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Navigating a Food-Allergic World

A Doctor’s Guide to Keeping Your Kids Safe.

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As a pediatric allergist and a mother to an active seven-year-old girl with food allergies, day-to-day life can be challenging at times. For some children, food allergies can be life threatening, which can provoke a lot of anxiety around food. The key to having a healthy and happy child is finding the right balance, so your kids are protected but not restricted.

Food allergies are becoming increasingly common—six to eight percent of kids and three to four percent of adults have some type of food allergy. Businesses, schools, and other parents are often more understanding than you think, so you don’t have to live with fear. With the right tools and confidence, food allergies do not have to be a limitation. Here are my suggestions for how to navigate life’s everyday challenges.

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Always carry epinephrine. Period. This is non-negotiable. If your child has food allergies, reactions can be unpredictable, and a primary risk factor for severe anaphylaxis is delay in administration of epinephrine. Carry a twin pack in case of severe reactions or in case you accidentally inject yourself in the thumb (it can happen when you’re scared). Know how to use the injectable, and make sure those around your child do, too. Benadryl is not a substitute for epinephrine.

Don’t be afraid to ask questions. You are your child’s advocate, and it is important to inquire about the ingredients and cooking environment your child’s food was prepared in. At restaurants, I am usually very specific with my instructions, including requests that cooks change gloves or wash hands, and use cookware (even ice cream scoops) that have been cleaned with soap and water. I would much rather be the “annoying parent” than be in the emergency room later.

Teach your kids early. Having a food-allergic child requires parents to remain vigilant, while simultaneously empowering their kids from a young age to advocate for themselves. It’s never too early to teach children about their allergies. When they become verbal, teach them to ask about their food. When they become older and more mature, teach them to be prepared, including learning how to administer epinephrine to themselves in an emergency situation. Having food allergies requires children to have body awareness; children should know what symptoms to watch out for. Food allergies typically cause symptoms that are immediate, such as hives, vomiting, throat and respiratory symptoms. Hives are not always present in a food-allergic reaction so don’t let their absence fool you.

Don’t be afraid of flying. One of the most dreaded environments of a parent with a food-allergic kid is an airplane. Parents worry about the snacks offered on the plane, and whether these allergens could trigger an airborne-reaction 40,000 feet in the air. Fortunately, the majority of kids are not triggered by airborne allergens. If you are worried that your child may be one of the very small percentage of these highly-sensitive kids, then speak to your allergist before flying, and make sure the airline is aware to not serve snacks that can aerosolize. I rarely worry about what those around my child are eating, unless she’s likely to come in close body contact with that person. Pack snacks if you are unsure of what is being served, and never take a chance on a new food before flying.

Get tested. The most common food allergens are cow’s milk, egg, nuts, soy, wheat, and seafood. Know that allergies are not always life-long. They are often outgrown—especially cow’s milk and egg. If you suspect your child has outgrown a food allergy, do not ‘test” them at home. It may be tempting to try just one bite, but it’s not worth the risk. Routine follow-up appointments with your allergist will help you find out if your child’s allergies have changed. Many allergists can perform a food challenge where the food can be given in a medically supervised setting. Repeated testing can present opportunities to expand your child’s diet and improve their quality of life.

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Kanwaljit Brar, M.D., is a pediatric allergist with National Jewish Health for Kids.

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