Food Allergy FAQs

Children and Food Allergies

Why has there been an increase in the number of children with food allergy over the past several decades?

There are several theories as to why food allergy and other allergic diseases have become more common. While it is not known for sure, one possibility for the increase is living in cleaner environments, confusing the immune system to react to food instead of infection.

What is the difference between food intolerance and food allergy?

A food intolerance is a response that takes place in the digestive system, and is a result of being unable to breakdown or to digest a food. Food intolerance is usually not life threatening. Food allergy involves the immune system, and is a result of the immune system over-reacting to a food protein. Food allergy can be life threatening.

What is the best way to prevent a food allergy reaction?

The only way a food reaction can be currently prevented is by strict avoidance of the food as an ingredient. While some children with milk or egg allergy might be able to tolerate milk or egg in baked goods, this is difficult to predict and should be discussed with your child’s allergist. Oral desensitization protocols are currently evaluated in research trials, but are not recommended for routine clinical use at this time.

Should my child’s day care/school be food allergen free?

Most schools and school districts have developed policies in this area. The following steps are generally recommended to keep children safe at daycare and school: allergen free tables should be provided in the lunch room, no sharing of food between children, children should wash their hands with soap and water or hand wipes (not hand sanitizer) before and after meals, and food should not be used in the classroom as part of lessons or art sessions. The St. Louis Children’s Hospital Food Allergy Management & Education (FAME) program is an excellent resource for your child’s school.

Will future food reactions become increasingly worse?

There are many factors that determine the severity of a reaction, including how much food was consumed. The severity of a reaction can change over time. Typically, reactions tend to be very similar in terms of symptoms and severity, as long as a similar amount of food has been ingested.

How likely is it that a food reaction will be fatal?

The severity of a reaction can vary from child to child, from food to food, and from time to time. Since we cannot predict which reactions will be severe and life-threatening, all reactions must be taken seriously. Unfortunately, approximately 150 people per year in the United States have a fatal reaction.

What is the best treatment for a severe reaction due to food allergy?

Epinephrine is the best medicine for treating a food allergy reaction.

My child’s epinephrine prescription comes as two-pack. Can I separate the two devices, or do should they be kept together?

After receiving a first dose of epinephrine, some patients will continue to have symptoms that may require a second dose of epinephrine. It is therefore important that the two-pack not be separated. If either dose of epinephrine is given, your child must be immediately evaluated in the closest emergency room.

Are hives always the first sign of a food reaction?

Hives are a common symptom of food allergy, but potentially serious food reactions can occur without hives. Children can have symptoms that can involve the airway, circulatory system and/or the gut with or without hives or rash. Treatment of other (stomach or breathing) symptoms should not be delayed even if hives or rash are not present.

Does my child need to avoid all foods that have a label that reads, “may contain,” “processed in a facility that also processes,” or “made on equipment with?”

These statements indicate the possibility of “cross-contact” situations during manufacturing, such as sharing equipment or processing lines between different foods. We advise avoiding foods with this type of statement on the label, as it is not clear if or how much of an allergen may be present.

Do skin test and/or blood-work results tell you how allergic a child is to a food?

Neither skin nor blood test results tell us how allergic a child is to a food or how severe of a reaction a child may have if he/she were to come into contact with a food allergen.

How often should a child with food allergy undergo skin or blood-work testing?

The frequency of testing to foods varies for each patient and depends on the age of the child and the specific food. Some patients may benefit from testing one time per year, while others may be tested less frequently, and some children may not need repeat testing.

If my child is avoiding a food allergen, why would blood-work levels increase over time?

These levels often increase, especially in the preschool years. It is not understood exactly why this occurs. However, these increases do not necessarily indicate a worsening of the food allergy.

Are all children who are allergic to peanuts allergic to tree nuts?

Approximately 30% of children with peanut allergy are also allergic to one or more tree nuts. However, due to the risk of cross-contact between peanuts and tree nuts and the difficulty in telling the difference between these foods in foods such as baked goods or mixed nuts, it is recommended that a peanut allergic child avoid tree nuts as well.

How do I know if my child has outgrown his/her food allergy?

Many factors influence the chance your child will outgrow his/her food allergy, including which food he/she is allergic to. Milk, egg, wheat and soy allergy in young children are often outgrown, while allergy to peanuts, tree nuts, fish and shellfish are less likely to be outgrown. The safest way to determine if the allergy has been outgrown is by doing an oral food challenge. Food challenges should only be performed by an allergist under careful medical supervision.

FAQs for School-Aged Children

Kid with a backpackQuestions parents/guardians should ask their child's health care professional/allergist when they are planning for their child to enter school:

  • Exactly what food(s) is my child allergic to?
  • Does my child need a referral to a dietician?
  • What are food allergy basics?
  • What are possible signs and symptoms of an allergic reaction and how might my child describe it (such as my tongue is hot/ burning, something is poking my tongue, there is hair on my tongue, something stuck in my throat, there's a frog in my throat, it feels like bugs in my ear/ itchy ear)?
  • What prescriptions are necessary? (Get them filled!)
  • How do I use an epinephrine auto-injector?
  • What are avoidance strategies?
  • How do I get an Emergency Care Plan (ECP) / Food Allergy Action Plan (FAAP)?
  • How can I involve my child in an age appropriate way in self management of their life-threatening allergies?

How do I ensure my child's safety at school? All children have the right to learn in an environment that is safe. For some families sending a child with life-threatening allergies to school can be scary

  • Parents/guardians are encouraged to have open communication and work to form a partnership between school staff, yourself and your child. This partnership should include the school nurse, school administrators, teaching staff, food & nutrition staff, transportation, coaches, and your child's classmates.
  • Submit the necessary paperwork and medications to assist school staff in creating a safe learning environment for your child such as:
    • Allergy History
    • Emergency Care Plan (ECP) / Food Allergy Action Plan (FAAP)
    • Medication Authorization, include the medications in original containers
    • Submit the Medical Statement for Special Meals signed by a licensed physician
  • Ask for advance notice to identify field trips/school events:
    • Site/Location
    • Safety Risks
    • Meals/Snacks
    • An adult trained in epinephrine auto-injector administration
    • The epinephrine auto-injector is accessible
    • If an allergic reaction were to occur, what is the emergency procedure?
  • Consider attending class trips and/or parties with your child.

Who can administer epinephrine in schools? Administration of epinephrine in schools will vary depending upon state regulations, school nurse practice acts, and individual school districts policies/procedures.

  • It is recommended that ALL school staff first receive training in recognition of the signs and symptoms of an allergic response, and in the safe and proper use of epinephrine premeasured auto-injection devices.
  • If any trained staff member determines that an allergic reaction is potentially life-threatening, the staff member may administer epinephrine at the direction of the school nurse (or designee) and according to the standing order and/or emergency care plan (ECP)/food allergy action plan (FAAP) for the student. 

Can my child possess/self carry medication at school or school sponsored activities? Possession and self-administration of medication in schools will vary depending upon state regulations and individual school districts policies/procedures.

  • Contact your local school district to determine the exact requirements.
  • School district can deny your request for your child to self carry/self-administration if the required paperwork is not submitted and/or if the child fails to follow school policies regarding self carry/self-administration.

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