TAAD Food Allergy Book

Living With Food Allergies

Stay safe, eat healthy, and live well even with food allergies.

Contents One Facts

Food allergy facts

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What are food allergies?

10

Allergy symptoms

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Two Causes

What are the most frequent food allergens?

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Food labels

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Three

Common questions How do you know if your baby has a food allergy?

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What will the doctor do?

25

How can you manage your toddler’s food allergy?

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Talking to children about their food allergy

28

What is the difference between food allergy, food intolerance and food poisoning?

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Four

Prevention & delay Is there anything I can do to prevent or delay a food allergy?

36

Take steps to avoid allergic reactions

37

New guidelines to help prevent food allergies in children

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Do kids outgrow food allergies?

42

9 tips for avoiding cross-contact of food allergens

46

Can food allergies be treated?

48

Five Six

Living with food allergy The impact of food allergies on quality of life

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Mental health concerns among youth with food allergies

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The reason Chemical pollutants and food allergies

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Pesticides in tap water

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Chapter One_Facts

//Toddler Allergy Appropriate Diet

One Facts

If you or someone you love is new to food allergies, start with the basics of understanding the condition, as well as how to prevent and treat reactions.

Food allergy facts

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What are food allergies?

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Allergy symptoms

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Every three minutes, a food allergy reaction sends someone to the emergency room.

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Chapter One_Facts

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Food allergy facts Every year children are negatively affected by dangerous food items. It’s a potential risk in our lives. More than 50 million Americans have an allergy of some kind. Food allergies are estimated to affect 4 to 6 percent of children and 4 percent of adults, according to the Centers for Disease Control and Prevention.

Educating families about toddler appropriate diets is important.

How many people have food allergies?

• Researchers estimate that up to 15 million Americans have food allergies, including 5.9 million children under age 18.

• That’s 1 in 13 children, or roughly 2 in every classroom.

• About 30 percent of children with food allergies are allergic to more than one food.

• As many as 6 million children in the United States have some form of food allergy.

Food allergy reactions are serious and can be life-threatening.

• Every 3 minutes, a food allergy reaction sends someone to the emergency room.

• Each year in the U.S., 200,000 people require emergency medical care for allergic reactions to food.

• Childhood hospitalizations for food allergies tripled between the late 1990s and the mid-2000s.

• About 40 percent of children with food allergies have experienced a severe allergic reaction such as anaphylaxis.

Food allergies are on the rise • The Centers for Disease Control & Prevention reports that the prevalence of food allergies in children increased by 50 percent between 1997 and 2011.

• Between 1997 and 2008, the prevalence of peanut or tree nut allergy appears to have more than tripled in U.S. children.

https://www.foodallergy.org/life-with-food-allergies/food-allergy-101/facts-and-statistics

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Chapter One_Facts

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What are food allergies?

A food allergy occurs when the body’s immune system sees a certain food as harmful and reacts by causing symptoms. This is an allergic reaction.

Foods that cause allergic reactions are called allergens.

Normally, your immune system protects you from germs and disease. It does this by making antibodies that help you fight off bacteria, viruses, and other tiny organisms that can make you sick. But if you have a food allergy, your immune system mistakenly treats something in a certain food as if it’s really dangerous to you.

serious allergic reaction called anaphylaxis. This reaction usually involves more than one part of the body and can worsen quickly. Anaphylaxis must be treated right away to provide the best chance for improvement and prevent serious, potentially life-threatening complications.

The same sort of thing happens with any allergy, whether it’s a medicine (like penicillin), pollen in the air (from grasses, weeds, and trees), or a food, like peanuts.

So the thing itself isn’t harmful, but the way your body reacts to it is.

Allergic reactions can involve the skin, mouth, eyes, lungs, heart, gut and brain.

Mild and severe symptoms can lead to a

http://www.kidswithfoodallergies.org/

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Allergy symptoms

Symptoms typically appear within minutes to several hours after eating the food to which you are allergic. An allergic reaction to food can affect the skin, the gastrointestinal tract, the respiratory tract and, in the most serious cases, the cardiovascular system.

An allergic reaction typically triggers symptoms in the nose, lungs, throat, sinuses, ears, the stomach lining or on the skin. For some people, allergies can also trigger symptoms of asthma. In the most serious cases, a life-threatening reaction called anaphylaxis can occur.

• Swelling of lips or eyelids

A number of different allergens are responsible for allergic reactions. The most common include: • Pollen • Dust • Food • Insect stings • Animal dander • Mold • Medications • Latex

• Asthma

• Coughing

https://www.foodallergy.org/life-with-food-allergies/food-allergy-101/symptoms-of-an-allergic-reaction-to-food

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• Skin rash

Chapter One_Facts

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Reactions can range from mild to severe, including the potentially life-threatening condition anaphylaxis.

Remember that reactions can be unpredictable. The first signs of a reaction can be mild, but symptoms can worsen quickly. And what caused a mild reaction one time can lead to a severe reaction the next time.

• Diarrhea

• Vomiting

• Colic

Keep in mind that children may communicate their symptoms differently than adults. Learn more about how a child might describe a reaction.

Mild to moderate symptoms may include one or more of the following • Hives (reddish, swollen, itchy areas on the skin) • Eczema flare (a persistent dry, itchy rash) • Redness of the skin, particularly around the mouth or eyes • Itchy mouth or ear canal • Nausea or vomiting • Diarrhea • Stomach pain • Nasal congestion or a runny nose • Sneezing • Slight, dry cough • Odd taste in mouth

Severe symptoms may include one or more of the following Swelling of the lips, tongue, and/or throat that blocks breathing • Trouble swallowing • Shortness of breath or wheezing • Turning blue • Drop in blood pressure (feeling faint, confused, weak, passing out) • Loss of consciousness • Chest pain • A weak or “thready” pulse • Sense of “impending doom”

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Severe symptoms, alone or combined with milder symptoms, may be signs of life-threatening anaphylaxis. This requires immediate treatment.

Epinephrine is the first-line treatment for anaphylaxis, and your anaphylaxis plan should be individualized by your healthcare provider. Delays in administering epinephrine for severe or persistent symptoms can be very dangerous, especially when the delay is an hour or longer.

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“Awareness is the greatest agent for change.” ­

—Eckhart Tolle, Spiritual teacher

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Chapter One_Facts

//Toddler Allergy Appropriate Diet

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Chapter Two_Causes

//Toddler Allergy Appropriate Diet

Two Causes

The most common food allergies in infants and children are grow some allergies (eggs, milk and soy) but may be less likely to outgrow others (peanuts, tree nuts, fish and shellfish).

What are the most frequent food allergens?

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Food labels

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Milk

Eggs

Peanuts

Tree nuts

Soy

Wheat

Fish

Shellfish

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Chapter Two_Causes

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What are the most frequent food allergens?

Eight foods cause 90 percent of most food allergy reactions: • Milk • Eggs • Peanuts • Tree nuts (e.g., almonds, walnut, pecans, cashews, pistachios) • Wheat • Soy • Fish (e.g., bass, flounder, cod) • Shellfish (e.g., crabs, shrimp, scallops, clams)

Allergies to peanuts, tree nuts, fish and shellfish tend to persist lifelong. Allergies to milk, eggs, wheat and soy often disappear with age, but not always.

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Food labels

The Food Allergen Labeling and Consumer Protection Act (FALCPA) is the primary federal law governing how allergens are represented on packaged foods sold in the U.S.

How FALCPA changed food labels

The law does not apply to:

People affected by food allergies need • Prescription and over-the-counter drugs to be able to identify potential allergens • Personal care items (such as cosmetics, quickly, easily and accurately. This is shampoo, mouth wash, toothpaste or especially important for parents and shaving cream) caregivers of children with food allergies. • Kosher labeling • Pet foods, supplements, and supplies This federal law, which passed in 2004 • Any made-to-order restaurant food and took effect January 1, 2006, seeks placed in a wrapper or container to do just that. It requires that food labels • Any food product regulated by the U.S. note allergens in plain language.

Department of Agriculture (meat, poultry and processed egg products) FALCPA affects all packaged foods sold • Any food product regulated by the in the U.S. and this includes: Alcohol and Tobacco Tax and Trade Bureau (alcoholic drinks, spirits, • Conventional foods beer and tobacco products) • Vitamins and dietary supplements • Infant formula and foods • Medical foods • All retail and food-service establishments • Vending machine food items • Packages labeled for individual sale

https://www.foodallergy.org/education-awareness/advocacy-resources/food-labels

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Chapter Two_Causes

//Toddler Allergy Appropriate Diet

Which allergens are affected?

How allergens are listed on food labels

FALCPA covers the 8 major food allergens: milk, egg, peanut, tree nuts, soy, wheat, fish, and crustacean shellfish.

Together these foods cause the majority of allergic reactions in the U.S.

FALCPA-regulated allergens can be called out in one of three ways:

FALCPA-regulated ingredients must be listed if they are present in any amount— even in colors, flavors or spice blends.

Manufacturers must list the specific nut, fish or crustacean shellfish present in the food (e.g., almond, tuna, crab).

Which allergens are excluded?

Molluscan shellfish—such as oysters, clams, mussels, or scallops—are not required to be labeled under FALCPA. Neither are seeds, such as sesame and mustard.

• In the ingredient list, using the allergen’s common name • Using the word “Contains” followed by the name of the major food allergen— Additionally, manufacturers are not for example, “Contains milk, wheat” required to list major allergens that may • In the ingredient list in parentheses, be present due to unintentional when the ingredient is a less common cross-contact during processing. form of the allergen—for example, “ albumin (egg)”.

If you have a food allergy that isn’t one Although FALCPA has made label-readof the major 8 mentioned above, you may ing easier, people managing food need to call the manufacturer to deterallergies should read all labels on all mine whether a food is safe. It’s also packages carefully, every time. Even important to remember that your allergen if you have bought a food before, ingredicould be missing from an ingredient list if ents can change without warning. it is part of a spice blend, color or flavorReading labels each time will ensure ing. This is common with ingredients such you avoid your problem food. as sesame.

Other exemptions include whole fruits and vegetables and highly refined oil derived from the major 8 allergens, as well as any ingredient made from such highly refined oil.

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Chapter Three_Common Question

//Toddler Allergy Appropriate Diet

Three

Common questions

How do you know if your baby has a food allergy?

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What will the doctor do?

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How can you manage your toddler’s food allergy?

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Talking to children about their food allergies

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What is the difference between a food allergy, a food intolerance and a food poisoning?

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How do you know if your baby has a food allergy?

Sometimes it’s easy to figure out that a kid has a food allergy. He or she might get hives or have other problems after eating it. But other times, what’s causing the problem is more of a mystery. Most foods have more than one ingredient, so if a kid has shrimp with peanut sauce, what’s causing the allergy­— the peanut sauce or the shrimp?

Doctors believe that allergies could be hereditary, which means if your parent or another close relative has certain allergies like hay fever, you’re more likely to develop the allergies. Some kids may develop food allergies while they are still babies, while others develop food allergies over time. This may be due to kids’ surroundings or changes in the body as they grow older.

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Many people react to a certain food but are not actually allergic. For example, people with lactose intolerance get belly pain and diarrhea from milk and other dairy products. That doesn’t mean they’re allergic to milk. They don’t feel good after drinking milk because their bodies can’t properly break down the sugars found in milk.

Chapter Three_Common Question

//Toddler Allergy Appropriate Diet

What will the doctor do?

If you think you may be allergic to a certain food, let your parents know.

They will take you to the doctor to get it checked out.

If your doctor thinks you might have a food allergy, he or she will probably send you to see a doctor who specializes in allergies. The allergy specialist will ask you about past reactions and how long it takes between eating the food and getting the symptom (such as hives). The allergist also may ask about whether anyone else in your family has allergies or other allergy-related conditions, such as eczema or asthma.

The allergist might want to do a skin test.

This is a way of seeing how your body reacts to a very small amount of the food that is giving you trouble. The allergist will use a liquid extract of the food and, possibly, other common allergy-causing foods to see if you react to any of them. (A liquid extract is a liquid version of something that usually isn’t liquid.)

extracts will go on the different scratch spots so the doctor can see how your skin reacts to each substance. If you get a reddish, raised spot, it shows that you are allergic to that food or substance.

Some doctors may also take a blood sample and send it to a lab. That’s where it will be mixed with some of the food or substance you may be allergic to and checked for certain antibodies.

It’s important to remember that even though the doctor tests for food allergies by exposing you to a very small amount of the food, you should not try this at home!

The best place for an allergy test is at the doctor’s office, where the staff is specially trained and could give you medicine right away if you had a serious reaction.

The doctor will make a little scratch on your skin (it will be a quick pinch) and drop a little of the liquid extract on the scratched spot or spots. Different

http://kidshealth.org/en/kids/food-allergies.html?W T.ac=ctg%23

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How can you manage your toddler’s food allergy?

Managing a food allergy in children or babies can be stressful not only for the child but also for the parents. There are 3 key things to be on top of when it comes to managing a food allergy:

Weaning and food allergy The Department of Health recommends that high allergenic foods (milk, eggs, wheat, gluten, soy, fish, shellfish, peanuts, tree nuts, seeds) be introduced from 6 months of age. There is no evidence to support delaying introduction of these foods after 6 months. They should be introduced one at a time, with a gap of 3 days in between each new food, so that it is easier to identify any food that causes a reaction. Make sure your child is well at the time of introduction, i.e., not when he or she has a temperature, has just had a vaccination, or has a cough or a cold.

Once your baby has had several attempts at eating the individual foods, you can start mixing them to increase the variety and enjoyment of eating. It may be helpful to keep a food and symptom diary (a food diary template can be found at the bottom of the page) to identify any foods that may have triggered a reaction. By the age of 12 months at the latest, your baby should have been introduced to all the major allergenic foods (where appropriate).

https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/42-childhood-food-allergy

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Chapter Three_Common Question

//Toddler Allergy Appropriate Diet

01/ Identify and avoid the cause (if possible) 02/ Recognise the symptoms of an allergic reaction

03/ Know what to do if it happens again

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Talking to a toddler about their food allergies

Through clear communication, you can help your child understand what it means to have a food allergy and how to stay safe.

A food allergy diagnosis can be overwhelming enough for an adult. This experience is even more daunting for a child. Young children may struggle to comprehend what is going on with their bodies and not have the words to fully describe how they feel physically or emotionally.

Through clear communication, you can help your child understand what it means to have a food allergy and how to stay safe. This is a skill that will serve him or her well in the future.

Start simple

Keep calm

For young children, introduce a few concepts at a time. Start with the most important things they should know to be safe:

Some parents may, understandably, feel anxious or fearful about allergic reactions because they know that allergic reactions can be life-threatening. Remember, children watch their parents to understand how to react to stressful situations. So your children may feel nervous or fearful themselves if they observe these feelings in you.

• First, explain that certain foods can make them very sick. Use simple terms such as “safe food” and “unsafe food.”

• Next, teach them the names of unsafe foods and what they commonly look like.

Point out gallons of milk, cartons of eggs, or bags of peanuts in the grocery store. Show them pictures of foods that are unsafe foods online, in books, or in magazines.

• Then, teach them to only eat foods given to them by their parents or other trusted adults. These other people can be a babysitter or grandparent—anyone who knows about their food allergies and is trusted to care for them.

• Finally, they should know to find an adult if they feel sick or need help. You can also explain your emergency plan in case they have an allergic reaction. Tell them this means giving them medicine and then going to the doctor.

https://www.foodallergy.org/life-with-food-allergies/newly-diagnosed/talking-to-children-about-their-food-allergy

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It is, of course, important that your child realizes food allergies are serious. But it is equally important that you try to remain calm when discussing their allergies.

You do not want to unnecessarily scare him or her.

When you have a positive tone about food allergies, children will follow your lead.

Chapter Three_Common Question

//Toddler Allergy Appropriate Diet

Involve your child

Find friends

It’s tempting to manage food allergies for your child in a “behind the scenes” fashion. But it’s important that children appreciate why you do certain things to keep them safe.

Kids who have food allergies may feel that they are different because of it.

Emphasize that there are millions of children and adults who have food allergies just like them—in fact, 1 in 13 kids in the U.S. has a food allergy.

Involve your child from an early age.

Openly model food allergy management behaviors, such as reading food labels and always carrying epinephrine auto-injectors. This will help them learn from your behavior and teach them skills they will use as they grow older. For example: • Use “we” rather than “I” statements: “We should read the ingredients to be sure this food won’t make you sick.”

• Explain food allergy management out loud. A simple statement before leaving the house such as “We have our medicine kit with us, so now we’re ready to leave!” can help reinforce that you do not go anywhere without their medication.

• Involve your children in grocery shopping and making meals that are safe for him or her to eat.

• Prompt your child to show others his or her medical identification. This is a good way to get him or her used to telling others about food allergies.

Help them identify and connect with peers and role models with food allergies.

One way of doing this is by getting your child involved with community activities and events, such as the FARE’s Food Allergy Heroes Walk.

Make it a part of your everyday conversation Food allergies affect the whole family, not just the child. Talk to them about their experiences. Help them to understand that a food allergy is a unique part of who they are. Role-play scenarios. Cook allergy-friendly recipes together. Don’t be afraid to have an open dialogue with your child! Remember, knowledge is power. An open dialogue will better prepare your food-allergic child to navigate the road ahead.

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Another idea is to join an online or in-person support group. A group like this can provide advice specific to your community, such as suggestions for local restaurants, products and events. Search FARE’s support group directory for a group in your area.

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Find tools and resources There are many tools and resources out there for newly diagnosed families. A great way to start is with a book. There are a great many allergy-themed children’s books out there, including Food Allergies and Me, Nutley the Nut-Free Squirrel, and Blue: The Monkey who was Allergic to Bananas. You can also get them a medical ID bracelet—many brands now carry fashionable and fun medical jewelry. Or learn about allergies on TV.

Help them learn how to discuss their allergies Teaching children the language they need to explain their allergy to other children and adults is another way to empower them.

Cook with them Healy also suggests encouraging kids to help out in the kitchen, particularly once they’re in grade school. Not only will they have a head start when they have to start cooking for themselves, but they’ll also have a better grasp of what they can and can’t eat. They will be better aware of substitutions they can make, as well.

https://www.healthline.com/health/allergies/talk-to-kids-about-allergies#5

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“First, parents need to make sure they understand what the allergen will do to the child. Then, give them the right words to explain that,” says asthma and allergy specialist Dr. Noga Askenazi. “For instance, if peanuts will cause anaphylaxis, teach your child to say ‘Peanuts will cause my throat to get tight’ or ‘Peanuts will affect my breathing.’”

Chapter Three_Common Question

//Toddler Allergy Appropriate Diet

“Learning how to cook recipes they can eat can reduce feeling helpless and make them feel empowered about taking control of their condition.”

— Maureen Healy, PhD, child development expert

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What is the difference between a food allergy, a food intolerance, and a food poisoning?

Food allergies happen when the immune system makes a mistake. Normally, your immune system protects you from germs and disease. It does this by making antibodies that help you fight off bacteria, viruses, and other tiny organisms that can make you sick. But if you have a food allergy, your immune system mistakenly treats something in a certain food as if it’s really dangerous to you.

Food intolerance is much more common than food allergy and is not caused by the immune system. The onset of symptoms is usually slower, and it may be delayed by many hours after eating the offending food. The symptoms may also last for several hours, even into the next day and sometimes longer. Intolerance to several foods or a group of foods is not uncommon, and it can be much more difficult to decide whether food intolerance is the cause of chronic illness, and which foods or substances may be responsible.

Usually comes on suddenly

Usually comes on gradually

• Small amount of food can trigger • Happens every time you eat the food • Can be life-threatening

Different symptoms

• May only happen when you eat a lot of the food • May only happen if you eat the food often • Is not life-threatening

Different symptoms

• Rash, hives, or itchy skin • Shortness of breath • Chest pain • Sudden drop in blood pressure, trouble swallowing or breathing—this is life-threatening. Call 911 immediately.

• Gas, cramps, or bloating • Heartburn • Headaches • Irritability or nervousness

http://www.webmd.com/allergies/foods-allergy-intolerance#1 http://kidshealth.org/en/kids/food-allergies.html?W T.ac=ctg#

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Chapter Three_Common Question

Food poisoning is a result of consuming food that was not fully cooked or is otherwise contaminated with bacteria.

The symptoms can develop rapidly, within 30 minutes, or slowly, worsening over days to weeks. Usually food poisoning is not serious and lasts 24-48 hours.

Usually comes on gradually • May only happen when you eat not fully cooked food or the food may be contaminated with bacteria • Is not life-threatening • Is not serious and lasts 24-48 hours

Shared symptoms A food allergy and an intolerance both can cause: • Nausea • Stomach pain • Diarrhea • Vomiting

Different symptoms • Abdominal cramping • Fever

https://www.allergyuk.org/food-intolerance/what-is-food-intolerance https://www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058538

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//Toddler Allergy Appropriate Diet

Chapter Four_Prevention & Delay

//Toddler Allergy Appropriate Diet

Four

Prevention & delay

Is there anything I can do to prevent or delay a food allergy?

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Taking steps to avoid allergic reactions

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New guidelines to help prevent food allergies in children

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Do kids outgrow food allergies?

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9 tips for avoiding cross-contact of food allergens

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Can food allergies be treated?

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Is there anything I can do to prevent or delay a food allergy?

This is the million-dollar question. In the past, the American Academy of Pediatrics (A AP) suggested delaying the introduction of certain foods in children who seemed likely to have allergies because their parents had allergies. But practices in other cultures—and recent research—suggest that might not be the best course of action.

The A AP now says there’s no solid evidence that waiting to introduce allergenic foods protects children from developing an allergy. In fact, delaying the introduction of allergenic foods may actually raise the risk of food allergies. If you think your child is likely to have a food allergy, talk with his or her doctor about the best strategy.

Experts are now suggesting you introduce new foods, including potential allergens, starting at 4 to 6 months of

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age, after some other typical foods have been started (such as fruits and vegetables and cereals). Introduce the new foods, including the potential allergens, one at a time, so if your child has a reaction you’ll know what he’s reacting to.

Don’t give your child cow’s milk until he’s 12 months old, but other dairy products are fine.

Breastfeeding may offer some protection against allergies. Consider breastfeeding your baby as long as you can, especially if you have a family history of allergies.

Chapter Four_Prevention & Delay

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Taking steps to avoid allergic reactions

The only way to avoid an allergic reaction • Educate family, friends, and others who is for your child to stay away from foods will be with your child about your child’s that have caused symptoms. Even traces allergies. Be sure to tell your child’s of an allergen can cause an allergic school and anyone responsible for your reaction. For example, people and pets child about his or her food allergies. who have eaten an allergen recently • Teach your child how to manage his or her can pass it on to your child through their food allergies. You can start teaching your saliva. Here are some steps you can take: child even at a young age. When old enough, teach your child to read labels.

• Learn how to read food labels for ingrediAlso teach your child how and when to ents your child is allergic to. Read the use an epinephrine auto-injector, and to label every time you buy a product, even tell an adult if he or she is having an if you’ve used that product before. allergic reaction.

Food ingredients in any given product • After the diagnosis, focus on what safe may change. food your child can have, rather than what • Ask about ingredients in foods that other he or she can’t have. Start with plain people make for your child. food with simple ingredients. From there, • Avoid passing allergens to food that you can look for new recipes that use are safe for your child to eat by washing safe ingredients. your hands and your child’s hands with soap and water before handling food.

Prepare and serve food with clean utensils and other kitchen items and on clean surfaces.

https://www.parents.com/health/allergies/food/new-guidelines-to-help-prevent-food-allergy-in-children/ https://www.babycenter.com/0_food-allergies_12409.bc

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New guidelines to help prevent food allergies in children

By Beth Fontenot, M.S., R.D., L.D.N. from thedoctorwillseeyounow.com

The report also presents research showing how gradual and early exposure to a variety of foods can prevent food allergies rather than cause them. The recommendations also mean that women who are pregnant and mothers who are breastfeeding are freer to eat what they want.

Your baby is 7 months old. You have introduced her to solid foods, and she is healthy and happy, sitting up, and about to start crawling. Should you feed her a little scrambled egg? A few years ago the answer would have been no. But today, the answer is go ahead.

Basic foods like rice or oat cereal, fruits, and vegetables should be introduced when babies are between 4 and 6 months of age, according to the new guidelines.

The best way to prevent food allergies, according to a new report by the American Academy of Allergy, Asthma, & Immunology (A A A AI) is to expose babies to more foods early, rather than delaying them. The recommendations, based on several studies and expert opinions, are a complete reversal of the guidelines of a decade ago.

The American Academy of Pediatrics published guidelines in 2000 recommending that infants not consume milk until they were 1 year old, eggs until age 2, and peanuts, tree nuts, fish, or shellfish until age 3. There was no evidence that delaying those foods prevented eczema and food allergies, so in 2008 those guidelines changed.

But it was unclear when and how to begin giving those foods to young children. As a result, many parents were confused about how to protect their children and remained cautious. Mothers-to-be cut certain foods out of their diets and left them out as they began nursing.

The 2013 report recommends that basic foods like rice or oat cereal, fruits, and vegetables should be introduced when babies are between 4 and 6 months of age, according to these new guidelines.

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The A A A AI recommends that allergenic foods like eggs and cow's milk be given for the first time at home, rather than at day care or in a restaurant and can be introduced after an infant has successfully tolerated a few of the basic complementary foods.

Introducing foods early can actually prevent food allergies in infants and children. Two studies found that there was a higher rate of wheat allergy in 5-year-olds who had not been fed wheat until after they were 6 months old.

Another found that delaying wheat in the diet until the age of 6 months did not protect against wheat allergy.

The report offers a review of a number of studies, including one which showed that small amounts of cow's milk in foods like baked goods, cheese, or yogurt appear to be safe to feed infants before the age of 1.

Chapter Four_Prevention & Delay

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The best way to prevent food Allergies, according to by the AAAAI is to expose babies to varies foods early, rather than later.

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This should not be interpreted as permission to replace formula or breast milk with cow's milk. That should be avoided until after the first birthday for reasons unrelated to food allergy.

Infants who ate eggs at 4 to 6 months appeared to have a lower risk of egg allergy than infants who first ate eggs later in life. And according to yet another study, children whose parents avoided feeding them peanut butter had a ten-fold higher rate of peanut allergy than those whose parents offered it.

It should be noted, though, that both peanuts and peanut butter are choking hazards in infants and young children, and a child who has a sibling with peanut allergy should be tested before eating peanuts because they are 7 times more likely to have a peanut allergy. Lastly, a study found that feeding an infant fish before the age of 9 months reduced the risk of eczema at 1 year of age.

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No one understands why, but food allergies in children are an increasing occurrence. At this time, about 5 percent of preschoolers in the United States have been diagnosed with a food allergy.

The foods that cause 90 percent of allergic reactions in the United States are milk, eggs, peanuts, tree nuts, shellfish, fish, soy, and wheat.

Chapter Four_Prevention & Delay

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Do kids outgrow food allergies?

Yes. This is an important point to emphasize. Children generally, but not always, outgrow allergies to milk, egg, soy, and wheat. New research indicates that up to 25 percent of children may outgrow their peanut allergy, with slightly fewer expected to outgrow a tree nut allergy.

There is no need to assume your child’s food allergy will be lifelong, though for many, this may be the case. If a food

allergy develops as an adult, chances are much lower you will outgrow it. Food allergies in adults tend to be lifelong, though there has not been a lot of research in this area.

25% of children may outgrow their peanut allergy

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National survey of U.S. children

The study, published online in the Annals of Allergy, Asthma and Clinical Immunology in July 2013, found that 3,188 children surveyed currently had a food allergy, while 1,245 had outgrown one. Key findings of this study include:

Few large studies have explored which factors could help predict whether or not a child will achieve tolerance—that is, outgrow an allergy. Between June 2009 and February 2010, Dr. Ruchi Gupta and colleagues (Ann & Robert H. Lurie • A little more than a quarter of the chilChildren’s Hospital, Chicago) surveyed dren—26.6 precent—outgrew their the families of 40,104 children nationallergies, at an average age of 5.4 years wide—the largest study of this kind to old. date. The researchers analyzed data • Children who were allergic to milk, egg, for nine common food allergies: milk, or soy were most likely to outgrow their peanut, shellfish, tree nuts, egg, fin allergies. The likelihood of outgrowing fish, wheat, soy, and sesame. shellfish, tree nut, and peanut allergies was significantly lower.

• The earlier a child’s first reaction, the more likely that child was to outgrow the allergy.

• Other factors that contributed to outgrowing an allergy included having a history of only mild to moderate reactions, being allergic to only one food,

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and having eczema as the only symptom. Conversely, children with severe symptoms (trouble breathing, swelling, and anaphylaxis) and multiple food allergies were less likely to achieve tolerance.

• Black children were less likely to outgrow their allergy than white children.

• Boys were more likely to outgrow their allergy than girls.

• Dr. Gupta and her team conclude that, while more studies over longer periods of time are needed to confirm these findings, this data can improve the management of food allergies and aid in counseling food allergy families.

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Chapter Four_Prevention & Delay

Outgrowing peanut allergy Peanut allergy is one of the most common food allergies among children. In the United States, the number of children with peanut allergy more than tripled between 1997 and 2008.

This allergy tends to be lifelong; only about 20 percent of children are fortunate enough to outgrow it.

A Canadian research team reports that children are most likely to outgrow their peanut allergy by age 6. After age 10, the chance of spontaneous resolution (i.e., of outgrowing the allergy) is much lower, according to this study, which was published online in the Journal of Allergy and Clinical Immunology: In Practice on June 27.

Between 1998 and 2011, the researchers, led by Dr. Anne Des Roches (Centre Hospitalier Universitaire Sainte-Justine, Montreal), followed 202 children with peanut allergy from early childhood (18 months or younger) to adolescence. To confirm their diagnosis and monitor their allergies, the children periodically received skin prick tests, along with blood tests, which measured the amount of peanut IgE in their blood. (IgE is the antibody that triggers the symptoms of a food allergy.)

Starting at age 5, children whose blood tests showed a comparatively low level of peanut IgE also had the opportunity to undergo food challenges, the most accurate test available.

At the end of the study, 51 of the original 202 participants—just over 25 percent—had outgrown their allergy.

Further, 80 percent of the children in this group were allergy-free before age 8.

Tests also showed that these children had low levels of peanut IgE in their blood.

In children who remained allergic, the amount of peanut IgE in the blood increased over the years.

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The Canadian team concluded that their findings are consistent with a previous study by researchers in Australia, which followed 267 children over 5 years.

They recommend additional studies to examine “whether spontaneous resolution may still occur in this population in late adolescence or early adulthood.”

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9 tips for avoiding cross-contact of food allergens

Foods that cause allergic reactions are called allergens. Even a tiny amount of an allergen can cause a reaction. Allergic reactions usually occur after your child eats a food that she or he is allergic to.

Precautions you should take to avoid allergic reactions Some parents choose to completely eliminate all food allergens from their homes. Others, especially those whose children have many food allergies, do not make this choice. If you choose to allow allergens in your house, you run the risk that those foods will “contaminate” your home and your safe foods. This is known as cross-contact.

Label foods in your home as “safe” or “ not safe” To ensure everyone (including your children, visitors, babysitters, etc.) can determine which foods in your home are “safe,” it can be helpful to label the food in your pantry, refrigerator, and freezer. A convenient way to do this is to use red and green circle-shaped stickers.

You can buy these types of stickers or make your own. The red stickers are for the unsafe foods and the green are for the safe foods (i.e., “red” means “stop” and “green” means “go”). Apply these stickers to every food item in your house.

Cross-contact occurs when a food allergen comes in contact with food or an item not intended to contain that allergen.

Small traces of allergens can cause allergic reactions.

There are several precautions you should take to avoid food mix-ups and accidental cross-contact.

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Avoid pantry mix-ups If you have both “safe” and “unsafe” versions of similar items (like soy milk and cow’s milk) in your home, do not store these products next to each other.

Designate particular shelves or cabinets for storing the “safe” foods. Avoid purchasing items that look similar to each other.

Avoid sippy cup mix-ups If your toddler is allergic to milk, buy a “special” sippy cup to use both at home and away from home. This cup is never used for anyone else. Put your child’s name on it. Once you put the lid on the average sippy cup you cannot see the contents. Having a special cup that is always used ensures that your child doesn’t grab the wrong cup by mistake.

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Avoid getting allergenic residue all over the house

Avoid contaminating your food supply If you keep both “safe” and “unsafe” foods in your household, you need to take steps to prevent cross-contact: • Washing hands – Remind everyone to wash their hands with soap and water before touching safe foods. Their hands could have allergens on them and they could make a safe food become unsafe.

• Utensils – Do not allow allergen-covered utensils to touch your “safe” foods.

For example, if a knife used on butter gets inserted into a jar of jam, the jam is no longer safe for dairy-allergic individuals to eat. If you spread butter on wheat bread toast and then dip your knife into the butter again, the butter will now contain traces of wheat.

• Countertops and other surfaces – Remind everyone to clean all surfaces after preparing food and to clean countertops before preparing food. Countertops could have traces of allergens on them.

Food prepared on an unclean countertop can result in cross-contact with allergens.

If you allow food allergens in your home, you need to prevent allergen residue from getting all over the house. Teach all members of your household to always wash their hands with soap and water immediately after touching or eating allergens. Consider confining all food consumption to your kitchen and dining areas. Otherwise, crumbs and traces will get onto your carpets, furniture, toys and other surfaces.

Don’t forget your guests When friends arrive, politely ask them (and their children) to wash their hands with soap and water. If your friends have infants, you may need to take precautions to avoid spit up on your carpets or furniture. The food, formula, or breast milk that is spit up is likely to be allergenic, and it will get on surfaces your child may touch. Set down a clean blanket for babies to protect carpet or furniture.

Take precautions when cooking Take steps to avoid cross-contact with allergens during the cooking or serving process: • If you are preparing both “safe” and “unsafe” food for the same meal, prepare the safe meal first.

• Do not use the same utensils to prepare allergenic and non-allergenic dishes.

• Place utensils, plates, and cutting boards directly into the sink or the dishwasher immediately after use. Teach your family that soiled items in the sink or dishwasher are not safe to use until they have been properly washed.

• If you use a barbecue, be sure to fully clean the grill before cooking for your child. Consider using foil or a clean grill pan to prepare foods for your child.

Take care to wash dishes Wash pans, utensils, and dishes in hot, sudsy water before using them to prepare food for someone with food allergies. It is best to rinse off dirty dishes and utensils before loading them into your dishwasher. This prevents stray bits of dried allergens from sticking to your clean dishes.

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Can food allergies be treated?

There are a number of promising approaches under study, and better treatments are likely to be available in the next few years, says Scott Sicherer, Professor of Pediatrics, Allergy and Immunology at Icahn School of Medicine at Mount Sinai in New York City.

At this time, however, there are no medications that cure or prevent allergic reactions to foods, and the allergy shots used for hay fever don’t work for food allergies. The key to preventing an allergic reaction is strict avoidance of the food.

Avoiding a particular food is trickier than it sounds. Foods show up in unlikely places, and even a little bit may be enough to trigger a severe reaction. Most people who have a severe reaction have eaten a food they thought was safe.

You’ll have to become vigilant about reading food labels, knowing which ingredients to avoid, and asking about ingredients in restaurant dishes or food at friends’ homes.

The proteins that cause the allergy can be passed on in your breast milk, so you may need to give up the offending food yourself if you’re nursing a baby with a food allergy.

Food manufacturers are required by law to list these top food allergens on product labels: eggs, milk, wheat, soy, peanuts, tree nuts, fish, and crustacean shellfish (crab, shrimp, and lobster but not mollusks like clams, oysters, or squid).

Nuts, fish, and shellfish must be named specifically.

And if you’re formula-feeding a baby who seems to be allergic to cow’s milk, you may need to change formulas.

Some babies who are allergic to cow’s milk are also allergic to soy, though, so it’s important to discuss the situation with your child’s doctor before making any kind of change.

All the allergens must be listed in plain language. For example, the label has to say “egg” instead of “albumin” or “egg” in parentheses after “albumin.” If you’re unsure about a product’s ingredients, call the manufacturer.

If your child has been diagnosed with a food allergy, you’ll want to learn all you can about it­— including exactly which foods to avoid, how to read labels, and how to recognize the early signs of an allergic reaction.

If your child must avoid many foods, talk with his or her doctor about seeing a dietitian to make sure the nutrients in his diet are adequate.

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Chapter Five_Living with Food Allergy

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Five

Living with food allergies

When someone develops a food allergy, everyone in the family must learn to adapt. TA AD has information and resources that will help you to stay safe and live well—today and every day.

The impact of food allergies on quality of life

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Mental health concerns among youth with food allergy

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The impact of food allergies on quality of life

By Pia Nørhede

Why is it important to measure the impact of food allergy on quality of life?

Individuals with food allergies or develop symptoms after eating foods that for the vast majority of the population are part of a healthy diet. The only way for the allergic individual to manage food allergy is to avoid eating the food that causes the allergic reaction. The quality of life of the food-allergic individual may be seriously impaired. The impact also extend to the family and friends of the allergic individual, as all have to be vigilant to protect the allergic individual from the foods to which he or she is (or believes to be) allergic.

Approximately 4-6 percent of children and 1-3 percent of adults are diagnosed with food allergy. However, up to 22 percent of the adult population believes that they are allergic towards one or more foods.

Whether they are truly allergic or not, they will have dietary restrictions, which may have an impact on their quality of life. For that reason, the quality of life of a large part of the population may be affected by food allergy.

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What is known today about the impact of food allergy on quality of life?

So far researchers have only to a limited extent investigated the impact of food allergy on quality of life. Specially designed questionnaires can measure people’s ability to function in their every day lives. Scientists call these questionnaires Health-Related Quality of Life (HRQoL) questionnaires. It is important to understand that two food-allergic individuals, who from the doctors’ point of view are affected to the same degree, may answer the questionnaire very differently. That is because individuals vary in how they cope with sickness and in their tolerance levels. A well-designed questionnaire should measure the problems that the food-allergic individuals themselves consider to be important rather than focusing on what is considered important by doctors or other professionals.

Chapter Five_Living with Food Allergy

General quality of life questionnaires are available that can be used in different diseases. Research using such questionnaires has shown that: • Daily life is more disrupted in peanutallergic individuals than in individuals with a rheumatic disease. • Family activities were limited in families with food-allergic children. • Female adolescents with food allergies feel more impaired health-wise and socially than female adolescents with other allergy-like conditions.

Researchers have recently developed and tested the reliability of a questionnaire that is specific for food allergy sufferers.

This questionnaire was designed to measure the parental burden of having a child with food allergy issues. In addition, two parent-administered questionnaires have been developed and are currently being tested on reliability. Answers to one of the questionnaires indicate that food allergy issues have a significant impact on almost all aspects of daily life.

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Mental health concerns among youth with food allergy

Published in The Journal of Allergy and Clinical Immunology in March 2016

Food allergy is rapidly becoming one of the most common chronic conditions diagnosed during childhood. Current estimates indicate that 4 to 8 percent of children in the United States are diagnosed with a food allergy. Food allergy issues require daily management, which may affect multiple domains of child and family psychosocial functioning and quality of life. The rise in the number of children diagnosed with food allergies may lead to an increase in the number of children and families who experience mental health concerns related to food allergy issues and would benefit from food allergy-related psychosocial interventions.

In a review recently published in The Journal of Allergy and Clinical Immunology: In Practice, Herbert et al. provide an overview of common psychosocial concerns

among children with food allergy concerns and their families and offer guidance to medical providers regarding their identification and treatment. The authors report that children with food allergies and their parents tend to report a range of psychosocial concerns that include parenting stress, anxiety, and worries about bullying. For many families, the primary question that must be addressed is how to balance the vigilance and preparedness required of a potentially life-threatening chronic illness with anxiety management and engagement in developmentally appropriate activities.

The authors reported that many families with psychosocial concerns benefit from having a medical provider listen to them

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and normalize their feelings, from being provided educational materials, and from being connected to other families of children with food allergies. However, when patients need additional psychoeducation about food allergies, need assistance problem-solving food allergy management, experience elevated anxiety about food allergy issues, and/or meet criteria for a mental health disorder, they should be referred to a mental health professional for consultation and provision of appropriate services. The mental health professional will conduct a clinical interview to determine if the child would benefit from short-term versus long-term psychotherapy and/or medication management. Psychotherapy is typically cognitive-behavioral therapy, a well-validated and frequently used treatment for children with chronic illness that is goal-oriented, collaborative, and typically short-term.

Chapter Five_Living with Food Allergy

As the number of children diagnosed with food allergies increases, it is likely that medical providers will encounter a growing number of parents who have questions about how to manage everyday food allergy-related psychosocial concerns.

Medical providers can validate patients’ feelings, normalize the challenge of balancing food allergy management with participation in developmentally appropriate activities, and provide early education

about food allergies and their psychosocial impact on daily life, but they may need to refer to a mental health professional for consultation when indicated. Additional research is needed regarding clinical interventions in order to further refine the psychosocial care that is provided to these families.

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Chapter Six_The Reason

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Six

The reasons

Chemical pollutants and food allergies

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Pesticides in tap water

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New study finds link between chemical pollutants and food and environmental allergies Food allergies are on the rise, affecting 15 million Americans. And according to a new study published in the December issue of Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACA AI), pesticides and tap water could be partially to blame.

The study reported that high levels of dichlorophenols, a chemical used in pesticides and to chlorinate water, when found in the human body, are associated with food allergies.

“Our research shows that high levels of dichlorophenol-containing pesticides can possibly weaken food tolerance in some people, causing food allergy,” said allergist Elina Jerschow, M.D., M.Sc., ACA AI fellow and lead study author. “This chemical is commonly found in pesticides used by farmers and consumer insect and weed control products, as well as tap water.”

“Other dichlorophenol sources, such as pesticide-treated fruits and vegetables, may play a greater role in causing food allergy,” said Dr. Jerschow.

Among 10,348 participants in the US National Health and Nutrition Examination Survey (2005-2006), 2,548 had dichlorophenols measured in their urine and 2,211 were included into the study. Food allergy was found in 411 of these participants, while 1,016 had an environmental allergy.

“Previous studies have shown that both food allergies and environmental pollution are increasing in the United States,” said Dr. Jerschow. “The results of our study suggest these two trends might be linked, and that increased use of pesticides and other chemicals is associated with a higher prevalence of food allergies.”

While opting for bottled water instead of tap water might seem to be a way to reduce the risk for developing an allergy, according to the study such a change may not be successful.

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According to the Centers for Disease Control and Prevention, an increase in food allergy of 18 percent was seen between 1997 and 2007. The most common food allergens are milk, eggs, peanuts, wheat, tree nuts, soy, fish and shellfish.

Food allergy symptoms can range from a mild rash to a life-threatening reaction known as anaphylaxis. The ACA AI advises everyone with a known food allergy always carry two doses of allergist-prescribed epinephrine. A delay in using epinephrine is common in severe food allergic reaction deaths.

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Pesticides in tap water

More Americans have food allergies than ever before, and a new study suggests chemicals in tap water may be partially to blame.

“Previous studies have shown that both food allergies and environmental pollution are increasing in the United States,” study author Dr. Elina Jerschow, an Assistant Professor of Allergy and Immunology at the Albert Einstein College of Medicine in New York City, said in a press release. “The results of our study suggest these two trends might be linked, and that increased use of pesticides and other chemicals is associated with a higher prevalence of food allergies.”

Researchers analyzed more than 10,000 Americans who were part of an ongoing U.S. survey of health and nutrition. They analyzed their urine levels and found more than 2,200 patients had measurable levels of dichlorophenols in their urine.

That’s a chemical used in pesticides and weedkillers, which is also used to chlorinate drinking water.

The researchers reported of those with measurable levels of dichlorophenols, 411 people had a food allergy and more than 1,000 had an environmental allergy, such as to pollen. People with the highest levels of the chemicals in their urine were more likely to have an allergy than those with the lower levels.

“Our research shows that high levels of dichlorophenol-containing pesticides can possibly weaken food tolerance in some people, causing food allergy,” said Jerschow.

The study, which was published Dec. 3 in the Annals of Allergy, Asthma and Immunology, does not find a cause-and-effect relationship between the chemicals, tap water and allergies.

About 4 to 6 percent of U.S. children have a food allergy, according to the Centers for Disease Control and Prevention. The agency notes an 18 percent rise in rates between 1997 and 2007. Common allergens include milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish.

Sufferers can experience symptoms ranging from hives, tingling in the mouth, trouble breathing or gastrointestinal symptoms to anaphylaxis—a severe,

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sudden allergic reaction that affects different systems in the body and swelling of the throat and tongue, possibly resulting in death.

To reduce exposure risk, Jerschow suggested people eat fewer pesticide-treated fruits and vegetables, since simply switching from tap water to bottled water may not be enough.

Dr. Kenneth Spaeth, Director of the Occupational and Environmental Medicine Center at North Shore University Hospital in Manhasset, N.Y. who was not involved in the research, said to HealthDay that the study raises a need for more research on pesticides in the environment.

“The immune system begins developing in fetuses and continues its development through childhood,” said Spaeth.

“Therefore, it is plausible that exposure to these pesticides during this development could alter the immune system in ways that could increase the risk of allergies.

Until further studies are done, no conclusions can be drawn but there is enough evidence for concern and certainly to further examine the issue.”

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This book is part of an MFA thesis project Junyi (Jolena) Yang yjybaby126@gmail.com jolenayang.com Copyright @ 2018 All Right Reserved No Part of this publication can be reproduced without expressed permission from TA AD.

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