It’s hard not to notice the rise in food allergies that has spread across most of our developed world in the past few decades. In the past 20 years alone, nut allergies have more than tripled. As of 2011, the prevalence of all food allergies in children has increased by 50% since 1997. Today, approximately 5.6 million children under the age of 18 have some kind of food allergy; according to Indian-American and Royal Oak-based allergist-immunologist Dr. Devang Doshi, that’s equivalent to two children per average American classroom.
While myriad arguments attempting to explain this universal phenomenon — the ‘hygiene hypothesis,’ for instance — blaming lack of exposure to allergens, hyper-sanitation, pesticides, genetically modified foods and global migration are gaining popularity, the real answer is still largely unclear. No matter how innovative the scientific world has become, there is still no factual explanation as for this rapid increase in the prevalence of food allergies. Moreover, according to Doshi, “as advanced as medicine is in Europe and in the United States and all the other developed countries, the only treatment for food allergy is strict avoidance. Nothing else.”
“Eggs, nuts, sesame, coconut, lettings, peas, chickpeas… it’s a long list,” says rising 8th-grader Simran Kheterpal with a giggle, when asked what allergies she’d been living with so far. Food allergies have been a part of her life for as long as she can remember. The biggest struggles take place in situations out of her own control. Simran knows well the constant need to “check and double check” her food while traveling and eating out at restaurants or relative’s homes.
“Whenever you eat something, there’s always an extra step if you have allergies” she says. That means putting in extra work and preparing far in advance to ensure her allergies are accounted for during for social occasions — outings that most kids her age consider simple, everyday happenings. Even when simply going out to a restaurant, Simran must carry in tow her multi-lingual ‘allergy cards’ as well as an EpiPen for good measure. When it comes to school events, summer camps, and other extracurriculars, Simran and her mother are accustomed to beginning preparations well in advance due to the countless email and over-the-phone conversations required to make sure her needs are accommodated.
Doshi, who has been practicing for over 20 years, tells me about a recent phenomenon he’s witnessed among his relatively large pool of Indian-American clients: Children of Indian parents born in the U.S. tend to be allergic to foods most common to the traditional Indian diet such as dairy, wheat, nuts, and lentils. Just as there is currently no proven explanation as to why allergies have skyrocketed across the board, there has not yet been much scientific discovery as to why specific allergens have been on the rise among specific populations. Yet, Doshi believes that a lack of exposure for first-generation Indian-American children to a wide variety of foods could be a major cause of this phenomenon. Immigrant parents, he suggests, “try very hard to keep [their children] on a very strict Indian diet” due to fears that they may develop an allergy or even “let go of their culture and stop eating Indian food altogether.”
For Indian-American families, food allergies may converge with other, more culturally or religiously influenced dietary practices. A traditional vegetarian diet, for instance, leaves little room for protein in the dairy, egg, and lentil-free diet a child with food allergies might have to follow. Even with Indian options that claim to be “allergen-free,” cross contamination through cooking utensils, airborne food particles, direct contact etc. is always a concern. Doshi says failure to make the appropriate adjustments — beginning to incorporate meat and dairy — to ensure adequate nutrition for children with food allergies could lead to severe developmental consequences not only to a child’s body, but their mind as well. Behavioral issues such as oral aversions, wherein an individual refuses to eat a certain food or group of foods due to the taste or texture, are common and serious concerns for young children with food allergies.
To avoid severe complications, families often must choose to sacrifice the diets they are accustomed to in order to make sure all dietary restrictions are accounted for. These kinds of sacrifices are routineto Simran’s mother Ruchi. “Being Indian, you know, we didn’t have a lot of meat in our normal meals growing up,” Ruchi says. “Given that Simran has allergies to eggs, nuts and lentils, [she] ends up eating a lot more meat and things that you wouldn’t normally think are normal in an Indian diet to kind of compensate.”
Ruchi also notes that the family has developed a few — her words — “odd habits” as a result of Simran’s allergies. Two glasses of milk per day, for instance, is a regular practice for Simran and her siblings.
Aditi Mukhi, a rising junior at Northville High School, says she’s actually had allergic reactions at Indian restaurants. “When they [Indian restaurants] are more authentic, they don’t really understand allergies, so they won’t make sure you don’t have an accident.” In Aditi’s experience, missing out on Indian and most other Asian cuisines — the result of her sesame allergy — has been particularly difficult. Watching her friends and family enjoy new, unique dishes she cannot can leave her feeling almost jealous of others who are able to freely explore so many cuisines without a second thought. “I love Asian food,” she says with a sigh. “I love all the flavors and I just want to experience that … I want to try all those things, and everyone’s like ‘It’s so good!’ but I can’t have it.”
The most difficult part of living with a food allergy, all agree, is the hidden, “behind the scenes” struggle — the everyday acts children and families have to take to ensure that they are well-prepared for every case and scenario, that they can trust food that is not entirely their own, and that no slip-ups occur in environments outside of their own control. Doshi terms these day-to-day struggles the “psychosocial aspect” of living with food allergies.
“Because of the nut allergies, she’s afraid to try different things and new things” Aditi’s mother, Anju says. She remembers a time at a birthday party where a hostess told Aditi that she didn’t think a seemingly safe brownie contained nuts, rather than answering her with a definitive no. Due simply to this brief hesitation, to Aditi, eating that brownie was completely out of the question and quite literally off the table. Even when traveling, anxieties over what and how she will get enough food overshadow all other concerns.
Children with allergies are faced often with pressures and decisions that become sources of real psychological distress. Aditi says the chronic stress of managing food allergies and the never-ending fear of experiencing a reaction has been “a big part of the reason I have really bad anxiety now.”
“It changes the way you think about things.”