The single cashew was an innocent offering by a grandfather to his 21/2-year-old granddaughter. But what followed was a harrowing experience that still reverberates in the life of Kristen Baehr of Overland Park.

Her daughter, Sophie, broke out in hives over her face and chest immediately, then threw up. En route to the hospital, she lost consciousness, so the family stopped at a fire station, and she went the rest of the way by ambulance.

Sophie, now 6, was saved by the epinephrine injections and emergency care she got, her mother said. And that was how the family learned that Sophie and her twin brother, Wyatt, have peanut, tree nut and shellfish allergies.

Sophie has a level-5 allergy, meaning she can’t touch these foods or eat food manufactured in a plant that also processes peanuts or tree nuts, Baehr said. Wyatt’s allergy is less severe. But they both carry EpiPens for life-saving injections if they are accidentally exposed.

Severe food allergies are one thing when children are babies, but quite another when they begin leave the nest to navigate the grade school world of birthday parties and summer camps, say parents who deal with the issue.

“It’s truly a life-changing experience,” said Colleen Connor, of Lenexa, who manages the Food Allergy Connection parents’ support group for the Johnson County area. Food Allergy Connection offers support for parents of allergic children at several locations in Kansas City under the umbrella of the Asthma and Allergy Foundation of America.

For families with severely allergic children, participation in such things as art class or day camp involve calling ahead with a long list of questions, Connor said. How experienced is the staff with the signs of an allergic reaction? Do they know how to use an EpiPen? Will parents be allowed to send their own snacks?

“You have to think 10 steps ahead,” said Connor, whose son, Nate, 11, has a peanut allergy.

Often that means a parent will sit through the event, especially with younger children, she said. It also may mean passing up some activities where safety can’t be guaranteed.

“The truth of the matter is, sometimes families with food allergies end up doing fewer camps or no camps to save ourselves the worry and hassle of figuring everything out,” she said.

That was the case recently for Baehr with a cheerleading camp and dance class she had qualms about. And another activity she considered, the Starlight Theater/Kansas City Zoo Act Like an Animal camp, says on its website that it can’t guarantee a nut-free environment because of the proximity to the animals’ food.

Food allergies are becoming more common, according to the Food Allergy and Anaphylaxis Network. The network cited studies from the Center for Disease Control that show peanut allergies in children have tripled from 1997 to 2008, and overall food allergies have increased 18 percent.

Organizations that offer kids’ activities are also becoming more aware. Sophie and Wyatt were able to attend art class at ARTrageous Creative Studio, a private business in the home of Julie Flanagan of Prairie Village. Flanagan had the training for dealing with children’s health issues when she taught art in grade school, she said.

Flanagan asks parents about allergies and health issues when they sign up, and then makes every effort to accommodate them, she said. “In my 20 years of formal education, (allergies) have increased a lot, but awareness of the protocol issues has increased along with it,” she said. “It takes a village to raise these kids and we all have to be on the same team.”

Blue Valley Recreation tries to prevent allergic reactions by asking parents to disclose them on the registration form, and then by being very careful at snack time, said Joann Miller, program coordinator.

“We try to identify it way ahead of time,” said Miller, who has a peanut allergy herself.

Blue Valley provides ingredient lists of any snacks and wipes down the tables ahead of time, she said. Also, the same person stays in the snack area each day of camp so he or she can become familiar with the kids, Miller said. And the staff is trained in how to handle an emergency, although there never has been one.

“The first rule of thumb is to avoid having the situation in the first place,” she said.

At Johnson County Parks and Recreation, snacks tend toward the safer — and healthier — choices of fresh fruit over chips or crackers, said Kim Chappelow-Lee, children’s services manager.

Children with allergies also sit at a separate table so they won’t come in contact with other children’s food, she said.

“It seems sad to segregate them, but that really is the safest, most effective practice,” Chappelow-Lee said.

The staff is consistent and trained in dealing with reactions, she said.

Having a staff that is knowledgeable is important, because children can’t necessarily be trusted to stick themselves with a needle when they’re in trouble, Connor said. It hurts. And anyway, it’s possible that they may pass out before they get to the EpiPen, she said.

Keeping vigilant is a lot of work for the parents as well. Baehr goes to the registration day of any activity to be sure the staff knows of her kids’ allergies, and her kids sport temporary “Say No to Nuts” tattoos because they don’t like wearing medical bracelets.

As they get older, she’s also been using flashcards to teach them various nut words that may be on food packaging, so they can read the packaging themselves.

Most friends and staff have been understanding, Baehr said. “I do worry they’re not invited to things as much as other kids,” she added.

In a dream world, no snacks would be provided at group activities, Connor said. “However, that’s not possible when they’re there all day. I’d just like everybody to be educated that food allergies are serious,” she said.