A diagnosis of food allergy instils fear in every parent. Even being a dietitian, this diagnosis was no easier for me to hear after my son had an anaphylactic reaction upon his first exposure to a peanut. We have no family history of food allergy and peanut butter was a staple of my childhood, eaten nearly every day, so the possibility that my sweet boy could potentially have an allergic reaction was not even on my radar.
At first, our doctors thought that it was so great that I was a dietitian – that managing his diet would be easy for me. But in many ways, my knowledge of food and nutrition did not ease my anxiety when it came to feeding my son. I read and reread ingredient labels until my eyes crossed, wanting to make sure that I didn’t miss anything, fearful that I would give him something that could be potentially life threatening. My mind would race through all of the scenarios: “What would happen when he started school?” “What about when we ate outside the home or when he goes to his first birthday party?” On and on, I felt the only way I could protect him and keep him safe was to be in complete control of every morsal that went in his mouth.
Several years have passed since that fateful day, and my anxiety and need for control have eased, but it is something I am always mindful of for his safety.
For tube fed infants and children with a diagnosis of food allergies, the transition away from a consistent formulation to an oral diet filled with exposure to new foods can feel scary, so here are some tips for managing food allergies:
Read food labels: It is important to get in the habit of reading food labels prior to weaning. The Food Allergen Labeling and Consumer Protection Act of 2004 mandates all food labels in the United States list ingredients that may cause allergic reactions for the 8 most allergenic foods of milk, wheat, soybeans, egg, fish, shellfish, peanuts, and tree nuts. Just recently sesame has been named as a top allergen and will require declaration on food labels as well.
Food labels should be read routinely, even on products you have purchased a hundred times already, as manufacturers don’t have to announce when they are making a formulation change; they just have to disclose the ingredient on the food label.
Know all the names for the allergen: Educate yourself about the major allergen and other ingredients that contain the presence of this allergen. For example, milk is a major allergen, but milk ingredients also include casein and caseinates, curds, galactose, hydrolysates, lactalbumin, lactoferrin, lactate solids, lactic yeast, lactoglobulin, lactose, lactulose, rennet, whey, etc. These ingredients contain milk protein and need to be avoided as well.
Careful food preparation and cooking: Be aware of potential for cross-contamination and cross-reactivity in the kitchen. Cross-contamination refers to when an allergen is applied directly or indirectly to another food. For example, if you are allergic to wheat and use the same knife and container of butter to butter your GF toast as was used to butter regular gluten containing bread, the cross contamination of bread crumbs on the butter knife could lead to an allergic reaction.
Cross-reactivity refers to the proteins of one food being similar to proteins in another food and the immune system identifies these proteins as being the same causing an allergic reaction. For example, the cross reactivity between cow milk and goat milk is close to 90%.
Notify everyone about the food allergy: Make sure friends, family, school, restaurants, and anyone who will be preparing food for your child is aware of the allergen. Chef cards are available for download from the Food Allergy Research & Education (FARE) website. These cards specify all the allergic ingredients that must be avoided as well as a request that all dishes, utensils, and preparation surfaces be free from traces of that allergen.
Formulate an emergency care plan and always carry your medication: Early recognition of the signs and symptoms of an accidental exposure and knowing the treatment plan is important. Make sure that everyone involved in your child’s care is aware of what to do in case of an allergic reaction by downloading a Food Allergy and Anaphylaxis Emergency Care Plan. This plan details your child’s name, age, allergy, medications being taken, list the symptoms, and steps of what to do in the event of an emergency such as how to administer epinephrine and when to call 911.
In short? While finding out that your child has a food allergy can feel really intimidating, there are lots of ways that you can keep your child safe. Following the above recommendations – and of course, reaching out to your weaning team when you’re worried – is a great start!
by Lisa Grentz, MS, RD, CD