Peanut Allergy

Dear Lisa,

My 2 year old son has been diagnosed with a peanut allergy. I cannot begin to tell you how petrifying it is to think that something so simple as eating a peanut can cause him to have such a severe allergic reaction that he could die. Now that the initial shock is settling, I want to make sure that I am doing everything that I can to keep him safe. I am with him 100% of the time, I read all food labels, I do not have any peanuts in the house at all and I always carry his Epipen, no matter where we go. Is there anything that I am missing? What other precautions can I take to keep him safe?

“Petrified of Peanut allergies”

Dear “Petrified of Peanut allergies”,

I applaud you for your diligence and effort in educating yourself about your son’s peanut allergy. Having a child diagnosed with a peanut allergy is a very difficult challenge because of the unpredictability of your child’s health and feelings of helplessness due to the lack of control of such a potentially life threatening situation. Be assured that you are not alone, because the incidence of peanut allergies is on the rise. In 2002, studies reported that the prevalence of peanut allergy had doubled over the past decade. (1)

There are some additional measures that you can take that can help keep your son safe. The best way to prevent an anaphylactic reaction is to always read all food labels. If an ingredient list is not available it is best not to let your child eat it. No matter how many times you buy the same product, you should read the ingredient label every time. I have had patients that had an accidental ingestion because a food product regularly used changed its ingredient list with no other obvious change in the packaging. Therefore it is best to read the ingredient list every time.

Most parents of children with peanut allergies avoid Chinese restaurants because they tend to use nuts in their recipes, and peanut oil to coat their pans. The same pan that is used to make a dish with peanuts may be used to make your child’s food, and there is a good chance of cross contamination.

Cross contamination is also very likely in bakeries because residual nut crumbs may accidentally be left on a surface where your son’s cake is made. It is safer to buy a cake with an ingredient list attached. When dining out, it is necessary to be very assertive when explaining your child’s peanut allergy to restaurant workers. Do no be afraid to question their ingredient lists for different dishes and inquire about procedures to limit cross contamination.

When ordering meals from an Italian restaurants ask how their sauce is made. Peanut oil may be used to prepare the sauce or nuts may be used as ingredients in some dishes. Lastly, chocolate commonly includes nuts or nut oils as an ingredient. Typically, chocolate made outside of the United States is not recommended because of the likelihood that it may contain nuts and not necessarily list this on the label.

Carrying an Epipen with you is the right decision because you never know if an accidental ingestion may occur. Even if you don’t keep any peanuts in the home and you read all labels, cross contamination or errors in packaging may still occur. Actually, it is recommended to carry more than one Epipen at all times.

You may need more than one Epipen in case one fails, in the event the Emergency Medical Services takes a long time to get to you and because anaphylactic reactions may be prolonged and the dose may need to be repeated. (2)

If an anaphylaxis does occur, give the Epipen right away. A delay in administration of treatment can result in a fatal or near fatal allergic reaction. Contact Emergency Medical Services immediately. To expedite their arrival have someone wait outside ready to direct them to your child, leave lights on and doors left propped open. If you are alone, prop the door open with a chair to bring attention to the entrance.

It is a good idea to have the number of your house posted clearly, making sure that tree branches and shrubbery don’t obstruct the view of the number. If need be, you can have your address painted on the curb. I have dealt with many Emergency Medical Service employees who informed me that hardest part of their job is finding a house address.

It is also a good idea to contact the Emergency Squad Chief and inform him/her that you have a child with the diagnosis of a peanut allergy and the potential for anaphylaxis. You can also mail a profile to the station. Mailing a profile to the squad will serve to familiarize the volunteers and workers with the people in the community who have the likelihood of needing their service.

The profile should be clearly written or typed and should include your child’s name, date of birth, weight, address, allergy, recommended treatment, other medical conditions such as Asthma, the doctor’s name and telephone number.

It is very normal for a parent to become overwhelmed with all of this information. Food Allergy Support groups can be very helpful for parents. Support groups can provide a place to share ideas, gain information and provide emotional support. You can contact your local health department and/or hospital to find a support group in your area.

The Food Allergy Network is a great resource. You can find updated information about food allergies, research, legislation and warnings about errors in labeling of food products.

References:
(1)Bassett, C. What to do when foods become allergens. The Clinical Advisor. 2005;Dec:43-48.
(2) Gray, J. New Guidelines reveal complexity of food allergy. Infectious Diseases in Children. 2006; April:10.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Advice for Parents- Keeping Kids Safe