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Managing Food Allergies in Children

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 one 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 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 10 percent if neither parent is allergic. 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. Zeiger, 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 life-long (peanuts, nuts, shellfish, and fish), milk and soy allergies are commonly outgrown by the first birthday. A great majority of children outgrow their food allergies before the age of three, and those with allergies after the age of three 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 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 six 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 by 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 found that her son is allergic to apples. Once the food allergy was detected, Harness made sure that neither she nor her son partook 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 thirty 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 what the next step will be. Although some parents are able to detect the allergen with the help of their general pediatrician, we recommended 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 children. Now it is up to you to ensure that your child is not exposed to their allergen(s). 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) website 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 and practices regarding their packaging requirements. Always read labels carefully!

"I didn't offer anything with apples and never kept it in the house, and I read everything," advises Harness. When eating in restaurants, Harness always checked the menu and asked for substitutions for anything that her son couldn't eat. 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. These 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 the food. To be safe, give your server a Food Allergy Restaurant Card and ask him or her to give it to the chef. In easy-to-understand language, the Food Allergy Restaurant Card explains the food allergy, warns about cross-contamination, lists dangerous foods and ingredients, and informs restaurant employees that immediate emergency medical care will be needed if the allergenic food is consumed.

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 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. Providing your child with visual reminders of their allergies will also guarantee that their allergy won't be forgotten. Food Allergy T-Shirts and clearly marked lunch boxes give a clear indication of your child's sensitivity to certain foods; visual indicators such as this 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. You should also review policies and procedures with school and camp staffs to ensure that they can accommodate the needs of your child.

As your children grow, empower them to take control of the food allergy. After all, the allergy could affect them for the rest of their lives, so encourage them to be proactive in the care and management of their food allergies and reactions. Regularly remind them that they should never trade food with others, nor should they ever eat anything with unknown ingredients. Even if a food does not initially contain the allergenic food as an ingredient, your child could be exposed to the allergen due to cross-contamination. A pan, dish, utensil, or surface used in food preparation could have been contaminated with a food to which your child is sensitive. Plan meals and pack safe and healthy foods to avoid the risk of allergic reactions. If your children are ever unsure of the best course of action, they should always ask an adult. Designate a trustworthy adult for your child to inform in emergency situations, if they ever think they may have ingested an allergen, or if they feel symptoms arising.

Protecting children from food allergies also means that you have to protect them from themselves. "Research shows that most fatalities due to food allergy occur between the ages of 10 and 19," says Anne Munoz-Furlong, founder and CEO of FAAN. This age group is at the most risk because there are a lot of social pressures placed on teens to "fit in." A survey of teens/pre-teens with food allergies and their parents indicates that social ramifications have much to do with how young people manage their disease as they approach young adulthood. The findings from this study demonstrate that teens are more concerned with the social isolation that a food allergy may cause rather than the dangers that the allergy poses. "What we begin to see during the transition from childhood to young adulthood a time of moving out from under the wing of mom and dad and deeper into peer circles is a shift from fear of an allergic reaction to fear of not fitting in socially because of the food allergy," Munoz-Furlong says. Although teens may not think it's socially acceptable to adhere to their food restrictions, there are easy and inconspicuous ways to manage their food allergies. Make sure your teen always carries Food Allergy Restaurant Cards to inform restaurant employees about the food allergy. Assure teens that they will remain "cool and safe as long as they guard against their food allergies. You may also want to point out that an anaphylactic episode would be far more embarrassing than meticulously inquiring about ingredients and avoiding potentially dangerous foods.

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. You should teach them to value their lives over any social inconveniences that a food allergy might present, trusting that they will protect themselves even when it may not seem like the "cool" thing to do. Most importantly, set a good example for your children by always reading labels and asking about ingredients; it just might save their lives.

To learn more about food allergies, please see our Food Allergy Frequently Asked Questions (FAQ).