High anxiety over allergies

Prominently displayed in every classroom in the House at Pooh Corner in Germantown is this chart:

Ben: peanuts

Audrey: blueberries and strawberries

Marley: squash

Mateo: fava beans

Tahir: seafood

Elie, Lola, Raj, Solveig, Zuri: dairy

Elise: milk, soy

Sarah: eggs

These are the reported food allergies of 12 out of 55 Pooh preschoolers.

"This is a relatively new phenomenon," says Teri DiCesare, owner and director of Child's Conceptions Day Care Center, which operates Pooh.

"We had our first allergy case - to peanuts - 10 years ago in a boy who's now in high school. Before that, I remember no allergies. A child would break out in a rash, we'd put calamine lotion on it and that was the end of it."

DiCesare knows that for some children, allergies are real, even life threatening, and says that her staff is trained to be meticulously vigilant. But she - and many experts - wonder whether somehow we've meandered into an epidemic, labeling every food sensitivity or food preference an allergy.

She may be onto something.

While the Centers for Disease Control and Prevention have identified 3 million children in this country as having food and digestive allergies (up nearly a third from 2.3 million in 1997), there is growing evidence that a significant number may not have them at all. Allergists and pediatricians are telling parents that they may be able to relax, that, in some cases, although not all, their children's diets may have been needlessly restricted.

The controversy over peanuts is especially heated. While the incidence of peanut allergy is said to have doubled in the last decade, naysayers such as Harvard professor of medical sociology Nicholas A. Christakis warn that increasing hysteria over nut allergies in children has created a crisis of unwarranted anxiety.

"About 150 people - children and adults - die each year from all food allergies combined," Christakis says. "Compare that number with the roughly 2,600 children and teenagers who die from gun violence, and figure out where our anxieties should be."

The litmus test is not what is learned through skin pricks or blood studies, but whether children react when they eat something. Eggs, cow's milk, peanuts and wheat are the four most common offenders in young children.

The problem, says David Fleischer, assistant professor of pediatrics at National Jewish Health, a Denver research hospital, is inaccuracy in testing. "The only way you can be sure a child has a particular allergy is whether he can eat the food without having a symptom," Fleischer says. "That is the gold standard. If all you have is a positive blood test, it might be accurate only half the time."

A food reaction is not the same as a food allergy. Three-year-old Aisha who vomits when she drinks milk may be lactose intolerant. And Mia, 4, who feels nauseated when she eats a poached egg, may simply be turned off by its runny consistency.

Distinguishing the difference requires a thorough history documenting a consistent reaction to a certain food, followed by a positive skin test. Both are critical. If, for instance, a child's skin test shows an allergy to wheat, but he has never had a symptom after eating pretzels and chocolate chip cookies, there's no reason to deprive him.

Noah Cohen, 10, of Jenkintown, is in the midst of "food challenges," hoping that he may have outgrown the allergies that have defined his life ever since he can remember. When he was 6 months old, his family was around the dinner table eating salmon. Suddenly Noah's face and hands turned crimson and hives popped out on his skin. His parents didn't know whether he had eaten a bit of salmon or just touched it. But that was the first clue that he might have an allergy.

The treatment was easy. His parents stopped taking fish into their home. But when it was time to enroll him in preschool, where they couldn't know if the boy beside him at lunch might be noshing on salmon salad, they opted to take him to an allergist. Noah turned out to be highly allergic to all fish in the salmon family, which included trout and whitefish. "There went our Sunday bagels and lox breakfasts with my parents," laments his mother, Julie Mann.

Over the years, Noah has had a smorgasbord of blood and skin tests. But recently, his pediatric allergist, Robert Anolik, who has eight offices in the Philadelphia region, initiated a regimen of food challenges. At first, his mother says, a little tuna was rubbed on Noah's lips. His mom waited silently, her heart pounding. After a short interval with no symptoms, he was given a small bite of tuna. Another brief wait, then two bites, then a big spoonful until he finally finished the contents of the container. "I wanted to cheer," says his mom.

Since that time, Noah has learned that while he still blotches around his mouth and neck when exposed to salmon and whitefish, he is non-allergic to flounder, cod, haddock and anchovy, which can be hidden in a lot of foods.

The news should have been reassuring. But Noah is terrified. "He has been told since he can remember that he has to avoid fish or he could die," says his mother. "Now he's getting a different message." Noah told his mother recently that he had a dream in which he was boxing a fish.

Mann sometimes blames herself, recalling that she ate "enormous quantities" of salmon - four or five times a week - during her pregnancy. But recent studies find no evidence that mothers' diets during pregnancy or lactation trigger allergies in their infants.

In fact, the American Academy of Pediatrics has revised its recommendations about when high-risk foods can be introduced into a baby's diet. It used to be no eggs until 2, no cow's milk until 1, no peanuts and fish until 3.

Now, the Academy's Committee on Nutrition and the American Academy of Allergy, Asthma & Immunology see no evidence to support banning those foods for babies 6 months old or older, even when they are high risk because of a first-degree relative with allergies.

One study has even suggested that children exposed to cereal grains before they are 6 months old are protected from a wheat allergy.

There are many theories, but no certainties, about why the allergy rate in children has risen by a third over the last 10 years.

One - dubbed the hygiene hypothesis - is that we may be too clean. Organisms, like the bacteria and viruses that enter the body along with "dirt" from the floor, may be good for children because they stimulate the development of a healthy immune system. And children raised on farms near animals that expose them to endotoxins have fewer allergies, studies show.

This doesn't mean that we should buy our children a pet pig or feed them diets laced with dirt, but we may have crossed a line that has made the immune systems of so many children go haywire.

"We need to practice moderation - too little and too much are both bad," says Jonathan Spergel, chief of the allergy section at Children's Hospital of Philadelphia, who says his 5-year-old son is truly allergic to sesame seeds. "We just don't know yet how to get there."

Meanwhile, some families are racked with contagious anxiety, says Mary Klinnert, associate professor of pediatrics at National Jewish Health, who directs a quality of life program for parents and their children referred from all over the country. Some are pushed to the edge by painstaking attention to meal preparation, concern about keeping their toddlers safe at birthday parties, curtailing or even eliminating restaurant meals and preempting sleepovers or sleep-away camp, all while worrying that their child might eat, smell or just be near the wrong food . . . and die!

"I'm concerned about the amount of anxiety that has been generated," says Klinnert. "For a child to die from an allergy, everything has to go wrong . . . and seldom does. We try to help families understand the real and imagined risks."

"You can hold yourself and your child hostage to his allergies or you can come up with solutions that will keep your lives as normal . . . and safe . . . as possible," says Kristine Littauer, who spent two weeks at National Jewish and learned that her 3-year-old son, Jack, could have a fatal reaction to ingesting dairy products, but he was not, as they believed, allergic to wheat, fish and sunflower seeds.

"At first it feels overwhelming," says Littauer. "But with the support of friends and family, we learned to live in a way that doesn't create our own prison."