Eleanor Garrow-Majka herds a group of pint-sized boys into her kitchen, giving them each a slice of pizza and some fresh veggies for lunch. Once they're munching happily, she hoists her 3-year-old son, Thomas, up and asks what he would like to eat. "A ham sammich," he tells her.
"He eats a lot of ham sandwiches," Garrow-Majka says of her grinning blond boy. "He has become a really picky eater."
But unlike lots of kids his age who turn up their noses at Mom's casserole or try to feed their broccoli to the dog, Thomas's finicky eating habits stem from a much deeper problem. One wrong move in the dinner department could cost him his life.
Diagnosed two years ago with a severe allergy to peanuts and all tree nuts (such as almonds, cashews, hazelnuts and pecans), even trace amounts of these otherwise harmless foods can set off a potentially deadly anaphylactic reaction in Thomas.
He's not alone. Of the 12 million Americans who suffer from food allergies, a quarter of them are allergic to peanuts, tree nuts or both. All food allergies included, there are at least 2 million school-aged kids watching every crumb that goes in their mouths to make sure it doesn't contain something that could kill them.
According to Anne Muñoz-Furlong, the founder and CEO of the Food Allergy and Anaphylaxis Network, the instances of peanut allergy doubled in American children between 1997 and 2002-and the number continues to rise.
"As a society, we're becoming more allergic," Muñoz-Furlong says. "No one really knows why."
Looking for answers
Theories abound, however.
The hygiene hypothesis points to the environment kids are growing up in today-the cleanest, most sanitized setting we've ever had-as the culprit. Maybe we've done such a good job of cutting germs and anti-bacterializing our homes that the immune system has little left to fight off. With extra time on its hands, it's possible that the body is starting to develop allergies just to stay busy.
Some claim that kids born by Cesarean section are more likely to develop allergies. Others speculate that exposure to certain allergens in utero puts kids at risk, leading some doctors to advise patients to avoid nuts during pregnancy. A growing public awareness about food allergies might also contribute to the rising numbers.
"With an increased availability of medical care, a child who would have been labeled as having a weak stomach in the past might be diagnosed as having a food allergy today," Muñoz-Furlong says.
According to Dr. Jennifer Kim, an allergy specialist at Children's Memorial Hospital, genetics and family history almost certainly play a role as well. She says that if one child in a family has a peanut allergy, the likelihood that his siblings will be afflicted with the same condition is 10 times higher than average.
Whatever the cause, food allergies often develop before age 3 and many-especially allergies to milk, eggs and soy-fade away by puberty. Peanut and tree nut allergies tend to be lifelong, though. One in five peanut-allergic kids will outgrow the aversion at some point, but only 8 percent will shed their allergy to tree nuts.
Discovering a food allergy
An allergic person can experience anything from hives and itching to vomiting to anaphylaxis, which can cause breathing difficulty, a drop in blood pressure and loss of consciousness.
All together, allergic reactions to food alone account for 150 to 200 deaths every year in America and upwards of 30,000 emergency room visits, not to mention all the smaller reactions that don't require a trip to the hospital.
One such emergency room-worthy reaction is how Garrow-Majka discovered Thomas's allergy in the first place. At a family birthday party, the curious toddler took a bite of a toffee bar coated in crushed pecans. Within a minute, his body reacted.
"His eyes swelled shut, his lips were swollen, he was coughing," Garrow-Majka says. "It was bad. You couldn't even tell it was my son. It was very scary to see a happy little boy turn into one huge hive."
Luckily, the hospital was only two miles away, so they were able to get Thomas to the emergency room quickly. Allergists at Children's Memorial diagnosed him a few weeks later.
Learning to live nut-free
Garrow-Majka and her husband Bob do everything they can to keep Thomas safe, but it's not easy. Peanut and tree nut products are surprisingly tricky to escape, which meant ubiquitous lifestyle changes for the whole family after Thomas's diagnosis.
They scoured the house, emptied their cupboards of anything that contains or could have come in contact with nuts, nut oil or nut extracts-including some hair products and makeup scented with almond oil and other potentially perilous ingredients-and began to hone their label-reading skills. They even replaced their oven in case it was tainted with lingering peanut oil residue.
Pregnant with her second child at the time, Garrow-Majka opted to quit working and stay home with her little boy instead of running the risk of leaving him with a nanny. These days, she runs a small daycare out of her Plainfield home so she can keep an eye on Thomas and monitor what he's eating. Any meals or snacks the daycare kids eat in her house, Garrow-Majka provides.
She tried sending Thomas to preschool, but pulled him out the day she arrived to pick him up and found penny-sized hives on his face. Another child, probably with nut residue on his hands, had touched Thomas, causing a reaction that took two doses of Benadryl and the rest of the day to reverse. The teachers claimed not to have noticed.
"If people aren't going to get it, they can't be around him," Garrow-Majka says. "One mistake, one accident could cost him his life. We're not going to take any chances."
Most of their friends and relatives are sympathetic and courteous about Thomas' needs, but Garrow-Majka still gets nervous sending him to other people's homes. If he has a play date, she goes with him. If he is invited to a birthday party, she calls ahead to make sure there won't be any nuts in the snacks or out around the house. If they're serving chocolate cake, she takes along a special treat for Thomas since normal boxed cake mixes aren't guaranteed nut-free.
Everywhere they go, Garrow-Majka carries a zippered blue emergency kit with an EpiPen, a written emergency plan, Benadryl and an extra medical ID bracelet that matches the one Thomas wears. But she knows she won't be able to be by his side forever.
"My biggest fear is leaving him alone with someone or when he goes to school," she says.
As more and more kids turn up with life-threatening food allergies, schools are forced to re-evaluate how to keep them safe. Peanut-free tables and classrooms are becoming a common sight in cafeterias, kids are now allowed to carry EpiPens at school and, at some schools, staff members are trained to spot danger signs for allergic kids.
At Wesmere Elementary in Plainfield, the school Thomas will attend when he's old enough, the provisions for kids with allergies are thought-out and efficient. With EpiPens on file for 19 kids-the most in their district-they have to be.
Any food served from the lunch line at Wesmere is peanut-free. No peanut oil, no peanut butter and obviously no nuts themselves are even allowed in the kitchen. The same goes for the rest of the elementary schools in District 202. The peanut-free table is specially cleaned, brought out only at lunchtime and situated near the doorway so that it's well ventilated. Staff members are trained to recognize and respond to allergic reactions, and teachers with severely allergic students are offered EpiPen training in case of an emergency.
"We look at each child individually to make sure their needs are met," says Laurie Inda, District 202's nursing coordinator. "Our method is simply prevention."
Another part of that prevention is rethinking classroom activities like birthday celebrations and holiday parties. Parents with kids in peanut-free classrooms are reminded periodically not to send treats containing nuts on their child's birthday, a requirement most parents accept graciously.
Food is carefully managed any time it's in the classroom, but the school is moving away from edible treats in favor of stickers, small toys or games as rewards anyway. According to Chris Kobe, Wesmere's school nurse, the kids don't seem to mind at all.
"This year, we decided not to have candy at all in the school for Halloween and the kids still had a blast," she says. "The kids are not all about food. As a society, I think we focus on food too much."
At least once a year, Kobe visits each classroom to talk about allergies. She teaches the kids how to recognize when a classmate is having an allergic reaction, how to be a good friend to a food-allergic classmate and what to do in an emergency.
The good news is they're getting it. Kobe's nephew, a student at Wesmere, will even stop his mom at the grocery store if he sees her picking up a snack food-like granola bars with nuts-that he's not supposed to have at school.
"The kids know what they need to do to keep other kids safe," Kobe says. "We give them lots of credit for that."
On the whole, the food-allergic kids at Wesmere are good about managing their allergies and neither Kobe nor Inda has ever seen a child rebel against his or her condition.
"They don't want to have a reaction. It's scary," Inda says.
Dealing with a food allergy can be draining and difficult, especially when it seems like no one really understands. That's why Garrow-Majka decided to start a support group for parents in the south suburbs.
At its bimonthly meetings, POCHA (Parents of Children Having Allergies) of Will County gets a group of parents together for moral support, to share ideas and stories and to talk about new allergy-safe products.
Having attended a POCHA meeting herself to get more information as a nurse, Inda says she gained a new appreciation for the lengths parents of food-allergic kids go to protect their children.
"It really opened my eyes," she says. "I can walk into a grocery store and buy whatever I want. Sales, generic brands, anything. They can't do that. They have to read every label. It made me realize that we have to be sensitive to that."
Although she loves sharing literature, new products and ideas with the parents in her group, Garrow-Majka says the most important thing is finding other people who understand.
"The biggest thing is to know you're not alone," she says. "I've become so used to it and this way of living that sometimes we think that there's no other way of living."
Katie Holland is a junior at Northwestern University's Medill School of Journalism and a former Chicago Parent intern.