Pediactric Questions & Answers - Food Allergies
Pediatric allergist Harvey L. Leo, M.D., answers questions about allergies and food sensitivities
FOOD ALLERGIES AFFECT MORE THAN 12 MILLION AMERICANS, INCLUDING 6 PERCENT OF CHILDREN UNDER THE AGE OF THREE. ALLERGIC REACTIONS CAN RANGE FROM MILD TO ANAPHYLAXIS, A SERIOUS CONDITION THAT CAN CAUSE HIVES, SWELLING, NAUSEA, CLOSING OF THE BREATHING PASSAGES AND EVEN DEATH. THERE IS NO CURE, JUST THE STRICT AVOIDANCE OF THE OFFENDING FOODS. NINETY PERCENT OF ALL FOOD ALLERGIES ARE CAUSED BY EIGHT FOODS: WHEAT, MILK, PEANUTS, TREE NUTS, EGG, SOY, FISH AND SHELLFISH.
Q Our child was just diagnosed with an allergy to cashews and possibly other nuts. Our family enjoys trick-or-treating on Halloween. Now what are we supposed
A Halloween is a worrisome time of year for food-allergic families. I know this both professionally and personally because my daughter has peanut and tree nut allergies. My wife and I take a few simple steps to keep the holiday special and fun. We pass out three different types of prizes. The first are individually wrapped treats with clearly labeled ingredients that parents can read. The second is a non-food prize, like stickers, little toys (larger than choking size), small gift cards, etc. The third treat is hard candy, something sweet that doesn’t contain nuts or other common food allergens. We have a separate bowl for each of these options, ready for any food-allergic or sensitive trick-or-treaters who come to our door.
Remarkably, there are at least a dozen food-allergic kids in our neighborhood, so our precautions fall in line with the needs of many of our neighbors. Some have a safe treat ready for our daughter. Since she is still very young, we usually visit only 10 to 15 houses but this is enough excitement to satisfy her for now.
For families living in neighborhoods that aren’t this cooperative, I suggest that parents allow treats to be collected but that they have a separate bag of approved snacks waiting at home. If the children are young enough, parents can exchange the collected goodies for the safe ones. This way, parents can control the amount of sweets their children eat. (Take the collected treats into work the next day.) Older children can turn their candy stash in to their parents in exchange for a larger prize. For many kids, dressing up in costumes and collecting door to door is the bigger event; at some point, sweets lose their charm.
If a child has a particularly sensitive food allergy, I recommend he or she wear cotton gloves or mittens to reduce skin contact. Make the gloves part of your child’s costume. Parents can also help their little ones select a safe snack out of a common candy bowl.
If you live in a neighborhood that has a collective party rather than traditional trick-or-treat, bring safe snacks for your child. Wrapping them and labeling them individually makes the party safer and more fun for other food-allergic youngsters.
Q Can you recommend some allergy-friendly snacks that I can bring to my child’s classroom?
A Generally, fresh or canned fruits and vegetables are the best options. If you choose canned products, select those packed in juice, not in light or heavy syrup. Baked goods are problematic because they can contain hidden food allergens.
Snack foods in individually wrapped packages sometimes work because the eight most common food allergens— wheat (not gluten), dairy, soy, egg, peanut, tree nuts, fish, shellfish—are labeled and teachers can help children make informed choices. One mistake that schools and parents make, however, is to focus on particular brands. Brands can change ingredients without notice; labels should be carefully examined each time.
To be on the safe side, provide the school with a stash of options for your child, which can be dispensed during snack time or special food events.
In many schools, classrooms are moving away from food rewards to help combat the rising problem of childhood obesity and diabetes. Given the increase in food allergies, this sounds like a good idea to me.
Q Is there a range of peanut allergy? Can someone be just a little bit allergic to peanuts?
A Yes, there is a range. Some people will get only mild symptoms after eating peanuts—maybe an itchy tongue or itchy ears. Children tend to show more skin-related symptoms, such as hives or rashes.
Most reactions to various substances are dose dependent —the more of a substance someone comes in contact with or ingests, the more vigorous the reaction. The problem with peanut allergy and other food allergies is that each reaction can be independent of the next. That means that someone who’s only had a few hives on his face after eating a teaspoon of peanut butter could have a more intense reaction the next time—without any warning.
Full anaphylactic reactions can occur with very small amounts (1/100th of an ounce) of peanut or other foods. The chance of an allergic reaction increasing in intensity rises when a food is ingested or absorbed through the mucous membrane, as opposed to just being touched or smelled. In addition, people with multiple allergies or those who suffer from asthma usually evidence more intense reactions.
The bottom line? If you’ve been diagnosed with peanut allergy, it is wise to be prudent. For safety’s sake, be as conservative as possible and avoid eating peanuts or products that contain peanuts.
Q My son has an egg allergy. Does this mean he’ll develop asthma?
A Unfortunately, there is a real connection between food allergies and the development of other allergic diseases. For example, young infants with persistent eczema have a higher risk of developing seasonal allergies or asthma. This doesn’t mean that all children with eczema or food allergies will develop seasonal allergies or asthma but recent studies suggest there’s a 30 percent chance these kids will have some form of wheezing or breathing issues later in life. Parents with allergic youngsters should be aware of this risk and report any suspicious symptoms to their child’s doctor.
Q Is there any risk in giving honey as a sweetener to my food-allergic 8-month-old baby?
A Children under one should not be given honey due to the risk of botulism, a serious condition caused by the C. botulinum toxin. Botulism can lead to neurologic problems, paralysis and possibly even death. Very young children are more susceptible to this toxin because their digestive systems aren’t yet fully developed.
In some instances, a person with serious seasonal allergies to pollens may experience mouth itchiness and even throat discomfort after consuming locally produced honey. It means that person is sensitive to the pollens in that type of honey. The same person may be able to safely tolerate honey produced from different pollen sources. LW
Harvey L. Leo, M.D. is a pediatric allergist with Allergy and Immunology Associates in Ann Arbor, Michigan. He also holds an academic position at the University of Michigan School of Public Health.