House CallDec/Jan 2013 Issue

Pediactric Allergies Q & A: Peanut Allergy, Pets, Anaphylaxis, & More!

Our medical minds address important allergy questions from readers.

Remember the Dog

Q: My toddler has just been diagnosed with several food allergies. I’ve been going through my kitchen shelves, reading labels and giving food away. Now I’m wondering about our dog—should I be looking at his food, too?

Dr. John Lee: Yes. Pet food can contain potential allergens. Young children have been known to eat from the dog bowl and become exposed this way. Note that your dog’s saliva can also be a source of cross contact. Whatever your pet eats can be transferred to your child through a friendly lick. Check the ingredient labels on all your dog’s food and snacks and switch to pet food that’s free of your child’s allergens.

Educating Kids

Q: My 6-year-old daughter has a severe peanut allergy. I’m concerned that she’ll be exposed to peanuts by playmates and school friends. How do I get these children to understand that her allergy is deadly serious without scaring them or embarrassing her?

Dr. Pistiner:Different age groups require different approaches. Of course, it’s important to talk with the parents of your daughter’s friends to alert them of the allergy and inform them of safety measures.

When I explain a serious allergy to elementary school children, I try to make several important points. Here’s the approach I suggest, along with examples of the language I frequently use.

1) Kids with food allergies need to do things a little differently than kids without allergies.

2) A food allergy is when a person’s immune system treats a food like it’s an invader. Some children can get very sick very quickly if they eat even the tiniest amount of the wrong food.

3) It’s really important for children with food allergies to have someone read labels before they eat a food. If they can’t read it, they shouldn’t eat it. That’s why it’s safest not to swap or share food.

4) Sometimes allergens can get on other things. This is why you should always wash your hands after you eat.

5) If you think your friend with allergies is having an allergic reaction or has eaten something she’s allergic to, tell a grownup right away.

6) Sometimes it’s hard to have food allergies. Other people’s feelings are important. Never, ever tease or bully.

7) Friends can help friends with food allergies stay happy and safe. Thank you for taking good care of each other.

There’s a short video (4 minutes long) available from that explains food allergies to children, using this simple approach. This free video, designed specifically for kids, is a very helpful tool for parents and families, schools, daycare facilities and camps—anywhere there are children associating with food-allergic kids. Go to

Don’t Touch

Q: Can someone get an allergic reaction just by touching the food they’re allergic to?

A: Dr. Pistiner: Healthy, intact skin does a good job of keeping allergens out. Two small studies showed that people had localized skin symptoms from touching their allergen but that they did not develop severe or full-bodied allergic reactions. It is very unlikely that this form of exposure would cause anaphylaxis. Keep in mind that this was healthy skin and those involved did not put their hands in their mouth, eyes or nose. It’s a very different situation when a toddler touches a food allergen and then later puts his hands in his mouth, eyes or nose.

Safe Clean Up

Q: What’s a good way to sanitize against food allergens? Is washing with plain soap and water enough?

Dr. Pistiner: A recent study looked at the effectiveness of various strategies to clean hands, as well as sanitize tabletops, of peanut protein. The study showed that for hand washing, soap and water, as well as commercial hand wipes, were effective; hand-sanitizing gels were not. In addition, soap and water, commercial cleaners and commercial wipes all worked to clean the peanut protein off tabletops. Keep in mind that these were adults performing the hand washing and the table cleaning, not children who may not have the best cleaning skills.

Know the Signs

Q: The two times my child has had anaphylaxis, the symptoms have been different. Is this normal? It scares me that I don’t know what to expect.

A: Dr. Lee: Each child can experience anaphylaxis differently. It can start with mild symptoms and can quickly develop into a life-threatening situation. It can involve two or more body systems (skin, lungs, heart, gastrointestinal tract, brain). Early treatment is life saving, which is why it’s important to be familiar with the range of symptoms.

Here’s a partial list of what you might see: Wheezing; shortness of breath; coughing; chest tightness; breathing trouble; voice change; swallowing difficulty; swelling; hives; itchy skin; itchy mouth, tongue or throat; itchy, red or watery eyes; dizziness; fainting; skin paleness; crankiness; a sense of impending doom; stomachache; throwing up; or diarrhea.

Remember that anaphylaxis can occur without any clear skin reaction—no rash or hives. Also, small children may have a hard time describing their symptoms to adults; they can tell you in different ways. Some children may notice a funny feeling in their mouth or tongue. I had one child who kept scratching his tongue.

Epinephrine is the first-line treatment of choice for anaphylaxis. EpiPen is currently the only brand of epinephrine auto-injector in the United States. Auvi-Q is a voice-guided autoinjector that has been FDA approved and should be available soon. Make sure that you’re comfortable with your child’s autoinjectors and how to use them. Visit the manufacturer’s website for information and instructions.

Best Treatment

Q: My sister has anaphylaxis. She says she hates to use an EpiPen because it causes a scene. When she gets hives and her throat swells up, she takes Benadryl. Is this a good response?

Dr. Lee:No. Benadryl and other antihistamines may be helpful to treat a few hives but epinephrine is the first-line medication to treat anaphylaxis. A study showed that in 88 percent of fatal and near-fatal cases of anaphylaxis, epinephrine was not administered in a timely fashion. Early recognition of the signs of anaphylaxis and prompt administration of epinephrine are literally life saving.

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