When Food Is A Danger

For the estimated 12 million Americans with food allergies, eating can be quite an adventure.

Just ask Chris Paganelli, 54, who has been allergic to eggs and chicken since childhood.

"I always joke that I am not very much fun to go out to a new restaurant with, because I end up being pretty neurotic," says the pharmaceutical rep and father of two, who lives in Silver Spring.

Can you blame him? At a recent business conference in Chicago, Paganelli made sure to let organizers know in advance of his allergy to chicken and eggs. So he thought it was safe to eat what appeared to be mozzarella on his luncheon salad. About 10 minutes later, Paganelli doubled over and got violently ill. He had accidentally consumed a large helping of chopped boiled egg whites -- one of the foods to which he is most allergic.

Like many people with food allergies, Paganelli has learned the hard way to be prepared. He reached for his emergency medical kit and quickly jabbed himself with an auto-injector of epinephrine to ward off anaphylactic shock, an allergic reaction that can be fatal in minutes. Even though he and many others need to take such extreme measures to protect themselves, Paganelli says most people still don't think that food allergies are "that big a deal."

Yet, some 30,000 people are sent to emergency rooms in the United States each year for food allergy attacks, which claim 100 to 200 lives annually. If it seems as if food allergies are on the rise, it's not your imagination.

"For reasons that we don't understand, the prevalence of food allergies has doubled in the last 15 years," notes Wesley Burks, chief of allergy and immunology at Duke University Medical Center. In a recently released report, the National Institute of Allergy and Infectious Diseases (NIAID) calls food allergies an emerging and "important public health problem."

Among the theories for the increase are changes in the way food is processed and the age when solid food is introduced to infants. Some experts also contend that our obsession with cleanliness overprotects the immune system, which then reacts too aggressively when confronted with perceived foreign invaders, such as peanuts, instead of just taking them in stride.

During a food allergy attack, the immune system overreacts to specific food proteins and manufactures too much immunoglobulin E (IgE). That in turn sets in motion a series of reactions that can produce anything from itchy hives and a runny nose to a life-threatening anaphylactic attack. (See the accompanying box for more on symptoms.)

How severe the reaction is varies according to how many times the offending food has been eaten, how much is consumed and the genetic makeup of the allergic person. Some of the most severe attacks occur from eating peanuts and tree nuts such as cashews.

Food allergies now afflict about 4 percent of adults and 8 percent of children aged 2 and younger, according to Marshall Plaut, chief of the NIAID's Allergic Mechanisms Section.

The good news: Studies show that many children outgrow their allergies. That's already happened for Gavin Perkins of West Hartford, Conn. Just 14 months old, he seems to have outgrown an allergy to wheat, although he still is allergic to chicken, eggs, dairy, soy and fish. Since Gavin breast-feeds, that means his mother, Lisa, has to be very careful about what she eats, too, because food proteins pass through breast milk.