply of oxygen and glucose to the brain and muscles while suppressing other non-emergency bodily responses.
Maintaining a balance between safety and normalcy is one of the toughest aspects of managing food allergies, according to Mrs. Parisi. For example, when the girls are invited to birthday parties or other events, she calls ahead to find out what foods will be served, so that she can supply her daughters with an alternative, such as non-egg-based cupcakes or cheeseless pizzas, so that they don’t feel excluded.
The social aspect of food allergies is not one to ignore, Mrs. Parisi notes, because food is a key element of almost every celebration. As children get older, fitting in becomes even more important. Anything that makes one child appear different from his classmates can be hard for that child to deal with. “If there’s a school activity that involves a food that Laura can’t eat, she would rather abstain than draw attention to the fact that she can’t have it.”
“Most people are nice about it, but no one really understands what it’s like,” her daughter Anna says. “They make fun of us sometimes.”
Acquired Dairy Allergies
In 2005, Claire Cucchi of Silver Spring, MD, discovered that her then 3-month-old son Patrick had a dairy allergy triggered by breastfeeding. As a result, she cut out all dairy from her diet for the entire year she breastfed him. “It was really hard for me,” Mrs. Cucchi says. “Dairy’s in more things than you might think—breads, sauces, cheeses, milk.” However, the action eliminated the baby’s vomiting and bloody stools that resulted from the dairy allergy.
At the recommendation of a pediatrician, Mrs. Cucchi enrolled her infant son in a clinical trial conducted by the National Institute of Allergy and Infectious Diseases (NIAID) on the National Institutes of Health (NIH) campus in Bethesda, MD. The study, led by Hirsh Komarow, M.D., in the NIAID Laboratory of Allergic Disease, involved providing Patrick with incremental increases in the amount of milk as a way to determine if his body could be acclimated to the dairy product. “We were there for 6 hours, and every 20 minutes he was given larger amounts of milk until eventually, he developed a reaction,” Mrs. Cucchi says.
When Patrick turned 1, Mrs. Cucchi began feeding him yogurt, which he tolerated at first but ultimately reacted to with hives, itchy eyes, and sneezing. Just a few months ago, she again started introducing dairy foods into Patrick’s diet, and he’s tolerated them without incident.
Now pregnant, Mrs. Cucchi worries that Patrick’s new sibling will also have food allergy troubles, noting that she too had a dairy allergy as an infant, and she has a 4-year-old nephew who is severely allergic to milk. Food allergies are often inherited.
A Rare Form of Food Allergy
Jeffrey Levine, of Minnetonka, Minn., was in his early 30s when he began experiencing strange physical symptoms, such as a quick but nonpainful abdominal spasm followed by profuse salivation. As the symptoms worsened over time to include vomiting, severe stomach aches, and diarrhea, Mr. Levine saw numerous physicians who dismissed his symptoms as the byproduct of stress. An endoscopy in 1996, however, determined he suffered from allergic eosinophilic gastroenteritis with multiple food allergies, a rare condition in which eosinophils, a type of white blood cell, attack the lining of the stomach, small intestines, and large intestines.
“Basically, anything that goes into my stomach, my body interprets as a bacterial invader,” says Mr. Levine, who is 49 years old.
He took prescribed steroids to combat the symptoms, which helped him feel better but also caused him to develop osteoporosis—a recognized side effect of long-term steroid use. Additionally, Mr. Levine tried different diets designed to eliminate potential allergic triggers, such as gluten and dairy, but nothing worked. For 3 and a half years, he lived on an unappetizing liquid formula of powder and water normally used in people with feeding tubes.
In 2002 and 2004, Mr. Levine participated in clinical trials led by Calman Prussin, M.D., in NIAID’s Laboratory of Allergic Diseases, which examined the use of different medications to combat the effects of allergic eosinophilic gastroenteritis. Nothing proved successful for Mr. Levine; however, Dr. Prussin’s team helped identify a regimen of seven medications, including a new steroid as well as another experimental drug on a compassionate-use basis, that provide some relief.
“I’m allergic to virtually all foods. With the drug regimen I’m on, I am now eating most foods, but with caution,” Mr. Levine notes. “It’s still hit-or-miss whether I feel okay or if I feel lousy.”
Tackling Food Allergy Research
NIH is the major source of federal funding for basic, translational, and clinical research on food allergies, and NIAID is the lead NIH institute on food allergy research. In June, the NIH issued a report from an expert panel of national and international food allergy experts, convened on behalf of the Secretary of Health and Human Services at the request of Congress, which established recommendations and priorities in food allergy research.
—Kathy Stover
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