WEST PALM BEACH, Fla. -- Oakley Debbs had a deadly combination: a severe allergy to nuts and acute asthma. And in a moment when the 11-year-old's guard was down over the Thanksgiving holiday, a bite of coffeecake was all it took to fatally undo years of caution.
What torments his parents is they thought they had stopped the allergic reaction in its tracks.
That Wednesday evening, when Oakley's lip began to swell, they gave him Benadryl, a drugstore remedy that counters the symptoms. It was more than an hour later, after Oakley had played, showered and gone to bed, that he complained his tummy hurt. He threw up and felt no better even as his mom, Merrill Debbs, lay beside him rubbing his belly. He threw up again.
Believing her son was on the brink of an asthma attack, she ran for his medication, and her husband, Robert Debbs, stepped in.
Oakley Debbs' heart stopped in a hospital room at 1:55 a.m. that Saturday. But, says Robert, "He died in my arms Wednesday night when he was convulsing. He just went limp."
Though paramedics revived Oakley's body, the fifth-grader, who had boundless energy and a fondness for red footwear, was gone even then, Robert said.
So rather than plan for a December holiday, the Debbs threw themselves into organizing a soccer tournament in Oakley's name and planning a funeral for him -- both on Dec. 10.
In between, they absorbed a calamitous lesson in the dangers of underestimating a food allergy while focusing on what they thought was the bigger threat: asthma. It's a lesson they want to share as quickly and as loudly as they can.
"We don't want this to happen to anyone else," Robert said.
Deaths defy tracking
It's challenging to definitively say how often food allergies kill in the United States.
Data kept by the nation's authorities at the Centers for Disease Control and Prevention are difficult to get. Officials there refer to statisticians at the Division of Vital Statistics who have plumbed the CDC databases to tease out deaths tied to food allergies and found that 18 people died in 2014 from "anaphylactic shock due to adverse food reaction."
The deaths in each year for the past 15 have ranged from a low of seven in 2002 to a high of 21 in 2013.
But that is probably not the full picture, said Dr. James Baker, an allergist and chief executive of the organization Food Allergy Research & Education, which bills itself as working on behalf of the 15 million Americans with food allergies.
"Part of the problem is you'll have a story like this and it will be marked as death by asthma. It's a coding problem. And often when people are brought into the hospital, they don't know what triggered it," Baker said.
Of one thing, Baker is certain: "The most closely aligned risk factor for death from a food-allergy attack is uncontrolled asthma."
A nut-free table
The Debbs are all too versed in the damage asthma can cause.
"I was thinking at first, oh, this is like the time he was 6 when he had an asthma attack," Merrill said. "He spent eight days in the ICU."
Oakley carried his inhaler with him 24/7, Merrill said. "He slept with it."
Still, it did not stop the West Palm Beach boy from playing soccer, quarterbacking a Rosarian Academy flag football team, running and jumping and more.
"We'd had run-ins with nuts before, but they were easily resolved," Robert Debbs said in a pause after picking out Oakley's grave site and before writing his obituary.
Oakley sat at a nut-free table during school lunch. (A best buddy who sat with him there and also has food allergies has stopped eating in the wake of Oakley's death, Merrill said. "He's scared.")
"We just didn't eat nuts. There were no nuts in our house. We once had to leave a party because there were nuts," Merrill said. "Peanut butter touched him and he had a blister."
A deadly combination
One in every 13 children has a food allergy. A 2013 study released by the CDC shows the numbers are on the rise, increasing by about 50 percent from 1997 to 2011. And the reason for that jump remains unclear, FARE's Baker said.
Asthma is a condition that inflames the tubes that carry air to the lungs. During an attack, the airways become swollen and the muscles around them contract, making it difficult to breathe. Inhalers often deliver steroids to stop the inflammation. At their worst, asthma attacks can cause respiratory arrest -- the lungs fail.
Allergies also inflame and when they do, that can exacerbate asthma, Baker said.
Even alone, allergies can also be deadly in severe cases, releasing a flood of chemicals from the immune system that can send a body into anaphylactic shock.
Specialists often report back to parents that their child's allergy is mild or severe, but Baker says it's "almost impossible" to be precise when it comes to a food allergy.
"The only way to tell is with exposure to food," Baker said. "It's not absolute. People can have a mild reaction, I have had people who have reactions only if they exercise or drink alcohol afterwards."
Baker wasn't able to speak to the details of Oakley's death, but he said food allergies can be tricky to gauge. A swelling lip or a spreading rash are visible alerts that an allergic reaction is taking place. Addressing the reaction with Benadryl or the like may dispel the outside signal but may not stop what's going on inside.
"What often happens, Benadryl will sort of mask the symptoms," Baker said.
And that problem can get worse as the food is digested and passed into the bloodstream, he said.
When someone is hit with the one-two punch of allergy and asthma, Baker said, both must be treated.
Red sneaker brigade
Merrill can recall multiple occasions when people shrugged off her concern about nuts and the danger they posed to her son. There was the time, maybe six years ago, when the family went to see Oakley's sister, Olivia, perform in a dance recital and the concession stand was selling nuts.
Merrill objected and said having them in the theater could end with her calling 911 should Oakley merely touch one. The concession operator stood firm -- but a man in line paid heed, bought out the stand's stash, collected the nuts and tossed them in the trash.
"When a mom tells you it's life-threatening, you listen," Merrill remembers him saying.
Yet, in recent years, their focus had been on asthma. Oakley, for example, did not carry an EpiPen, designed to deliver a life-saving shot of adrenaline in the case of an allergic reaction.
Were they unprepared? "Completely," Robert said.
Last week, FARE joined with the National Academies of Sciences, Engineering and Medicine to call for more research into what they called "many fundamental and as-yet unanswered questions about the origins and prevalence of severe food allergies in the United States."
"For too long, food allergies have been minimized, little understood and stigmatized," Baker said.
Oakley's family has become an unintended flag-bearer for this cause -- the "flag" taking the form of a red sneaker.
"He had a little bit of a collection -- red cleats for soccer, red Nikes, red Pumas -- to be cool. And maybe three other pair of red sneakers he'd outgrown," Merrill Debbs said.
Oakley's grandmother, Cathy Duemler, is wearing a pair he outgrew. Friends and family are wearing them, too.
They've staked out the online domain name redsneaker.org, Merrill said. And they're promoting the hashtag #LIVLIKEOAKS -- a play on sister Olivia's name and his. (Yes, it's an O thing, even the dogs' names begin with the letter O. They are the uh-Os, Robert jokes, seeking any brief moment of levity.)
The holidays can be particularly treacherous, Baker warns. "Thanksgiving has long been a very dangerous time because people are eating out, food comes in to the house." Ingredients often are a mystery.
The Debbses were out of town, visiting one of Robert's sisters in Maine when the disaster slipped into their home, delivered in a box of holiday treats from a well-known brand.
It looked like pound cake, Robert said. Now, of course, he knows that it was coffeecake -- walnut coffeecake. "It was just sitting on the counter."
A Section on 12/12/2016