Kids & Food Allergies

Keeping Children Safe in a Food-Centric World

Nearly six million American children have life-threatening food allergies. If that stat wasn’t on your radar before, the tragic death of Amarria Johnson, the first grader who died from ingesting peanuts at her Chesterfield County school in early January, has significantly raised awareness.

Allergies can lead to death when exposure causes anaphylaxis, the term for the immune system’s overreaction to a food protein. Anaphylaxis can affect the entire body. The most dangerous reactions involve the respiratory and cardiovascular systems. Death may occur when airways swell shut or from an extreme drop in blood pressure. Any report of allergic symptoms must be taken seriously. What looks like a mild reaction can quickly become deadly. Symptom expression is unpredictable, even in the same person. This means that a reaction might result in puffy lips in one instance, but the next exposure may result in a closed airway or shock. How can parents feel safe sending their child with a Life-threatening food allergy into the world?

“Making sure your child has immediate access to epinephrine is the most important defense a parent can take,” says allergist Ananth Thyagarajan, MD. “The second major safeguard is that parents maintain an up-to-date food allergy action plan at school and everywhere their child spends significant time.” Parents must be pro-active and make sure all paperwork is completed. Dr. Thyagarajan, who lives in Henrico County with his wife and kids and practices in Henrico and Chesterfield, stresses that open-communication between parents and school is key. For the sake of their children, parents should be nonconfrontational to help teachers understand how best to make their classrooms safe.

The Food Allergy and Anaphylaxis Network (FAAN) is an impressive resource to educate yourself, your child, her teachers, and other significant people in your child’s life. Originally founded by a mother in 1991, when information on food allergy was difficult to find, it has become the frontline for food allergy education.

As a parent, you have a responsibility to educate your child to speak up for herself to warn others of her food allergy. Yael Beckman, whose daughter Julie has a life-threatening peanut allergy, vividly remembers a Halloween when 3-year-old Julie “knocked on doors in her witch costume and said, ‘trick-or-treat, I’m allergic to peanuts.’ We let her participate in the same activities as her older sister, but she learned to be careful.”

For a child with a life-threatening allergy, school events including birthday parties, holiday celebrations, and field trips can be risky. “You realize how often events in Our culture are linked to food,” says Susie MacLeod, a mom of twins with severe food allergies. “Packing my children’s peanut-free lunch was easy, but what if a best friend offered to share a sugar cookie made with a peanut product?” For these families, every week brings landmines to navigate: cupcakes to celebrate a birthday; math problems solved by counting with M&Ms; well-meaning parents with post-game brownies. “You can’t monitor every minute,” says MacLeod. “We made it a family rule not to eat anything that didn’t come from home. Even when parents were aware of our children’s allergy, peanut-laden goodies still got into the classroom. It helps To have back-up treats like Starbursts and Skittles.”

Strict avoidance of the allergen is the only way to prevent a reaction. “That’s why a first line of defense is the child,” says Marguerite Pennoyer, MD, a Columbiaeducated allergist. “The child needs to be an active participant in the allergy plan and not eat anything given by anyone except a trusted adult who knows about the food allergy. Anaphylaxis occurs only with actual ingestion.”

Still, it’s scary to consider that a food can look peanut-free, but still be made with nut by-products or in a factory that uses peanuts in other products. Cross-contamination is common. To decrease risk, many schools are peanut-free or offer peanutfree tables, but this action is controversial.MacLeod is against peanut-free zones because she believes they provide a false sense of security that is more dangerous.In her experience, it is impossible to keep peanuts out of school because traces are in so many non-obvious foods.

“Another issue,” says Dr. Thyagarajan, “is a child may feel ostracized. It’s hard enough to be a kid without being labeled as different. There is a much greater risk of a child being bullied because of food allergy segregation than of a child having a severe allergic reaction from sitting at a foodintegrated lunch table. Plus, where do you draw the line? There are more children with severe allergies to milk and eggs than there are to peanuts; do we then make milk- and egg-free zones?”

Even with an allergy action plan, kids are kids, and cookies are tempting. Also, teachers who are aware of the plan get sick,And substitutes become the trusted adult in the classroom. That’s why all schools need to have a plan in place to identify children with food allergies, their care plan, and what to do if exposure occurs.

If the allergen is accidentally ingested, symptoms typically begin as hives, a tingling sensation of the tongue, and/or mild swelling of the lips. These may progress to vomiting, respiratory distress, severe swelling, and finally shock. The first signs of a reaction may be described in vague terms by a child. Think possible allergic reaction when a child with a food allergy describes anything unusual about her mouth, tongue, throat, or stomach. Not recognizing the early signs wastes valuable response time.

The treatment of choice for anaphylaxis is epinephrine, most commonly prescribed as an easy-to-administer EpiPen. Epinephrine counteracts the dangerous overreaction by opening airways and increasing blood pressure. If the child is showing mild symptoms such as an itchy mouth, a few hives, or nausea, use an antihistamine like Benadryl to suppress the histamine reaction. Continue to observe the child, as a mild reaction can turn dangerous in minutes. If symptoms progress, epinephrine should be injected immediately and 911 called. Make sure affected children go to the emergency room, as life-threatening symptoms reoccur in 20 percent of cases.

“Do not hesitate to give epinephrine,” says Dr. Pennoyer. “A saying I use to educate my patients is: Benadryl is for HIVES, EpiPens save LIVES. There is no reason not to administer epinephrine during an anaphylactic emergency; the risk of dying by withholding epinephrine is much greater.”

EpiPens are injections made for easy administration by self or others. The needle is designed to go through clothing and the medication will self-inject into the muscle. Grandparents, teachers, field trip chaperones, anyone responsible for the child should be trained in how to administer an EpiPen. “Two doses of epinephrine should be carried, as a severe reaction may require a second dose,” stresses Dr. Pennoyer. “Most co-pays will cover prescriptions for four EpiPens if they are written for two double packs, one for home and one for school.”

Children should be taught how to self-administer EpiPens as soon as their maturity levels allow. “I tell my patients to practice with expired EpiPens on watermelons,” suggests Dr. Thyagarajan. Directions are on the side on every pen and demonstration videos are easy to access at EpiPen.com.

One-in-four anaphylactic reactions occur in school settings. Schools must be prepared to treat allergic reactions in the event a student’s personal epinephrine auto-injector isn’t available or the student is having a reaction for the first time. This is why the School Access to Emergency Epinephrine Act, also called the Durbin-Kirk Bill, is being examined in Congress. The bill encourages states to ensure that epinephrine is available in schools and that school personnel are trained to administer it.

According to local newspapers, Amarria’s EpiPen wasn’t at school when she had her reaction, nor was there a school nurse.Having back-up epinephrine available would probably have saved her life. As well-stated by Dr. Thyagarajan, “Amarria’s death is beyond unfortunate, but it should serve to underscore the basics, not create reactionary panic. As long as a child has immediate access to her EpiPen and a plan of care is in place, parents should feel safe dropping their child off at school.”

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AllergyEats, the Most Comprehensive Source for Finding Allergy-Friendly Restaurants, Reports Details of Wendy’s & Burger King’s New Menus, Ingredients, Preparation Techniques 

BOSTON, MA – In many instances change is good, but as restaurants update their menus in an effort to stay competitive, these changes can be dangerous for the food allergy community.   When restaurants periodically revamp their menus, seemingly minor changes (like buttering a hamburger bun) can have a major impact on food-allergic customers, causing them to get ill or even have life-threatening reactions, according to Paul Antico, Founder of AllergyEats (www.allergyeats.com), the most comprehensive source for finding allergy-friendly restaurants.

Fast food chain Wendy’s recently changed their menu and now, for the first time ever, they’re serving some of their burgers and sandwiches on buttered buns, significantly impacting dairy-allergic customers.  Additionally, Wendy’s is toasting their buttered buns, so any toasted bun – even unbuttered ones – could potentially become cross-contaminated with butter in the toaster, creating a risk for dairy-allergic diners.

And Burger King just introduced a new thicker-cut French fry made with ingredients intended to make them “fluffier”.  The new fries are still free of the “Big 8” allergens (which include dairy, eggs, wheat, peanuts, tree nuts, soy, fish and shellfish), but the full list of ingredients has obviously changed.  People with less common food allergies need to be made aware of the new fries and should investigate the updated ingredient list on Burger King’s website before ordering them – even if they’ve comfortably eaten fries from this fast food chain in the past.

“I appreciate that restaurants need to evolve to stay competitive in the marketplace, but when a restaurant changes their ingredient list or preparation techniques, I believe they should communicate the changes to their customers, knowing that it could impact guests with food allergies,” said Paul Antico, Founder of AllergyEats, food allergy advocate and father of three food-allergic children.  “A staff person at Wendy’s may not think it’s a big deal to butter hamburger buns, but that one seemingly minor change could make a dairy-allergic customer dangerously ill.”

“There are a couple of important issues at play here, in addition to these menu changes.  Most fast food restaurants are owned by franchisees, and while these local owners are supposed to follow the recipes and protocols set out by the corporate office, some restaurants may stray a little or a lot, which can be dangerous for food-allergic customers,” Antico explained.

“Compounding the problem, many fast food restaurants hire young, inexperienced staff – and experience a high volume of staff turnover – so at any given time, there’s likely someone who is untrained and uneducated about food allergy issues preparing the food,” Antico continued.

Antico urges people with food allergies to always inform restaurant employees about their food allergies and ask about ingredient lists, dedicated fryers and possible cross contact – even if they’ve comfortably eaten at that establishment in the past.  And he urges all restaurants to clearly inform guests about any changes to their menu, ingredients and food preparation so customers can make more informed decisions about what (and where) to eat.

Antico constantly evaluates changes within the restaurant industry and informs the food-allergy community about how these changes may impact them. He regularly updates information on the AllergyEats website, the AllergyEats Blog (www.allergyeats.com/blog) and through related social media channels, including Facebook and Twitter.

AllergyEats provides valuable, peer-based ratings and feedback about how well (or poorly) restaurants accommodate food-allergic customers, so the food allergy community can make more informed decisions about where to dine (and which establishments to avoid.)  AllergyEats features more than 600,000 restaurants nationwide that users can rate, as well as restaurants’ menus (including gluten-free menus), allergen lists, nutrition information, certifications, web links, directions and more.

Most restaurant review sites include information about establishments’ food, ambiance or service, but AllergyEats is singularly focused on food allergies, with peer reviews spotlighting where people with food allergies or intolerances have more comfortably eaten and where they’ve encountered challenges.

AllergyEats features a new, free AllergyEats app (available at iTunes and the Android store), providing access to important information about restaurants’ peer ratings, feedback, menus and other information while on-the-go.  And the new AllergyEats Disney World microsite (www.allergyeats.com/disney) focuses on the allergy-friendliness of the restaurants in and around the popular theme parks and greater Orlando area.

AllergyEats has been endorsed by highly-respected food, health and allergy organizations and individuals, including the Asthma and Allergy Foundation of America, Gluten Intolerance Group, Massachusetts Restaurant Association, Chef Ming Tsai and more.   For more information, please go to www.AllergyEats.com.