Dr. Alan Greene on Life-Threatening Food Allergies

Critical facts about your child's dangerous food allergies.

Question

My 5-year-old son has been diagnosed with a fatal allergy to all types of nuts. Will we always have to live with the fear of an allergic reaction hanging over our heads?

Answer

Some individuals have reactions to particular foods. These reactions can range from mild intolerance to fatal allergies. Most of the children who develop life-threatening food allergies either have asthma themselves or a family history of asthma, eczema, or hay fever. Most of them have mild to moderate reactions (rash, wheezing, tingling, diarrhea, etc.) to the offending food before the allergy becomes severe. In a few children, though, the first time they eat the food they become sensitized; the second time they eat even a minuscule amount of that food, an explosive reaction occurs.

Life-threatening food allergies (most commonly to nuts, peanuts, or shellfish) can kill children in two ways. The first is called laryngospasm. As the food is swallowed it produces immediate swelling which includes the vocal cords. If the vocal cords swell shut, the child is unable to breathe and dies with terrifying rapidity. The second mechanism is called anaphylactic shock. The child swallows and digests the food and, as long as two hours later, goes into shock and dies.

Children with these life-threatening food allergies do not grow out of them. Without treatment they are lifelong conditions.

Treatment

The core of treatment is absolute and complete lifelong avoidance of all nuts and peanuts in any form. This includes nut oils and nut butters. Most intake of nut products, by people with known nut allergies, occurs when the nuts are present as a hidden ingredient, perhaps in a cookie, a cupcake, or even chili.

No matter how careful you are, it is almost inevitable that your son may be exposed to his life-threatening allergy trigger. For this reason, it's critical to learn about the second phase of treatment. You must be prepared to deal with the emergency when it happens. Learn CPR. Now.

Your child will need an EpiPen Jr. kit -- actually two EpiPen Jr. kits. These contain easily injectable epinephrine, the one drug that can stop this reaction in its tracks. You and your partner should each carry an EpiPen with you at all times, 24 hours a day. It is important that each of you is comfortable using it. If you think there has possibly been a nut ingestion, USE IT! Don't wait and see. Use the EpiPen and take your child to the emergency room immediately.

Educate Others

Once you have educated yourself on emergency care, it is vital that you educate any other adult who will be caring for your child. These adults should know CPR and should have an EpiPen. In a chilling study from Johns Hopkins University, 13 children with life-threatening nut allergies were followed -- six of them died. All six of these children had ingested nuts while at their various schools. They immediately went to their school nurses who told them to lie down and see if they felt better. Each of them did feel better and went back to class -- and died. Talk personally with your child's teachers, principal, and school nurse. Any adult taking care of your child should be given a written note that indicates your son has a life-threatening allergy to nuts and peanuts in all forms.

Don't go this road alone. It sounds like you have a knowledgeable allergist. You will also benefit from links to other families going through the same thing. Food allergy support groups are available in many locations. Whether or not you contact a local support group, I would definitely contact and join the Food Allergy Network. It costs about $20 per year and provides outstanding information, literature, videos, and the kinds of practical information and support you will need. Their phone number is 703-691-3179 or 800-929-4040. Their address is 10400 Eaton Place, Suite 107, Fairfax, Virginia, 22030. They also have a wonderful Web site at www.foodallergy.org. Contact them right away.

Some of the research being done right now in life-threatening food allergies is very exciting. Companies such as Genentech, based near San Francisco, are working on products to block this type of allergic response at the cellular and molecular level. This research is quite promising, but still only investigational.

Life-threatening food allergies are not rare. But as deadly and as common as they are, very few children actually die from them. With this combination of avoidance, preparation, and education, your 5-year-old can look forward to a long and healthy life.

 

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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