This article first was published by DFM News on July 10, 2012.

Less than an hour after her daughter’s first taste of peanut butter, Kirsten Cataldi found herself racing down the local drugstore’s child medication aisle with her swollen two-year-old on her hip, while speed-dialing her pediatrician on her cell phone. With the doctor on the phone, she tore open a box of Benadryl and measured out what would be the first of four doses required to dissipate the hives that had covered her toddler’s body. A trip to the doctor’s office the next day confirmed that Cataldi’s daughter, we’ll call her Sarah, was allergic to peanuts… and tree nuts, and coconut, and sesame. The doctor advised Cataldi that with such a severe initial reaction, additional exposure could send Sarah into anaphylaxis, a severe and potentially life-threatening allergic reaction that can include a drop in blood pressure, swelling of the throat, and inability to breathe.

Another mother, Aleasa Word watched her 13-month-old daughter, Kennedy, go into anaphylactic shock in her arms the first time she fed her cow’s milk. Soon, she was diagnosed with eleven life-threatening allergies. She has since outgrown several of them, though in some cases new allergies have popped up in their stead. When she outgrew her allergy to shrimp, Word’s seafood-loving family celebrated with a fish fry. “She literally ate two crumbs of tilapia and she almost died in my dining room.” Several weeks later, she had a reaction to fish being cooked in a restaurant. Even airborne, microscopic fish protein could send her immune system into overdrive.

Once considered rare conditions, food allergies now affect nearly one in ten children living in Delaware, a rate that surpasses the national average by nearly 20 percent, according to a Northwestern University study examining the geographic distribution of food allergies published this month in the medical journal Clinical Pediatrics.

This finding came as something of a side effect of the major focus of the study that has been widely publicized in the national press; children living in urban areas are more likely to suffer from food allergies than those living in suburban and rural environments. As Dr. Ruchi Gupta, lead author of the study explains, “We saw a stepwise decrease from urban centers to metro cities to urban outskirts to suburban areas to small towns, to rural.” In the process of charting prevalence against population density, Gupta and her fellow researchers at Northwestern also mapped out the prevalence by state naming Nevada, Florida, Georgia, Alaska, Maryland, Delaware, New Jersey, and Washington, D.C. as the 8 states with the highest prevalence rates, all with rates greater than or equal to 9.5 percent.

For many of these states, the findings are not necessarily mutually exclusive, says Ruchi Gupta, a practicing pediatrician, associate professor of pediatrics at Northwestern, and lead author of the study. “We found a huge disparity in the presence of food allergies in urban and rural environments,” says Gupta. Rates in urban centers were over 50 percent higher than in rural areas. For states like Nevada and Maryland, high rates in densely populated Las Vegas and Baltimore could push up averages for the entire state. Similarly, high rates found in Wilmington could have influenced Delaware’s overall rank. Despite being the second smallest state in the union, 2010 census data ranks Delaware as the eighth most densely populated state (including Washington, D.C. and Puerto Rico).

For the Cataldis, the Words, and other families living with the threat of food allergies everyday, this correlation holds little comfort. “Food allergies invade every aspect of your life,” says Cataldi. She packs a special cupcake for birthday parties and orders special Halloween candy that has not been manufactured on the same equipment as nuts. For now, Sarah attends a peanut-free daycare, but Cataldi worries about when she enters elementary school.

Linda C. Wolfe, director of School Support Services for the Delaware Department of Education says that Delaware public schools offer a higher level of care than in many states, because every public school in the state has a registered nurse on the premises. She adds that school nurses are trained to treat food allergies, including administering epinephrine, a hormone that naturally occurs in the body and is administered by injection to halt anaphylaxis. She adds that school nurses collaborate with the child, parents, and teachers to accommodate the child’s individual allergy plan. “In other schools, when you come to school parents are relying on a layperson to oversee the care of their child, whereas in Delaware, families have this nurse in place.”

Word has collaborated with school nurses all over the state through the Food Allergy and Asthma Multicultural Society of Delaware (FAMSOD), which she founded after scrambling to learn everything she could about advocating for and protecting her daughter. “[The nurses] are doing a fabulous job but they are stretched beyond belief.” She adds that she was not surprised to see Delaware ranked among the states with the highest prevalence. “I believe we need to do some environmental studies that are food allergy specific to try to identify why these children are having this.”

Gupta has been asking the question “why” for the past seven years in her research at Northwestern. However, as is often the case in medicine, studies can lead to more questions than answers. What about urban environments makes children more susceptible to food allergies? Do rural children’s immune systems become more robust because of their routine exposure to dirt, plants, and animals, as suggested by the hygiene hypothesis? Or perhaps air pollution from traffic, which also tends to correlate to population density, plays some role in creating hypersensitive immune systems.

Before researchers can tease out the “why” they must first have a firm hold on the extent of the problem. Gupta cautions that this is just one study and the implications for Delaware were not the major focus. Gupta suggests that Delaware researchers examine data on hospitalizations and emergency room visits. “If this is not something that is on the state’s radar already, it should be raising some questions,” says Gupta.

Currently, Delaware-specific data does not seem to be readily available. According to a Delaware Division of Public Health spokesperson, the DPH does not have any current work or expertise relating to food allergies. Wolfe says that the Department of Public Education does not currently track any chronic illnesses within the school system. Neither does Christiana Hospital, according to its senior manager of media and government relations.

People familiar with the study, and those who live with allergies, take this situation very seriously. Now the question that is left hanging: Will the state and the schools take it with equal seriousness?