There are currently no cures for a food allergy. Management is based on avoiding the food and being prepared to treat an allergic reaction should the food be eaten accidentally. Anti-histamines can help mild symptoms such as itching and hives, but an epinephrine injection is necessary for severe symptoms or breathing difficulties (eg, throat swelling, wheezing). If epinephrine needs to be given, the child should be immediately taken for emergency medical care, or if necessary, 911 called.
If your pediatrician believes there is any risk that your child could have a severe allergic reaction (an anaphylactic reaction) to food, your pediatrician will recommend that you—and your child, when old enough to use it by himself—always carry an epinephrine autoinjector device in case of an accidental ingestion of the food. It is essential that you review with your doctor how and when to use this medication. The devices are easy to use and the medication is safe, but it is important to be familiar with the device being prescribed so that there are no delays in providing emergency treatment. A child at risk for anaphylaxis should also wear medical identification.
There’s only one sure way to prevent food allergy symptoms, and that’s to avoid the problem food altogether, in all forms, at all times. Sometimes this is easier said than done. Product labels must be read carefully each time to ensure the allergic food is not an ingredient. Read the label each time because ingredients may change. This is extremely important for patients with severe food allergy. At home, avoid cross-contact of safe foods with an allergen. For example, a knife used in peanut butter and then in jelly may leave peanut residue in the jelly jar that could cause a reaction when the jelly is used another day. Similarly, be careful when preparing foods and using cutting boards, mixing spoons, and heating surfaces. In restaurants, have a careful conversation with the waiter to be sure that the allergen is not an ingredient or contaminant of your child’s meal, although this may not be guaranteed. For school, bringing safe foods from home may avoid problems with cafeteria meals, although many schools can provide safe foods with proper preparation. Strict no-sharing policies must be followed to prevent accidental ingestions. Also avoid using food products in craft and science projects to steer clear of accidental exposures.
It’s a fairly simple matter to keep a problem food away from a very young child who eats meals and snacks under the watchful eye of parents or caregivers. However, it is more difficult with an older child who has less supervision while eating. Not only your child but also his friends and their parents should understand how serious the condition is and how important it is to avoid the allergen in any form. Above all, children should be warned never to share or taste another child’s food.
Be sure to provide full information about your child’s food allergy to school and camp personnel and child care providers. Update information regularly at the start of each school year and as new facts become available. In this regard, it is important to report accurate information, ie, definite food allergies, not minor food sensitivities.
Food Allergy Myths and Misconceptions
- Food allergy affects behavior. There is no convincing research results showing that a true food allergy causes problems such as attention-deficit/hyperactivity disorder or autism. Some studies show that chemical preservatives or dyes, presumably through a pharmacologic rather than allergic mechanism, might contribute to these problems, but the evidence is weak and not widely accepted by experts.
- Sugar allergy causes behavioral problems. Parents may blame high-sugar foods for unusual behavior. However, the results of several carefully controlled studies of preschool and school-aged children showed sugar or artificial sweeteners had no effect on behavior.
- Each allergic reaction gets worse. It is not automatically the case that each subsequent exposure to the food will result in a worse allergic reaction. The severity of a subsequent reaction is not easily predicted and can be worse, the same, or milder than previous reactions.
- Peanut-allergic children should avoid all kinds of nuts. Peanut is a legume and not of the tree nuts family. Many children with peanut allergy can tolerate tree nuts, and vice versa. However, some children can be allergic to multiple different foods, including peanut and certain tree nuts. Make sure you are clear what the situation is with your child.
US labeling laws require disclosure of peanut, tree nuts (eg, almond, hazelnut, walnut), milk, egg, wheat, soy, fish, and crustacean shellfish ingredients in packaged manufactured foods. When a tree nut, fish, or crustacean shellfish is an ingredient, the type must be disclosed (eg, walnut, cod, shrimp).
Additional foods (eg, sesame) are being considered for inclusion in labeling laws.
Manufacturers may voluntarily indicate if an allergen is a potential unintended contaminant of a food by using advisory label terms such as “may contain” or “prepared in a facility that processes.” These voluntary statements cannot be used to know how much of an allergen is in a food or how often a food may contain the unintended allergen. Therefore, to play it safe, these foods are best avoided.
If your child is allergic to a food not covered by the law, you have to be extra careful. For example, there is a chance it is an ingredient in descriptive terms such as “spices.”
In some cases, you may need to contact a manufacturer to get additional information about ingredients. Whenever in doubt, just avoid that food.