Food allergies have more than doubled in the developed, Western World over the last 50 years and the reasons remain unclear. Yet recent data finds 8% of children in the US with a food allergy with 1/3 of those children at risk for severe or life threatening reactions. A Pediatrics study published today has some sobering news about our ability to protect children from allergic ingestions. When it comes to allergies and deadly reactions 2 things are necessary:
- Avoidance of known triggers/allergens.
- Treatment of anaphylaxis (severe reactions) promptly with epinephrine.
Trouble is, children get exposed to known allergens by mistake and people are often nervous or unsure about how and when to use an Epipen (epinephrine in a pre-measured syringe). All parents/caregivers/teachers/coaches need to practice use of an Epipen & refresh why/when to administer it to an allergic child.
The Study:
- Researches followed over 500 infants and young children allergic to milk and eggs (and many to peanuts) between 3 and 15 months of age. During the 3 years of the study, the majority of children (72%) had an exposure to an allergen that caused a significant reaction. Of the allergic reactions, 42% were reactions to milk, 21% to egg, and just under 8% to peanut. Reactions were most severe when a child was exposed to peanut, followed by milk, and then egg.
- Over 1/2 of the ingestions occurred after a non-parent adult offered an allergic food.
- 87% of reactions were due to accidental ingestions. Reasons for the mistakes? “Unintentional ingestions (eg, purely accidental such as forgetfulness, reduced supervision, not checking a product,etc), (64.9%); label reading error, (15.8%); cross-contamination, (15.1%); error in preparation, (4.1%); and manufacturer labeling error, (0.1%).”
- 11% percent of the reactions were severe. However, parents and adults caring for the children gave epinephrine only about 30% of the time when indicated. Study participants indicated not being able to recognize reaction, being too scared, not having the Epipen on hand, wanting to wait for more symptoms to develop, and not knowing if it was needed as rationale for not using the epinephrine.
What Parents Can Do To Support Young Children With Food Allergies
- Don’t Be Shy! Now is the time to reiterate your concerns and your care plan for a child with allergies in a daycare, preschool/school setting, or camp. When you drop off your child next, review their allergy history, their care plan, and reasons to use Epinephrine (an EpiPen) with their day time care provider. Don’t be shy.
- The EpiPen app. It’s free. Put it on your smartphone now if you’ve got one. Consider having your adult children, care providers, aunts and uncles or anyone else who cares for an infant or child with allergies download and review it, too. Get out a trainer Epipen or watch an instructional video about using an Epipen.
- Join FAAN and use their network as a support, a sounding board, a resource, and a community. Read their resources online to educate yourself and your family. Then go out and educate those who interact with your child on a daily basis. Don’t be shy about reminding teachers, friends, coaches, and relatives or refreshing what they know. Read labels.
- Know what anaphylaxis is really: It’s a serious allergic reaction with widespread effects on the body. It’s sudden and a potentially life-threatening reaction that involves two or more body parts (skin, gastrointestinal tract, heart, or respiratory tract) after an exposure to an allergen. Most food allergy anaphylaxis cases are ingestions. It is extremely rare for dust or contact/handling of food to cause anaphylaxis but some children can have more serious reactions.With anaphylaxis, there also can be swelling of the airway, serious difficulty with breathing, a drop in blood pressure, loss of consciousness, and in some cases, even death. If anaphylaxis is suspected, use epinephrine and call 911 immediately. If the reaction is worsening or it’s been 15 minutes and/or a child isn’t improving, consider repeating the epinephrine dose.
- If people around your child don’t “get it,” don’t give up. Use the words “life threatening allergy” as necessary when explaining your child’s risk of anaphylaxis to allergy exposure. Pull out your Epipen or Epipen trainer and show others how to use it and why. Prevention of ingestion is still a huge part of diminishing risk so feel free to refresh other’s knowledge quarterly.
What do you think about the study findings? Will you change what you do for your child at their daycare, preschool, or school?
Meagan says
My son has a skin contact allergy to milk- he gets hives wherever milk touches his skin. He doesn’t seem to have any problems with the milk he eats. We’ve take him off milk until his 15 month check up, though he’s still eating cheese and some other milk products. I’m still not clear on whether that’s an actual food allergy, or something else entirely.
Wendy Sue Swanson, MD, MBE says
Hi Meagan,
Sometimes children can have a contact dermatitis (a rash from contact) from foods. The rashes and the skin responses may not represent a true allergy or even an intolerance.
I think you’re smart to wait until the 15 month check-up to discuss with your son’s physician. You may inquire about an allergist depending on what your son’s doc thinks.
dr_som says
Love this post. Nice collection of resources for families. With epipen kit costing 200 bucks a pop, it can be hard for some families to purchase one for all the places the child goes. Schools probably should consider having one in the nurse’s office. Our school has a peanut table. Anyone who has nuts, eats there. Thus, the children with allergies are not always excluded and the other kids learn a little bit more about food allergies. Expired epipens can be used to train kids. They can practice on a piece of fruit. I think the epipen app is being updated and not quite functional. Do you have a direct link to the app? I have not been able to access it.
Wendy Sue Swanson, MD, MBE says
Love your idea about using expired Epipens for practice.
The trainer (that comes in the box) is a great tool for practice as well.
So, I’m having a hard time finding the app tonight, too. The app has been shown to me in the office (on iPhones) by two separate moms. I didn’t download it but looked through it on their phones.
Tonight, I can’t seem to find it through the app store on my phone.
Here’s a blog post about the app. https://allergynotes.blogspot.com/2011/01/official-epipen-app-for-iphone-and-ipad.html
When I go to iTunes it says it’s currently unavailable. App may have been taken down.
If anyone has insight, please share. Dr Som, I’ll keep looking.
Carrie says
With this increase in life-threatening allergies, it seems illogical that a school or day care is not able to have an epipen on hand at all times. We have AED machines to shock a heart, but if a child is clearly having an anapylactic reaction, there is nothing a teacher or caregiver can do, unless that student has specifically provided an epipen for use and signed all of the correct forms. if the choice is let a child die or use an “unprescribed” epipen, I would much rather have the latter. Couldn’t we give schools and day cares a prescription and then have a parent sign a form that says, if you believe my child is having a severe allergic reaction, please administer? The epipens are expensive and expire VERY quickly…and the prescription is for TWO. What kid only goes two places? There definitely needs to be better education, but I vote for better availability too.
Mona says
Thanks for the post… One of my sons has a peanut allergy, and has accidentally ingested peanut in the form of cookies at two separate church events. Luckily, no reactions (maybe because the peanut butter was cooked?). But it’s a tricky situation- I don’t want to ruin things for the bigger group, but it also feels like people should be more aware of peanut allergies with the explosion of them in recent years. My son is four- a scary age since I cannot control everything he eats any longer, yet he is not old enough yet to always be aware of the reality of the issue.
The more the issue is discussed, hopefully the more aware people will be about what they casually set out for children to eat.
Elizabeth Sampson says
I’m wondering if hives are related to a food allergy? My son has had hives everyday for 9 months now, we were told that it should just go away since he has no other symptoms. Should he be tested for food allergy?
Laura Ball says
Thank you for sharing this, I have a 22 month old that has peanut, tree nut, egg, and dairy allergies, and has anaphylaxis with both the nut and dairy allergy, not sure about the egg allergy. She is contact sensitive to the dairy allergy not sure about the others. If milk touches her skin she immediately gets blisters. She hasn’t ingested any since I was breast feeding her. I had to stop consuming anything with dairy in it while breast feeding. If I had dairy in my system she would immediately vomit and break out. I have been struggling to find information about children with similar problems and whether or not they can attend daycares. This info was really helpful. Again thank you for sharing this.
Wendy Sue Swanson, MD, MBE says
Laura,
I’m so glad this has been helpful. I really encourage you to join FAAN (linked to in the post) for support, learning, and tips to make this easier for you and your 22 month old! Patients in my practice really like it and draw lots of wisdom from the crowd there.
Gina says
My son is 22mths, in daycare and he has an Epipen in case of an emergency/allergic reation to eggs and nuts. The daycare has now asked me to fill out a new emergency plan form which includes a small paragraph at the bottom waiving any responsibilities of the staff/volenteers if my son has any adverse reactions to the medication administered. What do I do…what are my rights. If I don’t sign this waiver, then what?
Suhasini says
Hello
Do you have recommendations for local food caterers for daycare . Would prefer organic but need some contacts …
Wendy Sue Swanson, MD, MBE says
I don’t have great recommendations. Unsure exactly what you mean for caterers for daycare, though.
alison says
I am feeling incredibly frustrated today. My son, age 2 in one month, has severe food allergies. Tree nuts, sesame seeds, dairy, beef and soy. We have kept him out of daycare but today was his first day. I run my own business and I need childcare. My husband also works. I truly wish I could stay at home with him, but we are a 2 income family. We’ve made lots of changes for me to stay home with him this long and it’s not plausible anymore.
Unfortunately, I got a call today that he had an outbreak of hives in the first hour! Even with a SPELLED OUT ACTION PLAN FROM children’s hospital of philadelphia which says to administer benedryl at the first sign of hives, they still called to ask “if benedryl was necessary” or “if we should just monitor him.” IF YOU WERE MONITORING HIM IN THE FIRST PLACE HE WOULDN’T HAVE THE DAMN HIVES!!!!!!! GAH!
needless to say i had to pick him up and now he can’t be in that daycare. i don’t see a setting in which i feel comfortable leaving him at this age in a daycare. when he’s 5 or 6, he will have more control and understanding. right now if someone hands him something…it’s going in his mouth!
this seems to be the larger issue with daycare/preschool and allergies…the fact that toddlers cannot self-regulate like they will be able to when they are older.
we’ve become so insulated here in our home…no pets (had to say farewell to 2 dogs and a cat), no allergen foods at all…and life’s been grand. bye bye eczema! bye bye itchy skin. he actually sleeps now! it was a RUDE awakening this morning. i am almost mad at myself that i thought this could work. now i have to figure out a babysitter until january when we can hire on a full time nanny.
Wendy Sue Swanson, MD, MBE says
Alison,
What an awkward, unfortunate start. Going to find you some expert moms and dads to chime in here. I’m going to rally the troops. Your frustrations are valid (of course) and what I think you need most are expert parents to help.
You connected with FARE yet?: https://www.foodallergy.org/treating-an-allergic-reaction
Read this while you wait for smart parents to show up with more:
https://susannahfox.com/2014/08/26/food-allergy-101-hold-the-blah-blah-blah/
And hold on, I’ll find you some savvy moms/dads who can definitely give better advice than me.
Maida Chen says
Dear Alison,
i am so sorry to hear about your child’s first day. I have 3 kids, and my youngest who is now 2.5 years has severe food allergies (wheat, dairy, eggs, tree nuts, peanuts, sesame) as well. He started in a daycare when he was about 18 months. I love the staff at the daycare and from day 1 have had a great relationship with them and know that they try their best — to be honest though it was probably very related to the fact that my older two were enrolled in the same preschool (but did not have food allergies).
Prior to his start we met with his lead teachers in the toddler room, the center director, and the chef who we are fortunate is on sight and very allergy savvy. Not only did we have extensive paper care plans written out, i wrote the other families and explained and basically begged that they help us when it came to bringing food in from home, eating snacks in the car, etc. Some families responded, most did not. The daycare provided him his own personal table and tray that could be adjacent to the other kids but we pretty much decided no communal dining for him, just too risky when he was younger (he’s now in the preschool room and actually does share a table with non-allergic kids, but the entire school is nut-free which helps). He has his own dishpan and dishes, and his own sink and soap dispenser in the bathroom. The chef prepared his food with ingredients i supplied in sanitized pans prior to making everyone else’s meals (she is amazing). When she is on vacation i basically make and bring everything. They talked about his allergies frequently in the toddler room and now in the preschool room, to the point that other kids wanted to have his special food! The teachers and I harped on him and made him ask a grown-up if he could put anything in his mouth. Everytime something was denied, we linked it to an allergen “can’t eat that — it has XX” The administrative staff also were very involved; the teachers throughout the school, not just his classroom, were all given random “pop” epi-pen tests in order to collect paychecks, just so that nobody would forget. His medical plans needed to be updated and signed every month. I had some serious doubts about the success of this all but now at 2.5, my son knows to ask “Can me eat that” of any adult or teacher prior to putting anything in his mouth. Even with all that, i got frequent phone calls for hives and LOTS of Benadryl — many times without a clear cut offender.
Have no idea if that helps, and clearly we are very fortunate to have a great daycare, but it is possible to teach even this age group some safe habits early on. Good luck
Nancy Vive says
Sorry about your daycare experience. My son is severely allergic to peanuts and cats, and has asthma. He is 3 1/2. You can find a daycare that works and I found that its best to have a daycare that responds to your needs. My son has had some reactions to unexplained things at daycare and what helped is having a daycare that is willing to work through it. They often err on the side of caution as they learn to navigate allergies. As common as allergies are, not all daycares have experience with them. They basically call me whenever there is what they think is a reaction to let me know. We had an issue for a while with cat dander exposure at school (classmates with cats bringing dander to school on clothes) We started giving him an allergy med (kids zyrtec) and it seems to help. His school is also a nutfree facility which helps, though we did have one incident where a new teacher exposed my son to peanuts – however we feel that the daycare responded appropriately to that teacher’s error and worked to ensure the rest of the staff was properly trained. We have an epipen at school as well as carry one wherever we go. Good luck to you and hang in there.
Susannah Fox says
Alison,
I am so sorry about this awful experience! One of the best things I’ve done to help manage my son’s food allergies is join a local support group. It’s great to be connected with local parents who can give you tips about safe (even welcoming) daycare facilities. Then when your son is older, the community can help with the transition to elementary, middle, high school (and yes, although it’s hard to imagine) college.
Here’s a page where you can search for a local group:
https://www.foodallergy.org/support-groups
Another great resource is Kids With Food Allergies, run by a mom who wanted to create a one-stop shop for resources and information:
https://community.kidswithfoodallergies.org
Good luck!
Terri Lindemann says
Hi Alison,
Food allergy mom of a 9 year-old and school nurse here. I’m so, so sorry that your son had a bad start to daycare and that you have lost trust in the providers.
Some thoughts:
* Did you get any information about what may have caused the hives? Was there a breakdown in snack time/breakfast?
* Would there be a way to provide all of the food for your son? (I realize that food is often built into the cost of daycare, but we are just brainstorming here.)
*If that is not possible, have you thought of making a list of Safe/Not safe foods to leave with providers? (I found that helpful for babysitters, grands, daycare and Montessori along with regular reminders that they can call me to double check! A 30 second call is waaaaaaay better than a trip to the ER.)
* Have you connected with a food allergy parent group in your area? Perhaps they might have referrals of providers that have been educated (or teachable!) on food allergies.
*No referrals? Ask to visit a teacher meeting and talk with the staff (your allergist’s office might have a staff RN or MD who would be willing to help! Bribe them with cookies!) FARE has great info on staff training with presentations, pre-made signs, etc all free on the website for anyone who needs them.
Please know that there ARE good providers out there. I hope something in this list might help.
Susannah Fox says
I just want to second Terri’s suggestion to exchange phone numbers with the teachers. I let them know that they could text or call anytime. They often take a picture of an ingredient list and send it to me, I approve it or say no, and 30 seconds later the question is answered.
Katie seaward says
My daughter has anaphylactic reactions to all treenuts. She is now 3 1/2 years old, but she used to have anaphylactic reactions to milk as well, including allergies to eggs and soy. It was difficult to manage, and figure out what in the world to feed her, but I found that one of the most difficult things to manage was other people taking her allergies seriously. In the beginning when she was first diagnosed after having a swelling and breathing reaction to the milk protein in infant formula, I found that I even had friends who told me the allergies were mostly made up of a parent and that surely I was exaggerating her reactions. We had been prescribed EpiPen’s for her reaction to milk, and since that experience we have had to anaphylactic reaction to nuts (cashews in a Lara bar, and macadamia nuts in a cookie that she she accidentally ingested at a party). I think that my point in saying all of this is that even when I was not taken seriously by my friends, or made to feel as though I was being a hyper protective parent, I know that what I am doing is right for my daughter. I have had to advocate even when it makes me feel silly, and even when other people do not take me as seriously as I would hope, because I know that my daughter has been put in the emergency room several times and I know that her reaction to the substances is serious. I always carry EpiPen with me, especially after our surprise reaction to macadamia nuts at a party, and what was funny about that is that her allergist had told us that she was not allergic to macadamia nuts. I think it is important to always carry an EpiPen if you have an allergic child, especially as there are lots of cases of cross contamination. Bottom line don’t ever feel silly advocating for your child, don’t ever feel like you are putting other people out by insisting that your child not be given certain foods (especially at preschool and daycare’s) and do not hesitate to show other people how to use an EpiPen! I only speak from personal experience because I spent a lot of time feeling like I was putting other people out, and then my daughter had a surprise anaphylactic reaction at a party and it scared the wits out of me. I realized I don’t mind being the overprotective parent if it keeps my kid safe 🙂
Angie McCullagh says
I’m so sorry you had to deal with this on your first day of preschool. My peanut, tree nut, dairy and egg allergic son just started middle school last week, but I almost had a heart attack his first week of preschool I was so anxious. I would say to keep searching for child care you can trust. There are very careful people out there, but with toddlers it is really hard because you have to make sure none of the other toddlers are wandering up to yours with his allergens. Honestly, 2-3 is the hardest and it gets easier after that. A nanny sounds like a good alternative for you since you won’t then have to deal with other eating toddlers, but I know that is pricier.
Another option, if you feel safe doing it, is to be a force for good in this situation and teach your day care how to better handle severe allergies. FARE has some great resources for educating folks. I know this takes a lot of energy to be the trailblazer.
I mostly just wanted to tell you that I know how hard this is and we are here for you. Having a child with severe food allergies is incredibly stressful. Hang in there and virtual hugs!
MIchelle Landwehr says
This terrifies me! We have epipens in our non-verbal toddler daughter’s backpack (she needs to be nut and egg free) and are doing a training session with all of the teachers with the “trainer” included in her epipen pack. I can only hope that she doesn’t get exposed to anything. Luckily, her pre-school is a nutfree zone so that should help.
Big hugs, mama! Hope that this doesn’t happen again.
Elina Dayanova says
My son has an obstructive syndrome. Every simple cold turns into bronchitis. As a result we cannot afford taking our kid to a kindergarten as he catches a virus within max 3 days and then has to stay at home for 3-4 weeks recovering.
We did blood tests and it revealed that he’s allergic to cats/dogs, cow milk, and dust. We don’t have pets, he’s not drinking cow milk, and we wash our house literally every day.
Is there any way to lower down the probability of getting sick so often or at least avoid an obstruction? Our allergologist says that we simply have to waite till he grows up.