The New Rules for Food Allergies

If You're a New or an Expecting Parent

NEW RULE: Eat your veggies, plus fish and even nuts, while pregnant. Children with one or two parents who have any type of allergy are at higher risk for a food allergy, but many kids with allergies have parents with no issues at all. So researchers are working hard to identify the things in our environment that may affect risk, and recently landed on a powerful protective factor: a balanced pregnancy diet. In fact, studies have shown that consuming large amounts of unhealthy food while pregnant can even increase your child's risk of allergies. On the flip side, it seems that pregnant moms can reduce their child's risk by eating a Mediterranean diet, including lots of vegetables, fish, and healthy fats, like olive oil and -- if you aren't allergic to them yourself -- nuts. While doctors used to counsel against this, "early exposure seems to confer a protective benefit to the fetus, though more research is needed to prove this," says Kari Nadeau, M.D., associate professor of allergy and immunology at Stanford University School of Medicine.

NEW RULE: Don't be a clean freak. Many scientists think that our increasingly sanitized lives may not properly prepare a budding immune system, causing it to overreact to harmless food proteins. Drs. Sampson and Nadeau recommend bypassing antibacterial soaps and harsh household cleaners in favor of good old soap and hot water.

NEW RULE: Offer a variety of tastes early and often. In 2000, the American Academy of Pediatrics (AAP) advised all parents to wait until their baby was 2 to introduce eggs, and until age 3 to give nuts and shellfish. But now, the AAP supports giving these foods around 6 months along with others, even in kids with a family history of reactions (taking care to avoid choking hazards and offering them one at a time, of course). "Introducing a diversity of foods at a young age might actually help protect against allergies. We're not sure why, but it may train a child's immune system to not respond to any one protein as a threat," says Dr. Nadeau. Still, she advises parents of kids with a family history of food allergies to ask their doctor for help creating an eating plan and to look out for reactions to newly introduced foods.

NEW RULE: See an allergist if you suspect a food allergy. In the meantime, start a food log. Kids often show warning signs of a food allergy before they have a full-blown reaction. Rashes in young infants are a red flag: 37 percent of kids with eczema have a food allergy, and dry, red, itchy patches on the cheeks may be the first sign of eczema, says Dr. Sampson. Frequent tummy troubles and vomiting in infants should also raise suspicion. If your child shows any of these symptoms, see an allergist (consult the "physician finder" tool on the American Academy of Allergy, Asthma & Immunology's website, aaaai.org). Before the appointment, note what your child eats and when worrisome symptoms occur. "Both blood and skin tests can result in false positives, so results must always be interpreted in the context of the patient's everyday symptoms," says Sakina Bajowala, M.D., an allergist in North Aurora, Illinois, who writes the Allergist Mommy blog.

If Your Child Has Been Diagnosed

NEW RULE: When in doubt, use epinephrine. A big mistake even savvy parents make is waiting too long to administer epinephrine when they suspect an allergic reaction. Anaphylaxis can kill within minutes. "If a child has more than one symptom, for example vomiting and hives, or any breathing problems at all, or you're just worried enough to consider using epinephrine, use it," says Dr. Sampson. Any side effects are minimal -- nausea, increased heart rate, headache -- and are no worse for children who turn out not to have an allergy. If your insurance will cover it, keep two doses at home and at school, since one shot may not be enough to halt a reaction. "Kids with serious allergies should also always have their epinephrine with them on playdates or at activities outside of school," says Dr. Bajowala. If another adult is in charge, make sure he knows exactly where your child's epinephrine is (down to the specific pocket in her backpack), and how and when to use it. EpiPens have easy-to-follow instructions written on the side, while a newer product, Auvi-Q, actually talks you through an injection.

Food Allergies: Helping Your Child Cope
Food Allergies: Helping Your Child Cope

NEW RULE: Stand up for your child's rights at school. Once there's a diagnosis, the doc should write an emergency-care plan: instructions on how to avoid allergens and how to handle a reaction. Give a copy to the school nurse with the epinephrine, says Mitchell. "The nurse will be your point person for organizing a meeting that includes you, your child's teachers, and the head of the cafeteria to go over what precautions are already taken, such as cleaning cafeteria surfaces, and what additional measures are needed to protect your own child." (No school nurse? Start with your principal.) If the school's response falls short in any way, Mitchell recommends asking for another meeting to request a 504 evaluation. Section 504 of the Rehabilitation Act of 1973 requires that no child with a disability be prevented from participating fully at school (public or private). A 504 Plan can document more detailed expectations for the school, often including procedures for handling food in the classroom, not just the cafeteria.

NEW RULE: Don't assume a food allergy is forever. Most kids outgrow their allergies to cow's milk, eggs, soy, or wheat by age 16. But for reasons scientists don't fully understand, only 20 percent of peanut-allergic kids and 10 percent of tree-nut-allergic kids do. Studies are underway to improve those odds with a treatment called oral immunotherapy (OIT). By having a child swallow tiny and then incrementally larger doses of one allergen -- like peanut or milk -- every two weeks, "we train the allergic cells to become less allergic," explains Dr. Nadeau, who's performing clinical trials on OIT at Stanford. Like shots given for environmental allergies, food-allergen immunotherapy works by helping the body build a tolerance to an allergen. But some treatments need to be given daily and can take longer to work. And because it's possible for kids to have a severe reaction during treatment, immunotherapy must always be done by a specially trained professional (whereas environmental allergy shots are sometimes given by a pediatrician). Once the regimen is finished, kids need to be continually exposed to the food; if they aren't, the allergy can return.

For many kids, immunotherapy can be life-changing. "Before, we used to walk around saying 'Can't eat here,' 'Can't go there,' " says Diane Eiger, of Los Altos, California, whose son, Alex, now 9, was allergic to multiple tree nuts and peanuts when he started immunotherapy with Dr. Nadeau three years ago. Today, he can eat all of these foods without a reaction. "Now we can go to a deli or get Chinese food on a whim, and I don't have to buy the same 'safe' chocolate bunny for his Easter basket every year," says Eiger. Alex's first donut, at 71/2, was particularly memorable. "It was just a plain old glazed donut, but he grinned and closed his eyes like it was the best thing he'd ever eaten in his life," Eiger says. "It makes you realize just how much these kids miss out on."

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