By Bonnie Miller Rubin, Chicago Tribune reporter
October 24, 2012
For parents of children with food allergies, navigating everyday life can be like side-stepping land mines.
Play dates, birthday parties and after-school activities all pose potentially life-threatening hazards. And there's Halloween, when candy dropped into a trick-or-treater's bag can have tragic consequences.
Food allergies affect 1 in 13 children under age 18, according to a 2011 study published in Pediatrics. Two years ago, a seventh-grader died after eating Chinese food cooked in peanut oil during a party at her North Side school.
For more guidance on how to navigate food allergies, we turned to Dr. Ruchi Gupta, an associate professor of pediatrics at Northwestern University Feinberg School of Medicine and a pediatrician at the Lurie Children's Hospital of Chicago. She also recently received funding to partner with Chicago Public Schools to improve the management of food allergies throughout the district. Gupta is the author of a new book, "The Food Allergy Experience." For more information, go to foodallergyexperience.com. The following is an edited transcript of our conversation.
Q: I was stunned to see that three-quarters of all allergy-related fatalities can be attributed to food outside the home. So, knowing that, how do you balance safety with a kid having a normal life?
A: Education and preparation ... a state of mind I like to call "relaxed readiness." In my view, anyone around your child, from teachers to friends and family, needs to be educated on food allergy, signs and symptoms of a reaction, and how to manage it with antihistamines or an epinephrine autoinjector. The child should be aware and knowledgeable about avoidance, signs and symptoms, and what to do if they feel like they are having a reaction. A child is often his or her own best advocate. Kids can live normal lives if the people around them are supportive and educated.
Q: Why is the world beyond your own kitchen so dangerous?
A: Parents only have full control over their own home, which they can make sure is safe from all allergenic ingredients. Food is everywhere, and even if a food does not have the allergic ingredient in it, there is always a risk of cross-contamination. This means, even if one flavor of ice cream does not contain nuts, the scoop used to serve it may have just been used in a nutty ice cream allowing some nuts to contaminate the nut-free ice cream. Or maybe the facility in which it was manufactured or packaged uses the same equipment to make ice cream with nuts. Unfortunately, sometimes it takes only a tiny amount of the allergen to cause a reaction.
Q: Are allergies more common now or are we just diagnosing better?
A: Both. From the data, it seems that food allergies are increasing. Our study shows about 8 percent of the U.S. children are affected. ... That's 1 in 13 ... or about two in every classroom. As food allergies become more common, awareness is increasing and physicians are more knowledgeable ... and diagnose them appropriately.
Q: There's been rampant speculation that the spike in this condition can be attributed to the fact that we've become too hygienic with our hand sanitizers and antibacterial gels. Any more research on this?
A: This is one of the most popular theories right now. Research is increasing to support the "hygiene hypothesis," which suggests that ... being too clean interrupts the normal development of gut flora of the immune system, which normally protect against the development of allergies. In other words, our "developed" lifestyles have eliminated the natural variation in the types and quantity of germs our immune systems actually need to be exposed to for them to develop into a less allergic, better-regulated state of being.
Being clean is important and does safeguard against many infections, so I'm not advocating decreased cleanliness. However, I think that a healthy balance must be struck between allowing children to be filthy and overprotecting them from healthy exposure to germs. Analysis of the data is starting to suggest that breast-feeding, attending day care, having more infections, owning a pet or growing up in a farm environment can be protective against the development of future allergies.
Q: You have a 5-year-old daughter allergic to peanuts and tree nuts. ... But you also have a 10-year-old son who is not affected and loves peanut butter and jelly sandwiches. How do you do to keep one from resenting the other?
A: It is definitely a challenge. My son lives a less restrictive life as he is free to go anywhere without the worry of accidentally eating something dangerous. He does love his PB&J but has become used to soy butter and sunflower butter sandwiches. He also has opportunities to eat peanut butter when he is away from his sister. He is very supportive and protective of his sister now, looking at ingredient lists and even asking about ingredients at restaurants ... to make sure she is safe. We taught him to use the EpiPen in case of emergencies, since he is older. Ironically, he did once try to feed her a dessert with peanuts so that he could see the signs and try using it.
However, it's important to remember these are kids, and they may not understand how serious a food allergy reaction can be. This education is essential, and great tools exist in the book and through the Food Allergy Initiative (faiusa.org) and the Food Allergy & Anaphylaxis Network (foodallergy.org).
Q: Before your daughter came along, did you think parents were overreacting or imposing their rules on everyone else? What would you want parents on both sides to know?
A: I have seen and experienced it from both sides, and I do remember initially being sad my son could not take a PB&J to school because of other children with food allergy. However, because I am a physician, I understood the seriousness ... and did not ever feel parents were overreacting. ... I think it is critical for parents of children with food allergies to educate their teachers, staff and fellow parents on what their child is allergic to, what some definite safe foods are, what types of reactions the child could have. ...This can be done by reading the students a relevant book at the beginning of the school year, writing a letter to the other parents, and discussing it with school staff. If everyone is aware of and educated, it will decrease resentment and facilitate support.
Q: Is there an age when a kid is considered mature enough to patrol his own food intake?
A: It really depends on the child. Some kids mature and can do this as early as 6 or 7; other kids need more supervision. Sometimes, kids who did a great job in elementary school feel a lot of peer pressure during their teenage years because they do not want to look or feel different. ... This is when they need supportive friends and community the most. Oftentimes, kids know, but don't want to take the chance of being made fun of or bullied. Young adults with a food allergy claim that their allergy helped make them more responsible and organized. It is important to always keep the dialogue open and continue to build awareness and support.
Q: So how do you handle Halloween? A bag of peanut M&M's must be your worst nightmare.
A: Halloween is challenging. We make rules around candy: No eating while trick-or-treating, and all candy must come home first so that we sort through it together. My co-author, Denise Bunning, gave me a great tip: She would offer her kids a trade of all candy with allergenic ingredients for one of their favorite candies, or they could earn a quarter if they could tell her the allergen that was in the candy. Halloween is the best time of the year for both my kids, and if you stick to some basic rules, there is no reason why they can't have a blast!
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