4: Working with Risks

An immune response (like how your body reacts to germs) to certain proteins in foods
Symptoms usually affect the skin and lungs
Can be life-threatening
Usually need to avoid target food completely

Food Intolerance

Lack of certain enzymes that break down food
Symptoms are usually limited to stomach and belly
Typically are not life-threatening
Avoidance of target food is recommended

Typical Symptoms of Food Allergies

Allergic reactions usually begin immediately after exposure to the trigger food. Symptoms can be mild to severe. Allergies can also be life-threatening and require immediate medical attention. Below are some symptoms to look out for.

For More Information on Food Allergy Symptoms Click Here!

Diagnosing Food Allergies

1. Diet history - Most Important

- The allergist will ask for a diet history to find the links between the reactions and the suspected food.
- If you suspect a food allergy, record symptoms, how soon it happens after intake, and ingredient list of food, then share this with your allergist.

2. Allergy skin prick test

- Pricks the skin with a drop of the allergen. If allergic, a raised red bump will appear.
- High rate of false positives

3. Allergy blood test

- Tests the amount of IgE (an antibody) in the body for a particular food
- High rate of false positives

Blood & Skin Tests:

The severity of skin reaction or the amount of IgE in the blood does NOT mean the allergy is more severe. It means that there is a greater chance that there is an allergy.

What is FPIES?

Food Protein Induced Enterocolitis Syndrome is a reaction to specific foods in the gastrointestinal system. It is inflammation in the small intestine and the large intestine (colon). It normally presents after introducing solid food for breastfed infants and earlier in formula-fed infants.

FPIES vs Food Allergy

FPIES is a type of allergy that happens because of cells reacting in the digestive system, it does not happen right away. Due to this, there will NOT be hives, swelling, coughing, wheezing or other traditional allergy reactions.

Trigger Foods

Trigger foods are different for each child, but common foods are milk and soy.

These are common allergens, but it can also happen with foods that are not considered allergens like, turkey, rice, oats, avocado, and squash.

Reading Food Labels

What is required by law?

The nine major allergens (wheat, milk, eggs, fish, shellfish, soy, tree nuts, peanuts, sesame) must be clearly labeled on the ingredient list on the package IF it is an intentional ingredient in the product.

Could be on the ingredient list with the common name, could be used with the word “contains” (such as “contains milk”), could be in ingredient list with parentheses after its uncommon name- “albumin (egg)”

What is not required?

If the product was made in a facility with allergens and cross contact happens - it does NOT have to be on the food label.

However, the label might say something along the lines of:

“May Contain”

“Processed in facility that also processes”

“Made on equipment with”

What should you do?

Look for the label on the back with the allergens (always look on the back for an official label - sometimes front labels are not accurate)

“Peanut-free,” “Egg-free,” and others like this on the front of packages are not regulated and does not guarantee the product is safe

!!!!!Manufacturers can change products without warning so sometimes new allergens can be in what used to be a safe food - ALWAYS check food labels!!!!!

Can You Prevent Food Allergies?

Based on current research and guidelines, introducing diverse foods early to infants may help to prevent the development of food allergies

Introduce allergenic foods in infancy

Feed age-appropriate peanuts, eggs, and dairy to start and continue to do the other main nine allergens

If you have a suspected allergy:
- The child may receive an Oral Food Challenge (OFC) with an allergist
- An OFC is when the allergenic food in question is consumed at a allergists office under medical supervision. This is the safest way to determine if the food might cause an allergic reaction. If the child does have a reaction, there are trained medical personnel there who can mitigate the issue.
- After your child PASSES the OFC
  - Slowly, but consistently reintroduce suspected foods, monitoring for symptoms

Navigate Risks

Area of Concern

Schools

Daycares

Restaurants

Events with Food

Resources to Use

Reach out to teachers and school nurse

Reach out to the parents and caregivers of other children in your child’s daycare or classroom to alert them of the allergy

Speak to the server, manager, and chef to warn them of the risks; call ahead of time

Speak to family members, and offer solutions for potential meal replacements to comply with allergies

In ANY scenario, have a plan if things go bad (EpiPen, access to emergency services via phone)

Emergency Plan

If a severe allergic reaction is occurring, INJECT with EpiPen
- Child is swelling, unable to breath, turning blue, hoarse, has many hives over the whole body, severe vomiting
- EpiPen should ONLY be injected into the mid-outer thigh and may be injected through clothing (if injected into other body parts on accident, get medical assistances immediately)
- Press down firmly with the entire pen for at least THREE FULL SECONDS
Once EpiPen is injected
- Call 911 and explain that the child is having an anaphylactic allergic reaction
- If symptoms don’t improve after FIVE OR MORE minutes, another dose may be injected
- Administer antihistamines

Liberalize the Diet

Diversify the diet as much as possible; Don’t restrict foods they don’t have a diagnosed food allergy to
- For example: if your child is allergic to eggs, don’t avoid other allergens or foods unless there are confirmed allergies
Look for alternatives
- Almond butter and peanut butter can be replaced with sunflower butter
- Rice milk and coconut milk can be used instead of almond, cashew, dairy, or soy milk
- Chia or flaxseed “eggs” or applesauce can be used in baking as egg substitutes
- Gluten free flour blends, coconut flour, ground oats, and rice flour can be substituted for wheat flour
Utilize the ladder systems with confirmed egg or milk allergy (consult with your allergist before trying)
- The egg and milk ladder is great for liberalizing the diet with a known egg or/and milk allergy. Consult with your allergist before trying.
Reintroduce Allergens
- If you child PASSES an oral food challenge, reintroduce the allergen to avoid the recurrence of the allergy

Egg and Milk Ladder

Egg Ladder

Milk Ladder

Egg and Milk Ladder Goal

The goal of milk and egg ladders is to gradually introduce these allergens to a child who has egg or/and milk allergies. Consult the allergist!

References

Trogen B, Jacobs S, Nowak-Wegrzyn A. Early Introduction of Allergenic Foods and the Prevention of Food Allergy. Nutrients. 2022;14(13):2565. Published 2022 Jun 21. doi:10.3390/nu14132565

https://www.foodallergy.org/resources/facts-and-statistics#:~:text=Researchers%20estimate%20that%2032%20million,roughly%20two%20in%20every%20classroom

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https://www.bcchr.ca/foodallergy/resources/canadian-food-ladders

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