Sabrina Davidson* was at home alone with her daughter, Ava*, when she fed her a bit of peanut butter on a baby spoon as part of her morning snack. The seven-month-old had tried peanut butter once before, so Davidson was shocked to see hives appear on her face. Slowly, the red welts spread until her body was covered in them—a common symptom of food allergies. “I realized she was having an allergic reaction,” says Davidson, “but I had no idea how serious it was.”
The hives subsided on their own, and Davidson made an appointment with Ava’s paediatrician for that afternoon. Her husband returned home from work, her in-laws came over for moral support, and the first-time mom started to relax. But then, 90 minutes after the peanut butter snack, Ava’s lips started turning blue and she started to pass out. Davidson called 911. “It was incredibly traumatic,” she recalls. “I saw that moment when I closed my eyes for a long, long time.”
That day, Davidson and her husband joined a growing number of families living with food allergies. According to Food Allergy Canada, a patient education and advocacy organization, six to eight percent of kids under age three have food allergies, with peanut allergies affecting two in every 100 Canadian children. If you’re thinking, I don’t remember this being such a big deal when I was a kid, you’re right: The incidence of food allergy is on the rise.
“Food allergies are affecting more and more Canadians, and unfortunately the key strategy for families and individuals is avoiding the food. There is no cure,” says Beatrice Povolo, a spokesperson for Food Allergy Canada.
It can be overwhelming to realize something as seemingly harmless as food could cause a life-threatening reaction. For some families, this fear can be all-consuming at first. In other cases, it’s the exact opposite—the allergy isn’t taken that seriously until a more severe reaction happens down the road.
Finding that sweet spot between being cautious and fearful can be challenging. But it’s possible for your food-allergic child to lead a full, healthy and happy life. You’ll just need to layer in some precautions.
Symptoms and diagnosis
One of your first steps after a diagnosis should be arming yourself with information about exactly what a food allergy is—and what it isn’t. For example, food allergies are different from food intolerances, which can make you feel badly but aren’t life-threatening.
“A food allergy is an abnormal immunological response to a food,” explains Julia Upton, an allergist at Toronto’s Hospital for Sick Children. Put simply, your immune system thinks a normally harmless food, like peanuts, is an invader and, in response, produces something called immunoglobulin E antibodies (commonly called IgE antibodies), which set off symptoms like hives, vomiting, difficulty breathing, swelling of the lips, tongue or throat, or, more seriously, a drop in blood pressure or cardiac arrest. A severe allergic reaction is called anaphylaxis. Common food allergens are peanuts, tree nuts (like cashews, almonds, hazelnuts), eggs, milk, wheat, soy, sesame, seafood, sulphites (a preservative) and mustard. But technically, you can be allergic to any food protein.
To create a serious allergic reaction, the food needs to enter your body in some way, usually through ingestion. “Many people think you can react to a smell,” says Povolo, which isn’t true. While some people do react to touching an allergen (by getting hives where the contact was, for example) or by inhaling vapours or steam released during cooking that contain the food protein, “the greatest risk for someone with a food allergy is actually eating or ingesting what they’re allergic to.”
Often, kids are diagnosed as babies and toddlers, when they are being introduced to different foods. But they might not react on the initial ingestion, like Davidson’s daughter. That’s because the immune system needs to “see” the protein first, before it develops antibodies to it, Upton explains. Other times, albeit rarely, kids will eat a certain food for years before developing the allergy. You can even develop allergies as a teenager or an adult.
Conversely, kids can outgrow food allergies, but there’s unfortunately no way to know whether your kid will be one of the lucky ones. Milk, egg and soy are more often outgrown than other allergens, like peanut, tree nut and shellfish. Kids with multiple allergies are also less likely to outgrow them.
Learn to read labels
When a doctor diagnoses your kid with a food allergy, you’ll need to put procedures in place to ensure they never eat the food they are allergic to. Start by reading the labels of all the food you have in the house and anything you plan to purchase at the store. “It can be overwhelming for many people who are not used to reading labels,” says Povolo. Lots of parents new to food allergies report crying in the aisles of the grocery store when they realize how many products are now off-limits for their child.
But the good news is that in Canada, figuring out what’s in a packaged food is relatively straightforward, because by law, the major allergens need to be clearly labelled. In fact, companies often choose to declare major allergens in bold letters, like: CONTAINS MILK. (Note that this is optional, and companies also sometimes change ingredients; experts recommend you read the full ingredient list every time your child eats a food.)
When your child’s food allergy leads to anxiety You might also notice what’s called a “precautionary statement” on the label—something like, “may contain peanuts” or “processed in a facility that also processes wheat.” This is where things get a little murkier, since there aren’t any laws governing the use of those statements. The food may be at pretty high risk of contamination, or the risk could be negligible. In that case, it’s up to the parent to make a decision. “We recommend that they read the ingredient list and any ‘may contain’ statements for their allergens, and if they’re at all uncertain, we recommend they call the manufacturer and ask them directly,” says Povolo.
Some families choose to only have food in the house that’s safe for their child, and others keep problematic food in a separate cupboard or in a container in the fridge. Davidson, for one, prefers to keep her home 100 percent allergen-free. (In addition to peanuts, Ava is allergic to tree nuts and sesame.) “It was easy enough for us because we only have one child, so we didn’t have to worry about competing allergens or other food restrictions,” she says. Ultimately, it’s a decision each family needs to make. “It really varies in terms of the preference and comfort for the family,” says Povolo.
Preparation is key
Knowing how serious allergic reactions can be, you may wonder how you’ll ever feel safe bringing your kid to a play group or a restaurant. “The first time my husband took Ava to the park after her diagnosis, he lasted about five minutes,” recalls Davidson. “At the beginning, everything you see is a potential risk.” Over time, they developed strategies to make outings feel safer, like always bringing along wet wipes (for cleaning surfaces and Ava’s hands), safe snacks and emergency medication (see “Get to know your EpiPen,” below).
“Now she just runs and plays around like every other kid at the park. The only difference is that when she wants to sit on the bench and have a snack with her friends, she knows we have to wipe her hands first and that she can’t touch anything else while she’s eating,” says Davidson.
Granted, it’s way harder to be spontaneous when you’re dealing with a food allergy. Before going to a restaurant, families often like to call to see if they’ll be able to accommodate food allergies—don’t be embarrassed about suddenly becoming “that person” who asks a million questions about the menu. Food Allergy Canada recommends talking to the manager or chef, as well as the server, about your kid’s allergies and what menu options might work.
When it comes to family gatherings, you might find it a lot less stressful to hold the event in your own home so you can control the food or bring your child a safe meal. And be prepared for ignorant comments from those delightful relatives who think food allergies are “all in your head” or not as serious as they really are.
And speaking of relatives, anyone who’s going to be taking care of your kid or preparing food for them needs to understand food allergies too, stresses Povolo. You’ll have to explain to caregivers and family members what your child’s allergies are and what types of things must happen to keep them safe. This could mean a serious life change. Amanda Smith* and her husband, whose 19-month-old son is allergic to peanuts and some tree nuts, had to change their child care plans after his diagnosis, because the home daycare provider they had chosen (and paid a deposit at) said she didn’t feel comfortable managing the food allergy. “Travel also becomes more complicated,” says Smith. “We had a cottage weekend in the summer on an island and had to ask everyone not to bring nuts and peanuts, and we had to train everyone on how to use the EpiPen.”
Get to know your EpiPen
In a perfect world, you’ll take all sorts of precautions, and your child will never have an allergic reaction. But mistakes can happen. There’s also the chance of a safe food coming into contact with the allergen during cooking or preparation (called “cross-contamination” in the food allergy world) or even the slim chance of your child touching a surface with the allergen on it, like a smear of peanut butter, and then putting their hands in their mouth. Whatever the scenario, if your kid ends up ingesting their allergen, you’re going to need to whip out an autoinjector—and be prepared to use it.
If you’ve never seen one, an EpiPen looks a bit like an oversized marker with an orange tip, under which hides a needle. [Editor’s note: In May 2020, the pocket-sized Allerject autoinjector relaunched in Canada.] The epinephrine auto-injector is the go-to medicine for a serious allergic reaction because it can resolve multiple symptoms at once. “Epinephrine is able to act on many areas of the body to counter the effects of the allergic reaction,” says Upton. It’s common for parents to opt for an antihistamine like Benadryl first if the reaction doesn’t seem too bad, but Upton advises against this; among other things, antihistamines work more slowly and don’t help the breathing or blood pressure problems present in anaphylaxis. Your allergist should give you an allergy action plan that outlines what symptoms to look for and when to use the EpiPen. Generally, when your kid is showing symptoms from two body systems—say, skin and respiratory (for example, they have hives and difficulty breathing)—or if any one symptom is particularly severe, you should use the auto-injector. But when in doubt, just use it, says Upton. “It’s hard to tell how the reaction will progress, and we know that giving it earlier is better,” she explains. If you do use the auto-injector, you’ll need to call 911 and go to the hospital. But that’s not only because your kid needs to be examined after receiving epinephrine, says Upton. It’s also because although epinephrine will buy you time, your child may need to be treated further for the reaction.
So far, Ava hasn’t had any reactions that required epinephrine. “Because of due diligence and probably a lot of luck, we haven’t had another reaction since,” says Davidson. Now that she’s three, her parents feel they have a better handle on her allergies. But realizing Ava’s childhood wouldn’t have some of the classic childhood moments was really hard for Davidson to come to terms with. “I remember I spent days crying because I wouldn’t be able to take my kid for ice cream,” she says—the risk of cross-contamination at ice cream shops is just too high for her comfort level. “I’ve since realized now that she will just have a different experience. She’ll have something else that takes that special place.”
* names have been changed