More children are showing food allergies, including peanuts, but medical investigators don't have a clear explanation for the increase.
The recent death of a 13-year-old Sacramento girl from a peanut allergy raises the "key question" for John Lehr, CEO of Food Allergy Research & Education, a Washington, D.C., nonprofit: "Why are people dying, and what can we do to prevent it?"
The number of all allergies, including peanuts, is rising, said Dr. Sami Bahna, chief of allergy at Louisiana State University in Shreveport and past president of the American College of Allergy, Asthma and Immunology.
He said peanuts are the No. 1 food causing severe allergies in children. This is for two reasons: Peanuts are widely consumed and are stronger allergens than most other foods, especially in children, he said.
According to a report in May from the federal Centers for Disease Control and Prevention, the number of U.S. children who have food allergies rose by 50 percent from 1997 to 2011. In particular, peanut allergies among children appear to have tripled between 1997 and 2008, according to a study published in 2010.
There is still no cure for food allergies, although the federal government's investment in food allergy research has risen from $4 million in 2004 to $31 million today, Lehr said.
"But more work is needed," he said. "Scientists do not yet know why there has been an increase in food allergy prevalence."
Food allergies involve the immune system and can be life-threatening.
Bahna emphasized that true food allergies are much less common than positive skin tests show.
For example, peanut allergies affect 1 percent of the population, and of those, only a tenth are severely anaphylactic, capable of causing a sudden, severe and possibly life-threatening reaction. Ninety percent of peanut reactions are limited to gastrointestinal and dermatological or wheezing symptoms.
Often, allergies are overdiagnosed, which can lead to undue "psycho-social impacts" on the child, Bahna said.
Both Lehr and Bahna stressed having a proper diagnosis and detailed management plan from an allergist.
For those who do suffer from life-threatening food allergies, life continues, albeit precariously.
Kylie Kozar, 13, of Los Angeles was diagnosed with a life-threatening peanut allergy when she survived full-blown anaphylaxis at 18 months old after taking a bite of a Tiger's Milk protein bar. Her mother, Yael Kozar, was unaware of the severity of peanut allergies at the time.
Kylie's blood test showed her level of peanut allergy was "immeasurable," her mother said. Yael Kozar made the difficult decision to put her television career on hold for her child. "I couldn't trust the world," she said.
When Kylie was 7, she suffered another traumatizing near-death experience. Her family was eating dinner at one of the five restaurants they trusted. Kylie took a bite of a sauce that the waiter said did not contain peanuts.
"She was on my side of the table in less than a minute, clutching at her throat," Kozar said. The waiter ran back and found out the sauce did have peanuts. "I knew at that moment I had to inject," said Kozar, who administered an EpiPen to her daughter. Kylie's throat opened up immediately, but the reactions didn't end.
Kylie ultimately suffered four reactions and was in and out of hospitals for three days from one bite. Afterward, she continued to feel like her throat was closing. Doctors investigated and found esophageal scarring, which mimicked anaphylaxis.
Kylie was treated for post-traumatic stress disorder after the incident and still has recurring anxiety. "She thinks it's going to happen again," her mother said.
Until a cure is found, the only way to avoid a reaction is to avoid the allergen. Before she eats anything, Kylie makes sure she knows the ingredients. She also enlists the help of her friends, who tell her when they see someone with a peanut butter and jelly sandwich. Telling friends "you have an allergy and where your meds are is really helpful," Kylie said.
But how about enlisting the help of your entire school?
Elk Grove schools announced last week that the district would stop serving peanut products in its elementary schools in response to the death last month of 13-year-old Natalie Giorgi.
Bahna believes total peanut bans are impossible to implement, and he worries that they create a false sense of trust in the safety of foods prepared by others.
"The schools have been unable to be drug-free or gun-free," he said. "Schoolchildren with food allergies should eat food prepared by parents at home."
Last week, the U.S. House of Representatives passed a groundbreaking measure that would expand access to epinephrine autoinjectors in schools, which the president needs to sign, Kozar said.
But Giorgi's case is a reminder that emergency treatment can still fail. Giorgi's father, a Sacramento doctor, administered three EpiPens before his daughter stopped breathing. "That EpiPens may not always work," Kozar said, "is truly a new level of torture to the mind."
After the harrowing experience from the bite of sauce, Kozar presented her daughter with two choices. The first involved being "the bubble child": home-schooling, no sports and no play dates.
Kylie opted for the second. " 'I want to live in the real world and help others.' She said that at age 7," Kozar said. Kylie and her mother have since become national advocates for food allergy awareness.
Melissa Engel, 18, of Illinois has survived a childhood with multiple life-threatening food allergies, including peanuts. She said that awareness is "definitely already getting better since I was younger the labeling is getting better."
But this fall she faces a new challenge: college. In a month, Engel heads to Emory University in Atlanta. She eventually wants to be a pediatrician.
"Next year, I'm going to have to be trusting other people to be making my food. But you can't live your life in total fear. I'm very careful," Engel said. "If I have a bad feeling about something, I just don't eat it," she said.
"Once you're an adult, I think that's easiest because you can make your own food. And be in control. That's what's hardest is that you can't always be in control having allergies," Engel said.
Call The Bee's Ellen Le, (916) 321-1031. Follow her in Twitter @ellenble.