Doctors seek cause behind dramatic increase in ER trips

The rate of emergency room visits and hospitalizations of children with severe food allergy reactions nearly tripled in Illinois over five years, a recently released study by Northwestern Medicine reported, raising questions about the cause of such a dramatic upswing and offering an especially comprehensive data that may supply insights for what is a growing nationwide issue.

Increases in visit frequency were found across all ages and ethnicities studied, the report states, even among groups that in the past had relatively low levels of allergy problems.

“This study is really important because it shows the impact food allergies are having - especially in Illinois,” said lead study author Dr. Ruchi Gupta, a professor of pediatrics at Northwestern University Feinberg School of Medicine and a physician at Ann & Robert H. Lurie Children’s Hospital of Chicago.

“The big question is why … and that’s what we are working on to find out. We know that food allergies are tied to both genetics and the environment - and we know that something has changed for it to have gone up so drastically,” she said.

The children in the research experienced anaphylaxis, with symptoms that can include difficulty breathing, reduced blood pressure, loss of consciousness and potentially death.

The study included discharge data from 1,893 emergency room visits for food-induced anaphylaxis at about 200 Illinois hospitals from 2008 to 2012.

It showed 17.2 emergency department visits and hospital admissions per 100,000 children in 2012, up from 6.3 per 100,000 children in 2008. The rate increased each year of the study by an average of about 30 percent. The findings will be published in the Annals of Allergy, Asthma & Immunology.

Emergency visits overall rose 8 percent at Lurie Children’s Hospital in the same five-year period, according to Janis Quinn, director of Lurie’s emergency department.

“Anytime one diagnosis goes up that significantly, you need to ask why - and that’s why you study it,” Quinn explained.

It is unclear how Illinois compares with other states because few have accumulated five years of data to track the condition, Gupta said.

Equally perplexing to scientists is how income and race affect food allergies. Previous studies had shown that the most-affected children were white or from higher-income families. Hispanic children and children from lower-income families were least affected, Gupta explained.

The most recent study showed that food allergy-related visits to the ER by Hispanic, Asian, black and white children all increased. Hispanic children, who previously had the lowest reported cases of food allergies, had the biggest increase of emergency room visits and hospitalizations, with a 44 percent average annual rise.

But one point is unequivocal: Food allergies are a growing public health issue that affect an estimated 8 percent of U.S. children - often with tragic consequences. In 2010, a seventh-grader died after eating Chinese food cooked in peanut oil during a party at her Chicago school.

Fifteen years ago, the American Academy of Pediatrics recommended that parents withhold peanuts from children at risk of allergies until age 3. But in February, new findings published in the New England Journal of Medicine suggested that babies who are regularly fed small amounts of peanuts from infancy may be less likely than others to develop peanut allergies, though the regimen should be attempted only under a doctor’s supervision.

Gupta knows the difficulties of navigating everyday life with a severe allergy not just as a pediatrician, but as a mother. She has an 8-year-old daughter who is allergic to peanuts and tree nuts.

“Food is everywhere, and even if a food doesn’t have an allergic ingredient, there’s always the risk of cross-contamination … so even if one flavor does not contain nuts, the scoop used to serve it may have just been in a nutty ice cream.”

Dr. Christina Cochran, an emergency room physician at Lurie, said she has seen more food allergy-related visits than in the past.

“I’m not at all surprised by these numbers,” Cochran said.

“It’s clear that there’s an increase,” she said, “but there’s also been an overall increase in education. Parents are recognizing symptoms, calling their pediatricians … and coming to the ER a lot quicker.”

Meghan Moreno is one of those parents. She said she doesn’t waste any time getting to the ER with her 7-year-old daughter, Sophia. In fact, the Shorewood, Ill., mother estimates that she has made about five trips to a nearby hospital for Sophia’s food allergy and asthma so far this year. When Sophia goes to the ER with a peanut-related episode, the intervention usually calls for steroids, such as Prednisone, she said.

“Her eyes swell up, she breaks out in hives, she has trouble breathing,” Moreno said. “It’s very scary.”

Sophia was diagnosed with the peanut allergy at age 3. Neither her twin sister nor her parents are affected with the condition. Sophia sits at a peanut-free table at Trinity Christian School in Shorewood but is so sensitive that just standing near a trash can with a peanut-butter-and-jelly sandwich can cause her to start to itch and wheeze. Many destinations - like the zoo - are simply off-limits.

“We don’t even leave the house without Benadryl, an EpiPen and an inhaler,” Moreno said. “Until you experience the terror, you just can’t know.”