For a parent who is not familiar with food allergies, having a food allergic child over to play may seem intimidating. This blog is intended for parents whose children do not have food allergies who would like to know more about food allergies in order to safely host a food-allergic playmate.

Meals and Snacks

Obviously meals and snacks are the most critical times to be vigilant when you are caring for a child with food allergies. Follow these steps to keep your guest safe.

• Prior to the play date, arrange for the child’s parents to pack enough safe foods for the time they will spend at your house. Let them know if you plan to have a certain food so that they can provide an allergy-free alternative for their child and nobody feels left out. The most important thing is to only give the child the food that their parents provided. Food allergens are often hidden ingredients and it takes a lot of time and practice to master the art of reading food labels and detecting potential allergens. Never assume a food is safe.
• Make sure to clean the surface of the kitchen or table to remove any food protein residue from earlier meals. Soaps and commercial cleansing agents work well on counter tops, but dishwashing liquid is not enough.
• Be sure to wash your hands before and between handling foods. It’s important to remind the kids to wash their hands before eating as well. Use soap and water; hand-sanitizers will not get rid of food protein residues.
• When preparing food for the kiddos, be careful to avoid cross contact, where the proteins from one food mix in with another food. Even a tiny amount is enough to cause an allergic reaction in some people. To avoid it, use separate utensils when preparing food for the kids (or yourself).
• For the younger children, be sure to monitor the kiddos during meal or snack time and explain that it’s not safe for them to share or trade foods.

Airborne Allergens

Most children’s allergic reactions occur from actually eating the food that they are allergic to so as long as you keep the kid’s foods separate, you don’t need to worry about what your family eats around them. However, some kids have airborne allergens where they can have an allergic reaction by just being near the allergen. For example, you’ve probably heard of the “peanut-free” schools or lunch tables which are intended to protect children with peanut allergies who can react by just being around other kids eating foods with peanuts. You’ll need to use extra caution with these kiddos and be sure to not have any foods containing that allergen while the child is around.

Arts and Crafts

It’s important to note that food allergens can be triggered by non-food items too. For example, Play-Doh and most stickers are not safe for a child with a wheat allergy. For more information on allergens hidden in non-food items, refer to Christine’s blog post, from earlier this year.

Emergency Plan

No matter how careful you are, it’s still important to know the signs and symptoms of an allergic reaction just in case exposure occurs. Symptoms typically appear within minutes to two hours after a child is exposed. If you suspect an allergic reaction has occurred, call the child’s parents immediately. If the child is having a serious allergic reaction and having trouble breathing, call 911 first, then call the parents.

Some allergic children experience anaphylaxis, a severe allergic reaction that progresses rapidly and can lead to death. These kids are usually prescribed an automatic epinephrine injector (aka an “Epi-Pen”), which must be kept with them at all times. It’s up to the child’s parents to notify you if their child carries one and explain to you how to use it just in case of an emergency. FAAN provides some online videos that demonstrate how to properly use an epinephrine auto-injector, which may help you feel more comfortable using one yourself.

Now that summer has officially begun and the 4th of July is quickly approaching, you’re probably beginning to worry about upcoming picnics, cookouts, and days at the beach. Can your child with a severe allergy safely join in on the fun? Of course! With some careful planning and the right attitude, you and your child can enjoy the summer. Here are some tips to keep in mind:

Develop a list of your little one’s medications – including those taken only in an emergency

When preparing for an outing, it’s often easy to forget some of the smaller items that you keep stocked at home. To ensure you have everything you need, make a list in advance of the medications your little one uses – on a daily basis and in case of an emergency.

Prepare allergy safe food for your child in advance

If you’re picnicking with friends or family, make sure to bring some meals and snacks that your little one can enjoy. Not everyone shares your caution in handling certain ingredients, so go ahead and prepare the food yourself before leaving. And remember, to label all food carefully – it’s easy for someone to grab the wrong item, possibly leaving your child with allergies without a meal.

Make sure whoever is hosting the summer activity knows about your child’s allergies

Many times people are so busy preparing to host a group of people, that your child’s specific allergies might slip their mind. Play it safe -- even if the host knows you and your child well, it never hurts to provide a friendly reminder about what your child can and cannot eat.

Keep it clean

Avoid eating directly on park picnic tables – you don’t know who was there prior to your visit and what food residue might be leftover. Instead bring a table cloth and some plates that everyone can eat on. Disinfectant wipes are also great for quickly wiping down areas.

Have an emergency plan

No matter how much you plan, it’s still possible that your child will accidentally come into contact with a food that causes an allergic reaction. If and when this happens, it’s easy to panic and forget what you need to do to help your child. Prior to your outing, write down what needs to be done in case of emergency – this will not only help you but can also serve as a guideline for any other adults onsite who can offer a hand.   

HAVE FUN!   

While it’s important to plan for your outing to ensure your child’s safety, summer is about having fun! Remember to bring activities such as coloring books and games so that food is not the primary focus of the outing.

What summer plans do you and your little ones have?

- Mallory

While we usually write about common food allergy symptoms, such as diarrhea or eczema, more severe reactions like anaphylaxis are possible for many children and adults with allergies. Allergens that cause anaphylaxis include food, insect stings, drugs, latex, and even exercise.  When anaphylaxis happens as a result of contact with an allergen, a rapid immune reaction occurs that can quickly make breathing very difficult.  For those patients an immediate injection of epinephrine can prevent very serious complications.  Sometimes even the few minutes it takes emergency medical care to arrive is too long, and a personal device with automated injectable epinephrine, an auto-injector, such as the EpiPen® Auto-Injector, is essential.

The EpiPen, made by Dey Pharma, works by delivering a quick shot of epinephrine to the thigh.  There are also similar devices available, such as the Adrenaclick® and TwinJect®, both made by Shionogi Inc. Twinject is unique in that it has a built-in backup dose of epinephrine, which can take the place of two auto-injectors in an emergency.

Epinephrine helps the body to keep the airway open so that breathing does not become as difficult, allowing time for emergency medical care to arrive. But many parents worry that one auto-injector might not be enough or that something might go wrong that could require additional auto-injectors. For instance, someone nearby might experience a severe allergic reaction and need to use your child’s auto-injector. Or what if your child’s only auto-injector was unknowingly broken? What if the auto-injector were accidentally put in the fridge or left in the sun? What if the contents were cloudy? Or if it had expired? So many scary possibilities!

So, what is the right number of auto-injectors? The answer to that question depends on a number of factors. Bear in mind that the Twinject has two doses of epinephrine, but according to the company the second dose should only be used as a backup to the first dose and should not be saved for future allergy emergencies.

How Many to Carry?

On their websites, Dey Pharma and Shionogi recommend that patients at risk for allergic emergencies carry two doses of epinephrine. This is because up to 20% of patients who have an allergic emergency requiring epinephrine will require a second dose. At all times the injector should be kept close to room temperature, out of sunlight, and replaced by the expiration date. You can even sign up for an expiration date reminder on either of the websites. It’s a good idea to occasionally check the solution in the auto-injector to make sure it hasn’t discolored, which can be a sign of a possible loss of effectiveness.

If a long trip is planned, especially one overseas where similar products may not be readily available in pharmacies; two auto-injectors (or one that contains two doses) may not be enough.

Should you or your child carry more than two auto-injectors? Not necessarily. Additional backups would likely be for peace of mind. A second dose of epinephrine may be needed in an emergency, but more than two doses during an emergency should only be given with medical supervision. Some caregivers choose to carry two auto-injectors from different lots for added precaution.

Multiple Locations

Some patients who use auto-injectors prefer to carry the standard two with them and also keep backup injectors in one or more strategic locations. These might include an extra one or two at work, school, daycare, and/or a relative’s house. These are great because they can serve as backup in case someone forgets their daily go-everywhere auto-injectors. Just make sure you follow the recommended storage instructions everywhere you keep an auto-injector and check your backups for discoloration and expiration dates. Knowing that you have extra auto-injectors in places like this, in addition to the daily carry-with auto-injectors you have, may bring you more comfort.

How about you? How many auto-injectors does your family keep on hand, and where? Please share your thoughts in the comment section of this blog post.

- Rob

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