Food allergy: the layers of protection

Oftentimes when we are childproofing our homes with the birth of a new baby, or when we speak about keeping young kids safe in general, we talk about layers of protection. Summer is coming up and we often focus on drowning prevention-- if you have a swimming pool, you are told to take all the different steps to keep your child safe: keep your pool access doors always locked, set door alarms, have a safety net or a safety fence around your pool, start swim lessons for your children as early as you can, and teach your children to always swim supervised.

For families living with children with food allergies, I like to talk about Layers of Protection as well. Life happens. Unpredictable things come our way. Accidents sometimes happen. The more layers we have created to protect our children from fatal allergic or anaphylactic reactions, the less chances we have that those layers will fail all at once.

So lets talk about some of those layers.

1. Know your child’s allergies. Label them by name.
   This may seem obvious to some. But many times, allergies are not black and white. Some children with milk allergy tolerate baked milk products, but some do not. Some children are allergic to all tree nuts, while some are allergic to a single nut. Knowing exactly what your child is allergic to, what forms of the allergen (if any) they can tolerate, and what ingredients you need to be looking for, will help you take care of them.
    
2. Read all food labels, every single time. Learn to quickly identify every allergen.
   The food industry is constantly changing. Products change, and ingredients in the same known products change as well. I have seen many patients react to foods that they had previously eaten, foods that they considered “safe”, only to find out when they re-read the label that it now contained a different ingredient. Become familiar with the way products are labeled to quickly scan them for the allergens you are concerned about. The more labels you read, the better you will be at it. Teach your child and siblings to do the same as soon as they know how to read. Avoid products that say “may contain” or “processed in the same facility as” since we cannot assure that cross-contamination has not occurred.
    
3. Beware of those “protein” products.
   We are all concerned about what we feed our children, and children with food allergies already have many restrictions. We want them to eat healthy and wholesome foods, however some children with food allergy become fearful of trying new things or become quite picky. Sometimes we struggle to find adequate foods for them, and we may want to choose products that have a higher protein content or that look like a healthier choice. But remember, products that are labeled as “high protein” or “protein packed” often contain whey and casein, which are two types of protein found on milk, but they are often not clearly labeled as milk products. In a similar way, many vegetable chips contain nut powders or seeds to increase the protein content, and those can be also very dangerous. Remember- proteins are your major allergens! Always look to see where that “protein” is coming from.
    
4. Know your child’s risk of anaphylaxis.
   Children with IgE-mediated (antibody mediated) food allergies are at risk for anaphylaxis if they ingest the foods that they are allergic to. But some children have to avoid certain foods for other health reasons, some may have food intolerances, or some may have gastrointestinal food allergic disorders that do not lead to anaphylaxis if the food is ingested. Make sure you know what type of allergy your child has, and the potential symptoms they could have if the food is ingested.
    
5. Have a written Food Allergy Plan.
   In case of a true emergency, you may be anxious, scared or you may not even be there. Emergencies can happen anywhere, and they most often happen outside of your own home. Have a written food allergy plan that explains what to do in case of an emergency. This food allergy plan should list your child’s allergens, the possible symptoms of a reaction, and what medications to give in case of reactions with the correct dosing of each medication.
    
6. Always carry your emergency medications with your child.
   Every child that has IgE-mediated food allergy that can potentially lead to anaphylaxis should always carry an epinephrine autoinjector, which is a life-saving medication. Additionally, an antihistamine should also be available for minor reactions, as well as an albuterol or levalbuterol inhaler if your child has asthma, since allergic reactions can also trigger asthma attacks.
   
   Keep a copy of the food allergy plan and all emergency medications together in a small bag or container that goes with your child wherever your child goes. As children grow older, teach them to carry their own medications and how to administer them. Remember that teenagers are at the highest risk of fatal anaphylaxis!
    
7. Have yearly visits with your doctor or allergist.
   Children grow and their allergies may change. Some children outgrow their food allergies, and some don’t. Certain food allergies have a greater chance of being outgrown than others. New treatments are emerging for those with food allergies. Children’s weight changes, and their medication dosages need to be adjusted. Those are all reasons to see your doctor once every year.
    
8. Educate. Be your child’s advocate.
   Educate those around you and especially the ones that help you care for your child. Not everyone is aware of the potential dangers of a food allergy. Be your child’s best advocate, and help them learn how to be an advocate for themselves.
    
9. Seek support.
   Know that you are not alone. Food allergies are consuming and anxiety provoking, not just for the parents, but also for the child and the entire family. They affect every aspect of their lives. There are many food allergy networks, family support groups, hospital and clinic based food allergy centers that are here for you. Don’t be afraid to ask for help!
   
   Together, we can make the life of children with food allergies better, safer, and less scary. Make sure you protect your child with several layers. And while you are at it, give them a hug and tell them that you love them.