Food Allergy Series Part 4: What Can I do to Prevent A Food Allergic Reaction?

Food Allergy Series Part 4: What Can I do to Prevent A Food Allergic Reaction?

As parents and caregivers, you can protect your child with food allergies by learning how to read food labels, prepare safe meals, and discuss with others your child’s food allergy to keep your child healthy.

How do I Read Food Labels?

  • In the United States, all packaged foods must clearly identify eight specified food allergy sources: milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soy. However, this does not apply to packaged meats, chicken, and egg products.
  • How packaged foods are made can change at any time, so it is very important to read the label each time to avoid an allergic reaction, even if your child has eaten that food safely for years.
  • Standard of care is to have a nutritionist review with you and your family how to read food labels as the food allergen can be listed in both the ingredient list AND/OR the “Contains” statement.  See example below.  Also, technical or nonspecific names for food allergens that one may not be familiar with also may be listed (example casein = a milk protein).  Finally a nutritionist can be helpful in making sure your child’s diet is nutritionally adequate.
  • Allergens other than those listed above may still be listed on food labels with unclear names (eg, garlic or sesame seed may be listed as a spice, natural flavor, or even an artificial flavor). If you are unsure whether the food contains a potential allergen, call the manufacturer to clarify the ingredients.
  • Labels may state “may contain,” “processed in a facility with,” “manufactured on shared equipment with,” etc. The law does not specify which type of label should be used.  Unfortunately, none of these statements reflect the level of risk to your child.  For example, a bread that states “may contain nuts” is not more or less likely to cause an allergic reaction than a bread that states “manufactured on shared equipment with nuts.”  Most allergists, including myself, recommend avoiding foods with these labels as it is not possible to know the risk to your child.  Although this may restrict your child’s food choices, it is also the most likely way to keep your child safe.

 

How can I make sure that the food I prepare is safe for my food allergic child?

  • Some families decide to avoid having the food in the home if one person is allergic.  For example, if one child has a peanut allergy, the family makes the home “nut free.” Other families continue to have the allergenic food in the home but are careful to avoid giving the food to their allergic child.
  • If the food is introduced into the home, it is very important to avoid cross contamination by thoroughly cleaning utensils, dishes, cutting boards, cookware, storage containers, and other food preparation materials before serving your food allergic child a “safe” meal.  For example, if a child without food allergies uses a knife to prepare a peanut butter jelly sandwich, it is possible to accidentally contaminate the jelly jar with peanut butter.  The child with peanut allergy could then eat the jelly and have a food allergic reaction.
  • Using a dishwasher or liquid soap and water is generally enough to remove the food allergen from dishes and other food preparation materials.
  • To remove peanut allergen from tabletops, commercial wipes (such as Lysol sanitizing wipes) or household cleaners (such as Formula 409 or Target Brand cleaner with bleach) are effective.
  • Plain water or alcohol based sanitizers (such as Purell) does not remove peanut protein from the hands.  Bar or liquid soap with water however are effective in removing peanut protein from the hands.

 

How can I make sure my food allergic child is safe at restaurants?

Eating out can be difficult for children with food allergies.  Here are some tips to make it safer:

  • Let the restaurant chef and/or manager who is directly responsible for the food know about your child’s food allergy (rather than the waiter).  Inform them that it is a not just a dislike of the food.
  • Carry a restaurant card with your child and verbally make sure they understand the card.  An example of a restaurant card can be found below and at Interactive Chef Card. These cards can be printed on brightly colored cardboard stock paper, laminated, and kept in your wallet.

 
Restaurant Card

  • Always check with the chef that the food you have ordered for your child does not contain the food allergen.  Ingredients on the menu should not be trusted at face value.  If the chef or server is not sure about the ingredients, avoid the food.
  • Buffets and salad bars should probably be avoided given the high risk of cross contamination.

 

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Grace Peace Yu MD MSc

Dr. Grace Yu is a pediatrician and allergist immunologist who has conducted ground-breaking research to help children with life-threatening food allergies. She cares for patients at the Palo Alto Medical Foundation and serves as an adjunct Clinical Faculty Member at Stanford University School of Medicine.

Note: This Perspectives Blog post is written by a guest blogger of DrGreene.com. The opinions expressed on this post do not necessarily reflect the opinions of Dr. Greene or DrGreene.com, and as such we are not responsible for the accuracy of the information supplied. View the license for this post.

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