Fear and Allergies in the Lunchroom

It's 1 p.m. at Mercer Elementary School in Shaker Heights, Ohio, and Lena Paskewitz's kindergarten class is filled with the happy hum of kids getting ready for their favorite part of the day: lunch. Caleigh Leiken, 6, is toting a pink Hello Kitty bag her mom has packed with goodies: strawberry yogurt, string cheese, some veggies and a cookie. But there's one childhood staple missing—a PB&J. Caleigh was diagnosed with a peanut and tree-nut allergy when she was just 7 months old. Nuts are a no-no at her table in the Mercer lunchroom. Her allergy-free friends can sit there, but only if their lunches have been stored in a special bin and carefully inspected by the teacher. Home, too, is a nut-free zone for Caleigh. When she goes trick-or-treating this week, her candy will be scarier than any costume; she won't be able to eat any of it for fear it's tainted with peanut residue. For Caleigh's mom, Erika Friedman—whose other two kids also have allergies—food can seem like an enemy. "We plan everything," says Friedman. "It's our job—actually, everyone's job—to keep them safe."

There was a time when food allergies were of little concern to the medical community. Today about 11 million Americans suffer from them, and many scientists agree the numbers are climbing. Most significantly, peanut allergies—among the most dire—doubled between 1997 and 2002 in children under 5. "Clearly, the number has increased in the younger population," says Dr. Hugh Sampson, a food-allergy pioneer at Mount Sinai School of Medicine in N.Y. "We suspect that [in the future], the numbers in general are going to increase." Allergists say they're now seeing more children with multiple allergies than ever before, not just to 1950s staples such as milk and wheat—but to global foods we have adopted since, like sesame and kiwi. And allergies many kids outgrow—like those to eggs—seem to be lingering longer than they did in the past.

Parents of very young children now worry over the introduction of each new food, on alert for the first signs of trouble, such as rashes, diarrhea and vomiting. Deaths are rare, but the most-sensitive kids' throats may swell and completely close up if they're exposed to the wrong foods. Even if your school-age child is allergy-free, you still have to be concerned about inadvertently triggering an allergic reaction in one of your kid's friends or classmates. Dairy-free birthday cakes are de rigueur these days, as are no-peanut Halloween parties.

But why do allergies appear to be on the rise? One of the most intriguing theories, dubbed the "hygiene hypothesis," is that we've all become too clean. The immune system is designed to battle dangerous foreign invaders like parasites and viruses and infections. But clean water, antibiotics and vaccines have eliminated some of our most toxic challenges. Intriguing research even posits that kids born by Caesarean section, which have risen 40 percent in the last decade, could be at higher risk for allergies, perhaps because they were never exposed to healthy bacteria in their mothers' birth canals. Without hard-core adversaries, the theory goes, the immune system starts battling the innocuous—egg or wheat—instead.

Almost everyone, it seems, has had to adapt to the rise in food allergies. Affected kids are carrying EpiPens, syringelike devices loaded with epinephrine, in case of severe reactions. Many schools, like Mercer Elementary, maintain "peanut-free zones," where allergic students can eat in safety. A growing number of states are establishing allergy guidelines. Manufacturers, thanks to a federal law implemented last year, now list the eight most common allergens (from milk to fish) on their food labels. And many airlines offer their passengers pretzels instead of peanuts.

While scientists have a basic understanding of how allergies work, they can still be stumped by the immune system, which is too complex to submit easily to their control. There are no cures for food allergies—only treatments for some of the symptoms—and the best parents and children can do now is avoid the culprits. Still, in recent years, researchers have begun to make exciting progress. They're studying a radical approach: introducing the offending ingredients early to see if they can treat, cure or even prevent food allergies from developing. In one study, children allergic to peanuts are being given tiny amounts of peanut flour to see if they can build up tolerance. In another, funded by the Consortium of Food Allergy Research (coFAR), a five-year $17 million initiative launched in 2005 by the National Institute of Allergy and Infectious Diseases, researchers will give peanut-allergic adults small doses of an engineered peanut protein to ward off reactions and possibly eliminate the problem. The idea is ultimately to have a peanut-allergy vaccine. For Sampson, who is working on it, the quest for a solution is more urgent than ever. "We're desperate," he says.