Living With A Food Allergy

By Dena K. Salmon, Child magazine

Most parents would think nothing of serving their kids a stack of banana-nut pancakes or a tuna-fish sandwich on whole-wheat bread -- unless their child has a food allergy.

If he does, school cafeterias, restaurants, and the homes of his closest buddies can become scary places where a casual meal or quick snack might have life-threatening consequences.

Kids can be allergic to a variety of foods, but the worst culprits are wheat, soy, eggs, milk, fish, shellfish, nuts, and peanuts -- which are actually legumes. Allergies may develop at any time, and some can be outgrown, though peanut, fish, and shellfish allergies tend to be lifelong and cause the most severe reactions.

Laura Pettinato of Sherman, Conn., is severely allergic to shellfish, tuna, and a number of prescription drugs. Almost from day one, she says, her son Logan, who is now 4 1/2 years old, seemed to have allergies, too. His skin broke out in a rash soon after he was born, and he quickly developed a whopping case of cradle cap.

When he was 2 months old, Logan was diagnosed with eczema and his pediatrician recommended a steroid cream. Laura began doing research on her own and learned about eczema, allergy, and asthma.

''It's likely that all three conditions are carried by the same gene. If you have one, you have the potential to develop all three,'' Laura explains. ''I figured that Logan was allergic to something he was taking in through my breast milk.''

Through the help of a nutritionist, Laura discovered the problem was garlic. As long as she avoided it, Logan's eczema all but disappeared.''

Early signs of an allergy

When Logan was 6 months old, he was carefully introduced to solids. ''He was fine with each fruit and vegetable he tried,'' his mother says, ''but ran into trouble with egg whites when he turned 1.''

Laura made an appointment with Dr. Christopher Randolph, a pediatric allergist in private practice and an associate clinical professor at Yale University School of Medicine in New Haven, Conn.

Dr. Randolph explained to the Pettinatos that when a child is allergic to something he eats or inhales, each exposure causes the immune system to respond by producing an antibody called IgE.

''Every subsequent exposure causes more IgE to be produced, and when the body develops enough of this antibody, the next contact with whatever the child is allergic to causes the IgE to release chemicals such as histamine, which is actually what causes the symptoms of allergic reaction.''

''Because Logan had never been exposed to peanuts or shellfish, I advised the Pettinatos to avoid giving Logan these foods for another few years,'' Dr. Randolph says. ''A young child's immature digestive tract more easily allows allergenic proteins to pass through, which encourages the buildup of IgE.

''At around age 2, the gut becomes less permeable. If we wait long enough before introducing a potential allergen, the child may never develop the allergy.''

Peanuts, peanuts everywhere

That advice did the trick for a while. Then one day Logan was exposed to some friends who had just eaten peanuts and his face was immediately covered with hives.

Dr. Randolph suggested that the Pettinatos get in touch with the Food Allergy Network (FAN), a national nonprofit organization dedicated to raising public awareness about food allergies. The Pettinatos found FAN to be an invaluable source of information and help. (Call FAN at 800-929- 4040 or check its Web site at www.foodallergy.org.)

What does an allergic reaction look like?

An allergic reaction may occur within seconds of contact with the allergen, but less severe reactions may occur within two hours. Food allergy reactions usually start with a swelling of the tongue and often of the face and neck as well.

A common sign is hives: raised, red, itchy, irregular welts. Each welt may last up to 48 hours, and during a reaction, new welts may continue to appear on different parts of the body. An allergic reaction may also be accompanied by nausea, vomiting, cramps, and labored breathing.

The most severe allergic reaction, anaphylaxis, may be triggered by a minute amount of the offending food.

''Anaphylaxis is a massive release of histamine into the body,'' Dr. Randolph explains. ''It may start with difficulty in swallowing, followed by swelling of the tongue, as well as hives. The patient may exhibit itchy eyes and hoarseness, wheezing, and sneezing. There also may be abdominal cramps and diarrhea. The patient may lose consciousness and suffer from an irregular heartbeat. Death may follow unless the proper medical treatment is available.''

According to the National Institutes of Health, about 3 percent of children have a clinically identified food allergy, although some researchers estimate a more widespread problem.

Avoiding allergens in school

If it turns out that your child does have a food allergy, the only treatment is to eliminate the food from her diet. If she is diagnosed with a severe allergy, though, there is more that you can and must do, as the Pettinatos discovered.

Laura, an attorney who's now a stay- at-home mom, learned that children with potentially life-threatening allergies can be classified as disabled under under any of three federal laws: the Individuals with Disabilities Education Act; section 504 of the Rehabilitation Act; and the Americans with Disabilities Act.

When a child meets the disability requirements of one or more of the laws, his school district must work out a plan that ensures his safety during the school day. The plan is developed with input from the child's physicians, parents, and school personnel and must be approved by the child's parents before it can be implemented. A school must comply fully or the parents can take legal action.

A year and a half before Logan was due to enter kindergarten at the public school in his area, Laura wrote to the principal to inform him that her son had a life-threatening food allergy. The school invited her to meet with the principal and other staff members.

''No one at Logan's school had ever dealt with a child who had severe allergies, but everyone responded to our concerns quickly and professionally,'' says Laura. ''With the help of Dr. Randolph, we developed a food allergy management plan, one that enabled Logan to attend the school's preschool program this year.''

Logan's preschool teacher gives the children snacks provided daily by Laura (the other parents agreed to chip in), and nuts are never brought into the classroom. The teacher is vigilant about hand washing, too, because peanut protein is just like a germ on a surface for kids with severe allergies.

Logan, who will be starting kindergarten in the fall, is involved in every social activity except for eating in restaurants. His allergies have not kept him from making friends or living a normal life.

''My situation has gone from being a nightmare to something we all can live with,'' Laura says.

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