Junior Riya Kumar struggles to breathe in the passenger seat of her car as she enters anaphylactic shock. Her dad tries to weave through the congested rainy-day beltway traffic as they rush to the hospital, but ultimately Kumar has no choice but to inject her leg with an EpiPen—something she’s never done before.

Just 15 minutes earlier, Kumar and her dad were shopping for groceries at Lotte Plaza, an Asian supermarket, when her dad bought a samosa. Kumar had asked the saleswoman if the fried pastry had nuts, and the woman confidently replied that it didn’t. Kumar remembers feeling suspicious, but she still ate it.

“It was a bad reaction. I was stressed that I wouldn’t get to the hospital in time,” Kumar said. “It scares me how easy it is for me to put my life in danger like that. All it takes is one little mistake.”

Kumar is severely allergic to peanuts, tree nuts, sesame and kiwi, and she’s one of many Whitman students with a moderate to severe food allergy to major allergens like eggs, wheat, tree nuts, peanuts, fish, shellfish and soy. The Asthma and Allergy Foundation of America reported in 2014 that 5.4 percent of children under 18 in the U.S. have food allergies. In an informal lunchtime survey of 60 Whitman students across all grades, 12 percent had an anaphylactic—potentially life threatening—allergy.

But this wasn’t always the case. Allergy rates among American children increased by 50 percent between 1997 and 2011. Many allergists believe the reason for this sharp increase is the hygiene hypothesis—the idea that the over-sanitization of society stunts the growth and development of people’s immune systems. According to this theory, overusing antibiotics and vaccines that fight off bacteria eliminate the harmful bacteria but also reduce beneficial bacteria in our immune systems. In less-developed countries, where children are more exposed to infectious organisms, allergy rates are significantly lower, allergist Rachel Schreiber said.

Another theory is that the lack of early exposure to common allergens is responsible for the high allergy rates in the U.S. One study conducted by professor Gideon Lack from King’s College in London found that peanut allergy rates in Israel are significantly lower than those in England, even though both are high-income, industrialized countries. Ninety percent of families in Israel purchase a peanut-flavored snack called Bambas for their kids. The study concluded this early exposure could prevent Israeli children from developing peanut allergies.

Since Lack’s 2015 study, many allergists have changed their stance on exposing young children to common allergens, according to the National Institute of Health.

“The recommendations used to be that we were telling parents to not expose babies to highly allergenic foods until they were two or three years old,” Schreiber said. “During that time, the rate of allergies continued to rise, so we said that’s a bad idea because maybe earlier exposure will help them.”

Scheiber’s office provides oral immunotherapy, which allows patients with allergies to peanuts, tree nuts and sesame to slowly develop a tolerance to their allergen. The treatment provides patients with very small doses of their allergen that they eat and then increases those doses every two weeks. Schreiber said it’s not a cure, but it’s a way that a patient can become able to tolerate an accidental exposure. At around nine months of treatment, the patient is usually able to eat their allergen with reduced consequences. Although it’s possible for an adult to receive the therapy, all of Schreiber’s patients are children.

Allergies can often be financial burdens for families. Most oral immunotherapy costs around $120 per session, and the therapy requires 20 to 25 sessions. EpiPens also cost $109.99 and are only one time use. On top of that, EpiPens expire after around 18 months, and people often have to throw them out without having used them. If someone is experiencing anaphylactic shock and they use their epipen, it only provides a temporary solution. Using an epipen has to be supplemented by an emergency room visit or 911 call.

“Epipens are really expensive. If you don’t have good health insurance, then you probably can’t afford to have a reaction,” Riya said. “Not to mention, sometimes you need two epipens per a reaction.”

Riya considered allergy immunotherapy when she was seven, but she said she was hesitant to eat peanuts when her whole life she had been conditioned to avoid them at all costs.

Raj Kumar, Riya’s dad, said that Riya began reading the labels of her own food checking for her allergens since the moment she could read. Riya is responsible and vigilant about her allergies, yet he and his wife still fear a bad reaction, Raj said.  

“We worry every day,” Raj said. “Every time she leaves the house, every time she goes to a party, every time she goes to a summer camp, we are sick to our stomach that she might have a bad reaction, that she might not have her EpiPen with her.”

Junior Anna Krush is severely allergic to all peanuts and tree nuts. Although the only reaction she’s ever had besides mild rashes was the swelling of her face when she was two,  Krush has a very high peanut count, meaning her likelihood of having a reaction is high.

Krush is on the waitlist for allergy immunotherapy at the Southern California Food Allergy Institute. She isn’t sure if she wants to go through with the treatment because she still needs to learn more about the program, but she’s excited about the possibility.

“It would be really nice if I could be able to manage my allergies before I go to college,” Krush said. “It would make it a lot easier.”

Stacy Krush, Anna’s mom, is focused on preparing Anna and helping her live with her allergy. Whenever Anna’s EpiPens expire, they practice injecting them into oranges, so that both Anna and her parents would know what to do in the case of a reaction. Stacy said the hardest part about having a child with a severe allergy is living every day with the worry of the unknown, because a reaction could happen at any time.

“You hope that you prepared her to ask the right questions, you give her the confidence if she doesn’t feel comfortable in any situation to choose not to partake and in the case that she has a reaction you taught her what to do,” Krush said. “It’s one of those things that you can prepare for everything, but absolutely there’s always that fear that something is going to happen.”

Barnard College freshman Jennie Yu (‘18) is allergic to dairy, eggs, peanuts, tree nuts, shellfish, legumes, seeds and tropical fruit. Her allergies are so severe that she can’t be in a coffee shop for too long because milk proteins in the air from steamed milk can make it hard for her to breathe.

Yu said that although she has a routine of grocery shopping every week and cooking for herself, she runs into problems with her allergies at school. Barnard requires students to purchase a meal plan for all four years, yet Yu can’t eat most of the food off the meal plan, which costs $6,790 per year. Although this cost is covered by Yu’s financial aid, she’s written an article for Columbia’s online paper about changing this requirement, which most colleges have for at least freshman year. Although Columbia and Barnard are independent universities, Barnard students are allowed to enroll in nearly any class at Columbia.

“In terms of cooking and grocery shopping, I’m used to it; but not being able to say ‘I’m not able to eat any of the food you’re serving, so I would like a smaller meal plan,’ that is the thing that has bothered me the most,” Yu said.

For Kumar and Krush, living with their allergies has become a part of their daily routine. Although both have had a few experiences where other students have been insensitive about their allergies, Kumar said most of her friends have been accommodating. Kumar rows on the crew team and buys snacks at Whole Foods with teammates every week for their daily commute to the boathouse in the fall and spring. While her teammates browse the store for snacks, Kumar stands in the middle of the store and each person runs back to her with their choices, so she can double check the ingredients and make sure the snack doesn’t contain nuts.

Krush said sometimes it’s uncomfortable to tell people to not eat nuts around her, and, for the most part, she finds her allergy frustrating and consuming.

“At every restaurant I go to I have to ask, and on top of that I have to make a decision whether I believe the waiter, and if I think they know what they’re saying,” Krush said. “You constantly have to be on alert.”

For Yu, it’s difficult living with her allergies, especially because food is a prominent part of New York culture and social life.

“The hardest thing for me is seeing Instagram posts about creative food, or my friends will go on and on about this new restaurant they tried, and I know that I won’t be able to experience that for myself,” Yu said. “At this point, I live vicariously through them, but it’s still tough to know that I can’t eat that ice cream cone or that doughnut.”

Yu hopes that more people can understand the severity of allergies. Whenever anyone questions her about her allergies, she tries to inform them so they become more aware and understanding.

“I wish more people knew that allergies are legitimately life-threatening. For example, if you tell a server ‘I’m allergic to nuts. Can I have the salad without the walnuts on it?,’ there’s a possibility that they just pick off the nuts in the kitchen and then serve you that same salad,” Yu said. “They don’t realize that food, this kind of innocuous object that won’t hurt anybody else, can kill you.”

A prior version of this article incorrectly referred to Riya Kumar as a sophomore. The story has been updated accordingly.