In the United States, approximately six million children have some kind of food allergy, 90 percent of which are caused by milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat. During the holidays with all of the get-togethers that revolve around food, there are lots of opportunities for children with food allergies to get into trouble, making parents experience a special kind of seasonal stress that comes with the extra vigilance it takes to navigate a child through the temptations and pitfalls of delicious fare at festive events.
“Most food allergy accidents take place outside the home like at a party or at a relative’s home, usually because it feels safe to let your guard down,” said Ejaz Yousef, MD, FAAAI, chief of Allergy and Immunology for Nemours Children’s Specialty Care, Jacksonville, and pediatric allergist with Wolfson Children’s Hospital. “Those most at risk in these situations are small children, because they can get into things they shouldn’t, and teenagers who sometimes take risks even though they know better. The bottom line is you should never take risks.”
Does this mean you should just stay home? Absolutely not. With the right planning and understanding what the risks are and who is most vulnerable, Dr. Yousef said, your family can still venture out and enjoy the season.
What is a Food Allergy?
A food allergy is caused by an immune-related response to proteins in the food that can cause reactions such as hives, itching, nasal congestion, diarrhea, difficulty swallowing, tongue swelling and even loss of blood pressure. “There are four systems that usually get involved: skin, respiratory, gastrointestinal and cardiovascular,” said Dr. Yousef. “Anaphylaxis is an allergic reaction that involves two or more of these systems in the body, and anaphylactic shock, the most severe and life-threatening, is when the blood pressure is involved.”
Dr. Yousef added that parents need to be familiar with the symptoms and understand that allergies can start with a mild reaction like a stuffy or itchy nose after eating a particular food, symptoms that are usually ignored. Also, certain children are more at risk for developing a food allergy than others, and some are at a higher risk of having a severe allergic reaction. Children with skin conditions such as eczema have a higher likelihood of being sensitive to certain foods. Kids with asthma, especially those who have difficulty keeping it under control (which usually happens during the season change in the winter months around the holidays), are at greater risk of having a severe reaction that can lead to hospitalization and possibly death.
Communication is Key
What makes holiday outings so risky is that parents aren’t always aware of what ingredients are in each dish, or if the spoon used to serve the gravy might have been in a peanut dish beforehand and has become contaminated. “Whether it’s Thanksgiving at Aunt Sue’s house or the tree trimming at church, the risk is always there,” said Jodi Brindisi, RD, a registered dietitian with Wolfson Children’s Hospital. “It’s much easier to control ingredients when food is prepared at home where you can read food labels, confidently knowing exactly what you are giving your child.”
Both hosts and guests should feel comfortable talking up front about any food allergies a child or other family members may have and if anything should be prepared differently ahead of time. It may be helpful to provide the host with several recipes that are allergen-free and delicious for all or, as Brindisi suggested, taking along a dish you prepared at home, which is a great idea because you know what’s in it. “Most hosts appreciate it when you bring a ‘safe’ dish if there’s an allergy,” she said. “Then there’s no second guessing.”
Toting back-up snacks and drinks with you in a cooler or a bag for your child to munch on is another smart idea that really pays off if you end up staying somewhere longer than expected.
Mark Toney, MD, division chief of the Hospital Pediatrics Program at Nemours Children’s Specialty Care, Jacksonville, and Wolfson Children’s Hospital, said children who are admitted to the hospital after a food allergy incident are those who had an anaphylactic reaction that requires intervention and/or prolonged observation to make sure that the medication given is working. “Most of the admissions we see are because a child accidently ate something they were allergic to,” said Dr. Toney.
Follow Doctor’s Orders
The use of an epinephrine auto-injector needs to be immediate once a child eats something that has been known to cause a reaction in the past or if he or she begins to have a reaction to something. Children are also more vulnerable to a serious attack if the use of an epinephrine injection is delayed, and sometimes one rescue injection isn’t enough because it only lasts about 30 minutes.
Dr. Yousef stresses that parents should always follow the advice of their child’s doctor. “Also, be sure to have a clear plan in mind when you go out, and stick to it.”
More Food for Thought
For more information about food allergies, planning ahead for outings and even fun and safe allergen-free recipe ideas, Brindisi recommends that parents visit the following websites: kidswithfoodallergies.org, foodallergy.org and the American Academy of Allergy Asthma and Immunology.
Thank you to Wolfson Children’s Hospital for sponsoring this post.