A food allergy? Now what?

Shortly after my oldest daughter turned 1, a friend reminded me that this particular milestone meant I could now let her eat peanut butter (the recommendation at the time).

What a wonderful idea, I thought. And so one day I whipped up a PB&J for her lunch, she ate it and then she settled down for a nap.

When she woke up about an hour later, I was alarmed to see huge red hives covering her legs.

Although Benadryl cleared up her hives that day, we followed up with the doctor and received a diagnosis that unexpectedly rocked our carefree world: Our toddler was allergic to peanuts and tree nuts — an allergy that had the potential to be deadly!

Flash-forward to the present: My daughter is 17 and is, by all accounts, thriving.

Still, it took time for our whole family to adjust. And food allergies remain an everyday concern.

Unfortunately, parents receive this scary diagnosis every day: The Food Allergy Research and Education organization estimates that 1 of every 13 children in the U.S. now has a food allergy.

That’s about two kids in every elementary school classroom.

More and more people are beginning to understand what it means to keep someone with a food allergy safe: Strict avoidance is currently the only treatment; there is no cure. But many parents and other caregivers are understandably baffled about what it means to be allergic to a common food.

What should you do if your child’s pediatrician or allergist delivers this news? And how can you help your child stay safe at home and when you send him or her out into the world?

doctor and baby

GET EDUCATED

First: Start studying. It can be overwhelming, so begin with the basics.

When someone eats — or sometimes even touches or smells — a food he or she is allergic to, the immune system reacts. Reactions can be minor or severe.

Dr. Doug McMahon, an allergist at Allergy and Asthma Center of Minnesota who also sees patients at the University of Minnesota, cautions: “There is no way to predict how severe a reaction will be. Having a mild reaction one time does not mean the reaction will not be severe the next time.”

A severe reaction is called anaphylaxis and, if not treated promptly, can be fatal.

That’s why parents of young children with food allergies always need to carry an auto-injector of epinephrine/adrenaline, such as an EpiPen, a medication that stops or reduces the dangerous effects of an anaphylactic reaction, such as throat swelling or reduced blood pressure.

Parents need to know how to use epinephrine — and be prepared to do so.

McMahon said: “Know that a reaction is probably going to happen at some point in your life, so be prepared.”

READ LABELS

You can, of course, start by avoiding the allergen in your child’s diet. But avoiding a single ingredient might not be enough to keep your child safe.

Cross-contamination, which can happen through manufacturing or packaging processes — or even from using utensils or prep areas that contain trace amounts of the allergens — can expose your child to risk.

Allergens are also often present in foods that parents might not even think about checking: Pretzels, jellybeans and pizza can sometimes contain nuts, for example.

Under U.S. law, companies that make processed food must plainly list eight major allergens that pose risk to consumers. 

Many also voluntarily include advisory warnings on products that may include an allergen even though it isn’t an actual ingredient, including phrases such as “may contain tree nuts,” “manufactured on equipment that processes products containing peanuts” or “processed in a facility that uses milk.”

Parents must thoroughly read all food labels — and use extreme caution when it comes to homemade or restaurant foods that simply don’t come with labels.

kid with epicene

Parents of children with severe food allergies always need to carry an auto-injector of epinephrine, such as an EpiPen.

SPREAD THE WORD

Parents should make sure their child’s caregivers understand food allergies, can recognize signs of a reaction and are trained in using epinephrine.

Work with your child’s allergist to develop an action plan. This will spell out how to handle to different reactions, when to call 911 and who else to contact in an emergency. 

Give a copy to your child’s caregiver and school — and review it annually.

McMahon stressed the importance of making sure people understand the difference between a food allergy and an intolerance.

Most food intolerances, such as lactose intolerance, affect the digestive system only and are generally not life threatening.

An allergic reaction is an immune system response that affects the entire body and can lead to severe or even deadly reactions (anaphylaxis).

Celiac disease is sometimes mistakenly confused with a wheat allergy.

Celiac disease is not an allergy, but rather an autoimmune disorder in which eating gluten damages the small intestine. Gluten, which is present in a variety of grains such as wheat, doesn’t trigger life-threatening reactions the way a severe wheat allergy can.

Celiac disease is serious in other ways, however, and can cause intestinal tissue damage and other complications if the condition is not addressed.

INVOLVE THE KIDS

Another part of staying safe is educating children who have allergies — and their friends and their families — early and often.

Ana Hawkins of Woodbury, whose 3-year-old daughter, Juliana, has food allergies, said: “We try to teach her she has peanut, tree nut and egg allergies. She knows that we don’t share food.”

Tara Fellman of Shoreview, whose son, Spencer, has a food allergy, didn’t want to become a “crazy nut parent” when she was first adjusting to the news.

But that’s changed.

“Now I wear it as a badge,” she said. “Early on, I didn’t want to upset the apple cart.

“The school nurse used to say to us: ‘You are his advocate. Your child deserves to be safe.’”

REASONS FOR OPTIMISM

Along with the rise in food allergies in the U.S. has come more research — and reason to hope.

Children often outgrow certain food allergies (especially to milk and eggs) and those who don’t may benefit from new treatment options such as oral immunotherapy/desensitization.

Promising studies on a peanut patch, among others, are also under way.

Some restaurants now have allergy-accommodating menus. Disney World is known — among allergy families — as a haven for eating out with less worry.

Throughout the country, daycare centers and schools — from preschool through college — are responding to what some are calling an allergy epidemic and learning to address the needs of a growing number of young people with food allergies.

Changing laws that recognize this “invisible disability” are aiding in this process. Indeed, many children with food allergies qualify for protection under the Americans with Disabilities Act, which means they can’t be discriminated against based on their disability/allergy.

And some kids have 504 Plans at their schools, which outline how the school will accommodate a child’s specific needs so he or she can fully participate in all aspects of school.

Another silver lining: Though food allergies can be overwhelming and sometimes lifelong, they can also result in healthier diets and even, some parents say, greater empathy for others.

With my daughter, I’ve learned that kids with food allergies gradually gain the tools and confidence they need to take over for their worried parents.

They learn to become their own advocates, develop their own strategies for staying safe and then go about living their lives.

The big 8

While more than 160 foods can cause allergic reactions in people with food allergies, U.S. law identifies the eight most common allergenic foods, which account for 90 percent of food allergy reactions.

The following eight foods (and any ingredient that contains protein derived from one or more of them) are designated as major food allergens by the Food Allergen Labeling and Consumer Protection Act of 2004. Learn more at fda.gov.

  • Milk
  • Eggs
  • Fish
  • Crustacean shellfish
  • Tree nuts
  • Peanuts
  • Wheat 
  • Soybeans

peanut butter

When is peanut butter OK for kids?

Most allergists now recommend introducing highly allergenic foods, such as peanut butter, eggs and dairy, to babies early on — often as young as 6 months — rather than delaying those foods.

However, if you have a history of food allergies in your family, your doctor/allergist may want to do a food allergy test, such as skin testing, before you feed those foods to your child.

Read about the latest peanut butter recommendations at mnparent.com/pb.


Cathy Broberg is a freelance writer and editor who lives in Lino Lakes with her husband and two teenage daughters. She blogs about food allergies at sustenancewithfoodallergies.com