T. came home from school yesterday and told me there is a new single-allergen blanket ban in his school. A blanket single-allergen ban? Really? The first thing I did was check the calendar to ensure that it really is 2023.
Why does a balanced, safe, and evidence-based approach to food allergy matter, especially in children? Any food allergy policies need to include awareness of at least 14 common food allergens (4.45% of Irish children have a food allergy; some studies put this numbers as high as 6%!) to ensure safety in the community.
Balance and evidence-based approaches are needed since we know that overly restrictive policies can cause many of their own problems. Let’s be honest: banning everything from nuts to eggs to soy to fish to peanuts to milk to gluten is impractical.
Food Allergies: Let’s do the ultimate mythbusting list:
How are food allergies diagnosed? Food allergies are diagnosed by IMC registered physicians who have specialist training in allergy, and use evidence-based methods, including skin prick testing. Testing is always done in an hospital or medical setting with senior physicians on-site in case of emergency. This isn’t 100%. They can also be sometimes diagnosed by paediatricians or other doctors after an episode of severe reaction or anaphylaxis. In some cases, endoscopy in needed or, in case of non-IgE allergy, a hypoallergenic diet is tried – and this should only be done under guidance of a INDI/CORU registered dietitian. There is a big alternative market in “allergy testing” – and doesn’t work. Anythign requiring a hair or nail sample, a test that you post away a sample, “IgG” testing, enzyme testing – doesn’t work. Osteopath, chiropractors, naturopaths, acupuncturists, kinesthesiologists, and anyone advertising themselves as a “nutritionist” without CORU-registration does not have qualification to test, diagnose, or treat a food allergy, or prescribe diet restrictions in children. “Food sensitivity testing” using methods such as IgG is also a complete waste of your money. Because science.
Myth: If a child has a food allergy, small amounts of the allergen are “safe” or can help them grow out of the allergy**. This is false, and dangerous. Patients – child and adult – have died when alternative desensitisation “treatments” were done outside of hospital environments. If your child has been diagnosed with a food allergy, they need to avoid consuming that food. They also need an allergy action plan, created with you, their GP or consultant paediatrician or consultant allergy specialist. The school or child-care facility should have a copy of the allergy action plan. Check out IFAN for more. **The noted exceptions include the “Milk Ladder” approach to cow’s milk protein allergy, which incidentally, is now updated from when I did it with my son T. even just a few years ago! Egg and milk are notable that these are the two allergens that many children do grow out of after a period of time, and you can work with your child’s doctor about timing the re-introduction of those foods in childhood. Children rarely grow out of other food allergies, like nuts or fish, for example.
Myth: If I withhold common allergens from my child as a baby, they won’t get a food allergy. This is false, and can lead to highly restrictive diets as there are 14 common allergens. Parents tend to worry about one or 2 allergens, commonly egg and peanut, but they aren’t the only ones. 5% of children have some sort of food allergy. Did you know? Research shows that including common allergens in weaning is likely to decrease food allergy so talk to your GP if you are restricting food in weaning, since current expert advice is to introduce foods like peanut and egg at earlier stages than previously recommended years ago.
Myth: Food allergy and food intolerance are the same thing. They are different. Food intolerance will not induce life-threatening reactions or anaphylaxis. Food tolerances are commonly diagnosed and managed with an approached called FODMAP which should be done with guidance from an INDI/CORU registered dietitian, especially in children.
Myth: If a child has a allergy, even being in the same room with a nut or smelling a nut can cause anaphylaxis. This is false. Anaphylaxis and severe reaction happen from actually putting the food in the mouth. This misunderstanding years ago led to blanket-bans of single allergens in schools which are no longer recommended since 1) we now have better evidence from studies like this one adn 2) the bans don’t work. Got questions on that? Check out expert guidance. IFAN has great evidence-based information you an trust, with a copy of great research paper and current international guidelines which include contribution from Irish expert, Prof. Jonathan Hourihane. Approaches the we know do work include policies that include children taught to never share food, careful policies around classroom activities that expose children to allergens, and school activities such as bake sales, and good education around epi-pen use.
Myth: Children or adults with egg allergy cannot get vaccines. Not true. If you have a history of allergy or concerns, talk to your doctor but egg allergy is not a contraindication to vaccines, including MMR and flu.
While we are here, it’s not food but let’s bust this myth: Penicillin allergy is always inherited. It is common for patients to tell me they are allergic to penicillin when they aren’t. They assume because a family member is allergic, they are automatically allergic. Many patients also side effects from their illness, treatment, or antibiotic in the past may identify as penicillin allergic. It doesn’t always matter, but unnecessarily excluding penicillin antibiotics can greatly limit treatment options if you have serious infection. In some studies, as few as 10% of patients who identified as penicillin allergic actually were.
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