What can be done if someone has a reaction?
An Epi-pen is a device that injects epinephrine, which is a drug that can take away or lessen the symptoms of a reaction. If a child uses an Epi-pen, however, they should immediately call 911 or contact their local EMTs to get to a hospital facility as soon as possible because while epinephrine can be lifesaving, it doesn't always work.
We prescribe an Epi-pen, for the most part, to any child diagnosed with a food allergy who weighs more than about 22 pounds. Children with a history of anaphylaxis, peanut or tree nut allergy, and those who have both food allergy and asthma should receive an Epi-pen. The Epi-pen comes in two dosages: an Epi-pen for adults and a junior Epi-pen. We need to make adjustments and be a little bit more careful in infants who are smaller because the dose is too high.
How can caregivers protect children when they are out and about?
It takes a lot of effort, a lot of teamwork, and really good communication and education to try to keep kids safe. In schools, for example, the teacher, the principal, the school nurse, all should be informed about the child's condition. There should be a copy of this emergency health care plan in the school along with a supply of the emergency medications. It's useful for the child to have a Medic Alert bracelet.
Children need to be taught from an early age to be their own advocate. If somebody offers them something that if they can't confirm is safe for them, they shouldn't try to eat it. Similarly, they shouldn't trade lunches; whatever mom or dad sends in or approves for them is what they should be eating.
Do certain behavioral issues come up with children with food allergy?
The issues that I have seen in kids with food allergy include aversions to trying new foods. Some develop fairly limited diets because they just want to eat what's familiar to them because they know it won't make them feel sick. Other issues are dependency on the parents, particularly as the kids grow older and start to spend more time away from home. They may also experience anxiety about being in situations where they might be exposed to something, whether that's the school cafeteria, or going out to eat in a restaurant or being at a party.
How would someone know that a child had outgrown their food allergy?
It's very important for people to maintain contact with a food allergy specialist once their child has had a diagnosis. Since the prognosis is often good, you don't want that child to avoid that food indefinitely. Here at Children's Memorial Hospital, we recommend annual follow-up.
Are there myths about food allergy?
One is that there is a relationship between food allergy and behavioral problems such as ADHD. Another one is that a rotation diet, in which foods are rotated on a regular cycle according to their "food families," is a way to manage an allergy. Since reactions happen with each and every exposure to the food and since it generally takes only a small amount of food, there is no reason to think that reactions would go away just because you're on a rotation diet.
What is your overall advice to parents?
The guidelines from the American Academy of Pediatrics (AAP) encourage parents to delay introducing cows' milk until the child is one year old; to delay introducing egg until two years of age and to try to defer dietary introduction of peanuts, tree nuts, fish and shellfish until after three years of age. There is no AAP guideline for soy, but I suggest 12 months.
If you suspect your child has a food allergy, talk to your pediatrician. The more foods that you suspect, the more difficult it is for a primary care physician to conduct an evaluation and find the answer, so you may need to see a specialist. If there has been a history of a severe or life-threatening reaction, families should seek out a food allergy specialist. Also, if the child has very severe atopic dermatitis, particularly involving an extensive area of the child's body, that's a reason to see an allergy specialist as well. I would also suggest that the family learn more about food allergy. But parents need to be very careful about their sources of information; the Food Allergy and Anaphylaxis Network is an excellent source of information.