What Parents Often Do Not Know About Food Allergies

By Ria Khetan, BSPH Student in Nutrition

I was at a family gathering when my sister eyed a cute strawberry shortcake cake. She has always had a sweet tooth, craving something sweet to eat after each meal. She visits the table with all the deserts and takes a bite of the cake. However, within moments, her mouth and throat became extremely itchy, and it felt like her throat was starting to close, and she started vomiting. It had become apparent to everyone that she was having a severe allergic reaction. Emergency medical services were called and she was rushed to the nearest emergency room. A very frightening experience but one that led to many insights. A few days later after visiting an allergist, it was confirmed that my sister had developed an allergy to eggs. The Allergist informed us that lack of egg exposure during her infancy could have contributed to the development of the allergy.

There are many parents who have different opinions on whether introducing allergenic foods earlier to children is beneficial. The importance of early allergen introduction cannot be overstated. It has the potential to significantly reduce the risk of developing food allergies in children by enabling tolerance building from an early age and it offers the added benefit of a lifetime of lower healthcare and special dietary needs expenses and improved quality of life.

I participate in research being conducted in a food and allergy clinic at the University of North Carolina studying food allergies in children as well as the impact of environmental exposures on the development of allergic diseases like asthma. Food allergies in the United States approximately affect 8% of all children and are becoming a public health concern. Allergies occur in individuals when the immune system responds in an abnormal way to some foods such as wheat, milk, and peanuts. Schools have responded to the increase in food allergies by creating allergen free seating at lunch tables. Living with a family member who has food allergies can be challenging as well. Parents of children who have food allergies are under constant worry and have to carry EpiPen for the risk of their child undergoing anaphylaxis. The anxiety that parents face can affect everyday food that the family eats as well as the decision to visit a restaurant or attend a social gathering.

In recent years, there has been a noteworthy shift in guidance for when children should be introduced to allergenic foods. Guidelines now recommend exposure during infancy at four to six months of age. Many studies, particularly research focused on the early introduction of peanuts have found supporting evidence. Infants who were given peanut products were substantially less likely to develop peanut allergies at age five compared with those not exposed. However, until 2010, the American Academy of Pediatrics had recommended that parents delay allergic food substances and therefore recent change in guidance has caused confusion amongst parents. Some parents still argue that children may face severe allergic reactions to foods and are scared to try with their newborns. Also, in light of an increase in the number of food allergies, it can be a challenge to predict when children will develop allergies and to which foods. In some cases, early introduction to allergenic foods is not enough to avoid the development of food allergies. This uncertainty makes parents hesitant to follow this latest guidance. However, if a variety of allergenic foods are fed cautiously under the guidance of trained medical professionals in a clinical setting, parents’ anxiety may be reduced.

This is ample evidence that early exposure to allergens actively contributes to early building tolerance as the treatment for many of these potential allergies. My sister is undergoing oral immunotherapy for egg allergy. In this treatment a small amount of egg protein is administered over time to the child who is allergic to eggs. This treatment can take months or even years and varies by patient. Oral immunotherapy is effective but requires huge commitment from parents. Parents have to drive their child to an appointment weekly and wait at the doctor’s office for a couple to many hours. Oral immunotherapy treatments are also costly. 

Apart from therapy, managing and treating food allergies are both costly, and pose a burden on families. EpiPens which include epinephrine is the only medication in the market that can reverse severe allergic reactions. Since parents often distribute multiple EpiPens for school, home and work, the cost of each EpiPen which runs into hundreds of dollars can add up. Parents also have the unneeded worry of emergency room visits and hospitalizations that can occur and the medical bills that would arise from there.

Parents of children with food allergies often purchase allergen free foods. These foods are more expensive, often costing 30% more than normal foods that may include traces of allergens. On birthdays, my family only gets egg free cakes. They are almost always double the price compared with normal cakes with eggs. Moreover, with a family member, who has food allergies, we often need to modify their own diets leading to more expensive groceries. All this time, effort, and cost can possibly be avoided or reduced with the introduction of allergenic foods to infants.

I urge new parents to discuss their child’s nutritional needs with their pediatrician and get their professional advice. Parents can start with small actionable steps such as placing the allergenic food in the same plate as the infant’s food. Parents can join food allergy groups on social media to ease their worries and also see how other parents have introduced their children to allergenic foods. Lastly, both pediatricians and parents should follow the new nutrition guidelines.

Peer-edited by Tejaswini Petkar, Researcher, Msc

Picture credit: iStock