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One out of every 13 children has a food allergy that could morph from mild to life-threatening without notice. Here's what every parent, coach and Sunday School teacher should know.

Everyone in the family knew Natalie Giorgi was allergic to peanuts. The 13-year-old Sacramento twin had been diagnosed as a child, she was careful about what she ate, and her parents knew how to use an Epi-Pen, the device that can stop a life-threatening allergic reaction with an injection of epinephrine.

But when Natalie went into anaphylactic shock after eating a treat at a summer camp in 2014, emergency measures failed and she died in her parents' arms. Her father, Dr. Louis Giorgi, later said, “We need to take simple steps to protect all of our children. There can never be another Natalie. And there should never be.”

Unfortunately, there are Natalies and near-Natalies every day. Every three minutes, someone goes to an emergency room because of a food allergy, and the number of children diagnosed is growing with bewildering speed.

One in 13 American children — think two children in every classroom — has a food allergy, according to Food Allergy Research & Education, an advocacy group based in Washington, D.C. Diagnoses of food allergies increased 50 percent between 1997 and 2011, according to the Centers for Disease Control and Prevention, and health professionals still aren’t sure why, although there is speculation that — ironically — our homes are too clean.

“We think one of the reasons that the prevalence of allergies and asthma has increased in the U.S. is how clean our environments are. It looks like that in some respects a certain amount of dirt and bacteria are good for the immune system, and help to bring balance,” said Dr. David Scott, an allergist with the Allergy and Asthma Center of Western Colorado.

For families untouched by food allergies, they may be a source of irritation, the reason their children can no longer pack peanut-butter-and-jelly sandwiches in their school lunchboxes. British comedian Ricky Gervais recently complained on The Tonight Show about a flight on which he was denied peanuts in first class because another passenger had a severe peanut allergy. “In my head, I’m thinking, why is that my problem?” he said to laughter. "I know this person would die, but I've never wanted to eat nuts more."

The joke enraged people with food allergies worldwide, who point out there is no such thing as a mild food allergy; they can morph without warning from an inconvenience to a cause of death.

"At any time, there could be an anaphylactic reaction," even if previous reactions have been mild, said Scott Riccio, senior vice president of education and advocacy for Food Allergy Research & Education, based in McLean, Virginia.

That's what happened with Natalie, who heartbreakingly apologized to her parents while she was dying. Until she began vomiting about 20 minutes after biting into a frosted treat made with Rice Krispies, her only reaction to consuming peanuts and tree nuts had been a lip rash at age 3.

We're No. 1

Riccio knows the risks of food allergies both personally and professionally; he and his wife learned that their daughter, now 11, had a peanut allergy just before she turned 2.

The diagnosis was the startling disruption of normalcy experienced by 6 million other American families who discover that their children can't eat things most people can eat without issue. Peanuts and tree nuts are the most common allergies, followed by eggs, milk, wheat and soy.

Food allergies are most common in childhood and, in some cases, can be outgrown, but 15 million children and adults in the U.S. have at least one, and the United States has more cases than any other countries, according to a 2013 study published in JAMA Pediatrics.

The authors found that at least one of the four types of atopic disorders — asthma, eczema, allergic rhinitis and food allergies — afflicts 34.5 percent of children born in the U.S., compared to 20.3 percent of children born in other countries.

Researchers have blamed everything from obesity, diet and climate, but agree that it’s likely a combination of environmental and genetic factors, including an overly sanitized society that has not allowed Americans’ immune systems to develop properly. “There’s good immunology research to help us understand this, but it doesn’t explain everything,” Riccio said.

Regardless of the cause, the prevalence of food allergies presents challenges not only for families with allergic children, but for schools, churches and other organizations that work with children and serve food.

If compassion doesn't motivate businesses to make accommodations for people with food allergies, the prospect of legal liability will. As food allergies grow, so do the number of lawsuits associated with harm and death.

Natalie Giorgi's parents sued the city of Sacramento, which runs the camp where the child died; the case is still pending.

In Boston, Panera Bread is being sued by the parents of a 5-year-old who was served a grilled-cheese sandwich containing peanut butter, even though the order indicated a peanut allergy. News reports have said a language barrier might have led to the mix-up, which was not fatal, but resulted in an overnight hospital stay.

And in Britain, the owner of an Indian restaurant will serve a jail sentence for the death of a 38-year-old man who had ordered food without peanuts, but was served a chicken dish with traces of nuts and collapsed after eating one bite.

The lawsuits illustrate the challenges that people with food allergies face every time they eat something not prepared in their own kitchens — as well those faced by churches and other organizations and groups that serve food to children.

Brotherhood Mutual, which insures churches and ministries, advises church leaders to train their staffs about how to spot and respond to an allergic reaction, and to train workers to use an EpiPen. With regard to food, "When in doubt, don't serve it," Brotherhood Mutual's guidelines say.

Symptoms to know

As for parents, they should suspect a food allergy and see an allergist or talk to their physician if a child has one of the risk factors: significant eczema, any other type of allergy (if you have one, you're likely to have others, Scott said,) and/or a parent with a diagnosed food allergy.

More than a quarter of children treated with Epi-Pens at schools, however, have never been diagnosed with an allergy before having a reaction.

This is why there are legislative efforts to make EpiPens as common as fire extinguishers across the country. (They require a prescription to obtain, but some people say everyone should know how to use one.)

Also, everyone should become familiar with the signs of anaphylaxis: wheezing, coughing and shortness of breath, accompanied by mouth itching and swelling of the tongue and lips. Health professionals recommend an EpiPen injection immediately after ingestion of a suspected allergen, not to wait until symptoms of anaphylaxis occur.

Natalie's parents, who started a public-awareness foundation in her honor, The Natalie Giorgi Sunshine Foundation, said often people just don't understand that a food allergy can be deadly.

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“We are not anti-peanut. We are pro-awareness. We’re for safety and simple accommodations. Thinking about it when you have a birthday party or the kids over after a swim meet. It doesn’t cost any more, doesn’t involve new equipment, nothing fancy. Just a thought. We need to know what we’re serving people, especially in public places," Dr. Giorgio said.

"Food allergies can obviously be very serious, and because the number of people affected by allergies is growing, this is everyone’s problem,” he said.

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