Like many of his patients, Dr. Robert Wood, an allergist and chief of pediatric allergy and immunology at Johns Hopkins University School of Medicine in Baltimore, has suffered from a severe peanut allergy since he was an infant. So he knows, firsthand, how hard certain allergies are to control. But even an allergist with allergies can make mistakes.
“One holiday, my allergist colleague presented me with a gift of beautifully decorated cookies and, without me even asking, he reassured me that the cookies were peanut-free,” Wood recalls. He ate one cookie and had the most severe reaction of his life, requiring five shots of epinephrine to ward off a potentially fatal allergic reaction called anaphylaxis. “I violated my own no-cookie rule of never eating baked goods unless I made them myself,” says Wood.
And the cookie culprit? It turns out that the same spatula had been used to make a batch of peanut butter cookies prior to the peanut-free ones. A trace amount of contamination was enough to prove life-threatening to Wood.
From cookies to pretzels to non-food items such as clay, unsafe ingredients can hide in anything. This means a diagnosis of food allergies, particularly multiple ones, can turn simple pleasures such as snacks, holiday meals and playdates into anxious occasions. For parents of food-allergic kids, the happy rite of passage of sending a child to her first sleepover can be nerve-racking—or even impossible. And for parents whose children have no allergies, it might seem too daunting to host a playdate with a child who needs to bring his own food or wipe surfaces before playing, meaning many allergic kids get left out of the fun other kids get to have.
“I’ll never forget when I picked my son up at school and saw his whole class eating cake and ice cream, while he sat alone with a bag of wheat-free pretzels and water,” says Gina Clowes, founder of the website www.allergymoms.com. “The school forgot to tell me there was going to be a party, and my son was completely excluded from the class celebration.” With the number of allergy sufferers skyrocketing—two times more children had peanut allergies in 2002 than they did in 1997—it’s important to arm yourself with the right information. Whether you want to determine if you or your child has a food allergy or if you just want to be prepared for kids who do, KIWI will help you navigate through this dangerous ailment.
Be Smart About Symptoms
A food allergy causes a person’s immune system to overreact to the proteins contained in an ordinarily harmless food. The symptoms of an allergic reaction can vary widely. Parents should be on the alert for stomachache, cramps, vomiting, itchy mouth, trouble breathing, dizziness or other symptoms. The skin is often the first place where symptoms show in the form of itchiness or hives, but many fatal or near-fatal reactions can occur without them. Generally, symptoms of anaphylaxis or an allergic reaction will occur within minutes to several hours after eating the offending food. “My newborn son was covered head-to-toe with hives on his second day of life and those hives stayed with him for years,” says Clowes. “In addition to hives, his first year was a whirlwind of acid reflux, eczema, ear infections and lack of sleep.” Clowes’ son was eventually diagnosed with more than a dozen food allergies, some life-threatening.
Know That Reactions Can Vary
According to Dr. Scott Sicherer, an associate professor of pediatrics at the Jaffe Food Allergy Institute and the author of Understanding and Managing Your Child’s Food Allergies, the severity of an allergic reaction depends on how sensitive the person is to the food, how much of it he ate and additional conditions such as asthma. Also, a patient’s personal history of severe reactions—particularly to trace amounts of an unsafe food—is a risk factor for more severe future reactions.
But this reaction rule isn’t hard and fast, says Sicherer. “The biggest misconception is that each exposure to a food will result in a more severe reaction than the one before.” Not only will reactions vary for a particular patient, but one person who is allergic to milk may tolerate an ounce of it before a reaction occurs, while another can get sick from a drop or less. For some very sensitive people, reactions will occur from extremely small exposures, such as kissing the lips of someone who recently ate the trigger food. What’s more, a person with multiple food allergies could have different thresholds and severity of reaction to each trigger food. For those children who suffer from severe reactions, that means parents can never leave home without epinephrine and have to prepare all caregivers with an emergency plan.
With so much variation, it can be hard to distinguish a food allergy from a food sensitivity or food intolerance, which are adverse reactions to food that do not involve the immune system. For example, lactose-intolerant individuals lack an enzyme (lactase) that’s essential for digesting milk sugar. To be sure a person has a true food allergy, he must visit an allergist for a diagnosis.
Have Faith in the Future
According to Sicherer, children are more likely than adults to have allergies to eggs, milk, wheat and soy, while severe adult allergies typically come from peanuts, tree nuts (including walnuts, almonds, cashews, pistachios and pecans), fish and shellfish. This may be due to the fact that children with food allergies often outgrow them—it’s estimated that 90% of egg, milk, wheat and soy allergies diminish or disappear by the age of five. One in five young children will outgrow a peanut allergy, but fewer will outgrow allergies to nuts or seafood. But even if you think your child may be clear of his allergies, consult an allergist before diving back in to suspect foods.
To keep outlooks high in a food-allergic household, speak with your doctor about allergy statistics and research so your child knows she’s not alone. “Allergy research has made some amazing strides…but when you have or your child has food allergies, the world seems to be divided into those who ‘get it’ and those who don’t,” Clowes says. “You learn not to judge those who don’t ‘get it,’ but you also do not—and cannot—depend on them to keep your child safe.”