I am often asked what else can be done to help one’s child with food allergies.  I truly believe that the more you know, the more empowered you can be to help your child lead as happy and as normal a life as possible.  Below are some commonly asked questions that I hope will be helpful to you and your family, ranging from the psychological effects of food allergies in children to the latest clinical research in food allergies and how you can get involved!

How can my child help to prevent a food allergic reaction?

Once children become verbal, they can let others know that they have a food allergy.  When offered food, the children in my family with food allergies will let the person offering the food know that they have a food allergy.  They typically do not share or take food from other children or adults because even the most well-meaning person may not realize that the chocolate chip cookie they offered was contaminated with peanut butter from the peanut butter cookies they had made at the same time while using  the same spatula.  This has unfortunately happened to many a peanut allergic child.

How does a food allergy affect my child psychologically?

One study showed that having a food allergy was similar to having Type I diabetes in children.  It is important to recognize that children may feel frustrated by their food allergies as they may not be able to enjoy all the different foods that their friends and family are eating.  Some families may decide if their child is milk allergic to have a birthday cake made without milk.  Or if they go to a birthday party, a special and treasured muffin or cake is made for the food allergic child so that he or she does not feel like he or she is missing out.

How can I tell if my child is being bullied or teased because of his or her food allergy?

In one study 24% of children (and 35% five years and older) with food allergies were victims of bullying, teasing, or harassment.  For 86% of these children, the teasing, harassment and bullying occurred numerous times at school. Unfortunately, one-fifth of food allergy-related bullying involved school staff.

The children were both verbally teased and physically threatened with the food to which they are allergic. Two-thirds of the children felt sad, depressed, embarrassed and/or humiliated because of the teasing and bullying.

As a parent, you should regularly ask your child whether anyone is giving them a hard time about their food allergy.  If your child seems sad, depressed or withdrawn, you should ask them what is causing them to feel this way and get them help if needed.  Child psychologists can be very helpful in this regard. School staff should adopt a zero tolerance policy for bullying and have in place a plan for quickly dealing with bullying and teasing.  You can also engage your pediatrician and allergist to educate the school staff, parents, and children about food allergies.

Should my child wear a Medic Alert bracelet?

Absolutely.  Medic Alert bracelets are important to wear in case your child is having an allergic reaction and cannot communicate because of breathing or blood pressure problems.

We recommend that the bracelet state the following:

“Food Allergy -> Epinephrine and call 911.”  Make sure to add your contact number (e.g. cell phone number) if there is room.

Medic Alert and Lauren’s Hope make very attractive Medic Alert bracelets that are customizable to all ages.

Should I hold off on introducing certain foods to my children to prevent food allergies?

The evidence is not clear that delaying the introduction of certain foods will decrease the odds for developing food allergies. Research is currently being done to determine whether early introduction of peanuts into a child’s diet affects the development of food allergies. No results have yet been published, but when they become available they will be widely shared.

Besides strict avoidance and epinephrine are there any other treatments for food allergies?

People are becoming desensitized to food allergens by ingesting small daily, incrementally increasing doses of food allergen.  This has proven effective and relatively safe, but should only be done in a research trial.  Other treatments currently under research investigation are a traditional Chinese medication, Xolair (an anti-allergy antibody medication), recombinant food proteins, and ingestion of eggs of a parasite called whipworm.

If you are interested in food allergy research trials for your child, please look at clinicaltrials.gov.

How can I meet other families who have children with food allergies?

There are often many local support groups in the area who meet to help each other.  One such resource to help you find a support group is found on foodallergy.org.  You can also ask your allergist for tips for finding other families or support groups that may be helpful to you.

What are other resources for parents whose children have food allergies?

1. Food Allergy and Anaphylaxis Network – an excellent resource for everyone with food allergies.  They send out e-mail alerts about contaminated food products and a newsletter with very informative articles by food allergy experts.  The website also contains books, videos, and other teaching tools to educate children with food allergies as well as schools and workplaces about food allergies.  This is a must-see!
2. “Food Allergies for Dummies” by Robert Wood MD Allergist.  An excellent and detailed book for people with food allergies.
3. How to Manage Your Child’s Life-Threatening Food Allergies – Practical Tips for Everyday Life by Linda Marienhoff Coss.  Containing more than 200 pages of tips on how to manage a child’s food allergy, this book includes hundreds of easy-to-read tips, numerous checklists, sample forms, and real-life examples.
4. The Parent’s Guide to Food Allergies by Marianne S. Barber with Maryanne Bartoszek Scott, M.D., and Elinor Greenberg, Ph. D.  This book provides an extensive exploration of all aspects of food allergy management in day-to-day life. An invaluable resource for those struggling with a new diagnosis.
5. Caring for Your Child with Severe Food Allergies by Lisa Cipriano Collins, M.A., M.F.T. This informative book offers pertinent facts to help families cope with the emotional aspects of raising a child who has severe food allergies. Parents will learn both how to reduce risk while encouraging normal emotional development and how to address the needs of the child as well as the rest of the family.

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.

• 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.

What should I do In Case of an Allergic Reaction?

A food allergic reaction can be a frightening experience.  Below I hope to help guide and empower you to be able to know the most effective way to treat an allergic reaction should your child have one.

How common are food allergic reactions?

Studies have shown that the rate of food allergic reactions is greater than 15% per year per child.  One study even showed that there is a 1 in 2 or 50% chance that your child will have an accidental ingestion leading to a food allergic reaction per year.

This happens because it not always easy to know if a packaged food or restaurant meal contains a food allergen.  As a result, it is very important to know how to treat an unexpected allergic reaction.

What should I do in case my child has an allergic reaction?

It is important that your doctor complete a food allergy action plan for your child that goes over exactly what to do in case of an allergic reaction.  Your doctor can tailor the food allergy action plan specifically to your child based off your child’s history of reactions and special circumstances.  These food allergy action plans can be found at foodallergy.com.  You should review the food allergy action plan with your child’s school, as well as with family members and baby sitters so that they know exactly what to do in case of an allergic reaction.

The general recommendation for food allergic reactions is to give injectable epinephrine and call 911 unless your child is only having mild itchiness or hives.  Epinephrine is the only life-saving medication in a food allergic reaction.  When in doubt, give epinephrine.  The benefits of giving it to prevent life-threatening complications in nearly all circumstances outweigh the risks of side effects (including fast heart rate, dizziness, shakiness, and/or nausea).  Moreover, these side effects go away as epinephrine is a hormone naturally produced and broken down by the body.

Should I carry one or two dose of Epinephrine with me?

In 10-20% of allergic reactions, a second dose of epinephrine is needed to treat the allergic reaction.  Therefore it is very important to carry two doses with you at all times.

What if I am scared to use the Epinephrine?

If you are too scared to give the epinephrine make sure that family and friends know how to use it.  You can give it to them to administer to your child if she or he is having an allergic reaction.

We recommend practicing how to use epinephrine with a training device with your doctor or nurse in their office as well as by watching the training videos that accompany the device at home. There are many different brands of epinephrine including Auvi Q (which verbally gives you directions on how to use the medication), Epipen Twin Paks, etc.  You should use the brand that you feel most comfortable with and is the most convenient for you to carry.  The more you practice with the device and train others on how to use it the more comfortable you will feel.  I also recommend using the real device on an orange or melon as the feel of the training device is slightly different than that of the actual injector.

Giving injectable epinephrine can be less painful than receiving a vaccine and will within seconds to minutes help stop or slow down the allergic reaction.  Some children have told me how surprised they were at how little it hurt and were grateful that they could breathe again or no longer have tummy pain.  Every child though has a different pain threshold and some may cry when it is administered, which is normal.  Please talk to your doctor if you have concerns about using epinephrine.

How do I take care of my the epinephrine?

It should be carried with your child at all times.  Avoid extremes of temperature (e.g. glove compartment of a car on a hot day) as this can degrade the epinephrine.  Avoid direct sunlight exposure.  If the clear white boxed opening on the EpiPen turns colors or becomes cloudy, the epinephrine is no longer effective.  EpiPen Twin Packs should be refilled every year.  Please make an appointment with your doctor when your EpiPens need to be refilled.  With old or expired EpiPens we recommend that you practice with them on melons or oranges and train family members and friends to do so as well.

What if I only have an expired epinephrine on me when my child has an allergic reaction?

Use it.  It is better than not receiving any epinephrine at all.  One study has shown that expired epinephrine still may contain an effective amount of epinephrine.

What is the role of antihistamines such as Zyrtec or Benadryl in treatment food allergic reactions?

Antihistamines such as liquid or chewable Zyrtec (generic name = cetirizine) or Benadryl (generic name = diphenhydramine) only help relieve itching or hives and may take up to 20-30 minutes to start working.  Antihistamines do not help breathing problems, airway swelling, stomach problems, or reverse low blood pressure.  As a result they are considered second-line treatment for food allergic reactions.  Epinephrine should always be used first unless the reaction is only mild itching or hives.

I am often asked as an allergist how can I tell if a child is having a food allergic reaction.  It is not always easy to tell and thus it is important to know all the possible symptoms of a reaction.  Being able to recognize the symptoms early on can prevent your child from having worsening and potentially life-threatening symptoms.

What are the symptoms of a food allergic reaction?

Children have unique ways of describing their experiences and perceptions, and allergic reactions are no exception. Precious time is lost when adults do not immediately recognize that a reaction is occurring or don’t understand what a child is telling them.

Some children, especially very young ones, put their hands in their mouths or pull or scratch at their tongues in response to a reaction. Also, children’s voices may change (e.g., become hoarse or squeaky), and they may slur their words.

The following are examples of the words a child might use to describe a reaction:

• “This food’s too spicy.”
• “My tongue is hot [or burning].”
• “It feels like something’s poking my tongue.”
• “My tongue [or mouth] is tingling [or burning].”
• “My tongue [or mouth] itches.”
• “It [my tongue] feels like there is hair on it.”
• “My mouth feels funny.”
• “There’s a frog in my throat.”
• “There’s something stuck in my throat.”
• “My tongue feels full [or heavy].”
• “My lips feel tight.”
• “It feels like there are bugs in there.” (to describe itchy ears)
• “It [my throat] feels thick.”
• “It feels like a bump is on the back of my tongue [throat].”

How can you tell the difference between a food allergic reaction and an asthma attack?  What do you treat first?

• Asthma and a food allergic reaction can look very similar, especially when there are only respiratory symptoms with a food allergic reaction.  This occurs in about 20% of cases when no skin or gastrointestinal symptoms are present to suggest a food allergic reaction versus an asthmatic one.  It is important to take into account the context of the symptoms.  If for example you know you have eaten at home with only safe foods, then the symptoms are less likely to be a food allergic reaction than if you were eating out or at a party.
• The beauty of epinephrine is that it is a great drug for both asthma and food allergic reactions, so you can never go wrong giving the epinephrine when there is any doubt.

What is the treatment for food allergies?

It is important to strictly avoid the food allergen and to carry an injectable medication known as epinephrine with your child at all times.  This treatment is the standard of care.  Many families ask how strict should they be in avoiding the food allergen.  Even a tiny amount of a food allergen can trigger a life-threatening allergic reaction.  Food allergies cause about 100-150 deaths per year.  As a result, strict avoidance is the most likely way to keep your child safe.

Having a child with food allergies can be a life-changing experience both for the child as well as everyone that takes care of him or her.  I know first-hand having children in my family with food allergies.  It has given me a passion to help children with food allergies through education, patient care, and research.  This is the first of a five part series over the next week in which we will discuss food allergies.  We will discuss commonly asked questions about food allergies and tips on how to keep your child safe and healthy.  I wish we had enough time and blog space to discuss each and every one of the more than 170 foods that have been reported to cause food allergies but since we don’t I hope that the general tips and answers to the many questions that I have been asked by families like yours over the years will be helpful to you.  Thanks so much for reading.  I would love to hear your stories, questions, and comments!

What is a food allergy?

A food allergy is a reaction in which one’s immune system thinks of a particular food as a foreign invader.  Typical symptoms include itchy red skin, coughing, vomiting, sneezing, and watery red eyes.  These symptoms are pathways that the body uses to try and remove the food allergen from the body (with vomiting is the most clear example of how your body expels the food allergen from the body).  Typical allergic reactions occur within minutes to an hour upon exposure to the food.

Allergic reactions typically happen after eating the food allergen.  It can also occur in other situations such as:

• Touching the food allergen which typically causes red, itchy skin
• Rubbing the food allergen into the eye which can cause swollen, red, watery eyes
• Breathing in the food allergen particles in the air (as a result of steaming, boiling, frying, grating, shedding, or grinding) which can cause difficulty breathing and coughing in highly sensitive children.  As a result, children who are highly sensitive should avoid situations in which there is a risk of food allergen inhalation. (Note the peanut allergen from peanut butter does not easily become airborne, but it may become airborne from peanut flour or “dusty” roasted peanuts.)

How can I tell if my child has a food allergy?

The definition of a food allergy is an adverse reaction mediated by the immune system that occurs reproducibly upon exposure to the food.  However, it is sometimes difficult to tell if your child has a food allergy or not.  For instance, some people who eat or drink milk products then develop bloating and gas.  This may be because they cannot break down a sugar in milk products called lactose.  In such a case, the bacteria in the gut ferment this sugar and cause gas and bloating.  This condition is known as lactose intolerance.  Lactose intolerance is not considered a food allergy but rather a food intolerance.  It can be helped with products such as Lactaid, an enzyme that breaks down lactose in your body, which can be taken before you eat or drink milk products to prevent symptoms. If you are not sure if your child has a food allergy, it is best to talk to your child’s pediatrician.  He or she can also refer your child to an allergist for testing.

How are food allergies diagnosed?

The most important way in which a food allergy is diagnosed is by your child’s history.  If the history is consistent with food allergy, your doctor may order allergy skin and/or blood tests to confirm the allergy.  If there is doubt about whether the symptoms represent food allergy or not, then a food challenge may be performed.   If your child has a food allergy, it is important that your child be seen by a board certified allergist for consultation and at least yearly follow-up appointments.

How common are food allergies?

It is estimated that up to 8% of children and up to 3-4% of adults have food allergies.

What are the most common food allergens?

Milk, soy, wheat, eggs, peanuts, tree nuts, fish, and shellfish cause over 90% of all food allergies.  However over 170 foods have been reported in the literature to cause food allergic reactions.

What caused my child’s food allergy?

A combination of genetic and environmental factors.  It is estimated that children who are born to parents who have allergies are 60% likely to develop some kind of allergy, whether it be eczema, hayfever, food allergies, or allergic asthma.  If only one parent is affected, the child has a 40% risk of being allergic.

Furthermore, in identical twins, if one is allergic to peanut, the other twin has a 67% chance of also being allergic. In siblings, if one sibling is allergic to peanut, the other sibling has a 7% risk.

One of the environmental factors hypothesized to affect the development of allergies is an environment that is “too clean.” This “hygiene hypothesis” posits that when the child’s environment is too clean, the immune system doesn’t have enough “work” to do and it may cause the immune system to skew towards an allergic predisposition since there are very few viruses and parasites to attack. There are many theories as to why food allergies are on the rise, but we do not know with 100% certainty why the number of children with food allergies is increasing.

Traveling with a child who has food allergies means having to do some legwork before you go. Whether you choose to dine out or eat in on your vacation, or a combination of both, you’ll need to do some pre-planning. The more work you’re able to do in advance, the less likely you are to encounter any pitfalls, disappointments, and most importantly reactions, along the way. Hopefully these tips will help make it even easier!

Eating In

• Make a meal plan – include breakfast, lunch, dinner and snacks.
• Focus on meals that are naturally free of your allergens and easy to prepare.
• Focus on meals that have as few ingredients as possible.
• Plan for bag lunches/snacks on your day(s) of travel.
• If you’re staying with family, ask what their plans are for food so you can work something similar into your meal plan or plan meals that are naturally free of your allergens that everyone can eat together.
• To save money, pack some of your staples or things you don’t use a lot of. Examples: if you use ground chia as an egg substitute for your child’s pancakes, pack some in a reusable container and bring it with you. This is much preferable to buying a whole bag when you get there and having to schlep most of it back home with you.
• If you aren’t sure if the local stores will have your gluten-free pasta, or other obscure item, bring some with you.
• Incorporate a visit to a local Farmer’s Market into your trip. It will give you a great feel for the area and you’ll have some fresh veggies to munch on or include in your meals.
• Be mindful of cross contamination.
• Give the food prep and eating surfaces a good scrub down to remove proteins and particles.
• Scrub any nooks and crannies that might be hiding allergens (rims of pots, crevices in slotted spoons) and then run them through the dishwasher for good measure.
• Don’t use wooden their wooden spoons or cutting boards to prepare your food – they are porous and cannot be thoroughly cleaned.
• If you’re staying with family, explain why this is necessary so they don’t think you’ve gone off the deep end.

Dining Out

• Plan ahead:
• Check out websites like Allergy Eats and even Yelp!. Both offer apps for your iPhone or Android device. Keep in mind the information on these sites are given by customers and while they can be a good starting place for information, it’s important you reach out to the restaurant staff yourself and do your own research.
• Call ahead. Speak to the manager of the restaurant and/or kitchen. Ideally, make reservations so they know you are coming.
• Speak to your hostess and server about your needs. Most restaurants are well aware of food allergies and Celiac disease, but do not assume they know how to keep you safe. If you’ve called ahead, this will streamline your experience.
• Carry food allergy cards. These are cards with and explanation of your allergens. They are designed to be given to servers and kitchen staff to help prepare your food safely.
• Bring your own food. I know, this is a major faux pas with restaurants and movie theaters. But there have been times when visiting family where 10 people wanted to go to a particular restaurant where there is nothing safe for my kids to eat. I pack them a meal and if the server or staff asks questions, I explain my children have food allergies. I have never had someone take issue with that response and honestly, I think they’re relieved not to have to deal with the extra work and liability.
• Some resorts, like Disney, are very accommodating to people with food allergies and other special needs. Follow the same protocols of calling ahead and making reservations to make your experience go smoothly.

Traveling with food allergies isn’t care-free. In fact, you may need to rest up from your vacation when you return home. But the experiences travel can provide for kids to connect to distant family, see new places, and encounter the world in a whole new way can be extremely rewarding — for the whole family.

Planes are notorious for the tiny pouches of peanuts they adore handing out. With peanut and other life threatening food allergies steadily rising, it’s surprising that these are still the go-to snacks of so many airlines. Unfortunately, this makes flying with a peanut allergic child a risky venture, but not an impossible one. Here are some special precautions you can to take to make sure everyone has a safe trip.

Call Ahead

Call the airline directly and speak to a real human. Explain that your child has a life threatening peanut allergy. Tell them you will need your flight to be a peanut-free flight, meaning they agree they will not serve any peanuts on your flight. Make sure the person you are speaking to understands this. If you don’t feel confident that they do, ask to speak to their supervisor. Some people ask that the airline provide written confirmation of their request. Some airlines will provide this, some won’t. Some airlines will ask for proof of medical diagnosis, so be prepared to provide this.

Do not accept a ‘buffer zone’ as a solution. Even though the scientific jury is out on airborne reactions, the risk still exists and is significant enough that I wouldn’t take a chance. You don’t want to find out your child reacts to airborne peanuts at 30,000 feet above sea level.

Be Prepared

Have your Epi-pens (in their original box with prescription labels), 2 – 3 single-serving Benadryl, rescue inhaler (if necessary), medic alert bracelet and allergy information cards in your carry-on bag. Some airlines will check carry-on size suitcases if there isn’t enough room in the overhead bins, so be sure all of the above items are in your purse or other small back that can fit under the seat in front of you. If you’re flying with another adult, have them carry two extra Epi-pens just in case. Bring wipes for cleaning surfaces that your child will come in contact with on the plane. (Click here for FAAN information about cleaners that remove peanut allergens.)

BYOF

Bring your own food. Your safest option is to say ‘no thank you’ to the airline snacks and instead bring food from home you know is safe. In addition to packing food for the flight in our carry on bags, we usually pack a small suitcase with food (we have multiple allergies). The bonus is that once the food is eaten we have room for souvenirs and the like.

Double, Triple Check-In

Arrive at the airport with ample time to deal with any unexpected snafus. When you check in, make sure there is a note on your child’s ticket that indicates they have a peanut allergy. When you get to the gate, check to see that the crew has been notified of the allergy. Ensure that they are aware that the airline has agreed no peanuts will be served on your flight. Make sure that you and your peanut allergic child are seated together.

When you board the plane, take a moment to introduce yourself and your child to the flight attendant greeting you at the door in order to make sure they are aware of your child’s allergy. Let them know where you are seated and that you are available if they have any questions about your child’s allergy. You may want to make a recording of yourself by this point, but the more people that are on the same page, the more people that can keep your child safe and prevent a reaction.

Seating Arrangements

If you and your child have to sit with a stranger, explain that your child has an life threatening food allergy. Because many people bring their own snacks and food on planes, politely ask that they not eat any nut products while on the plane. Most people will be happy to oblige your request, but if you get any indication they aren’t willing to be cooperative, ask the flight attendant to switch seats.

The Wipe Down

When you get to your seats, wipe down all the surfaces that your child will have contact with on the flight to remove any peanut proteins (arm rests, seats, tray tables, window area). Look around the seats, floor and seat pouches in front of you for stray peanuts and packaging from the previous flights.

In Case Of Emergency

All of the above will hopefully prevent a reaction, but no situation is foolproof. If your child does have a reaction on the plane, follow the emergency protocol you have previously discussed with your child’s allergist. Notify the airline staff as soon as possible so that medical treatment can be waiting at the gate when you arrive at your destination.

There are a number of things to considering when planning a vacation with a food allergic family member. One of the first things you need to consider is where to stay. By now you are probably fairly used to having to cook a lot of your own meals and you can accomplish this while away from home if you play your cards right. Whether these options will work or not depends on what and how many foods you are avoiding.

Family

If you are fortunate enough to have family members sympathetic and understanding to your food allergy needs, and who are willing to put you up for a few nights, this is a great option. You get to spend quality time with family and maybe even share meals together. As a bonus, this is also a far more frugal option in terms of lodging and dining. Just make sure that the family you are staying with is aware of issues of cross contamination and that you have a conversation about that before hand. You don’t want to show up with your peanut allergic child and have Uncle Fred eating a peanut butter sandwich at the table.

Another important note about staying with people; dog treats are often made with peanuts, peanut butter and/or wheat. If the family you are staying with has a dog, make sure you discuss necessary precautions with your host prior to your arrival.

Suite

Many hotels offer suites with full or partial kitchens. With this option, you’ll be able to plan and prepare a majority of your family’s meals. While these suites may be more expensive, you will save by eating out less, or not at all. When you arrive, make sure you do a thorough scrub down of eating and food preparation surfaces. This link to FAAN has some information about the best cleaners for this job. Usually in these suites, there are food prep items and dishes. Send your partner out to the pool or to play with the kids while you spend a few minutes scrubbing any nooks and crannies that might be hiding allergens (rims of pots, crevices in slotted spoons) and then run them through the dishwasher for good measure. While this is certainly not how most folks envision starting a vacation, if an hour of cleaning risky areas can prevent a reaction then it is worth the time.

Rental property

If you’re going on vacation for a week or longer you might consider renting a house, condo or apartment near your destination. These short term rentals aren’t too hard to find, depending on the area, and typically offer a full kitchen. As with the suites, you’ll want to do a quick, but thorough cleaning in the kitchen/dining areas to reduce the risk of cross contamination.

Hotel Room

While the above options are the most ideal for a family that has to prepare a majority of their own food, you might be able to make a regular hotel room work if your child is only allergic to one or two things. If you at least have access to a fridge and microwave, you can eat some meals in the room. Breakfasts of cereal with milk (or milk substitute), fruit and other snacks, sandwiches, canned soup, etc. It’s not eating like a king for sure, but on the most basic level it could work.

Resorts

If a resort is in your budget, you may find that their restaurants are much more familiar with catering to food allergic individuals than your run of the mill hotel. When planning your vacation, call around to different resorts and ask about their policies. Ask to speak to the person in charge of food services for the resort. Resorts like Disney are famous for being very accommodating to folks with food allergies, and children with special needs in general. Make sure you notify them of your dietary needs when you call to make reservations at individual eateries. Some eateries within the Disney resort may be better equipped to handle food allergies so make sure you ask when you call.

I blindly stuck my hand in my purse and fished around, looking for his Epi-Pen. I couldn’t find the familiar thick plastic injector and dumped my bag out only to find that it was missing. I must have given it to him, or my mother, another time and forgot to get it back. I was horrified, feelings of self-deprecation over my negligence washed over me. I quickly assessed our situation. We were at my mother’s house which is very low risk, he was going to do a 1K fun-run with my sister who was well aware of his allergy, the things and places to avoid and they would be back within a few hours. I relaxed a little, but everyone was on high alert now.

The feelings associated with forgetting his Epi-Pen are not pleasant: guilt, fear and anxiety. The ‘what-ifs’ swirled in my brain. But the reality is, we’re human. We forget things, it happens. I always have his Epi-Pen with me, so assumed it still was. Thankfully the day passed without incident, as all our days (except one) have for the last 10 years that his peanut allergy has been a part of our lives. Our good fortune doesn’t make me naive, though. Instead it’s a stark reminder that I need to always be checking, and re-checking, to make sure we have what we need.

Whether a day out at the park or a week long cruise, there are certain things that families with food allergies have to consider before departing on their excursions. As prominent as anaphylactic allergies are in our lives, important things can be missed in the fray of packing and preparing to be away from home. Hopefully this checklist will help you remember those key things. If your child is old enough and/or developmentally able, have them go through the checklist first so they have a sense of ownership over their health and well being (and you can, of course, double check later).

Pack a ‘day pack’

In a small, zippered bag, place the following:

• two epi-pens
• 2 – 3 single serving bendryl packets
• allergy/restaurant cards
• emergency information card (if needed)
• a rescue inhaler (if needed)

This pack keeps all the critical things in one place so while traveling, when you’re going out for a day-trip on your vacation, or sending your little one off with a family member, you can easily grab it to take along. This is a great thing to have on hand all the time, not just while traveling.

Epi-Pens

Somewhat obvious, but remember the following things:

• check expiration dates and get refills before going
• bring them in their boxes with prescription labels to avoid any hold-ups at airport security
• bring at least 4 with you, ideally 6 for trips longer than a day. Two in the day pack, two with the other adult (who isn’t carrying the day pack) and two in the checked luggage.

Benadryl

Purchase individual serving packets for the day pack and day trips. For long trips or flights, keep a few extra with you (in addition to the ones in the day pack). For trips longer than a day, purchase a full bottle in addition to the individual dose packets (check in your luggage if flying).

Medical Alert Bracelet

Make sure information is accurate and up-to-date and that the bracelet is in good shape. Replace if necessary.

Asthma medications and inhalers

If your child also has asthma remember to:

• check expiration dates
• check counters to ensure there is enough medication for the trip
• don’t forget spacers, if needed
• carry nebulizer and medication, if needed

Allergy Cards

I stumbled on these Food Allergy Cards recently and think they are a great way to notify the staff at restaurants and eateries of your food allergy needs. There are several companies offering these with a variety of information and verbage. Choose the one that best fits your needs, or have ones tailor made for you through a printing company.

For international travel: translated cards can be a life saver — literally.

Emergency Information Cards

In case you are for some reason separated from your child, write out several index cards with the following information on them:

• child’s name, allergens, health concerns (asthma, diabetes, etc)
• parent’s names, cell phone numbers
• local relatives/contacts and their phone numbers (if applicable)
• place one of these cards in the following places: one in each parent’s luggage, in parents purse/wallet, in the day-pack (see below), and in child’s bag/carryon.
• another option: buy ready made ones, these even have your child’s picture on them.

Our lives revolve around food. We need nourishment to be healthy, for our bodies to function and grow, and food also brings us emotional happiness. Sharing food traditions is very important to many families. But when a food allergy enters the picture, it’s akin to an earthquake hitting that huge part of our lives. Our ideas, beliefs, comforts and traditions are shaken up. And as the dust settles, we have to learn new ways of being, cooking and eating.

Traveling with food allergies, especially that first time, can feel like a huge challenge. Everything you have taken for granted previously goes right out the window. Stopping to grab a bite to eat takes on a whole new set of requirements to ensure that everyone in the family can eat safely.

Embracing Change

Some families have a hard time adjusting to this new way of eating. They may feel grief and loss about missing out on traditional love foods or places to eat. They may even avoid traveling because it feels like too much work to figure out how to keep everyone safe. Those are all normal feelings and it’s important to honor them. But don’t let them prevent you from doing what you love as a family. With a bit of pre-planning, you can make traveling and eating on the road safe and fun for the whole family.

New Normal

The good news is that a lot of restaurants and resorts are more aware of food allergies and the impact on their guests. In fact, it’s becoming relatively mainstream. Many restaurants have gluten-free menus, at least. Restaurant managers and wait staff are becoming experienced at responding to customer questions about food allergies.

The bad news is that while they may ‘know’ what food allergies are, they can be unaware of cross-contamination issues and the meticulous way food much be prepared to keep allergenic guests safe. Don’t assume the restaurant knows how to safely handle food allergies. Part of eating out for you is going to have include a conversation with the manager or wait staff to ensure they know how to safely prepare your family’s food.

If you’re feeling a bit anxious about inconveniencing the restaurant staff, don’t! Their job as your server is, well, to serve you. You can always pay them a compliment at the end of the meal by leaving a generous tip. If you prefer, you can call the manager ahead of time and explain your situation; see what the restaurant can offer you in terms of support and reassurance around eating at their establishment. Just make sure you don’t call during the breakfast, lunch or dinner rushes; 10AM – noon and 2PM – 4PM are probably the best times to call.

Creating Traditions

One of the silver linings of having food allergies is experimenting with foods you may not have previously considered. And it sometimes forces you to be creative and come up with new ways of cooking old favorites. For example, we love popcorn, but with several family members sensitive to corn we can’t enjoy it with a movie like we used to. Enter “pop-rice”. So simple: crumble a couple rice cakes into a bowl, drizzle with warm butter (or butter substitute), and sprinkle with salt. Voila! The kids love it and it feels like a true treat for them.

With a bit of research before you travel, you may be able to scout out some restaurants and eateries that are safe and offer unique treats for your food allergic family. There are vegan (egg and dairy free) ice cream shops and gluten-free bakeries to be found. Food on vacation doesn’t have to be a foreboding prospect, it can be a fun treat for all family members with a little bit of planning.

What part of traveling with food allergies most concerns you?