Allergies: from nuisance to life-endangering

By: BRADLEY J. FIKES - Staff Writer | Saturday, July 29, 2006 6:15 PM PDT ∞

Ever since the birth of her son Luke, allergies have been the focus of Carol D'Agnese's life.

Luke, who will be 5 in August, has been to the emergency room five times after having anaphylaxis, a life-threatening allergic reaction.

Luke can't eat anything containing eggs, milk or nuts ---- not even a trace. Paramedics, as well as the staff at Children's Hospital where he's treated, have become familiar with the family.

D'Agnese reads ingredient packages in minute detail searching for the allergens (allergy-causing substances). She goes so far as to call supermarkets and their suppliers to determine exactly how the foods were made.

"I talk to buyers, I talk to line managers, to purchase managers in food-processing facilities ---- I have to go right up the chain," D'Agnese said.

The family, which lives in Rancho Penasquitos, carries its own food when going to parties. When traveling, the D'Agneses check the destination and the route to make sure they're close to a hospital. And everywhere they go, they carry "epipens," automatic injectors loaded with epinephrine, an antidote for anaphylaxis. They keep the injectors in the house, in the car, wherever Luke might go.

Flawed defense


Allergies occur when the body's disease-fighting immune system goes astray. The immune system consists of antibodies and white blood cells that home in on intruders. With allergies, harmless substances trigger a frenzied defense, which can cause runny noses and other symptoms normally found in colds. So what is usually a defense itself becomes the problem.

Anaphylaxis is an extreme form of allergic reaction in which these symptoms are magnified. So instead of just a runny or swollen nose, the airway can totally close from the swelling, suffocating the patient. So for people like Luke, their natural defenses are also their greatest danger.

Mere contact with the allergen-containing foods can set off the reaction. Once, Luke was splashed with milk. Although D'Agnese quickly washed it off and took him to the hospital, Luke went into anaphylaxis. Over the next few hours, a scarlet rash spread across his skin.

"It looked like he had first-degree burns from his shoulder up," D'Agnese said.

That was a slow reaction. When Luke actually ingests the allergen-containing food, the reaction is immediate. Luke was first diagnosed at 11 months, when he was fed cheese.

"His face and limbs started to swell within 10 to 15 seconds," she said.

That was his first trip to the ER.

Luke understands his danger. When offered a new food, he'll ask to know the ingredients, as he did recently with two brands of banana waffles.

"Both were labeled dairy free, nuts free, and vegan. My son said, can I really eat them? Read me the ingredients," D'Agnese said.

One of the waffles, it turned out, carried a warning of potential "cross contamination," because they had been made on a production line that had handled nuts.

"For us, there wasn't a choice," she said. "There's no real room for error. He's going to have to be aware of this for the rest of his life until it goes away, and it may never go away."

Luke drove the point home by taking the initiative, D'Agnese said.

"He threw them away for me," she said.

A normal disease?


Luke is at the extreme end of the allergic continuum. Most people find allergies an inconvenience, ones that can make life eye-wateringly, sneezingly miserable. But more serious diseases like asthma also are common.

It's normal to have allergies, at least in the United States. More than half of Americans test positive to one or more allergens, according to the National Institute of Allergy and Infectious Disease. Researchers at the institute and the National Institute of Environmental Health Sciences published this finding in the August 2005 issue of the Journal of Allergy and Clinical Immunology.

Dust mite, rye, ragweed and cockroach are the most common allergens; about one-quarter of the population is sensitive to them. For foods, peanuts top the list of allergens, with 9 percent of the population sensitive. Animal proteins, such as venom from bees and other stinging insects, cause allergic reactions, some life-threatening, in susceptible people. And drugs such as penicillin also can cause allergic reactions.

According to the NIAID, allergies are the sixth leading cause of chronic disease in the United States, at a cost of $18 billion a year.

Aside from developing allergic symptoms, allergies can be detected more comfortably in medical tests. One method is to apply small quantities of possible allergens to the skin, scratching or pricking the surface to make sure the allergen is absorbed. Food allergies can be diagnosed by changing the diet and observing the reaction. There's also tests for abnormal functioning of the body's disease-fighting immune system, which consists of antibodies and various types of white blood cells.

Causes


Just as allergic reactions can be caused by many different allergens, there are different underlying causes of allergies. There's a genetic component with some allergies, such as certain kinds of asthma, a major health problem in the United States.

An estimated 9 million children younger than 18 years have been diagnosed with asthma, a rate of 12.5 percent, according to the U.S. Centers for Disease Control and Protection. And 25 percent of emergency room trips are asthma-related, according to the U.S. Centers for Disease Control.

The South Atlantic island of Tristan da Cunha has one of the world's highest rates of asthma. About 100 of its 300 inhabitants are asthmatic, and the disease tends to run in families.

Sequana Therapeutics, a now-defunct San Diego biotechnology company, examined Tristan's population and announced it had found the asthma-causing gene. However, further research found other genes implicated in asthma.

Race is also a factor; Blacks are three times more likely to be hospitalized with asthma and die of asthma as Caucasians, according to the Allergy and Asthma Foundation of America.

But genes aren't the whole explanation; a large and growing body of research points to environmental causes such as air pollution. The incidence rate of asthma and other allergies has been increasing in the United States and other industrial societies for decades. From 1980 to 1999, the percentage of deaths primarily caused by asthma rose from under 15 percent to 20 percent, according to the Centers for Disease Control.

Getting help


While scientists search for answers and better treatments, those with allergies or their families help each other, such as through the Food Allergies & Anaphylaxis Network. FAAN's San Diego chapter plans a fundraising walk Sept. 9 in Balboa Park.

The walk is sponsored by Verus Pharmaceuticals, a Carmel Valley company that makes a TwinJect, a double-dose epinephrine injector. More than 30 percent of anaphylaxis patients require more than one dose of epinephrine, said Amy Caterina, a spokeswoman for Verus. Go to http://tinyurl.com/l6zlj for more information on the walk. Verus is at http://www.veruspharm.com/.

D'Agnese said she was referred to FAAN by Children's Hospital after her first trip with Luke to the emergency room. With her life turned upside down, the group gave her both support and knowledge.

"You have to completely rethink about how you live," D'Agnese said. "It's overwhelming for parents."

Not only did the D'Agneses have a lot to learn, they had to educate everyone who comes into contact with Luke, such as friends, relatives and the preschool Luke attends, of his allergies.

Grateful for the support from FAAN, D'Agnese now volunteers with the group, and talks to parents of children with newly diagnosed allergies.

D'Agnese takes hope in knowing that many children outgrow their allergies, or at least become less allergic. Luke used to be allergic to soy products, but he outgrew that allergy at 3. That means Luke can enjoy soy ice cream and other soy-based alternatives to milk products.

.And Luke's younger brother, Max, who will be 3 in September, has no known food allergies.

-- Contact staff writer Bradley J. Fikes at bfikes@nctimes.com or (760) 739-6641.

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