Increasing Threats in the Lunchroom

By: Mary B. Hammock, MSN, CPNP

Increasing Threats in the Lunchroom

Several years ago, when it was recommended to wait until two years of age to introduce peanuts, I reviewed the guidelines with a mother who was eager to give her two-year old son a peanut butter and jelly sandwich. As this is her favorite food, she made a big event out the situation – checkered tablecloths, fancy napkins and cutting off the crusts. The first bite made John smile and the second bite made him vomit twice (including two doses of antihistamine), turn blue, start with heavily labored breathing, and finally, left him on the floor unconscious. All of this occurred within 8 minutes of his first ingestion of peanut butter. After a panicked call to me, I told his mother to hang up and dial 911. EMS arrived quickly, gave him epinephrine and breathing treatments, and transported him to the hospital, where he stayed for awhile. This mother still tells me it was the worst day of her life. She was frightened by what occurred and felt utterly helpless watching her child nearly pass away before her.

Facts To Know About Food Allergies

More than 50 million Americans are estimated to have some kind of food allergy. The Centers for Disease Control and Prevention estimate 4-6 % of children are affected by some food allergy. An allergy is a hypersensitivity response triggered by the immune system. It can be as mild as a temporary stomachache or as severe as an anaphylactic reaction – which can be life-threatening, and at times even fatal. The response can occur with the first exposure or the thirty-first exposure and it can illicit different symptoms and/or a different severity of symptoms with each exposure. While food allergies tend to run in families, it is impossible to predict whether a child will inherit a parent’s food allergy or whether siblings will have a similar hypersensitivity response. It is more likely that having two parents with food allergies predisposes the child to developing food allergies.

What Food Allergies Do To The Body

WebMD provides a great description of food allergies and the toll it takes on one’s body. Food fragments responsible for allergic reactions are proteins within the food that usually are not broken down by cooking or by digestion, allowing them to survive and cross the gastrointestinal lining, enter the bloodstream, and migrate to target organs. “The complex process of digestion affects the timing and location of an allergic reaction.” The first symptom experienced may by “itching in the mouth as one starts to eat the food. After the food is digested in the stomach, abdominal symptoms, such as vomiting, diarrhea, or pain may start. When the food allergens enter and travel through the bloodstream, the can cause a drop in blood pressure. As the allergens reach the skin, they can induce hives, or when they reach the lungs, they may cause bronchospasm, which is wheezing or constriction of the airways.” Any and all of these symptoms can result in anaphylaxis and typically occur within moments or up to an hour after ingestion. Scientists are currently trying to determine why food allergies have become so frequent and prominent in the last decade and what is the best way to prevent or manage them. Eggs, milk, soy, and peanuts are the most common food allergies in children and unlike adults, children can outgrow some of their allergies through avoidance of the offending agents. The exceptions are peanuts, fish and shellfish.

When Is A Food Allergy Happening

Food allergies can be particularly tricky. A cross-reactivity food allergy can occur when one is highly allergic to birch pollen and has an itchy mouth after eating the peel of an apple or one is allergic to latex and simply cannot eat bananas. This is called “oral allergy syndrome.” Food allergies have to be differentiated from possible food poisoning; histamine toxicity, which is common in some cheeses, wines or large fish; lactose or gluten intolerance; sulfite intolerance, from some foods and preservatives and naturally occur during wine fermentation; and there are even cases of unpleasant events in a person’s life resembling an allergic reaction

Ways To Diagnose Food Allergies

Fortunately, there are a few ways to diagnose food allergies. First, one’s healthcare provider should take a thorough history, which may include detailing a food diary of what was eaten, lists of ingredients, and symptoms. An elimination diet may also be suggested in the hopes of removing the offending food or foods and the symptoms resolve. A second way to diagnose food allergies is through skin prick testing. Skin tests are rapid, simple and relatively safe. The downside to skin testing is that anaphylactic reactions should not be skin tested because it could be very dangerous. Secondly, patients with extensive eczema are not good candidates for skin testing as well. Finally, skin testing may reveal more positive reactions that the patient is not responding to. For that reason, determining true allergies relies on testing results and a patient’s food ingestion/reaction history. The third way to diagnose food allergies is to consent to RAST or ELISA testing of the blood, which measures the presence of food-specific IgE in the patient’s blood. This testing can also pick up cross-reactivity or positive results for which patients do not have symptoms. This too should be interpreted, along with the patient’s food ingestion/reaction history. These tests can come back in 1 -7 days depending upon the lab used.

Stay Tuned For Treatments

Next month, I will detail treatment for food allergies. Given that some are severe and life threatening, I feel the more prepared everyone, including the general public, is, the safer our children and families will be. Healthy Steps Pediatrics is helping to GROW healthy children one step at a time. If you have questions or concerns about possible allergies and your children, call 678-384-3480 for an appointment today.