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Most children love birthday parties, but for 9-year-old Cullen Woodward, they can be a scary occasion.

Cullen is allergic to eggs, and eating a bite of birthday cake could lead to swelling, gasping, and even a trip to the emergency room.

To increase awareness and support a cure for food allergies, the Isbell Elementary School student is serving as an ambassador for the Walk for Food Allergy: Moving Toward a Cure, the third annual event in the Dallas area organized by the Food Allergy & Anaphylaxis Network. The 2.2- mile walk is scheduled for 10 a.m. Saturday at Bob Woodruff Park in Plano.

“The main reason why I like being an ambassador is because I feel like it’s really important to let people know how dangerous food allergies can be, and so that we can find a cure for them,” Cullen said.

Dallas event chairperson Amy Hasslen expects about 500 people to participate in the family-friendly walk, which will be followed by a carnival that will include bounce houses and a live band.

Hasslen is also the mother of a child with severe food allergies, a condition that is rapidly growing for unknown reasons. FAAN statistics show that about 4 percent of the U.S. population suffers from food allergies, with one in 17 children under age 3 reporting food allergies.

Milk, eggs, peanuts, tree nuts, wheat, soy, fish, and shellfish account for about 90 percent of all food-allergies in the U.S., FAAN reports, with between 100 and 200 deaths from anaphylaxis caused by food occurring each year.

“It’s the little things that people don’t think about in every day life [that make dealing with food allergies difficult],” Hasslen said. “Our lives pretty much revolve around food, and you have to be on guard continually, because even a trace of a food allergen in something can cause a severe reaction.”

Cullen’s mother, Heather Woodward, watched with horror as her 10-month-old son’s eyes swelled shut and he began gasping for air when she gave him a hard-boiled egg for the first time. The food barely touched his lips when the reaction began.

The Frisco resident said that the hardest aspect of initially coping with food allergies is determining what is safe to feed the child.

“At that point it was like everything in the world n every bread, every baked good n had eggs in it,” Heather said. “It was a good six month learning curve to figure out what to feed your child when touching a small amount of it can make him stop breathing.”

Once the family determined what foods Cullen must avoid, the challenge became overcoming the fear of new dishes and the feelings of being excluded from classmates and friends. Cullen takes special cupcakes to birthday parties, because he cannot eat any cake or other treat baked with eggs.

“Sometimes I get teased, and I really hate that because it’s kind of scary having a food allergy,” Cullen said. “A lot of times when I go for birthday parties I really wish I could just have what other people are having, and I feel different.”

Hasslen said she struggles with her daughter experiencing the same feelings.

“The hardest part is watching your child not be able to participate in birthday parties,” she said. “They can’t eat the same food the other kids are eating.”

Through the Food Allergy Walk, Hasslen and the Woodwards are hoping to eliminate common misconceptions about food allergies and raise money for research. The Plano walk is one of 26 across the country working toward the same goals.

“We really want to have people out there supporting this and getting the word out,” Hasslen said.

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There are several factors that can trigger asthma symptoms. These factors are known as asthma triggers. Everybody has their own set of triggers.

Common asthma triggers include:

* allergens (substances that trigger allergies by causing an immune response):
o mould
o pollen
o animal dander
o cockroaches
o dust mites
* irritants (substances that irritate the airways):
o smoking
o secondhand smoke
o strong odours, such as paint fumes
o cold air
o air pollution
o humidity
* food additives (e.g., sulphites)
* viral infections
* physical activity
* stress
* gastroesophageal reflux disease (GERD)
* certain medications (e.g., beta-blockers, ASA (Aspirin®) and other nonsteroidal anti-inflammatory drugs (NSAIDs))

Asthma triggers irritate your airways and cause them to become narrow and inflamed, which makes it difficult to breathe. You can control asthma symptoms and reduce your need for medication by avoiding exposure to common asthma triggers.

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AAAAI and FAAN educate about dangers of anaphylaxis

With the upcoming school year approaching, the American Academy of Allergy, Asthma and Immunology (AAAAI) and the Food Allergy & Anaphylaxis Network (FAAN) are asking every parent of a child with food allergies or a known insect sting allergy to alert their child’s school to the condition and have an action plan ready.

A potentially life-threatening allergic reaction, called anaphylaxis, can be triggered by exposure to one or more allergens, including foods, insect stings, drugs, and latex products. Anaphylaxis can affect multiple areas of the body (such as skin, respiratory tract, gastrointestinal tract and the cardiovascular system). Symptoms can include severe headache, nausea and vomiting, sneezing and coughing, hives, swelling of the lips, tongue and throat, itching all over the body, and anxiety. The most dangerous symptoms include difficulty breathing, a drop in blood pressure, and shock - all of which can be fatal.

“All school staff must be made aware of the potentially severe nature of an anaphylactic reaction,” said S. Allan Bock , MD , FAAAAI, and Chair of the AAAAI’s Anaphylaxis Committee. “Parents need to work together with teachers, coaches and school nurses to avoid triggers and act quickly if a reaction occurs.”

To protect your child, and prevent anaphylaxis, the AAAAI and FAAN encourage parents to take the following steps before the school year begins:

* Work with an allergist/immunologist to identify your child’s triggers and reinforce these to your child. If possible, provide your child with a medical bracelet or necklace that identifies his or her specific allergy.
* Tour your child’s school or childcare facility before school starts, and meet with the staff to inquire about policies regarding foods and other potential triggers brought into the classroom.
* Provide staff with information and resources to educate them about your child’s allergy. Have your child’s allergist/immunologist provide clear, written instructions on recognizing a reaction early and administering medication in case of a reaction. Inform staff to call 911 immediately if a reaction occurs.
* Teach staff when and how to properly administer medications such as injectable epinephrine, encouraging them to handle the medication and ask questions. Explain to them that they cannot delay in administering medication to your child, and that they are obligated to assist your child and to include him or her in normal school activities. Children with a history of anaphylaxis should carry epinephrine with them at all times.

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People are often confused about food allergy and whether it is the cause of their or their child’s problem. Some key information will help you separate fact from fiction.

These tips will give you a working understanding of food allergy and help you decide if you should consult an allergist/immunologist.

1. Food allergy is a myth.
Fiction. Food allergy is a well-understood medical problem that causes a clearly defined set of symptoms.

Allergist/immunologists do make a distinction between food allergy and food sensitivity. People who get headaches from wine, gas from beans, diarrhea from lactose or a runny nose from spicy food have food sensitivity. People who develop hives, itchy mouth, throat closing, cough, wheezing or shock from peanuts, shellfish or milk have food allergy.

2. Food allergy is hard to diagnose because you never know when you are going to react to the food.
Fiction. If a person is allergic to a food, they will have an allergic reaction to that food every time they eat it.

People with food allergy usually have a reaction soon after eating the food, generally within 15 to 60 minutes. Most people who have a true food allergy know what food they are allergic to before they speak with an allergist/immunologist.

For some people, each reaction is the same. For example, each time they eat shellfish, they get hives. For many people, however, each reaction is worse than the last. A food exposure that caused wheezing the last time may cause respiratory distress or shock the next time.

3. People with food allergy are allergic to so many foods that they couldn’t eat if they avoided all of them.
Fiction. Studies have shown that the vast majority of people with food allergy are actually allergic to only one or two foods.

People with a food allergy often think they are allergic to many different foods because they are not aware that their problem food is a hidden ingredient in a variety of foods. For example, a person who is allergic to milk may not know that some brands of water-packed tuna have non-fat dry milk added to them, or that some hot dogs have milk protein as an ingredient.

4. Food allergy is diagnosed by food allergy testing.
Fiction and fact. Most of the time, food allergy is diagnosed by history. Food allergy skin testing or food allergy blood tests (RASTs or CAPRASTs) are often helpful, but do not, by themselves, make a diagnosis.

Food allergy testing may give a false positive. This is particularly true if the tested food has not caused an identifiable reaction. The only sure way to diagnose food allergy is with a food challenge. In a food challenge, the patient is given the food suspected of causing the reaction to bring on some symptoms of food allergy. This procedure is safe if performed by an experienced physician in a controlled environment. Food challenges give the most reliable information about whether a person is allergic to a food.

5. Food allergy can be treated by “desensitization” with shots or drops.
Fiction. At this time, the only treatment for food allergy is to completely avoid the problem food. Researchers are looking for treatments for food allergy, but no approach has been shown to be safe and effective in humans.

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Anaphylaxis is a “systemic reaction,” which means that various parts of the body are affected that are a distance from the allergen’s initial entry site (e.g., a sting site for insects or the stomach for foods). Symptoms of anaphylaxis can vary from mild to severe and are potentially deadly. Here is a list of possible symptoms that may occur alone or in any combination:

* Skin: hives, swelling, itch, warmth, redness, rash
* Breathing: wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, nasal congestion/hay fever-like symptoms, trouble swallowing
* Stomach: nausea, pain/cramps, vomiting, diarrhea, itchy mouth/throat
* Circulation: pale/blue color, poor pulse, passing-out, dizzy/lightheaded, low blood pressure, shock
* Other: anxiety, feeling of “impending doom,” red/itchy/watery eyes, headache, cramping of the uterus

Reactions usually begin within minutes of exposure, but may be delayed. Sometimes symptoms resolve, only to recur or progress a few hours later. The most dangerous symptoms are low blood pressure, breathing difficulties, shock and loss of consciousness, all of which can be fatal.

There are a variety of medical conditions that may mimic anaphylaxis. These include heart attacks, anxiety attacks, choking and seizures, among others. If you experience any unusual symptoms, it is vitally important to seek immediate medical attention (e.g., call 911) for prompt treatment and to determine the cause of the symptoms.

Substances that trigger reactions

* Foods: Essentially any food can trigger an allergic reaction, but some of the most common ones that cause severe anaphylaxis are: peanuts, nuts from trees (e.g., walnut, cashew, Brazil nut), shellfish, fish, milk and eggs.
* Stinging insects: The venom of stinging insects such as yellow jackets, honeybees, paper wasps, hornets and fire ants cause discomfort for most people who are stung. However, reactions can be severe and even deadly for people with allergies to these venoms.
* Medications: Virtually any medication can trigger an allergic reaction. Common categories of drugs that cause anaphylaxis are antibiotics and anti-seizure medicines. Medical therapies such as certain post-surgery fluids, vaccines, blood and blood products, radiocontrast dyes, pain medications and other drugs may cause anaphylaxis or anaphylactoid reactions.
* Latex: Some products made from natural latex (from the rubber tree) contain allergens that can trigger reactions in sensitive individuals. The greatest danger of severe reactions occurs when latex comes into contact with moist areas of the body or internal surfaces during surgery, because more of the allergen can rapidly be absorbed into the body.
* Exercise: Although rare, exercise can also trigger anaphylaxis. Oddly enough, it does not occur after every exercise session and in some cases, only occurs after eating certain foods before exercise.
* Other: Anaphylaxis has rarely been associated with exposure to seminal fluid, hormones and exposure to extreme temperatures. When no cause is found and the reaction is definitely anaphylaxis, it is termed idiopathic anaphylaxis.

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The AAAAI’s How the Allergist/Immunologist Can Help.

Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:

* Have a diagnosed food allergy.
* Have limited their diet based upon perceived adverse reactions to foods or additives.
* Have a family history of allergies and have or are expecting a newborn and are interested in identifying strategies for preventing allergy in the infant.
* Have experienced allergic symptoms (urticaria, angiodema, itch, wheezing, gastrointestinal responses) in association with food exposure.
* Experience an itchy mouth from raw fruits and vegetables.
* Are an infant with recalcitrant gastroesophageal reflux or an older individual with recalcitrant reflux symptoms, particularly if they experience dysphagia.
* Are an infant with gastrointestinal symptoms including vomiting, diarrhea (particularly with blood), poor growth, and/or malabsorption whose symptoms are otherwise unexplained, not responsive to medical management, and/or possibly food-responsive (even if screening allergy tests are negative).
* Have known eosinophilic inflammation of the gut.

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1. Avoid the food. The best way to treat food allergy is to avoid the specific foods that trigger the allergy.

2. Ask about ingredients. To avoid eating a “hidden” food allergen away from home, food-allergic individuals must always inquire about ingredients when eating at restaurants or others’ homes and make the seriousness of their allergy known. Poorly informed people may think that “picking” the ingredient out of a dish they are about to serve is fine. Although it has been shown that just smelling peanut butter will not cause a reaction, sometimes food allergens can be airborne, especially in steam, and can cause reactions. Boiling or simmering seafoods have been particularly implicated. Talk to your allergist/immunologist about more things to watch for in homes and restaurants.

3. Read food labels. It is important for food-allergic people to carefully read food labels. The United States and many other countries have adopted food labeling rules that ensure food allergens are listed in common language, such as “milk” rather than a scientific or technical term, like “casein.” However, during the initial period of enactments (2006), it is still prudent for food allergic people to become familiar with technical or scientific names for foods. For example, sometimes wheat is listed as gluten.

4. Be prepared for emergencies. Anaphylactic reactions caused by food allergies can be potentially life-threatening. Those who have experienced an anaphylactic reaction to a food must strictly avoid that food. They may need to carry and know how to use injectable epinephrine and antihistamines to treat reactions due to accidental ingestion. People who are commonly around the patient, such as spouses, co-workers, school administrators and staff such as school nurses, teachers or daycare workers, should also know how to use the injectable epinephrine. Those with food allergies should also wear an identification bracelet that describes the allergy. If you have an anaphylactic reaction after eating a food, it is essential that you have someone take you to the emergency room, even if symptoms subside. For proper diagnosis and treatment, make sure to get follow-up care from an allergist/immunologist.

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An allergist/immunologist is the best qualified professional to diagnose food allergy. Diagnosis requires a carefully organized and detailed assessment of the problem. First, the allergist/immunologist will take a thorough medical history, followed by a physical examination. The allergist will inquire about detailed contents of the foods, the frequency, seasonality, severity and nature of the symptoms, and will ask about the amount of time that elapses between eating a food and any reaction.

Allergy skin tests may be helpful to determine which foods, if any, are triggering a patient’s allergic symptoms. In skin testing, a small amount of liquid extract made from the food is placed on the back or arm. In a test called a prick test, a needle is then passed through the liquid on the top layer of the skin. In some cases fresh foods may be needed for skin testing.

If the patient develops a wheal-a raised bump or small hive-within 20 minutes, this positive response indicates a possible allergy. If the patient does not develop a wheal, the test is negative. It is uncommon for someone with a negative skin test to have an IgE-mediated food allergy. Skin tests are not helpful when sensitivity to chemical food additives is suspected.

Your doctor may also use blood tests for IgE to specific foods, called RAST testing or CAP-RAST, to diagnose food allergies. In certain cases, such as severe eczema all over the body, an allergy skin test cannot be done. Your doctor may recommend a food RAST blood test to obtain the same information that can be found with a skin test. For diagnosis of milk, egg, peanut or fish allergy, the level of the CAP-RAST test may help predict future food allergy reactions to these foods. False positive results may occur with both food allergy skin testing and blood testing. Food challenges, described below, are often required to confirm the diagnosis.

The allergist/immunologist may suggest that the patient keep a food diary, which is a detailed record listing foods eaten, date, time and any symptoms that occurred after eating the food. When an allergy to a single food is suspected, the allergist may recommend eliminating the food for a time. If symptoms are relieved, the allergist/immunologist may add the food to the diet once again to further determine if it causes a reaction (however, this is never done when the patient has a history of anaphylaxis).

If the diagnosis of food allergy remains in doubt, the allergist/immunologist may recommend a “blinded” food and/or food additive challenge test. These tests are conducted in the doctor’s office, or at times, in the hospital under close observation. Usually, the suspected food or a neutral food, called a placebo, is fed to the patient in colorless capsules, or in a non-allergenic slush or pudding. Neither the patient nor the doctor knows whether the suspected food or the placebo is being eaten. This is called a “double-blind” challenge. When properly performed, these challenges are very reliable in establishing a concrete cause and effect relationship between a food and an allergy symptom.

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The most common allergic skin reaction to a food is hives. Hives are red, very itchy, swollen areas of the skin that may arise suddenly and leave quickly. They often appear in clusters, with new clusters appearing as other areas clear. Hives may occur alone or with other symptoms.

Atopic dermatitis, or eczema, a skin condition characterized by itchy, scaly, red skin, can be triggered by food allergy. This reaction is often chronic, occurring in individuals with personal or family histories of allergies or asthma.

Asthma symptoms such as coughing, wheezing, or difficulty breathing due to narrowed airways, may be triggered by food allergy, especially in infants and children.

Gastrointestinal symptoms of food allergy include vomiting, diarrhea and abdominal cramping, and sometimes a red rash around the mouth, itching and swelling of the mouth and throat, abdominal pain, swelling of the stomach and gas.

In infants, non-allergic, temporary reactions to certain foods, especially fruits, are common. For example, a rash around the mouth, due to natural acids in foods like tomatoes and oranges, or diarrhea due to excess sugar in fruit juice or other beverages, occur with some frequency. However, other reactions are allergic and may be caused by traces of the offending food when eaten again. As they grow older, some children may tolerate foods that previously caused allergic reactions.

Less than 21% of patients with peanut allergy will outgrow it. Periodic food allergy check-ups with appropriate food challenges should be carried out under the supervision of an allergist.

Severe allergic reactions

In severe cases, consuming a food to which one is allergic can cause a life-threatening reaction called anaphylaxis- a systemic allergic reaction that can be severe and sometimes fatal. The first signs of anaphylaxis may be a feeling of warmth, flushing, tingling in the mouth or a red, itchy rash. Other symptoms may include feelings of light-headedness, shortness of breath, severe sneezing, anxiety, stomach or uterine cramps, and/or vomiting and diarrhea. In severe cases, patients may experience a drop in blood pressure that results in a loss of consciousness and shock. Without immediate treatment, anaphylaxis may cause death.

Symptoms of anaphylaxis are reversed by treatment with injectable epinephrine, antihistamines, and other emergency measures. It is essential that anyone with symptoms suggesting possible anaphylaxis get emergency treatment immediately.

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Up to 2 million, or 8%, of children, and 2% of adults in the United States are estimated to have food allergies.

With a true food allergy, an individual’s immune system will overreact to an ordinarily harmless food. This is caused by an allergic antibody called IgE (Immunoglobulin E), which is found in people with allergies. This antibody may develop after eating the food repeatedly in the past but without having problems. Food allergy may appear more often in someone who has family members with allergies, and symptoms may occur after that allergic individual consumes even a tiny amount of the food.

Food intolerance is sometimes confused with food allergy. Food intolerance refers to an abnormal response to a food or food additive that is not an allergic reaction. It differs from an allergy in that it does not involve the immune system. For instance, an individual may have uncomfortable abdominal symptoms after consuming milk. This reaction is most likely caused by a milk sugar (lactose) intolerance, in which the individual lacks the enzymes to break down milk sugar for proper digestion. Your allergist can help you determine the difference between intolerance and allergy and help you in establishing a management plan.

Food allergens -those parts of foods that cause allergic reactions-are usually proteins. Most of these allergens can still cause reactions even after they are cooked or have undergone digestion in the intestines. Numerous food proteins have been studied to establish allergen content. Some allergens (most often from fruit and vegetables) cause allergic reactions only if eaten before being cooked. Most such reactions are limited to the mouth and throat.

The most common food allergens are the proteins in cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts.

All foods come from either a plant or an animal source, and foods are grouped into families according to their origin. Peanuts, black-eyed peas, kidney and lima beans, and soybeans are members of the legume family, whereas asparagus, chives, garlic and onion are, surprisingly, members of the lily family.

In some food groups, especially tree nuts and seafood, an allergy to one member of a food family may result in the person being allergic to all the members of the same group. This is known as cross-reactivity. However, some people may be allergic to both peanuts and walnuts, which are from different food families; these allergies are called coincidental allergies, because they are not related.

Within animal groups of foods, cross-reactivity is not as common. For example, people allergic to cow’s milk can usually eat beef, and patients allergic to eggs can usually eat chicken.

With shellfish, crustaceans (shrimp, crab and lobster) are most likely to cause an allergic reaction. Molluscan shellfish (clam, oysters, abalone, etc.) can be allergenic, but reactions to these shellfish are less common. Occasionally, people are allergic to both types of shellfish.

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