Food Allergy Basics
A food allergy is an immune system response to a food protein that the body mistakenly believes is harmful. When the individual eats food containing that protein, the immune system re-leases massive amounts of chemicals, triggering symptoms that can affect a person’s breathing, gastrointestinal tract, skin and/or heart.
It is estimated that up to 2% of Australians, including 1 in 20 children suffer from food allergies and some of them will experience a life-threatening (anaphylactic) reaction.
There are eight foods that account for the majority of food allergic reactions: nuts, fish, crustacean (prawns, lobster, crab etc), eggs, milk, sesame, soy and wheat.
Peanuts are the leading cause of severe allergic reactions, followed by tree nuts, crustacean, fish and milk.
Currently, there is no cure for food allergy. Avoidance of the food is the only way to prevent a re-action.
Adrenaline is the first line treatment for severe allergic reactions and can be administered via an auto-injector called the EpiPen.
Any food can trigger anaphylaxis. It is important to understand that even trace amounts of food can cause a life-threatening reaction. Some extremely sensitive individuals can react to even the smell of a food.
Mild to moderate allergic reaction
- Tingling of the mouth
- Hives, welts or body redness
- Swelling of the face, lips, eyes
- Vomiting, abdominal pain
Severe allergic reaction- ANAPHYLAXIS
- Difficulty and/or noisy breathing
- Swelling of the tongue
- Swelling or tightness in the throat
- Difficulty talking or hoarse voice
- Wheeze or persistent cough
- Loss of consciousness and/or collapse
- Pale and floppy (young children).
The signs and symptoms of food sensitivities vary greatly depending on the body’s response and can include:
- Allergic shiners (puffiness or dark circles under the eyes) Anxiety
- Asthma Attention-deficit disorder
- Bed-wetting Bronchial infections
- Colic Constipation
- Crohn’s disease or colitis Diarrhea
- Ear infections Eczema
- Frequent infections Hyperactivity
- Irritable bowel syndrome Obesity or excess weight
- Rashes Runny nose
- Spitting up in infants Vomiting
It is quite possible that your child is eating the wrong foods for his or her system. Food allergies and sensitivities can be the underlying cause to many childhood illnesses and symptoms without parents even being aware. It is important to remember that all people (including kids) are biochemically different. While Child A can happily eat an ice cream cone with no side effects, Child B may develop an ear infection as an allergic response to dairy. The key to alleviating a child’s symptoms is to pinpoint the sensitive or allergic food in question and eliminate it from the diet, either completely or for a period of time.
Why do people get food allergies?
Your body has an immune system.
This system makes antibodies to fight off germs which get into your body.
Sometimes the immune system makes a mistake, and thinks that something you have eaten could harm you.
Antibodies go into action and release a chemical called histamine which is what causes the allergic reaction.
People are more likely to have allergic reactions to food if other people in their family also have allergic reactions.
Food Trial Tips
- Introduce 1 food – wait 2 weeks, if no symptoms present continue giving that food and add another food. If there are symptoms, remove the food.
- Add the 2nd food – after 2 weeks, if no symptoms continue giving that food and add another food. If there are symptoms, remove the 2nd food.
- Add the 3rd food – after another 2 weeks, if no symptoms continue giving that food. If there are symptoms, remove the 3rd food.
Are Premature Babies More Likely to Develop Food Allergies?
Almost certainly not. Because premature babies’ digestive tracts are immature at birth, parents often wonder whether these children are at higher risk of food allergies or other related conditions. A recent large-scale study of infants born in Manitoba, Alberta, Canada in 1995 compared babies who were born prematurely or with low birth weight to those who were born at term or with normal weight to try to discover whether these two factors were related to later development of food allergies.
Researchers also looked at other risk factors for food allergy, especially whether parents or siblings also had food allergies or asthma and factors potentially associated with the Hygiene Hypothesis, like number of siblings and whether the child lived in an urban or rural setting.
In comparing birth weights, researchers in this large-scale study found that no birth weight or gestational age infant, heavy, light, premature, on-time, or post-term, was statistically more or less likely to develop food allergies. This is consistent with older studies about premature babies and food allergies. Factors that were associated with later development of food allergies were the same as had been identified in other
Is It Possible for My Child to Outgrow a Food Allergy?
Yes, sometimes. The chances of a child outgrowing food allergies depend on several factors. One is the type of food the child is allergic to. A study found that 79% of children outgrew dairy allergies by the age of 16. Children with egg allergies have a greater than two-thirds chance of outgrowing their allergies by late adolescence. In contrast, only about 20% of children diagnosed with peanut allergies, and 10% of those with tree nut allergies, ever outgrow their allergies.
Another factor that has been strongly associated with outgrowing food allergies of several types is specific IgE levels. The lower the levels of allergen-specific IgE detected in blood tests, the greater the chance the allergic patient will eventually outgrow the allergy.
Studies have found that allergies can be outgrown well into adolescence. Your allergist will have specific recommendations for monitoring your child’s chances of outgrowing his food allergies. They will likely involve measuring his allergen-specific IgE levels through blood tests. And, if those numbers look favourable (and if your child has had no other signs of still being allergic to his allergens), conducting a double-blind placebo-controlled food challenge to determine whether your child has developed a tolerance to his allergens.
What is anaphylaxis?
Anaphylaxis is a life-threatening allergic reaction caused by eating food or coming into contact with an-other product which provokes allergy.
It must be treated as a medical emergency, requiring immediate treatment and urgent medical attention. Anaphylaxis is a generalised allergic reaction, which often involves more than one body system (e.g. skin, respiratory, gastro-intestinal, cardiovascular). A severe allergic reaction usually occurs within 20 minutes of exposure to the trigger and can rapidly become life threatening.
The most dangerous allergic reactions involve the respiratory system (breathing) and/or cardiovascular system (heart and blood pressure).
Anaphylaxis is the most severe form of allergic reaction.
How common is anaphylaxis?
The Australian Society of Clinical Immunology and Allergy reports that around 1 in 20 children suffer from food allergies (and of these, about one in ten could suffer a severe reaction, causing anaphylaxis) and around 1 in 100 adults are afflicted.
A person who is suspected of having a food allergy should obtain a referral to see an allergy specialist for correct diagnosis, advice on preventative management and emergency treatment. Those diagnosed with severe allergy must carry emergency medication as prescribed as well as an Anaphylaxis Action Plan signed by their doctor. Food allergic children who have a history of eczema and/or asthma are at higher risk of anaphylaxis. Administration of adrenaline is first line treatment of anaphylaxis.
Management & Treatment
Anaphylaxis is a preventable and treatable event. Knowing the triggers is the first step in prevention. Children and caregivers need to be educated on how to avoid food allergens and/or other triggers.
However, because accidental exposure is a reality, children and caregivers need to be able to recognise symptoms of an anaphylaxis and be prepared to administer adrenaline according to the individuals Anaphylaxis Action Plan.
Research shows that fatalities more often occur away from home and are associated with either not using or a delay in the use of adrenaline. In Australia, adrenaline can be purchased on the PBS in the form of an auto-injector known as the EpiPen. The EpiPen auto injector is an intra-muscular injection of adrenaline for the emergency treatment of anaphylactic reactions. It is available in two doses, EpiPen Jr or EpiPen.
Always remember this…..
It is possible to lead a normal life. You are not alone. Often people feel overwhelmed, angry and anxious after a diagnosis of food allergy is made.
- Plan ahead
- Always read all labels
- Understand different ingredient names
- Educate those around you
- Take safe food with you where ever you go unless you know safe food is available
- Keep up to date with product changes and the latest in research
- Allow extra time when grocery shopping to read labels
- Do not hesitate to ask questions (especially when eating out)
- Have an emergency drill from time to time including checking expiry dates on your EpiPen
- Become an AAI (Anaphylaxis Australia Inc) Member.
- Knowledge is power
- Educate your child who is at risk and their siblings
- Empower your child to manage their anaphylaxis, as they grow older.
- Recognise early signs or symptoms of anaphylaxis.
Patients who are at risk of anaphylaxis should:
- Wear a Medic Alert bracelet or disc. This increases the likelihood that adrenaline will be administered in an emergency by doctors or ambulance officers.
- Carry (and know how to use) self injectable adrenaline (EpiPen). Adrenaline acts as a natural “antidote” to some of the chemicals released during severe allergic reactions. Adrenaline should be considered as First Aid for the treatment of anaphylaxis.
Starting Kinder with Food Allergies (Ref – Kylie Sanderson)
Before Starting What Do I Do?
Meet with the staff to discuss your child’s individual medical history and needs. Discuss any perceived high-risk times. A Management Plan that includes risk minimisation strategies should then be developed. Keep staff in-formed about any changes or updated allergy tests that may occur.
Talk with staff about also trying to educate other families about the seriousness of food allergy through the centre’s newsletters. Gentle reminders could also be included at regular intervals.
You must provide an Anaphylaxis Action Plan signed by your doctor. The parent must provide a Medical Kit (containing Action Plan & medication, including an adrenaline auto injector, EpiPen). This needs to be at the Kinder whenever the child is present. Your child’s name, allergic triggers, list of contents and recent photo can be placed on the lid and container. Use the same photo on all items to ensure consistency.
The Medical Kit should be stored out of direct sunlight and be easily accessible in the event of an emergency. It must NOT be in a locked cupboard or locked room. Place a pen/marker in the kit so that the time the EpiPen is given can be recorded in an emergency. Have a card detailing the name of the child at risk of anaphylaxis, their age and their allergies, the facilities phone number, address and nearest cross streets near the central telephone.
For any special events such as birthdays fill a box with a variety of safe items, which the staff/child can choose from when a treat is required. Discuss a non-food reward option for all the children. Staff can give stamps and stickers to acknowledge positive behaviours and good work or even as a special treat.
Provide cup cakes in a clearly labelled container with you child’s name on it. These cup cakes can be given to the child with food allergy when non-allergic children bring in birthday cakes. Store the cup cakes in the Kindergarten freezer and defrost them at the beginning of the session.
Morning/Lunch/Afternoon Tea Ideas
The safest option is for parents to always provide food for their food allergic preschooler whilst they are in care. If this is not an option, it is critical that the parent speaks with the chef who prepares food for all the children. Some changes may need to be made to remove high-risk foods from the childcare environment.
Ask the staff how/where the children eat their meals and snacks. Do they eat at tables, on the floor, in small groups or in a large group? Will your child need very close supervision during eating because of their age or lack of understanding? Discuss food sharing or food swapping amongst children with kinder staff. How will the kinder educate all children about not sharing food?
Storage of food containers should ideally be in the kitchen, not in backpacks. The child’s food is then protected from other children handling the contents or mixing up containers. Staff will be required to bring out food at appropriate times and place them back in kitchen when finished. Separate drink bottles/cups should be clearly labeled with child’s name and allergy and kept somewhere separate from other children’s drinks. (An easily identifiable sticker can help a child recognise their cup if they are unable to read their name in written form).
All staff will need to undertake anaphylaxis training and will need to know how and when to administer the adrenaline auto injector (i.e. EpiPen) in the event of an emergency as per the individuals Anaphylaxis Action Plan. All staff need to be aware of the centre’s anaphylaxis management guidelines/policy.
Above all it is vital you communicate and build a strong relationship with the Kindergarten staff to ensure you trust in their professional care and they feel supported as well. Ask lots of questions, offer suggestions where appropriate and arrange regular meetings to review progress and make changes deemed necessary. Become a partner in your child’s care. Caring for a child at risk of anaphylaxis can initially be overwhelming for staff and they need your ongoing support. Be open to negotiation on ‘do-able’ best management practises, which will allow your child to have a fun time at childcare.
Where to get assistance
Detecting a food allergy may feel like searching for a needle in a haystack. To the surprise of most parents, the common scratch test performed in most doctors’ offices does not test for food allergies or sensitivities. There is, however, a blood analysis measurement called the ELISA test that can be used to detect the reactions of white blood cells to certain foods. This test is useful for measuring immediate or delayed responses. Food allergy testing can be done by skin prick tests and patch tests, these tests are used to guide elimi-nation diets i.e. strictly avoiding all foods which the patient has tested positive on allergy testing.
Ask your Pharmacist for advice
- Try to identify the source of the problem and make every effort to avoid any known allergens.
- Follow the Diet Hints. Try to identify any possible food allergies with a Doctor or Dietician.
- Your Pharmacist may suggest an antihistamine. There are several brands available. Watch for any possible side effects which may include drowsiness.
- If the allergy has caused a rash, your Pharmacist may recommend an anti-inflammatory cream.
- Vitamin C is considered by some people to have natural antihistamine properties.
- www.allergy.org.au – Food intolerance
Fast Ideas Safe Recipes for Kids” book can be purchased through the The Ilhan Foundation, Firbank Grammar School, Crazy John’s stores in Victoria or online at Star Allergy Alerts
Why am I different? – My First Allergy Book by Naomi Antenucci – Written especially for young children under three years of age, this book explains food allergies in clear and simple language.
Food Allergy: an overview by Meenakshi Bharkatiya, Kamal Singh Rathore, Ankur Maheshwari, Sunita Panchawat & R K Nema ; 2010
cook book on allergy-free-cooking for kids