Allergic Food Reaction in Kids
Help! My Child is Anaphylactic to Nuts
Having your child diagnosed with anaphylaxis is very stressful for parents. Anaphylaxis is an allergic reaction that causes swelling of the throat, difficulty breathing, low blood pressure and can be fatal. Anaphylactic shock can occur from insect stings, food, and medications. As if our worries about our children aren't enough, now we have to watch everything they eat as well.
These were some questions that were asked of me by a friend of mine who is a doctor involved in anaphylaxis treatment in children. She wanted to be sure she was addressing parents concerns without sounding too much like a medical doctor so she asked me to answer them for her. In learning to keep my son, who has anaphylaxis, safe I had to become somewhat of an expert. Even after he was diagnosed we inadvertently caused some anaphylactic allergic reactions. My son is allergic to nuts, and you'd think avoiding nuts would be easy, but it's not. There was a huge learning curve for us, as nuts show up in some foods that you wouldn't expect. The stress of having a child who is at risk of going into anaphylactic shock is comparable to that of a family having a child with a severe disability.
Our Story of Anaphylaxis
First it was peanuts, then it was tree nuts
My son probably developed a peanut allergy very early in life. I believe as early as around 2-3 months because we saw hives and facial swelling around this time. I only suspected it was an allergy because a friend's son had a peanut allergy and I started putting two and two together when I realized that I was eating peanut butter on my toast in the morning and then, when my son woke up, I'd kiss him and nuzzle him. So basically I was smearing peanut butter all over him when I kissed him.
My son stopped breast feeding, and lost weight (went from 16 lbs to 13 lbs). My doctor didn't seemed to be concerned, but I was because he was refusing my milk. Thinking I had some problem with my milk drying up, I switched him to formula. Later I realized that he probably stopped breasting feeding because I would eat peanut butter on toast whenever I had hunger pangs. He was most likely being exposed to peanut butter when I latched him on as I probably had some on my hands.
Once I switched him to a bottle, he would feed well sometimes and other times when I put a bottle near him he would scream like crazy. I finally figured it out that I made all his bottles in the morning while I was eating my toast with peanut butter on it, so I was transferring traces of peanut butter to the bottle nipples from my hands.
It took me a few months to convince my pediatrician to do allergy tests on my son. I took my son in once when his fontanel was swollen - I'm sure she thought I was shaking him. I had dropped my peanut buttered toast on his head. My pediatrician now says that she has all babies tested when they lose weight or have any swelling. This was 10 years ago and they didn't believe in testing for allergies until kids reach the age of 3. My son was just about one year old by the time we got into see the allergist. At that time he tested positive for allergies to peanuts and eggs.
We thought he grew out of the allergy
When he reached three years old we had him tested again and this time he tested negative for peanuts and eggs. He was one of the lucky ones! He was one of the kids that grew out of his allergy. They suspect that around 20-30% do when they are diagnosed very young, and the parents don't have any allergies, asthma or eczema. If a child has asthma, their chances of growing out of their allergy are slim.
After getting negative skin tests we had to challenge eating peanuts in the allergists office. The skin tests, can be false, so they suggest eating small amounts to prove the allergy has in fact, gone away. It's very important that you do the challenge in a controlled medical setting and don't try it at home. The allergist said we were in the clear and my son could eat nuts again, but we still kept them away from him, until one day at Grandma's house.
And then one day....
My son was about 4 years old and Grandma had some mixed nuts on the coffee table. He grabbed a handul of nuts and popped them in his mouth. His reaction was immediate and he spit them out, started screaming, then coughing, and progressed into a full anaphlyactic reaction. After another trip to the allergist my son tested positive for tree nuts.
So he went from being allergic to peanuts, grew out of it, then became allergic to tree nuts. At first he just tested positive for the tree nuts - cashews and pistachio's, but when we had him tested last year he reacted to just about all the tree nuts. He is not allergic to peanuts anymore, but we still have to avoid peanuts because they usually have trace amounts of tree nuts on them because they are commonly processed in plants that also process tree nuts. We generally just tell people he has a tree nut and peanut allergy to avoid trying to explain to people the difference.
What is Anaphylaxis?
The difference between allergies and anaphylaxis
There is a difference between having an allergy and having anaphylaxis. Just having a normal allergy means you may get watery eyes, an itchy nose and sneeze. If you have anaphylaxis (a more severe form of an allergy) you may get those symptoms as well, but you are also at risk of having throat swelling and breathing problems.
An anaphylaxis reaction is a full body allergic response to an allergen. An anaphylaxis reaction is life threatening, because airways can swell and the person can have difficulty breathing. As well there may be a drop in blood pressure, both of which are potentially deadly.
Can my child be in the same room as someone else eating nuts?
Yes, with the exception of the very young
The risk to a very young child is that the person eating nuts will have left a small amount of peanut butter behind on a pencil, table, or desk. When the allergic child comes along they may get this amount on their hands and then rub their eyes, pick their nose or stick their hands in their mouths. Ingestion occurs when the allergen comes into contact with any mucous membrane (eyes, nose, mouth). This is a very real risk for small children in the school setting, which is why it is recommended to keep the classrooms in which these children are in, free of nuts and nut free snacks are served.
It's very important to teach allergic children to wash their hands before eating so they don't have accidental exposure to their allergen from peanut/tree nut residue on their hands, which they ingest by rubbing their eyes, picking their noses or putting their fingers/hands in their mouths.
Nut proteins don't travel through the air. There are stories of people being exposed on airplanes, but it is believed the exposure came from surface contact because airplanes serve nuts during flights which means the surfaces in airplanes are covered with nut proteins, so when the allergic person comes along they get exposure by touching these surfaces, and then touching their eyes, nose, or mouth. Nut allergic people usually have a heightened sense of smell so they don't like to be around their allergens. It's not uncommon to see highly allergic kids sniff their food before eating it.
Allergy alert products - Epi pen cases, wrist bands, no nuts badges
Also available for other allergies - dairy, tree nut, latex, etc.
Will my child grow out of a tree nut or peanut allergy?
Possibly a peanut allergy, but probably not a tree nut allergy
Our son is proof that it is possible to grow out of a peanut allergy. At one time it was thought that a child wouldn't grow out of a peanut allergy, but now it's believed that 20-30% of them do. The odds are better when there isn't a family history of allergies or asthma. Some children do grow out of a tree nut allergy, however the statistics are much lower than those for peanuts.
Is there a cure for a nut allergy?
No, not yet
There's lots of research going on and it's likely in another 5-10 years we will see a cure of some sort for peanut allergies. Researchers are looking at allergy-free peanuts where they are genetically manipulating the proteins in peanuts. There's also some research showing that injections of small amounts of your allergens can help the body build a tolerance, so it's likely in the near future we will see some sort of "cure" for allergies.
What causes a peanut nut allergy?
There are many theories on how a peanut allergy develops
There are many theories about why there are more peanut allergies these days. One study showed that children raised on farms had less allergies. Researchers think that children raised on farms are exposed to more mold and allergens so their immune systems get a better work out and they are more resistant to allergies and asthma.
Pregnant mothers are advised to avoid eating nuts as it's believed that they are exposing the infant to nut allergens before their bodies are able to handle it. I wonder how much truth there is to this because I ate cashews during my pregnancy and my son has a cashew allergy. I've never eaten cashews any other time except when I was pregnant.
How am I going to keep my child safe at school?
For parents who are anxious when their allergic children starts attending school think about whether your child gets hives or has reactions when moving about in the community. The reality is there are trace amounts of nuts on surfaces everywhere in public places so it's likely the child gets exposure when they go to the grocery store, movie theatre, touching the taps in a washroom. If your child moves about in your community without having reactions, then they will likely not have too much trouble in school. For a child who gets hives all the time then the school environment will be more challenging for them.
Conversely, I tell the school that an anaphylactic child hiving in school is their warning bell that the potential for a deadly reaction is increased because it means the child is coming into contact with their allergen. If they are coming into contact with their allergen then the likelihood of a full blown reaction is increased.
I sucessfully campaigned to bring anaphlyaxis awareness in my son's school, but I did it from a "food awareness" perspective rather than presenting it as allergies. I focused on nutrition and brought to light all the activities in the school which revolved around food, much of it cookies, cakes, and junk food. The school was very responsive because the junk food being fed to the students affected the whole school rather than one individual. They took a look at all the celebrations they had and set up guidelines to make the food served healthier. We don't have a nut free school but we now have one that is allergen reduced, plus one that's serving healthier food. My son still can't participate in many of the food activities, but I'm greatly relieved that there aren't cookies with nuts coming into the school.
What about other products containing nuts?
Avoid all bath oils, lotions, shampoos, etc. with nut oils
Avoid all products containing your allergen. Even if you are not ingesting these products they are still a risk to you. A hand lotion containing nut oils may cause you to hive severely and if you were to transfer that to your eyes, nose, or mouth this has the potential to cause a full anaphylactic reaction. Normally skin contact alone is not enough to cause more than hives but again it's the amount of your skin that comes into contact with the allergen that is the problem, so lotions and bath oils that contain nut oils are very risky. Lip balms are particularly risky because they are being ingested when applied to your lips.
What about getting siblings tested?
Yes, if it impacts the family
We have two children, and only one of them is anaphylactic. We made our home totally nut free because I wanted my allergic son to be free to open the cupboard and not have to worry about whether the snack was safe or not. Problem was that meant my older son wasn't being exposed to nuts in his diet. It presented a problem when our older son was at school because we didn't want the school being the first to expose him to nuts in case he was allergic as well. I never had my older son tested, but in hindsight I wish I had because it would have eased our anxiety.
A sibling's chance of having a nut allergy, is about 4-5% and jumps to 10-15% when either or both parents have allergies. The reasons for testing a sibling would increase if the sibling had asthma or eczema, or if either parent had allergies.Testing siblings gives the parents peace of mind. Having an allegic child can impact hugely on the family's meals and outings. If you are a family that travels a lot, managing your child's allergy on the road can be very difficult. Consider the impact of the allegy on your family when thinking about testing your other children. If your family is having difficulty coping, then test the siblings so you have peace of mind.
Allergy testing for children is done with a skin scratch or a panel pressed into the skin. With the skin scratch a liquid drop of the allergen is put on the skin and then scratched with a sharp pointer. The panels are pressed into the skin and can hurt because it's like having a dozen needles poked into you at the same time. The skin scratch is much more kid friendly so you may want to ask beforehand what type of testing the allergist uses for children.
What is the treatment for a peanut allergy?
The best treatment for a peanut allergy is to avoid any exposure to the peanut protein. That means avoiding trace amounts as well. Always carry an epi pen because even with practicing avoidance there is the risk of accidental exposure through cross contamination.
What about foods that are labelled 'may contain traces'?
Strictly avoid products that contain trace amounts of nuts
A nut allergy is more deadly than most of the other allergies because it can be set off with such a minute quantity. No other allergy needs such a small amount to trigger a reaction. Plus none of the other allergies take hold and progress as quickly as nut allergies do. That's why it's so important for nut allergic kids to carry their epi-pen with them, because the allergy can progress so rapidly there often isn't time to go running for an epi-pen. It's easier to stop the reaction in the beginning stages, which is why an immediate response is so imperative. You lose critical time if you don't have access to epinephrine. It's like train going down a hill. You may be able to stop the train when it's just starting out, but by the time it's gathered speed and really rolling, it's almost impossible to stop.
Where I live it isn't mandatory to state whether there "traces of nuts" in a product. I stick to the well-known brands rather than the generic/no-name brands because the well-known brands have their image to protect. If a kid dies eating Kellogg's cereal it could seriously impact that company's business, however if a kid dies eating a no-name brand there isn't much impact. The big companies tend to be more proactive in their labeling.
There are many foods that aren't labelled, such as those in bulk bins, or delis. Always be aware of cross-contamination and that these foods are likely to have "trace" amounts of nuts in them.
Many people don't understand about traces. They say "oh, my child can eat traces" because the child hasn't had a reaction. In a factory it's only those first 100 boxes of crackers from a run of 20,000 that have trace amounts in them, so the odds of a product "really" containing trace amounts aren't high, but they still have to mark every box. You never know when you buy that box of crackers whether you are buying the first one processed or the last one. Manufacturers who frequently switch product lines and have short runs are more likely to produce products that have trace amounts in them.
The amount needed to trigger a reaction also differs between people. Some people can eat a whole nut before having a reaction, whereas another might have a reaction if a nut just touched their tongue. However, even though the tolerance level can vary between people, it's always suggested that nut allergic people avoid trace amounts because their tolerance level could change at any time, and the risk isn't worth it.
If you've only had mild reactions, does this mean future reactions will be mild as well?
Past reactions are not predictive of future reactions. Plus the severity of the reaction depends on the amount ingested. The larger the quantity ingested, the more likely the reaction will be severe. Allergies to nuts, no matter how mild, are always considered anaphylactic because they can progress so rapidly into anaphylaxis. There is no such thing as a "mild" nut allergy. ALL nut allergies are treated as potentially anaphylactic.
What is the most dangerous time of life for kids with anaphylaxis?
The teenage years
Interestingly parents have the most anxiety about their child's allergy when the child is very young, however children are at a higher risk for having a dangerous reaction when they hit their teen years. This is because it's "not cool" for teens to carry their epi-pens with them and they frequently leave them in their lockers, if they carry them at all. Teens also have a view that they are immortal and indestructible. They go out with their friends and don't want to appear different, so they indulge in the same activities and eating to fit in with their peers.
What about soy nuts? Is coconut a nut?
No, they aren't nuts
A soy allergy is different from a nut allergy so a person who is allergic to peanut/tree nuts can use a product with soy in it without any problems. A person who is allergic to nuts can also eat soy (if they don't have a soy allergy). Same with the spice nutmeg, it doesn't contain nuts. Coconut aren't nuts either. It's confusing because they have the word "nut" in them, but they don't contain nuts.
Are peanuts a tree nut?
No, they are not
Peanuts and tree nuts are different. Peanuts are not actually a nut, they are from the bean family and considered a legume, so they're not really a nut at all. Peanuts and tree nuts are commonly processed together in manufacturing plants, mixed and packaged together. Allergists generally advise staying away from tree nuts if you are allergic to peanuts, and vice versa, because of the risk of cross contamination.