Navigating the food allergy minefield

Pediatrics for Parents, August, 2004 by Linda Marienhoff Coss

For most parents, dropping by a friend's house for a visit, accepting an invitation to a child's birthday party, or signing a child up for day camp are not anxiety-filled occasions. But for parents of children with severe food allergies, each of these situations can feel like stepping into a potential minefield. Why? Because for their children, ingestion of even a tiny amount of a common food could be deadly. Food, and food residue, is everywhere--and keeping their children safe is a constant challenge.

What is a Food Allergy?

A food allergy is caused when a person's immune system mistakenly believes that a normally harmless substance--food--is harmful. This should not be confused with food intolerance, such as lactose intolerance, which is a less serious adverse reaction to food that does not involve the immune system. Although just about any food can trigger an allergic reaction, there are eight foods which are responsible for 90% of all allergic reactions: peanuts, tree nuts (such as walnuts, cashews, and almonds), milk products, eggs, wheat. soy, fish, and shellfish.

When a food-allergic individual eats the food to which he is allergic (or, in some extreme cases, merely touches or inhales particles of that food), his immune system releases massive amounts of chemicals and histamines. Surprisingly, the reaction can begin within seconds or minutes of exposure to the allergen. Symptoms can range from mild--such as one or two hives on the face--to an extreme, potentially fatal reaction known as anaphylaxis.

Children with severe food allergies are at risk for anaphylaxis. An anaphylactic reaction can affect one or more bodily systems, including the skin, respiratory system, gastrointestinal system, or cardiovascular system. Symptoms may include one or more of the following:

* Swelling or tingling of the lips, tongue, or throat

* Hives (anywhere on the body)

* Nausea, vomiting, diarrhea, loss of bowel control

* Breathing difficulty and/or wheezing

* Hacking or repetitive cough

* Drop in blood pressure

* Loss of consciousness.

Without immediate treatment, anaphylaxis can rapidly lead to death.

How Do You Treat Food Allergies?

There is currently no cure for severe food allergies. The only "treatment" is complete avoidance of the allergen. Allergic reactions caused by accidental exposure to the allergen must be noticed and treated very quickly. While liquid antihistamine is usually sufficient for treating very minor reactions, it will not stop a life-threatening reaction. The "drug of choice" for initial treatment of a life-threatening anaphylactic reaction is an injection of epinephrine followed by a trip to the hospital emergency room for further treatment and observation. An EpiPen[R]--a disposable and easy-to-use automatic injection device which is available by prescription only--is used to give this initial injection to the child.

Who Do I See to Diagnose My Child's Food Allergies?

If you suspect that your child may suffer from food allergies, make an appointment to take your child to a board certified allergist. The physician will take a complete medical history, including detailed information about your child's previous allergic reactions, and will perform allergy tests (either "skin prick test" or blood tests or both) to determine the diagnosis.

If your child is at risk for anaphylaxis, the allergist will give you a prescription for EpiPen[R] and teach you when and how to use it. It is imperative that your child's emergency medication must always be kept readily available, because accidents are never planned.

What are the Most Common Issues Faced by Parents of Severely Food-Allergic Children?

How do you care for a child who can have an almost immediate and potentially fatal allergic reaction if he eats even a trace amount of a common food? How do you keep a child from touching the food residue that can be on surfaces everywhere, knowing that whatever is on the child's hands can easily end up on her food or in her mouth?

A diagnosis of life-threatening food allergies affects almost every aspect of the family's life. After the parents learn the basics of how to keep their child safe, one of the biggest challenges is often that of getting all the other adults in the child's life (such as relatives, friends, and caretakers) "on board" the food allergy management team. Many people refuse to believe the seriousness of the diagnosis, and may even do things that are potentially harmful, such as offer the child allergenic food.

Other issues depend on the child's age. The biggest challenges in caring for a severely food-allergic toddler usually revolve around a toddler's innate need to put everything within reach into his mouth. As the child gets older the parents must gain the cooperation of school personnel in creating a safe school environment. For teenagers, the biggest issues tend to be with social and peer group issues. Regardless of the child's age, parents face challenges in their family's home and social life, and in their ability to dine in restaurants and travel.