When food bites back: Coping with food allergies
It started out as an innocent family dinner at a restaurant, but ended in a rush of panic. My 3-year-old son’s face was painfully swollen and distorted. He’d just eaten yakisoba noodles — something he’d eaten many times before at other restaurants. Knowing that my son is allergic to peppers, I checked the dish and saw no sign of them; I didn’t even think to ask.
But within less than five minutes of eating, he was rubbing his eyes, his toddler cheeks were puffy and red, and little bumps had formed all around his mouth and on his cheeks. I gave him a dose of Benadryl, but a few minutes later, his eyelids were puffing over his eyes, swelling them shut. I was just about to give the shot of epinephrine I always carry in my purse and ask the waitress to call 911 when the reaction began to subside.
The restaurant, it turns out, used bell peppers in the sauce on the noodles. It was at this moment that I realized we could no longer trust sauces at restaurants, potlucks or even friends’ houses. Italian marinaras, Mexican salsas and Asian sauces — a whole world of flavors — are no longer on his list of safe foods.
Though my son’s allergy is not a common one, he has joined the 8 percent of children nationwide who can no longer eat whatever they want because of food allergies. These are kids whose families face a lifetime of constant vigilance. Cutting out entire categories of foods can be tricky at best; at worst, having an allergy that is severe can make eating the wrong food life-threatening.
The biggest concern is the possibility of anaphylaxis, which comes on quickly. Symptoms include swelling of the face, eyes or tongue; pink, inflamed skin; hives; and difficulty breathing. “Anaphylaxis is a misdirected immune response that people have when they are exposed to an allergen,” says Dr. Michael Kennedy, a physician at the Northwest Asthma and Allergy Center. If left untreated, anaphylaxis can lead to death. That’s why food allergies are so scary. Most pediatricians recommend that kids with food allergies always have an automatic injector of epinephrine (EpiPen) on hand to work quickly to counteract the body’s allergic response. But Kennedy says the best defense is to strictly avoid the food the child is allergic to, and to use scrupulous care in avoiding “cross-contamination” — such as using the same serving spoon for a peanut-laden dish and a peanut-free dish, for example.
So what can parents do to reduce the risk of illness from something as small as a peanut?
Altering your lifestyle
Once a food allergy is detected, it can change the way the family shops, cooks and eats. It’s easier for parents to monitor an allergy in their home, where they have complete control over the ingredients in a child’s food. But play dates, toddler groups, school, camp and even birthday parties pose a problem.
Kate Heino, a Kirkland mother of three, knows this well: Her two oldest children have food allergies. With her 7-year-old son allergic to nuts, shellfish and possibly gluten, and her 5-year-old daughter allergic to eggs, Heino has had to become a master of preparing food for children with allergies. She’s careful about cross-contamination in her kitchen and orders baked goods, snacks and candy from an allergy-specialty Web site (see sidebar below). When her kids attend birthday parties, she brings their own cupcakes and ice cream, and often takes along special meals when visiting friends and relatives. Heino also works closely with her children’s teachers, and asks that they read children’s books about food allergies to the class to help classmates understand (see sidebar below).
The school’s role
In fact, school presents a unique difficulty for families with food allergies — especially when other parents provide daily snacks or send in food for special occasions and parties. Kennedy recommends parents work closely with school staff to come up with a plan. “Young kids usually need to have an EpiPen in the classroom rather than down the hall from them in the office,” he says. “Teachers have a responsibility, and it needs to be guided by the parents, who should work closely with the prescribing physician to determine what’s needed on a case-by-case basis.”
Some parents opt to provide all their child’s own snacks, but this can make the allergic child feel isolated. After all, kids want to have what the other kids are having. “It’s a constant trade-off between inclusiveness and safety,” says Kelly Morgan, president of Washington Food Education Allergy Support Team (FEAST), a support group for Puget Sound-area parents of children with food allergies. Some schools attempt to address this by creating special “peanut-free” tables, an imperfect solution at best, say some, because the kids with allergies are still isolated from their classmates.
How food allergies are handled in schools is such a complicated safety issue that last spring, a group of parents from the Food Allergy Initiative Northwest (FAI) lobbied the state to pass legislation that will go into effect next month. This new law requires all publicly funded schools in our state to receive training and guidelines from the Office of the Superintendent of Public Instruction on how to provide a safe environment for food-allergic children.
As a result of this new regulation, Hilary Stephens, the food allergy community health educator at Seattle Children’s, is busy training school nurses, school staff and parent groups on how to establish these guidelines in local public schools.
Stephens says one mistake schools often make is attempting to set up a “nut-free” school zone. “There’s no way of saying that environment is nut-free,” she says. “I don’t believe it’s possible when you have that many children bringing food from home. When a school calls itself a ‘nut-free’ environment, I think it gives a false sense of security. I think a school can say they are a ‘reduced-risk’ environment. They can make sure there will be no nuts served in their cafeteria or served as snacks, but the reality is they can’t really claim it’s nut-free.”
Morgan agrees. “If the school has a cafeteria, it’s easier to manage. But when kids are eating in their classroom, you can have allergens all around the classroom.”
A rising epidemic
Growing evidence points to an increase in food allergies over the past several years. The Centers for Disease Control and Prevention (CDC) reports that food allergies in children increased 18 percent from 1997 to 2007. A 2003 study published in the Journal of Allergy and Clinical Immunology found that the prevalence of peanut allergies in children doubled in the five years between 1997 and 2002. And in his book, Food Allergies for Dummies, Dr. Robert Wood, a pediatric allergy specialist at Johns Hopkins Children’s Center, says, “Over the last 20 years … the prevalence of food allergy appears to have risen sharply.”
The reasons for this increase are not clear. “No one knows for sure, but our bodies have not changed over the past 20 years, so it can’t be biological; it has to be environmental,” says Kennedy. He describes one possible theory — the “hygiene hypothesis” — which is a concept first published in the British Medical Journal in 1989. Researchers noted that children from larger families had stronger immunity to allergies. They concluded this was possibly due to these children being exposed to more infectious agents through their siblings, thus strengthening their immune systems.
Today, Kennedy says, the theory is that we may live in a society that’s just too clean. “Most of us no longer live on the farm like children did a few generations ago, and modern children’s immune systems are no longer being exposed to bacteria and dirt like they were in the past,” he says. The hygiene hypothesis suggests that our modern hypervigilance against germs — with vaccinations, antibiotics, sanitizers and household cleaners — may play a role in making children’s immune systems more susceptible to food allergies.
But Robyn O’Brien, a mother of four in Boulder, Colorado, the founder of the website AllergyKids.com and author of the book The Unhealthy Truth: How Our Food Is Making Us Sick and What We Can Do About It, does not believe the increase in allergies can be explained by the hygiene hypothesis alone. “The problem of allergies begins in the immune system,” she says. “Well, 70 percent of a child’s immune system is in their digestive track, so if that is not functioning properly, it can leave them vulnerable to childhood diseases like allergies.” In other words, O’Brien says, the increase in food allergies could be linked to ingredients in the American diet. She says that our exposure to foods with antibiotics and added hormones (through our meat, poultry and dairy), and a tendency to eat processed foods containing chemical additives, preservatives and genetically modified ingredients has all played a part in weakening children’s immune systems and making them more susceptible to food allergies.
Genetically modified (GM) foods entered the U.S. market in 1994 without any special labeling. Today, experts estimate that as much as 70 percent of processed foods contain genetically modified ingredients. The most common GM foods are soybeans, corn and cotton. Soy, corn and cottonseed oils are common ingredients in many processed foods, and much of our nation’s conventionally raised livestock and poultry are fed GM soy or corn.
GM plants contain genes from two different species. In her book, O’Brien uses the example of a genetically modified tomato plant that contains a scorpion gene that acts as an insecticide. Inserting the gene of the scorpion makes the tomato plant resistant to pests, but there have been no long-term studies to see how genetically altered foods such as this affect the human digestive system, and many scientists and doctors throughout the world have warned about the potential risk of GM foods contributing to an increase in food allergens.
Dr. Kenneth Bock, author of Healing the New Childhood Epidemics: Autism, ADHD, Asthma and Allergies, says that genetically modifying foods change their protein structure, and this has the possibility of making them unrecognizable to the immune system. According to Bock, some children may have a genetic predisposition to be sensitive to these new food proteins, and that — coupled with environmental triggers — can make them more susceptible to diseases such as allergies.
Food allergy help for parents
There is some good news for parents. In January 2006, the Food Allergen Labeling and Consumer Protection Act went into effect. It requires that companies making processed foods containing the top eight allergens of milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat clearly list the allergen in plain language on the label. Companies must also disclose if their foods are made on shared equipment with these allergens — a potential cause of cross-contamination — even if the food itself does not contain that ingredient. This has gone a long way in helping parents make their choices at the checkout stand, but unlike some other countries, U.S. laws still do not require food companies to disclose if their foods contain genetically modified ingredients. Because of this, O’Brien has decided to avoid processed foods for her family and cook from scratch or serve whole foods. “If it’s not something your grandmother would have had on her table, don’t put it on yours. Get back to real foods,” she advises.
Keeping kids healthy is key, but parents of children with allergies also need support in coping with the fear and stress that having a child with a severe food allergy brings. “I felt isolated for a while. While the other moms would be talking at the park, I’d be right next to Henry making sure he didn’t eat a cracker that had been dropped by other kids,” says Heino, who found great advice and support from the parents she met though Washington FEAST.
One unexpected cost of food allergies? Ruined friendships. Parents like Morgan say not everyone understands the need for constant vigilance. To other parents, it can also feel like an imposition to accommodate a severely allergic child. When a fellow mother just isn’t “getting it,” it’s no longer safe to send your allergic child to her house.
“I’ve lost friendships over this, because at my core, I have to have my child safe, and there are some people who just don’t understand,” Morgan says.
“You worry about your child’s health, but you also worry about your child in the social areas. You mourn the loss of a carefree life. But that grief can eventually turn into an awareness that you can have a full life. You just have to have different rules.”
Katie Amodei is a Lynnwood-based freelance writer and mother. Her 5-year-old son has food allergies.
Anatomy of a child's allergic reaction
When a child with a food allergy eats the food she’s allergic to, her immune system interprets that food as a threat. Here’s a simple description of the body’s response — called anaphylaxis — and why allergic reactions may tend to get worse with each exposure.
The first time the child encounters a food she’s allergic to, her body determines it to be a toxic invader, and the immune system goes to work making immunoglobulin E (IgE) antibodies. These antibodies will be ready to attack that protein if and when it shows up in her system again.
The next time the child eats the offending food, IgE antibodies are ready in the bloodstream and attach themselves to mast cells, which defend the body and promote healing. In an allergic reaction, those mast cells rush out to the food protein and spray it with potent chemicals rich in histamine. This can cause inflammation, swelling, a sudden drop in blood pressure and constriction of the airways in the lungs. At its worst, anaphylaxis can lead to death in a matter of minutes if left untreated.
Food allergy resources
Washington Food Education Allergy Support Team (FEAST). Support network for families of children with food allergies in western Washington.
Allergy Kids. Purchase food-allergy supplies and download the safe-schools teacher-training program, including a sample letter to your child’s teacher and classmates’ parents.
Food Allergy Initiative. Tons of tips on how to manage food allergies at home, in school and at camp. This site also has strategies for eating out and traveling, including restaurant cards.
Food Allergy Community Health Education Program. Food allergy education to help create a safer environment for children In partnership with the Food Allergy Initiative.
Food Allergy & Anaphylaxis Network. Guide for the latest info on food allergies. Sign up for allergy alerts and purchase supplies like EpiPen belts.
Food Allergy Website Just for Kids. Part of the Food Allergy & Anaphylaxis Network, this site for kids has allergy-related projects, coloring pages and fun activities.
Safety Sack. Clear, child-resistant pouches designed to hold medication and directions in the event of a severe allergic reaction. Great for camp, play dates, sleepovers and other activities.
Divvies. Offers nut-, dairy- and egg-free baked goods and candy.
Books for parents on children's food allergies
How Food Allergies Affect the Family: How to Cope, Stay Safe and Enjoy Life by Nicole Smith
Food Allergies for Dummies by Robert A. Wood
Healing the New Childhood Epidemics: Autism, ADHD, Asthma and Allergies by Kenneth Bock
The Unhealthy Truth: How Our Food Is Making Us Sick — and What We Can Do About It by Robyn O’Brien
Books for children about food allergies
Allie the Allergic Elephant by Nicole Smith
Cody the Allergic Cow by Nicole Smith
Chad the Allergic Chipmunk by Nicole Smith
The Peanut Butter Jam by Elizabeth Sussman Nassau
The Princess and the Peanut Allergy by Wendy McClure