Fear and Allergies in the Lunchroom

There are still many mysteries about how allergies start and why they sometimes stop. Researchers know that babies with egg or milk allergies and the persistent rash known as eczema are more prone to some other allergic disorders later on. Take Emily Godwin. Neither of her parents has food allergies, but at 3 months, Emily developed eczema. Five months later, doctors diagnosed food allergies. Today, at 6, she can't eat eggs, wheat, tree nuts and grapes. But little Emily has had one victory: she recently outgrew a milk allergy. In fact, many kids get over milk and egg allergies naturally—another mystery that docs don't understand. Researchers at Mount Sinai and four other sites funded by CoFAR are now recruiting 400 infants who have milk or egg allergies. The infants will be monitored over five years to see how many develop peanut allergies and how many outgrow their milk or egg allergies. The goal: to better understand at the molecular level what triggers allergies and what makes them go away. Ultimately, that knowledge could lead to treatments.

The holy grail would be to stop allergies from developing in the first place. Prof. Gideon Lack, of King's College London, has studied allergy incidence worldwide and has discovered an intriguing paradox: countries that have advised avoidance of peanuts in early childhood, like the United States, have seen the greatest rise in peanut allergies. In some Asian and African countries, on the other hand, where children eat a variety of peanut products starting at a very young age, peanut allergies are far less common.

Now Lack has enrolled more than 200 babies with eczema or egg allergies—but no known peanut allergy—in a groundbreaking trial. He'll give half the babies a peanut-containing snack; the other half will avoid peanuts. He'll then follow them all until age 5 to see if he has stopped a peanut allergy before it takes hold. "We're going to try to intervene during a narrow window of immunological opportunity in the first year of life," says Lack. If it works with peanuts, it could apply to other foods as well. Lack is hesitant, however, to make predictions and warns that nobody yet knows which method—avoidance or exposure—will turn out to be the best way to go. "I don't want to give the impression that feeding peanuts is a safe way to prevent peanut allergy, because we really don't know," he says. If parents try to introduce peanuts early at home, "it could be dangerous." If the study is successful, however, it could lead to a turnaround in medical advice.

For now, parents must be hypervigilant. "They are always walking on eggshells," says Rep. Nita Lowey, who authored the federal labeling law. The labels—which require that ingredients be clearly described for consumers rather than scientists ("milk," not "casein")—are helping, and groups like the Food Allergy & Anaphylaxis Network (FAAN) applaud them. But FAAN, a nonprofit advocacy group, still worries about hidden threats. Schools sometimes use old peanut-butter jars to store crayons. Certain kinds of paint contain egg. And while the label on microwave popcorn may state that it contains milk, egg and fish, an allergic kid who isn't carefully checking the list might be at risk.

At home, Mom and Dad can control what their kids eat. The challenge is keeping them safe outside. Anne Bullard, director of Gwynn Valley Camp in Brevard, N.C., remembers the worry-free days of the past. "Twenty years ago, peanut butter was put out in the dining room for everyone," she says. "Not anymore." Today, even though just 1 percent of the 1,050 kids attending the camp have food allergies, the camp uses no nut products in its dining room. On mac-and-cheese nights, dairy-free options are on hand for campers who can't eat milk products.

Schools vary in the accommodations they make. Julie Forrest, of Waldwick, N.J., transferred her 7-year-old son, who has peanut and tree-nut allergies, out of a school where she says she was told by the principal that his safety could not be guaranteed. A study published this month found that while two thirds of surveyed schools had allergy-emergency plans, most of the policies were "missing essential components"—things as basic as having emergency contacts and student- health histories on file. And schools aren't the only ones who are lax. Some restaurant chains try to avoid nut products—Burger King carries only the occasional pie with nuts, which arrives in a sealed box—but others take fewer precautions. Another study, published in July, found that even parents of kids with allergies were increasingly ignoring "may contain" labels; 75 percent of parents said they paid attention to them in supermarkets, compared with 85 percent in 2003. The fact that the warnings are now so common may have created a new problem—with so many foods labeled, it's hard to know which really might be dangerous. "All of a sudden, it says, 'Manufactured on equipment that's used for peanuts' … Who knows what that means?" says Mike Lade of Houston, whose son Andrew, 7, can't eat peanuts. "We need a uniform standard for all of these wishy-washy 40 variations of 'maybe it does, maybe it doesn't'."