By Maggie Downs
The Cincinnati Enquirer

SYMMES TOWNSHIP - It's 11:30 a.m. when Joe Greenlee files into the middle school cafeteria at Cincinnati Hills Christian Academy with his classmates.

Inside, Joe goes one way. His friend, the one holding a peanut butter sandwich, walks the other.

They can't sit together.

For Joe and six other food-sensitive children at his school this isn't just lunch; it's a potentially fatal half-hour.

That's why the eighth-grader sits at a separate table, segregated from his classmates. (His friends can join him, but only if they don't bring along foods containing nuts or nut oils.)

This has been Joe's life since the fifth grade, when the middle school established a peanut-free area for him. At other schools, he ate in isolation.

"It's hard to not worry when you know one wrong bite can kill your child," said Joe's mother, Nancy Greenlee of Sycamore Township. "The table protects him."

Joe and his classmates are among an estimated 8 million Americans - 2.7 percent - who suffer from food allergies. Of those, 3 million are allergic to peanuts, the leading cause of severe allergic reactions in the United States. Each year, up to 100 deaths are blamed on peanuts.

Such allergies are on the rise. Dr. Amal Assa'ad, a pediatric allergist at Cincinnati Children's Hospital Medical Center, recently built a database from patients that showed peanut allergies occur more frequently than cow's milk or egg allergies, which traditionally were more widespread.

No one knows for certain why this is happening, but a study released this year found topical ointments containing peanut oils applied early in life could lead to allergies as an adult. Another theory is that roasting peanuts could make them more allergenic.

Nuts at school

As the number of peanut-sensitive children increases, schools are finding ways to cope.

RESOURCES

• Cincinnati Food Allergy Awareness, Support and Training (FAAST): www.faastcincy.org; e-mail: help@faastcincy.org; (513) 588-6863; PO Box 565, Loveland 45140. • Food Allergy and Anaphylaxis Network: http://www.foodallergy.org • American Peanut Council: http://www.peanutsusa.com • American Academy of Allergy, Asthma and Immunology: http://www.aaaai.org

Schools like Cincinnati Hills and Cincinnati Country Day School in Indian Hill opt for peanut-free tables, which are rapidly becoming fixtures in Tristate cafeterias.

That option isn't without controversy. Some think the peanut-free tables further ostracize children who already have trouble participating in social events and field trips. They advocate just the opposite - places where students who eat peanut products sit together.

Cincinnati Hills administrators chose the peanut-free area after discussions with parents, teachers and students.

"It's difficult, because you don't want the peanut-free table to be like isolation," said Cincinnati Hills middle school principal Diane Blackburn. "That's why we tried to keep ours pretty close to the other tables and give it a cool name."

The table in the "Peanut-Free Zone" is small and square, while the others are long rectangles. It sits a few feet away from the others, tucked into a far spot in the cafeteria.

Industrial antibacterial wipes, rather than regular cleaning fluid, are used to clean the peanut-free table and chairs after each lunch period.

Despite the disparities, the peanut-free zone has become kind of hip.

"It's fun. I get my own place to sit with my friends," said sixth-grader Brooke Spicer.

The middle school has almost entirely banned peanuts. The cafeteria never serves anything with peanuts, nuts are forbidden from school functions and the teachers' lounge is peanut-free.

While most Tristate schools handle food allergies on a case-by-case basis, some have additional nut policies:

• In Bellevue schools, students are asked to keep the peanuts at home. Also, lunchroom cooks do not use peanuts in any form.

• At Princeton City Schools, menu items identify if foods contain nuts. Appropriate substitutes are provided for any allergic students.

• Hilltop Elementary School in Wyoming previously had an "allergy table" for students affected by such things as milk and peanuts. The most sensitive students moved on to the middle school, eliminating the need for a separate table.

Bite of reality

"I think every parent of a child with food allergies has at one time been called too sensitive or paranoid," said Jennifer Redmond, executive director and founder of Cincinnati Food Allergy Awareness Support and Training.

"(But) I'm not talking about a rash here. Unless you have been in a position where your child has almost died, you don't understand."

PEANUT ALLERGIES 101

Common foods that cause allergic reactions: Milk, eggs, peanuts, tree nuts (walnut, cashew, etc.), fish, shellfish, soy and wheat. Most common symptoms after ingestion: • Itching and swelling of the lips, tongue or mouth. • Itching and/or tightness, hoarseness, and hacking cough. • Hives, itchy rash, swelling of the face and/or extremities. • Nausea, abdominal cramps, vomiting and/or diarrhea. • Shortness of breath and/or wheezing. • "Thready" pulse. Symptoms appear: Typically within minutes to two hours after the person has eaten the food to which he or she is allergic. These reactions are called anaphylaxis. That is: a sudden, severe, potentially fatal, systemic allergic reaction that can involve various areas of the body. Anaphylactic reactions can be mild to life-threatening. The danger: Anaphylaxis causes 30,000 trips to the emergency room and about 100 deaths each year nationwide. Individuals who are allergic to foods and have asthma are believed to be at a higher risk for developing an anaphylactic reaction. If someone has an anaphylactic reaction: Call 911 and request epinephrine or check if person carries a supply. Get the person to a hospital as soon as possible. He should plan to stay at least four to six hours. Source: The Food Allergy & Anaphylaxis Network

The problem is a severe allergic reaction known as anaphylaxis. Symptoms, which range from diarrhea to hives, occur within minutes to two hours after contact with the allergy-causing substance.

Redmond of Loveland prefers to use the technical term when she discusses the allergies of her 11-year-old son, Brian.

"If I say 'food allergy,' it's easy for people to brush you off. They think it's no big deal," she said. "But say 'anaphylaxis' and they listen."

Food-induced anaphylaxis causes 30,000 trips to the emergency room each year, according to the Food Allergy & Anaphylaxis Network.

So just don't eat peanuts, right? It's not that simple - especially for people like Joe, who is also smell and touch sensitive.

Once when Joe dropped his pencil in class, a child who had recently eaten peanuts picked it up. When Joe grabbed the pencil, he broke out in hives and couldn't breathe.

The last time he attended a Reds game, the scent of roasted peanuts gave him hives for two weeks.

"The kids used to tease me about it when I was younger. But when they realized how serious this is, they stopped," he said.

Many products contain peanuts or peanut-containing ingredients. Some are listed under different names (for example, hydrolyzed plant protein), while others aren't listed.

Peanut-free products can be cross-contaminated by other foods - often chocolate, baked goods and cereals.

Peanuts are even found in some kitty litter, wallboard, fireplace logs, paper and animal feed.

"It's tough to cope with the fact that your child is safe nowhere," Redmond said. "Even in your own home, there are things that can get in."

Field trips and school parties are also problematic.

"So many things at school revolve around food," said Cynthia Betcher, Cincinnati Hills high school nurse and board member of Cincinnati Food Allergy Awareness Support and Training.

"The best thing parents can do is to have some snacks already at school, so their kids don't have to abstain from the fun."

This became an issue recently as tension heightened in Iraq. Safe, peanut-free food was necessary for these children as schools prepared for possible lockdowns.

The challenges don't change with age, either. Kids are messy, so it's tough to keep offending foods from young children. But teen-agers can be just as much at risk.

"They have this 'It's not going to happen to me' attitude," Redmond said. "Plus, they have more exposure to different things."

And more exposure to the opposite sex. A report in the June 6, 2002, New England Journal of Medicine showed that more than 5 percent of people with severe food allergies had a reaction prompted by kissing. This can occur by locking lips with someone who has eaten nut products up to six hours prior to smooching.

Controlling allergies

There is no cure to peanut allergies.

In the event of accidental ingestion, epinephrine (adrenaline), is the medication of choice for controlling a severe reaction. It is available by prescription as an EpiPen auto injector.

At the Cincinnati Hills middle school, many staff members carry EpiPens in the event of an emergency. Allergic children carry their own, too.

Emotional support is also available for families with food allergy sufferers. Cincinnati Food Allergy Awareness Support and Training , for example, was started by Redmond in 1997 with nine members. Today there are 300.

"As your child gets older, they need to know that there are other kids out there like him or her," she said.

The group does educational counseling, too, including a back-to-school program for schools and parents each year.

"I've seen an enormous change in Cincinnati since we first started," Redmond said. "Schools are increasingly more accommodating."

More hope is on the horizon.

The first drug designed to protect those who are severely allergic to peanuts is slowly moving toward federal approval.

"I've got a lot of hope that by the time my son is college age, there will be something other than avoidance and an EpiPen out there," Redmond said. "But we have to tackle this with the mentality that there might not be."

The still-experimental drug, called TNX-901, significantly increased the threshold of sensitivity to peanuts during trials.

"It'll change our lives," Greenlee said. "Then I'll just have to say, 'No drinking. No driving.'

"Not 'No peanuts.'"

E-mail mdowns@enquirer.com