Wednesday, February 10, 2016

Keeping kids with food allergies safe on Valentine's Day

Guest bloggers Terri Brown-Whitehorn, M.D., and Lynda Mitchell answer questions about the risks associated with food allergies on Valentine's Day, as well as the precautions families should take to keep their children and teenagers safe.

Keeping kids with food allergies safe on Valentine's Day


Valentine’s Day usually means celebrations and exchanges with chocolate and other treats, and marks a popular time for parties and dates involving food. While it’s tempting to just dig in, children and teens with food allergies need to be aware that many of these foods contain common allergens.

Today’s guest bloggers Terri Brown-Whitehorn, M.D and Lynda Mitchell answer questions about the risks associated with food allergies on Valentine’s Day, as well as the precautions families should take to keep their children safe.

Brown-Whitehorn is an allergist/immunologist in the division of allergy & immunology at The Children’s Hospital of Philadelphia and an associate professor of clinical pediatrics at the Perelman School of Medicine, University of Pennsylvania. Mitchell is the president and founder of Doylestown-based Kids With Food Allergies, one of the largest nonprofit organizations for parents of food-allergic kids with more than 22,000 members.

How can Valentine's Day pose a risk for children and teens?

Schools and other venues often have celebrations and parties with food. Many traditional party foods and candies contain common allergens such as peanuts, tree nuts (almonds, walnuts), eggs, milk, and wheat. In addition, children often exchange Valentine’s Day cards that sometimes have candy attached to them, which also may contain allergens. Boxes of chocolates are everywhere and if labels are not read or available, a child or teenager with food allergies is at risk for an allergic reaction.   

Can a kiss cause an allergic reaction? Have you encountered this?

I have been practicing allergy for many years and have never had a patient have a severe reaction to a kiss. I have had many food allergic children develop topical reactions (hives at the site of touch) on their skin if kissed by someone who just had ingested dairy or another allergen.  We have also had children develop topical reactions to spilled milk or cracked eggs. These children are not at risk for a severe allergic reaction.

Although many worry that a kiss from a non-allergic person to an allergic person can lead to a severe reaction, this is not commonly seen. However, in an exquisitely allergic individual, a reaction is possible. Teens need to be aware of others' allergies. Also, teens with food allergies need to be aware of their food allergies and not try to fit in by eating a chocolate without knowing the ingredients.

How common is it to have a severe allergic reaction for a child/teen with no prior history?

Allergic reactions can occur at any age although the majority are known by school age. Most children are diagnosed with milk, egg, soy, peanut and wheat allergy as they are exposed to the food sooner. Typically, if a food is tolerated without a reaction, then one typically does not develop an allergy to that food. Exceptions include new shellfish and/or tree nut allergies.  We have also had children and adolescents tolerate multiple tree nuts such as almonds or walnuts, and then have a reaction to cashews or Brazil nuts.
What are the most common severe allergies?

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If one is allergic to a food, there is the possibility of having a severe allergic reaction. For instance, I have had patients with severe reactions to garlic, beans and beef. Although these foods are not the "common" food allergy triggers, they do and can cause severe reactions. The most common foods that cause allergic reactions include: milk, eggs, soy, wheat, peanut, tree nuts, fish, shellfish and sesame.

What can happen with someone has a severe allergic reaction? When do you have to go the hospital?

Severe allergic reactions often develop quickly.  Children can develop hives, but do not always; breathing problems; swelling of mouth/lips/face; vomiting/diarrhea; abdominal pain; fatigue; and/or a sense of doom. If a child has mild hives or mild skin swelling, typically an antihistamine is given with improvement.  

However, if the reaction progresses and the child develops more symptoms or worsening symptoms, the child would need to immediately go the hospital (call 911).  On the other hand, some children develop severe symptoms immediately and going to the hospital is warranted immediately.  If these children have an epinephrine autoinjector, it should be given first and 911 called.
What can families do to keep their children safe?

1. No sharing:  For Valentine’s Day, teach your child to never share food or accept candy or treats unless a parent or responsible adult has read the ingredient label and determined that it is safe for the child to eat.
2. Get Involved: Parents can also get involved in party planning to take the emphasis off foods – instead suggest activities, or exchanging food free treats like heart stickers, pencils or other items with a holiday theme.
3.  Offer safe solutions:  If food must be served, offer some safe alternative choices so all of the children in the classroom can safely be included.
4.  If you can’t read it, don’t eat it:  Be sure to check all Valentine’s cards that come from home and remove any candy or treats that are not properly labeled with ingredient statements.

The most important thing is to educate yourself, your child and others to prevent any kind of allergic reaction, and to always be prepared to treat an allergic reaction by having a food allergy action plan in place and by having emergency medicines nearby. The first line of treatment for a severe allergic reaction called anaphylaxis is an epinephrine autoinjector.

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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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