I Can't Eat That

Managing food allergies in children.

Peanuts, shellfish, milk, eggs, soy and wheat may sound like items on a grocery list, but in reality those foods are some of the most common and dangerous allergens to more than 12 million Americans who suffer from food allergies. Recent studies have found that almost eight percent of U.S. children under the age of 1 have allergies to food. As parents scramble to provide the best and safest food for their children, their efforts may do little good without the knowledge needed to guard against the dangers of food allergies.

Approximately 200 deaths a year are attributed to anaphylactic shock, a severe, rapid and life-threatening multi-system allergic reaction. Upon contact with a food allergen, the body releases chemicals into the tissues of the heart, lungs, digestive system and skin, and blood vessels widen so much that blood pressure plummets. Anaphylactic reactions can affect virtually any organ in the body. Even minute amounts of an allergen may cause an anaphylactic reaction that can lead to death within minutes if left untreated. Despite the fact that food allergy is a fairly common disease, it is among the most frequently misunderstood and misdiagnosed illnesses, especially among children.

Children whose parents both have allergies have about a 40 to 70 percent chance of developing allergies themselves. The risk drops to 20 to 30 percent if only one parent has allergies, and it goes down to ten percent if neither parent has allergies. Protecting children from food allergies begins as early as pregnancy. Many expecting mothers avoid eating any foods to which other family members are allergic; this may reduce the risk of their newborn developing food allergies. According to a 1995 study in the Journal of Allergy and Clinical Immunology, at-risk infants had a reduction in the instance of food allergies when their mothers abstained from cow’s milk, peanuts and eggs during the prenatal period.

While genetic inheritance is a factor in the development of allergies, “avoiding the early introduction of potentially allergenic food is the basic step in the primary prevention of food allergies in children who are at high risk,” says Dr. Robert S. Zieger, chief of allergy at the Kaiser Permanente Medical Center in San Diego. Cow’s milk, soy, eggs, peanuts and wheat account for 90 percent of food allergies among babies and children. Although some food allergies are normally lifelong (peanuts, nuts, shellfish and fish), milk and soy allergies are commonly outgrown by the child’s first birthday. A great majority of children outgrow their food allergies before the age of 3, and those with allergies after the age of 3 often outgrow them if they are not exposed to the allergen for a year or two.

Food allergies often go undetected and untreated for too long, as some of the symptoms closely resemble other ailments. Some symptoms of food allergies include itching, stuffy nose, wheezing, hives, watery or red eyes, diarrhea, constipation, nausea and fussiness. A food allergy can be so severe that any contact with the allergen will cause immediate swelling of the lips, tongue and throat. In many cases, eczema (a skin rash) is the only sign of a food allergy and may get overlooked. If your infant or child is suffering from any of these symptoms, consult your pediatrician, as it may be an indication of a food allergy.

Determining whether your child has a food allergy can be the most difficult part of the journey to safe eating habits. However, there are some very simple and easy ways of detecting food allergies in children, even infants. Michelle Harness, mother of three, realized her son had a food allergy when he was just 6 months old. “He would have frequent upset stomachs, diarrhea and constant colds,” says Harness. Concerned for her child’s health, Harness turned to her pediatrician for answers. Harness thought it may have been something that she was eating during the time she was breastfeeding, but her pediatrician suggested evaluating her son’s diet first. She began keeping track of what her son ate and watching for any signs of an allergic reaction. Within two months, Harness had detected the allergen by the process of elimination. She discovered that her son is allergic to apples. Once the food was detected, Harness made sure that neither she nor her son ate of any products that contained apples.

Discovering a food allergen is not always an easy process. One of the best ways of tracking down a food allergen is to prepare a food diary. Food diaries record when and what foods are eaten each day. This method helps you track symptoms and look for common factors. If breastfeeding, track what you eat 40 minutes to an hour before nursing. Often, this will help narrow down the allergen. Once completed, the food diary can be taken to your pediatrician or allergist to ascertain the next step. Although some parents are able to detect the allergen with the help of their general pediatrician, I recommend that you consult an allergist.

An allergist/immunologist is a physician specially trained to manage and treat allergies and asthma. Seeing an allergist is important for many reasons. Although you may have discovered a food allergen, that may not be the full extent of your child’s allergies. People who have one type of allergy are more likely to be allergic to other substances. Locate a local allergist/immunologist to perform diagnostic exams such as skin tests, serum IgE tests and oral food challenges to determine the extent of your child’s allergies.

During an oral food challenge, the patient is given a very small amount of the suspected allergen. An oral food challenge is the most accurate method of determining the extent of food allergies, but it can be very dangerous; never attempt an oral food challenge outside of a physician’s care. In some cases of food allergy, other associated allergens may produce the same allergic reactions as the primary allergen. Check with your allergist to ensure that you have detected all allergens for your child.

Detecting a food allergy is only the first step to a healthy and responsible diet for your child. Now it is up to you to ensure that your child is not exposed to the allergens. Always check ingredient listings before feeding anything to your child. Keep up with the latest Food Allergy Alerts by frequently visiting the Food Allergy and Anaphylaxis Network (FAAN) Web site and be aware that an allergenic food may come into contact with other food products during storage, processing or packaging, particularly with fresh produce. The Food Allergen Labeling and Consumer Protection Act (FALCPA), which just went into effect January 1, 2006, requires that all food manufacturers clearly state the presence of major food allergens such as milk, eggs, fish, peanuts, wheat and soybeans. But be mindful that it may take time for the food industry as a whole to become compliant with this new law, and international companies may have different policies regarding their packaging requirements. Always read labels carefully!

If you have a young child with a food allergy, always carry Table Toppers with you to provide a sanitary eating surface for your child when eating out. The disposable “eat-on” place mats have adhesive strips to keep them in place, and they form a barrier to guard against the allergens, dirt, germs and toxic cleaning chemicals commonly found on public restaurant tables. Watch for cross-contamination in restaurants and make sure the restaurant staff knows that they must use very clean cookware, utensils and surfaces when preparing your child’s food. To be safe, give your server a Food Allergy Restaurant Card (www.achooallergy.com/foodallergycards.asp) and ask him or her to give it to the chef. In easy-to-understand language, the Card explains the food allergy, warns about cross-contimination, lists dangerous foods and ingredients and informs restaurant employees that immediate emergency medical care will be needed if the allergenic food is consumed by your child.

In addition to arming yourself with information, you must also inform all caregivers of your child’s food allergy. It is the next essential step to ensure that your child is not exposed to an allergenic food. Make sure to notify daycares, schools, camps and caregivers of your child’s allergy. Also, establish a plan of action that provides information regarding your child’s allergies, including written medical documentation, instructions and medications. Be sure to provide properly labeled medications and replace them after use or upon expiration. Food allergy t-shirts (www.achooallergy.com/food-allergy-shirts) and clearly marked lunch boxes give a clear indication of your child’s sensitivity to certain foods; visual indicators such as these are particularly valuable in situations such as summer camp, where some adult supervisors may not know about your child’s food allergy or may easily forget about it.

Guiding your children through the course of life is not an easy task, but you need to ensure that you have equipped them with the knowledge and skills to manage their allergies. Most importantly, set a good example for your children by always reading labels and asking about ingredients; it just might save their lives.