By Dr. Paul Ehrlich
I am sorry that I have not gotten back on this issue of food allergy and a recent spate of stories about exposure as children venture out in the world.
I have tried to put myself in parents’ shoes and have a few thoughts about food allergies as well as other things like dogs, cats, horses, and so on. These things might enrich a child’s environment under ordinary circumstances but become a problem because of allergies. We can control exposures in the home, but the triggers are out there and our kids might encounter them.
When I speak to parents who have six-month old kids with allergies, I am quick to point out that until the child walks and is able to grab for foods, I don’t worry too much. Once the child becomes a toddler who can run, grab for foods in an instant and not be able to distinguish between what he should and should not eat, the problem emerges.
The three-year old can be told what to do and will listen. The next big concern comes when the child first attends school where there is food outside the accepted diet. In most cases, with the child trained, knowledgeable teachers and administrators, and up-to-date paperwork, things seem to do along smoothly until adolescence when many children push the envelope.
During all of these times the parents and their children must be re-examined, the doctor must must reinforce the importance of carrying and being prepared to use the necessary medications, prescription EpiPens and the OTC antihistamine Benadryl.
I tell parents never to depend on anyone–restaurants, friends, grandparents—anyone, without constantly reminding them of the consequences if the “rules” are not followed. One thing I stress is that parents themselves and all caregivers should gain comfort in using injectable medication like the EpiPen. Inhibition about injecting a child is common, and even understandable, but weighed against the consequences of not giving it, there is no contest. It can’t hurt. It saves lives.
If the child is in school, reminders take on a special meaning because of food, snacks, birthday parties and trips to restaurants. But unless you can be sure of the source of each food, trust no one. If I had my way, food in the classroom would be kept to a bare minimum.
Finally, the best study I know of about contact with peanuts through touch or inhalation gave little support to the idea that this represents a threat of anaphylaxis. However, there is a danger that trace amounts of peanut residue from one child’s hands could end up on the hands of an allergic child and then find its way into the mouth where if would be capable of causing a serious reaction. As I have previously written, I have never encountered this. General hand washing and mouth rinsing are precautions, by the way, that are not part of the ADA or any other federal law.
To me, the crucial element is that our food allergy families have to be prepared. That is why I have run a support group for 30 years in which experienced food allergy parents share what they know with one another and with newcomers.
We always have a demonstration of epinephrine injection for the new parents, and the most important lesson is: NEVER BE AFRAID TO USE THE MEDICATION.