Multiple Food Allergies Are on the Rise

in Food Allergy
Published: July 2, 2010

This examination of the rise of multiple food allergies is from the Allergic Living archives.

It was a week so harrowing that Michelle Wilson can have trouble remembering which child reacted first. For the mother from Prince Albert, Saskatchewan, the anxiety began on the first birthday for younger daughter Paige. The family was celebrating over ice cream when the child’s head began to swell. “It was scary,” Wilson says. “She became unrecognizable.”

The family was waiting on Paige’s appointment with an allergist when 3-year-old Brooke also had a reaction, just days later. “We gave her one peanut, and she immediately dropped to her knees and started vomiting,” Wilson recalls. This was surprising: Brooke had eaten food containing traces of nuts before without incident. Wilson called her doctor back to say, “Now I need a referral for both kids.”

Today at the age of 6, Brooke is allergic to peanuts, and is avoiding all nuts on her allergist’s advice. Paige is allergic to milk, egg, chicken, is avoiding peanuts and tree nuts, and has eczema and several environmental allergies. Michelle and Eldon Wilson always knew their kids could be at risk for food allergies since Eldon is allergic to fish, tree nuts and eggs.

But in that one angst-ridden week, their lives changed forever. After Michelle realized a milk spill “was like a Level 4 biohazard,” the family eliminated allergens from the house. Soy milk became a major source of protein.

Allergists say more and more people like the Wilsons are walking into their offices with longer lists of foods suspected of causing reactions.

“The impression is that there are more people with food allergies, and there are more foods that they’re reactive to,” says Dr. Scott Sicherer, associate professor of pediatrics at the Mount Sinai School of Medicine’s Jaffe Food Allergy Institute. Sicherer, who is the author of Understanding and Managing Your Child’s Food Allergies, also notes that children are not outgrowing their food allergies at the same rate they were a few years ago.

In the days before his interview with Allergic Living, Sicherer did a tally of food allergic patients he saw in his New York office. Only three out of 21 were allergic to just one food. Similarly, a 1996 British study of 62 peanut- and tree nut-allergic people found that a quarter of them were allergic to another food, like milk, eggs, sesame or legumes.

But there aren’t many studies yet on the causes of multiple food allergies, as scientists are focused on trying to understand what genetic and environmental factors predispose a person to an individual allergy, like peanut or egg. Sicherer says the population in general is becoming more allergic, including more environmental allergies, eczema and asthma, so more food allergies are just part of that picture.

Reactions Come
in Food Groups

There is some evidence that multiple food allergies occur in patterns. Some can be explained: for example, someone who is allergic to several types of shellfish.

Other clusters are less obvious. Although peanut is a legume, not a nut, people with tree nut allergies are more likely to have a peanut allergy than the general population, and vice versa. A third of the 5,100 children and adults that the Virginia-based Food Allergy & Anaphylaxis Network has tracked in its tree nut and peanut allergy registry are also allergic to eggs, Sicherer says.

If a baby comes in with milk and egg allergies, “I start to think about peanuts,” Sicherer says. “There’s about a 20 to 25 per cent risk that the child is going to develop a peanut allergy. If that child is not already eating peanuts, I would want to evaluate them for that possibility.”

Fast Facts About Multiple Food Allergies

With the advent of more multiple allergies comes more challenges for allergic people and their families, says Dr. Peter Vadas, director of the division of Allergy and Clinical Immunology at St. Michael’s Hospital in Toronto. Not the least of these can be trying to convince other health professionals how allergic some people are to their grocery list of danger foods.

“I remember patients coming back and telling me their pediatrician was incredulous that the child had so many food allergies,” Vadas says.

Parents, too, can have a hard time grasping a diagnosis of multiple allergies. At first, Karen Eck and her husband Claude Beaucaire of Gatineau, Quebec, didn’t think much about their son Maxime’s troubles with food when he was an infant. Looking back, the boy had warning signs of allergy all along: he threw up frequently, refused to eat some foods, and occasionally got hives.

Eck’s “big wake-up call” was a massive reaction that Maxime had at daycare to green beans just before his second birthday.

“His eyes were so swollen that it looked like he had a golf ball under each eye,” she recalls. Maxime was referred to an Ottawa allergist on Eck’s request, and the doctor advised keeping her son away from legumes, eggs, chicken, and peanuts. “We were shocked,” she says. “I did not know there was such a thing as multiple food allergies.”

Eck and her husband sought a second opinion. Not only was Maxime’s diagnosis confirmed, his list grew. “We thought, ‘How can someone be allergic to so many things?’” By age 3, fish and potato were no-nos. Today, at the age of 8, tree nuts and pumpkin seeds are also on Maxime’s roster of foods to avoid, and he has oral allergy syndrome.

Multiple Allergies

With multiple allergies, a list of must-avoid foods usually grows gradually, as parents watch a child react to different meals. A history of what a person ate and how they reacted is key to pinning down what’s a true allergy, what’s an intolerance, and what foods are safe to eat, says Dr. Tim Vander Leek, an Edmonton allergist and assistant clinical professor at the University of Alberta’s pediatrics department.

One of his “biggest pet peeves” is when he sees family doctors and other allergists perform large screens of skin-prick tests and blood tests when a person hasn’t eaten or reacted to those foods.

“Now this individual is being given this list of foods that they need to avoid that isn’t based on anything that has actually happened to them,” he says. “Many of those foods, they could have tolerated without any problem.” Vadas agrees, noting that a skin-prick test done in the absence of a patient’s history has a false positive rate as high as 50 per cent.

Although the process for diagnosing will be specific to the individual and the circumstances, the experts say it begins with a detailed history of what foods the patient has eaten without reaction; what the person was eating when the reaction happened; and when any new or unexplained symptoms appeared. Based on that information, Vadas says, he’ll perform skin tests for suspected allergens.

Once an allergy is confirmed, Vander Leek said he may also steer patients away from related foods, such as other nuts if a person is reacting to one tree nut. The exception would be a food the person has already eaten and tolerated well in the past.

For some, it’s crucial to narrow down what foods are safe because their list of allergies is so extensive. Eck says her son’s allergist has identified five fish that are safe for Maxime to eat, and four he must stay away from. Having options for protein is important, since Maxime can’t have poultry, tree nuts, peanuts and legumes, and refuses to eat pork and most kinds of beef.

and Road Trips

Deciphering that list of “yay” or “nay” foods is just the first of many challenges of living with a bundle of food allergies. Eating out and traveling, for instance, can be daunting. Travel-lover Julie Mototsune didn’t go away on holiday for three years after her son Mark had two of his earliest reactions while on vacation.

The family from Oakville, Ontario, was staying in a cottage on Lake Erie. Mark, who is allergic to eggs, peanuts, tree nuts, fish, shellfish, legumes, pineapple and numerous seeds, was then 17 months old and crawling on the floor. “He had a huge reaction,” Mototsune says. “He was covered in hives. It looked like the hives were going into his eyes. He was just swelling up everywhere.”

Two months later, the family tried again, taking a trip to a resort in northern Ontario. Despite receiving assurances the chef could accommodate Mark’s allergies, he reacted to the first meal he touched. “Within five minutes, he was vomiting and covered again in hives,” Mototsune recalls.

But the family that likes to travel couldn’t stay home forever. Julie, her husband Richard, 8-year-old Alannah, and Mark, now 5, take weekend car trips within a couple hours of home, and bring along safe foods in a cooler. “We eat picnic style in our hotel room, and the kids love it,” Julie says. “They think it’s so fun to be away from home.”

The Wilsons also needed a new approach following a “nightmare” road trip to Edmonton, in which Paige itched and swelled at every restaurant stop. Their travel solution is a 28-foot trailer, complete with kitchen. It has given them the freedom to visit relatives and go touring.

Eating out in a family’s hometown carries equal risk. A month after Eck discovered son Maxime’s allergies, her second son Xavier was born. He, too, developed life-threatening food allergies, but not to all of the same foods as his brother. For the boys, eating out is a rare event. Maxime, now 8 years old, is usually safe with pizza, but Eck is intent on keeping dairy-allergic Xavier away from cheese. A night at a chicken joint for Xavier, 6, is possible, but it wouldn’t be right for poultry-sensitive Maxime.

As a treat, Eck approached a restaurant she knew to be allergy-friendly to ask if they could accommodate a fancy meal for the family. She gave each boy’s list to the restaurant and chose dishes for them, and the staff took extra precautions, such as sterilizing and wrapping up cutlery for each boy. It cost nearly $400 for three adults and the boys, but it was a wonderful evening. But when Eck e-mailed to thank the restaurant, she got a devastating reply.

“We now appreciate how much work you go through to keep your children safe, and we really don’t feel that we can do it again,” she read. “It was very difficult. I was quite down for a while.”

Down, partly because Eck and Beaucaire rarely get a break. Mealtime is an elaborate production. The pair usually cooks two or three different dishes for one safe meal, plus lunches for the next day. Fortunately, Beaucaire loves to cook. “I used to be a bad and very unwilling cook,” Eck says. “Claude finally sat me down and said, ‘Listen, you’ve got to stop being like this.’ I needed that.”

Today, Karen is immersed in helping others to cope with allergies as the volunteer leader of the Ottawa Anaphylaxis Support Group. But she found it important to accept the amount of work it took to keep her own sons safe because “to do it unwillingly, it just takes a lot of energy out of you.”

For an adult with multiple food allergies, dining out also presents a challenge. Consultant Marilyn Friedmann, 44, often meets clients in restaurants and has seen servers “fly into a panic” when she asks for a meal without fish, shellfish, nuts, peanuts or mushrooms.

It can be an embarrassing experience. “You sit down, you order and you explain your allergies, and then they say to you, ‘maybe you should eat somewhere else.’”

While working for a food manufacturer a few years ago, Friedmann was at a conference when a chef piped up about her allergies in front of about 30 people, including the company president.

“Don’t you realize that allergies are God’s way of getting rid of the weak people?” Friedmann recalls him saying. “I said, ‘Well, he’s allowed me to live this long. I think he’s got a purpose for my life.’ I was absolutely appalled.”

An Upside
to Allergies

There are bound to be frustrating times in a life with multiple food allergies. Julie Mototsune misses the exotic recipes she used to cook. Karen Eck would like to take a vacation with her husband, without overwhelming a caregiver. Extra vigilance is required at school, at work, and during sporting events and social gatherings, for multi-allergic children and adults alike.

Friedmann had concerns about having children because of the challenges she had faced, such as severe asthma attacks and eczema so bad, she says she looked like “a monster.” Friedmann now has two sons, age 12 and 14, and neither inherited her allergic tendencies.

But she firmly believes that there’s a palpable upside to a multi-allergic life. “It makes you more aware of other people with vulnerabilities,” she says. “I think it makes you a more sensitive person.”

Karen Eck says her sons’ allergies have made her family more involved with their school and community than they otherwise might have been. “We get meetings with the teachers, and sometimes we sit and talk to them for half an hour a day. Other parents don’t get that.”

Eck also likes to revel in the moments when she meets someone who understands how serious her sons’ food allergies can be. “People,” she notes, “will amaze you sometimes.”