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The four things parents need to know about food allergies

Posted by Dr. Claire McCarthy  June 24, 2012 04:08 PM

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Food allergies are on the rise in kids--and the best people to keep allergic kids safe are their parents. 

That's the message of a new study published in the journal Pediatrics--and it's one I couldn't agree with more as a pediatrician. Here are the four most important things I think parents need to know:

1. Food allergy symptoms can be subtle, especially at first. It's not always hives. It could be eczema, or constipation, or diarrhea, or vomiting, or a bit of blood in the stool. It could be that a baby isn't growing. If any of this is going on with your child and doesn't get better, or your child is having other health problems that don't have a clear explanation, ask your doctor about checking for food allergies.

2. If your child has any kind of reaction to a food, call your doctor. The thing is, just because the reaction is mild (a little bit of a rash, an itch in the throat) doesn't mean that the next time will be mild--reactions often get worse with repeated exposures. And it's not always clear what the cause of the reaction is--you might think it was the macadamia nuts in the cookie, but maybe it was the eggs in the recipe. Food allergies can be life-threatening. If there is even a suspicion of a food allergy in one of my patients, I want to know immediately so I can do testing and be sure the parents have the medications they need, because...

3. Medications are crucial. There are two that you must have handy if your child has food allergies. The first is diphenhydramine, better known by the brand name Benadryl. It's what you want to give for a mild allergic reaction, like if they have a few little hives but are otherwise fine. But if there are any signs of a more serious reaction, the medication to give immediately is an epinephrine injection (most commonly prescribed in something called an Epipen, which is very easy to use). If you know (or even think) your child has a food allergy, talk to your doctor about getting an Epipen. I always prescribe three of them: one for home, one for school or daycare, and one to travel with the child.

Signs of a more serious reaction include:
  • trouble breathing (from throat swelling or wheezing)
  • hives (more than just a few) or flushing of the skin
  • swelling of the face, tongue, or eyes
  • dizziness or fainting
  • nausea, vomiting, or diarrhea
  • feeling anxious
If you aren't sure that it's a serious reaction but you think it might be, give the Epipen. It's always better to be safe than sorry. In the Pediatrics study, only 30 percent of the kids who had serious reactions got epinephrine, which is far too low. And if things get better (which they usually do) after giving it, it's still really important to go to an emergency room--because once the epinephrine wears off, the reaction can come back.

4. Vigilance is key--and harder than people realize. To prevent a child from eating something they are allergic to, parents have to be fanatic label readers. I really do mean fanatic. You might be certain that something doesn't have peanuts in it, but you won't know if it was made using machines that also made peanut-containing foods (so might have traces of peanut) unless you read the label. And parents need to be incredibly careful about every ingredient they use in cooking. In the study, half of the serious allergic reactions in the children were from foods their parents gave them. 

Parents also need to make sure they educate not just everyone who cares for and feeds the child, but the child too. It's best to make it a rule that the child shouldn't eat anything without checking with a parent or the person the parent designates to be the Food Checker in their absence.

Eleven percent of the serious reactions happened when parents knowingly gave their child something they were allergic to, to see how allergic they were or because they thought they weren't allergic anymore. Oops, huh? It can be really tempting to do that, but don't. If you think your child may have outgrown a food allergy, talk to your doctor about how you can find out for sure. 

This may seem overwhelming, and at the beginning it can be. But the more you learn, the easier it gets.The Food Allergy and Anaphylaxis Network has a great website full of information (and recipes, too!) that can be helpful. The Allergy department at Boston Children's Hospital has a great team that helps families every step of the way.

Get educated, and ask for help. Those are good rules of thumb with any medical problem--and key for helping children with food allergies lead healthy and happy lives.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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