The Local Farms-Healthy Kids bill that Gov. Chris Gregoire signed into law earlier this year has lifted huge barriers that once made it all but impossible for local farms to get their food into schools. Because of previous federally mandated bidding and purchasing requirements, farmers simply couldn’t compete with big, out-of-state food purveyors that sold food at much cheaper prices.
Now that those bidding barriers no longer exist, schools are being encouraged to apply for grants that will allow – and, in fact, require – that they purchase at least some of their fresh fruits and vegetables directly from local farms. The food-to-schools push begins with elementary schools where at least half of the students qualify for free or reduced-price meals.
Schools that win grants will have to develop their own systems for procuring, delivering and preparing local, in-season products. These logistics can be complicated. Getting farm-to-school programs up and running will be hardest on large school districts like Seattle’s, which has one central kitchen that sends food to about 30 elementary schools.
South of Seattle, the Auburn School District has a two-year head start with its fruit and vegetable program, which provides a blueprint that smaller local school districts can follow. Eric Boutin, Auburn’s child nutrition services director, spoke with Seattle’s Child about the challenges that he and other Washington school districts face as they strive to “eat local”:
SC: Give us a look into the fresh fruit and vegetable programs that you’ve developed for the Auburn School District.
EB: If you take a look at our school lunch programs, you will see some of the most organized, efficient food service operations in all of Puget Sound.
We have partnerships with “Growing Washington,” a group of Washington state farmers who have products available throughout the year. They have committed to growing 20,000 pounds of potatoes for our 22 schools next year – we serve them oven-roasted instead of French fried. We purchase lettuces from “Let Us Farm,” and apples and pears from Baird Orchards in Eastern Washington.
SC: You have a successful school garden program. What is your model for this program?
EB: In June 2007, the school district sent me to Berkeley, Calif., to attend a seminar presented by the Center for Ecoliteracy. The session, Rethinking School Lunch, was both beautiful and powerful. Chef Alice Waters is the inspiration and force behind the Edible Schoolyard at Martin Luther King Middle School in Berkeley, which is universally noted as the model school garden in the United States. Between the Berkeley session and the MLK garden, the inspiration for our own garden took place, but we wanted to take it a little further. Although still in the growing stage, we have a little over one acre between Auburn High School and Washington Elementary School.
Mrs. Jackl and Mr. Blackburn, teachers at Auburn’s Washington Elementary School, started a Garden Club. Fourteen students eagerly planted and tended the plants in May and June 2008. Also, the high school has a career and technical education class taught by Mr. Bruce Morris. These horticulture students helped plant the orchard and worked on the design of the garden.
We have planted 45 apple, pear, plum and fig trees from local Raintree Nursery, and we have a very nice vegetable garden. We endeavor to plant foods that kids will readily eat.
SC: How does your garden program compliment your educational goals?
EB: We think the connecting the cafeteria with an outdoor classroom (“The Center for the Study of Lunch”) inside an old greenhouse has made this program unique…to help make the connection between the earth, the plants and foods we can eat and the healthy lives we can live.
A garden is a perfect place to put a real-world context on many of the concepts students are learning in the classroom – health and nutrition, obviously, but math and science and art all can be directly experienced in a garden. It engages kids, and hopefully helps them develop an appreciation for the beauty and benefits of growing and eating wonderful foods.
We have just started plans at Hazelwood Elementary for a child nutrition garden. Fifth-grade teacher, Holly Donnelly, wants to use the garden to teach WASL-linked science outcomes. We will use the resulting produce in our kitchen and lunch program.
SC: What are the some of the challenges in partnering with local farmers?
EB: “Farm to School" programs sound wonderful. The challenge comes in the actual implementation. A school district takes on a lot of extra work to make these connections – from individual contact with a host of farmers (rather than one delivery company that already does this work) – to receiving and distributing the food from multiple vendors, to paying them all individually.
I am not saying it is not a positive program, I am just saying it is much more labor-intensive – which means expensive. It seems to me, the key needs to be to get our delivery companies to source and promote local food products and have us order from them. This would solve the distribution/contact/invoicing problems. It is not fair or realistic to expect your school food service director to spend nights and weekends visiting farmers’ markets to try to round up local products. We should be looking at food systems that support our local farmers, that are sustainable and replicable, that will best serve all parties involved.
SC: How can parents help support improvements to our nutrition services at home?
EB: The lunch programs in our schools need to serve all students in the community. Parents can help by reviewing the menu with the children and helping them to make the best choices. When they get home, ask them what they ate with their main entrée. Did they choose fresh fruits and vegetables?
Parents can also call or e-mail their food service department and give menu ideas. We have the constraints of budget and labor cost – and offering choices that 300 to 600 kids from widely diverse backgrounds will find tempting and delicious – but we welcome new ideas and the enthusiasm that can help get the children to choose the new menu items.
SC: Finally, how can we help resolve the funding constraints all our school districts face?
EB: Food service directors throughout Puget Sound understand good nutrition and fresh healthy foods, but when you look at the lunch program financially, you will see we have about one dollar to pay for the food for each lunch. One dollar to pay for the milk, bread, entrée, vegetable, fruit and occasionally a dessert – QUITE A CHALLENGE!
Child nutrition programs are primarily funded by the federal government, but also a little by the state. Parents can help support the school meals program by commenting on the federal Farm Bill when it comes up for renewal, and the Child Nutrition Reauthorization Act…also tell the governor or their representatives that we must better fund our nutrition programs.
Parents can also say to their local school board: “We must serve our children better,” and ask for their support (financially and administratively). Our school board has a true understanding of the need for quality nutrition programs and they continue to challenge us to improve to better serve our students.
Riki Mafune is a Seattle nutrition and health educator and mother of two.
Monday, October 11, 2010
Living with Food Allergies
The bad news about food allergies is that strict avoidance of the allergy-causing food is the only way to avoid a reaction. There are no medications to cure food allergies, although epinephrine (adrenaline) is prescribed to reverse anaphylaxis, the most severe reaction. Children may also be given antihistamines, such as Benadryl®, to control itching, hives or runny nose, or a bronchodilator, such as albuterol, to control asthmatic reactions to food.
We asked Anne Munoz-Furlong, founder and CEO of the Food Allergy & Anaphylaxis Network (FAAN), to share tips for living with a child’s food allergies. Munoz-Furlong was motivated to start the network in 1991 after her infant daughter was diagnosed with milk and egg allergies.
SC: What are the most important things parents of newly diagnosed children with food allergies should know? Many of them say they are overwhelmed at first.
AM-F: If a parent of a child who is newly diagnosed with food allergies is feeling overwhelmed, that is completely normal. It sounds so easy to say, “Avoid milk,” but the reality is that it takes planning and some creativity. The good news is, in time, living with a restricted diet becomes second nature. Some families say they consider food allergy part of the family. They think about it before making all decisions including eating in restaurants, during food shopping, before planning vacations, etc. Like anything else, education is the key. Once you learn what others have done and begin to incorporate food allergy into your family and your lifestyle, it does get easier.
SC: Once food allergies are diagnosed, should the patient always be in the care of an allergist (specialist)?
AM-F: An allergist is a pediatrician or internist with additional training specializing in allergy. Some families get a diagnosis from an allergist and then go back to their primary care physician for ongoing care. If a child is very allergic, an allergist may be the best option for managing the child’s allergies.
SC: Do you have any advice on avoiding hidden allergens in products – tips on being a good label-reader?
AM-F: The best tip for being a good label reader is to never take short cuts. Ingredients can change without warning. So, read the label for all foods before you buy them. Some families read the label three times – once at the grocery store, once before storing the food at home, and once before cooking the food. They tell us that they often see an allergen they missed the first two times they read the ingredient label. Don’t forget to read ingredient statements for bath and beauty products, too; many of these include foods such as almonds, milk, wheat or eggs.
SC: Should families forego going to restaurants, birthday parties, etc? Should the child always bring her own food?
AM-F: There is no reason families should let their food allergies stop them from going to restaurants, visiting friends or attending birthday parties. The key here is to plan ahead. Call the restaurant and ask about ingredients or visit their Web site to be sure there is something your child can eat. When visiting other people’s homes, tell them in advance about the food allergy. Offer to bring food with you so you know your child will not go hungry and you don’t have to worry about a reaction. As children get older, some opt to leave before food is served during a party; others eat before leaving home and simply enjoy the games and activities without worrying about the safety of the food being served. Involve the child in making these decisions and always carry a snack with you in case you are delayed or having so much fun you don’t want to leave the party.
SC: Are there tips for working with your children so that they don't feel deprived and resentful about not being able to eat certain things?
AM-F: Involve children in decisions about parties to attend, how to handle food, and who should know about their food allergy. Empowering children in this way makes them feel in control and allows them to build self confidence – two great traits that will serve them well as they approach their teen years and spend more time with friends, away from home.
Some families allow their child to select favorite treats that can be traded for candy or goodies they receive from friends. This type of system allows the child not to feel deprived when turning food down.
SC: What are the guidelines for carrying antihistamines and epinephrine?
AM-F: Your child’s doctor will be able to provide guidance on what medications to take and when to use them if a reaction occurs. It is best to have written instructions that can be shared with anyone caring for your child, so that there is no guesswork if a reaction occurs. The FAAN Web site (www.foodallergy.org) contains a sample Food Allergy Action Plan in the download section. Keep in mind that managing food allergies is a process, not an event. You will have to change your management plan as your child ages and is able to take on more responsibility.
SC: Do you have advice for dealing with family members or friends who may downplay the allergies and say parents are turning their kids into
“picky eaters”?
AM-F: It is not uncommon for families to encounter someone who “doesn’t get it.” Try not to engage emotionally. Rather, spend your time trying to show them educational resources that explain food allergies, so that they learn you aren’t making this up. Have them go to Web sites such as FAAN’s, tell them about meetings they can attend, or invite them to go to a doctor’s appointment with you so they can ask the doctor about their concerns.
Local Parents Share Insights
Although she was at first overwhelmed by her daughter Danyel’s extensive allergies, Chay Bigger of Bellevue approached the diagnosis with a positive attitude and optimism.
“It changed the way we ate as a family – for good,” Bigger says. They all stick to the diet Danyel, 8, needs, although Chay and her husband Shawn do not have food allergies and Josie, 5, has milder allergies.
“We can save money by not going out to eat,” Bigger says, adding that there are only two restaurants where they can go and feel safe. A nutritionist guided them into a food rotation plan, in which permitted foods are eaten on a four-day rotation. “It totally simplifies meal planning and shopping. I always know exactly what we’ll have. It’s been a blessing,” she says. For dessert, she serves sorbet, popsicles and whole fruit bars, often homemade.
Bigger role-plays with her girls, so that they understand what to do if they see food sitting out or are offered foods they can’t have at another house. A snack goes with them wherever they go, including birthday parties. “Other kids want what they have because it’s different,” she says.
On a more serious note, she says Danyel always carries her own epinephrine and “takes ownership” of that. Bigger emphasizes being prepared for a disaster by having what the kids need ahead of time, including their foods and medications. “Make sure your friends and family understand the seriousness of it,” she says. “I know I can trust some family members and not others.”
Jen Costigan of Seattle is just beginning to deal with her 3-year-old son Will’s allergies to gluten, dairy products, nuts and pineapple. The entire family has gone dairy- and gluten-free, and her son will be re-tested in six months to see how things are going.
“Things we really rely on as a family are fresh fruits and veggies, organic meats, rice milk, sweet potatoes, rotated grains and gluten-free products (sparingly),” Costigan says. I’m resisting the idea of trying to remain on the ‘American’ diet (cereals, sandwiches, pasta, cheesy foods, baked goods) by substituting with processed gluten-free or modified soy foods. Something about that just doesn’t seem like a healthy option. I’d rather that my son just learn to eat whole foods and rotated grains, etc., than to try to fit himself into the unhealthy American diet mold.”
Costigan has already begun to empower her young son. “Will is learning to ask if things are ‘gluten free’ and proudly announced to his teacher the day after his testing that he could not eat any ‘glue’.”
Heather McCrone, the Bellevue mother of Aubrietta, 8, and Kelsey, 6, discovered Aubrietta’s allergy to tree nuts when her daughter was 2. Her allergy is so severe that 1/8 of a pecan could send her into anaphylaxis and kill her without immediate medical intervention. Because of that, McCrone carries an Epi-Pen® (a self-injectable device containing epinephrine) with her at all times and is very attuned to Aubrietta’s first signs of exposure.
“Aubrietta wears a medic alert bracelet and has been taught to go to an adult and point urgently to her bracelet if swelling in her mouth makes her unable to talk,” McCrone says. “I accompany her on all field trips and to class parties in school when parent volunteers bring in food. When she goes on play dates or to birthday parties when I cannot be present, she is only allowed to eat fruit and cheese or treats I send along with her.”
As Munoz-Furlong says, many families consider food allergies when making any decisions. “The biggest impact has been when we travel,” McCrone says. “On our week-long ski and camping trips, where we will be more than half an hour from a hospital and out of cell phone range, I pack from home all the food that she will eat for the week. We save a lot of money by not eating in restaurants when we travel! Before we leave on a trip, I go online and map out where all the hospitals are, just in case. I also make sure that 911 service is available in the more rural areas we might pass through.”
McCrone finds the hardest part of her daughter’s allergy is in “dealing with well-meaning people who believe that allergies are just food preferences.
“Some have told me that I’m indulging my daughter in being a picky eater and if I snuck some nuts into her food, she’d learn to like them. A friend who practices alternative medicine keeps urging me to let her administer some Chinese herbs that would supposedly cure her. I’ve come to avoid these people – some of them close family members – because I fear that they will act on their suggestions to prove their point.”
Judgmental comments are the last things parents of allergic children need, Munoz-Furlong agrees. She and others recommend finding other parents who can be part of a support system.
“What I needed at first was encouragement,” Bigger says.
Wenda Reed is a Bothell writer and mother of two.
Editor’s Note: To learn about food allergies and their symptoms, why the incidence is rising, how to ward off food allergies, and how to receive a diagnosis, read “Food Allergies: When Food Becomes an Enemy."
We asked Anne Munoz-Furlong, founder and CEO of the Food Allergy & Anaphylaxis Network (FAAN), to share tips for living with a child’s food allergies. Munoz-Furlong was motivated to start the network in 1991 after her infant daughter was diagnosed with milk and egg allergies.
SC: What are the most important things parents of newly diagnosed children with food allergies should know? Many of them say they are overwhelmed at first.
AM-F: If a parent of a child who is newly diagnosed with food allergies is feeling overwhelmed, that is completely normal. It sounds so easy to say, “Avoid milk,” but the reality is that it takes planning and some creativity. The good news is, in time, living with a restricted diet becomes second nature. Some families say they consider food allergy part of the family. They think about it before making all decisions including eating in restaurants, during food shopping, before planning vacations, etc. Like anything else, education is the key. Once you learn what others have done and begin to incorporate food allergy into your family and your lifestyle, it does get easier.
SC: Once food allergies are diagnosed, should the patient always be in the care of an allergist (specialist)?
AM-F: An allergist is a pediatrician or internist with additional training specializing in allergy. Some families get a diagnosis from an allergist and then go back to their primary care physician for ongoing care. If a child is very allergic, an allergist may be the best option for managing the child’s allergies.
SC: Do you have any advice on avoiding hidden allergens in products – tips on being a good label-reader?
AM-F: The best tip for being a good label reader is to never take short cuts. Ingredients can change without warning. So, read the label for all foods before you buy them. Some families read the label three times – once at the grocery store, once before storing the food at home, and once before cooking the food. They tell us that they often see an allergen they missed the first two times they read the ingredient label. Don’t forget to read ingredient statements for bath and beauty products, too; many of these include foods such as almonds, milk, wheat or eggs.
SC: Should families forego going to restaurants, birthday parties, etc? Should the child always bring her own food?
AM-F: There is no reason families should let their food allergies stop them from going to restaurants, visiting friends or attending birthday parties. The key here is to plan ahead. Call the restaurant and ask about ingredients or visit their Web site to be sure there is something your child can eat. When visiting other people’s homes, tell them in advance about the food allergy. Offer to bring food with you so you know your child will not go hungry and you don’t have to worry about a reaction. As children get older, some opt to leave before food is served during a party; others eat before leaving home and simply enjoy the games and activities without worrying about the safety of the food being served. Involve the child in making these decisions and always carry a snack with you in case you are delayed or having so much fun you don’t want to leave the party.
SC: Are there tips for working with your children so that they don't feel deprived and resentful about not being able to eat certain things?
AM-F: Involve children in decisions about parties to attend, how to handle food, and who should know about their food allergy. Empowering children in this way makes them feel in control and allows them to build self confidence – two great traits that will serve them well as they approach their teen years and spend more time with friends, away from home.
Some families allow their child to select favorite treats that can be traded for candy or goodies they receive from friends. This type of system allows the child not to feel deprived when turning food down.
SC: What are the guidelines for carrying antihistamines and epinephrine?
AM-F: Your child’s doctor will be able to provide guidance on what medications to take and when to use them if a reaction occurs. It is best to have written instructions that can be shared with anyone caring for your child, so that there is no guesswork if a reaction occurs. The FAAN Web site (www.foodallergy.org) contains a sample Food Allergy Action Plan in the download section. Keep in mind that managing food allergies is a process, not an event. You will have to change your management plan as your child ages and is able to take on more responsibility.
SC: Do you have advice for dealing with family members or friends who may downplay the allergies and say parents are turning their kids into
“picky eaters”?
AM-F: It is not uncommon for families to encounter someone who “doesn’t get it.” Try not to engage emotionally. Rather, spend your time trying to show them educational resources that explain food allergies, so that they learn you aren’t making this up. Have them go to Web sites such as FAAN’s, tell them about meetings they can attend, or invite them to go to a doctor’s appointment with you so they can ask the doctor about their concerns.
Local Parents Share Insights
Although she was at first overwhelmed by her daughter Danyel’s extensive allergies, Chay Bigger of Bellevue approached the diagnosis with a positive attitude and optimism.
“It changed the way we ate as a family – for good,” Bigger says. They all stick to the diet Danyel, 8, needs, although Chay and her husband Shawn do not have food allergies and Josie, 5, has milder allergies.
“We can save money by not going out to eat,” Bigger says, adding that there are only two restaurants where they can go and feel safe. A nutritionist guided them into a food rotation plan, in which permitted foods are eaten on a four-day rotation. “It totally simplifies meal planning and shopping. I always know exactly what we’ll have. It’s been a blessing,” she says. For dessert, she serves sorbet, popsicles and whole fruit bars, often homemade.
Bigger role-plays with her girls, so that they understand what to do if they see food sitting out or are offered foods they can’t have at another house. A snack goes with them wherever they go, including birthday parties. “Other kids want what they have because it’s different,” she says.
On a more serious note, she says Danyel always carries her own epinephrine and “takes ownership” of that. Bigger emphasizes being prepared for a disaster by having what the kids need ahead of time, including their foods and medications. “Make sure your friends and family understand the seriousness of it,” she says. “I know I can trust some family members and not others.”
Jen Costigan of Seattle is just beginning to deal with her 3-year-old son Will’s allergies to gluten, dairy products, nuts and pineapple. The entire family has gone dairy- and gluten-free, and her son will be re-tested in six months to see how things are going.
“Things we really rely on as a family are fresh fruits and veggies, organic meats, rice milk, sweet potatoes, rotated grains and gluten-free products (sparingly),” Costigan says. I’m resisting the idea of trying to remain on the ‘American’ diet (cereals, sandwiches, pasta, cheesy foods, baked goods) by substituting with processed gluten-free or modified soy foods. Something about that just doesn’t seem like a healthy option. I’d rather that my son just learn to eat whole foods and rotated grains, etc., than to try to fit himself into the unhealthy American diet mold.”
Costigan has already begun to empower her young son. “Will is learning to ask if things are ‘gluten free’ and proudly announced to his teacher the day after his testing that he could not eat any ‘glue’.”
Heather McCrone, the Bellevue mother of Aubrietta, 8, and Kelsey, 6, discovered Aubrietta’s allergy to tree nuts when her daughter was 2. Her allergy is so severe that 1/8 of a pecan could send her into anaphylaxis and kill her without immediate medical intervention. Because of that, McCrone carries an Epi-Pen® (a self-injectable device containing epinephrine) with her at all times and is very attuned to Aubrietta’s first signs of exposure.
“Aubrietta wears a medic alert bracelet and has been taught to go to an adult and point urgently to her bracelet if swelling in her mouth makes her unable to talk,” McCrone says. “I accompany her on all field trips and to class parties in school when parent volunteers bring in food. When she goes on play dates or to birthday parties when I cannot be present, she is only allowed to eat fruit and cheese or treats I send along with her.”
As Munoz-Furlong says, many families consider food allergies when making any decisions. “The biggest impact has been when we travel,” McCrone says. “On our week-long ski and camping trips, where we will be more than half an hour from a hospital and out of cell phone range, I pack from home all the food that she will eat for the week. We save a lot of money by not eating in restaurants when we travel! Before we leave on a trip, I go online and map out where all the hospitals are, just in case. I also make sure that 911 service is available in the more rural areas we might pass through.”
McCrone finds the hardest part of her daughter’s allergy is in “dealing with well-meaning people who believe that allergies are just food preferences.
“Some have told me that I’m indulging my daughter in being a picky eater and if I snuck some nuts into her food, she’d learn to like them. A friend who practices alternative medicine keeps urging me to let her administer some Chinese herbs that would supposedly cure her. I’ve come to avoid these people – some of them close family members – because I fear that they will act on their suggestions to prove their point.”
Judgmental comments are the last things parents of allergic children need, Munoz-Furlong agrees. She and others recommend finding other parents who can be part of a support system.
“What I needed at first was encouragement,” Bigger says.
Wenda Reed is a Bothell writer and mother of two.
Editor’s Note: To learn about food allergies and their symptoms, why the incidence is rising, how to ward off food allergies, and how to receive a diagnosis, read “Food Allergies: When Food Becomes an Enemy."
Living with Food Allergies
The bad news about food allergies is that strict avoidance of the allergy-causing food is the only way to avoid a reaction. There are no medications to cure food allergies, although epinephrine (adrenaline) is prescribed to reverse anaphylaxis, the most severe reaction. Children may also be given antihistamines, such as Benadryl®, to control itching, hives or runny nose, or a bronchodilator, such as albuterol, to control asthmatic reactions to food.
We asked Anne Munoz-Furlong, founder and CEO of the Food Allergy & Anaphylaxis Network (FAAN), to share tips for living with a child’s food allergies. Munoz-Furlong was motivated to start the network in 1991 after her infant daughter was diagnosed with milk and egg allergies.
SC: What are the most important things parents of newly diagnosed children with food allergies should know? Many of them say they are overwhelmed at first.
AM-F: If a parent of a child who is newly diagnosed with food allergies is feeling overwhelmed, that is completely normal. It sounds so easy to say, “Avoid milk,” but the reality is that it takes planning and some creativity. The good news is, in time, living with a restricted diet becomes second nature. Some families say they consider food allergy part of the family. They think about it before making all decisions including eating in restaurants, during food shopping, before planning vacations, etc. Like anything else, education is the key. Once you learn what others have done and begin to incorporate food allergy into your family and your lifestyle, it does get easier.
SC: Once food allergies are diagnosed, should the patient always be in the care of an allergist (specialist)?
AM-F: An allergist is a pediatrician or internist with additional training specializing in allergy. Some families get a diagnosis from an allergist and then go back to their primary care physician for ongoing care. If a child is very allergic, an allergist may be the best option for managing the child’s allergies.
SC: Do you have any advice on avoiding hidden allergens in products – tips on being a good label-reader?
AM-F: The best tip for being a good label reader is to never take short cuts. Ingredients can change without warning. So, read the label for all foods before you buy them. Some families read the label three times – once at the grocery store, once before storing the food at home, and once before cooking the food. They tell us that they often see an allergen they missed the first two times they read the ingredient label. Don’t forget to read ingredient statements for bath and beauty products, too; many of these include foods such as almonds, milk, wheat or eggs.
SC: Should families forego going to restaurants, birthday parties, etc? Should the child always bring her own food?
AM-F: There is no reason families should let their food allergies stop them from going to restaurants, visiting friends or attending birthday parties. The key here is to plan ahead. Call the restaurant and ask about ingredients or visit their Web site to be sure there is something your child can eat. When visiting other people’s homes, tell them in advance about the food allergy. Offer to bring food with you so you know your child will not go hungry and you don’t have to worry about a reaction. As children get older, some opt to leave before food is served during a party; others eat before leaving home and simply enjoy the games and activities without worrying about the safety of the food being served. Involve the child in making these decisions and always carry a snack with you in case you are delayed or having so much fun you don’t want to leave the party.
SC: Are there tips for working with your children so that they don't feel deprived and resentful about not being able to eat certain things?
AM-F: Involve children in decisions about parties to attend, how to handle food, and who should know about their food allergy. Empowering children in this way makes them feel in control and allows them to build self confidence – two great traits that will serve them well as they approach their teen years and spend more time with friends, away from home.
Some families allow their child to select favorite treats that can be traded for candy or goodies they receive from friends. This type of system allows the child not to feel deprived when turning food down.
SC: What are the guidelines for carrying antihistamines and epinephrine?
AM-F: Your child’s doctor will be able to provide guidance on what medications to take and when to use them if a reaction occurs. It is best to have written instructions that can be shared with anyone caring for your child, so that there is no guesswork if a reaction occurs. The FAAN Web site (www.foodallergy.org) contains a sample Food Allergy Action Plan in the download section. Keep in mind that managing food allergies is a process, not an event. You will have to change your management plan as your child ages and is able to take on more responsibility.
SC: Do you have advice for dealing with family members or friends who may downplay the allergies and say parents are turning their kids into
“picky eaters”?
AM-F: It is not uncommon for families to encounter someone who “doesn’t get it.” Try not to engage emotionally. Rather, spend your time trying to show them educational resources that explain food allergies, so that they learn you aren’t making this up. Have them go to Web sites such as FAAN’s, tell them about meetings they can attend, or invite them to go to a doctor’s appointment with you so they can ask the doctor about their concerns.
Local Parents Share Insights
Although she was at first overwhelmed by her daughter Danyel’s extensive allergies, Chay Bigger of Bellevue approached the diagnosis with a positive attitude and optimism.
“It changed the way we ate as a family – for good,” Bigger says. They all stick to the diet Danyel, 8, needs, although Chay and her husband Shawn do not have food allergies and Josie, 5, has milder allergies.
“We can save money by not going out to eat,” Bigger says, adding that there are only two restaurants where they can go and feel safe. A nutritionist guided them into a food rotation plan, in which permitted foods are eaten on a four-day rotation. “It totally simplifies meal planning and shopping. I always know exactly what we’ll have. It’s been a blessing,” she says. For dessert, she serves sorbet, popsicles and whole fruit bars, often homemade.
Bigger role-plays with her girls, so that they understand what to do if they see food sitting out or are offered foods they can’t have at another house. A snack goes with them wherever they go, including birthday parties. “Other kids want what they have because it’s different,” she says.
On a more serious note, she says Danyel always carries her own epinephrine and “takes ownership” of that. Bigger emphasizes being prepared for a disaster by having what the kids need ahead of time, including their foods and medications. “Make sure your friends and family understand the seriousness of it,” she says. “I know I can trust some family members and not others.”
Jen Costigan of Seattle is just beginning to deal with her 3-year-old son Will’s allergies to gluten, dairy products, nuts and pineapple. The entire family has gone dairy- and gluten-free, and her son will be re-tested in six months to see how things are going.
“Things we really rely on as a family are fresh fruits and veggies, organic meats, rice milk, sweet potatoes, rotated grains and gluten-free products (sparingly),” Costigan says. I’m resisting the idea of trying to remain on the ‘American’ diet (cereals, sandwiches, pasta, cheesy foods, baked goods) by substituting with processed gluten-free or modified soy foods. Something about that just doesn’t seem like a healthy option. I’d rather that my son just learn to eat whole foods and rotated grains, etc., than to try to fit himself into the unhealthy American diet mold.”
Costigan has already begun to empower her young son. “Will is learning to ask if things are ‘gluten free’ and proudly announced to his teacher the day after his testing that he could not eat any ‘glue’.”
Heather McCrone, the Bellevue mother of Aubrietta, 8, and Kelsey, 6, discovered Aubrietta’s allergy to tree nuts when her daughter was 2. Her allergy is so severe that 1/8 of a pecan could send her into anaphylaxis and kill her without immediate medical intervention. Because of that, McCrone carries an Epi-Pen® (a self-injectable device containing epinephrine) with her at all times and is very attuned to Aubrietta’s first signs of exposure.
“Aubrietta wears a medic alert bracelet and has been taught to go to an adult and point urgently to her bracelet if swelling in her mouth makes her unable to talk,” McCrone says. “I accompany her on all field trips and to class parties in school when parent volunteers bring in food. When she goes on play dates or to birthday parties when I cannot be present, she is only allowed to eat fruit and cheese or treats I send along with her.”
As Munoz-Furlong says, many families consider food allergies when making any decisions. “The biggest impact has been when we travel,” McCrone says. “On our week-long ski and camping trips, where we will be more than half an hour from a hospital and out of cell phone range, I pack from home all the food that she will eat for the week. We save a lot of money by not eating in restaurants when we travel! Before we leave on a trip, I go online and map out where all the hospitals are, just in case. I also make sure that 911 service is available in the more rural areas we might pass through.”
McCrone finds the hardest part of her daughter’s allergy is in “dealing with well-meaning people who believe that allergies are just food preferences.
“Some have told me that I’m indulging my daughter in being a picky eater and if I snuck some nuts into her food, she’d learn to like them. A friend who practices alternative medicine keeps urging me to let her administer some Chinese herbs that would supposedly cure her. I’ve come to avoid these people – some of them close family members – because I fear that they will act on their suggestions to prove their point.”
Judgmental comments are the last things parents of allergic children need, Munoz-Furlong agrees. She and others recommend finding other parents who can be part of a support system.
“What I needed at first was encouragement,” Bigger says.
Wenda Reed is a Bothell writer and mother of two.
Editor’s Note: To learn about food allergies and their symptoms, why the incidence is rising, how to ward off food allergies, and how to receive a diagnosis, read “Food Allergies: When Food Becomes an Enemy."
We asked Anne Munoz-Furlong, founder and CEO of the Food Allergy & Anaphylaxis Network (FAAN), to share tips for living with a child’s food allergies. Munoz-Furlong was motivated to start the network in 1991 after her infant daughter was diagnosed with milk and egg allergies.
SC: What are the most important things parents of newly diagnosed children with food allergies should know? Many of them say they are overwhelmed at first.
AM-F: If a parent of a child who is newly diagnosed with food allergies is feeling overwhelmed, that is completely normal. It sounds so easy to say, “Avoid milk,” but the reality is that it takes planning and some creativity. The good news is, in time, living with a restricted diet becomes second nature. Some families say they consider food allergy part of the family. They think about it before making all decisions including eating in restaurants, during food shopping, before planning vacations, etc. Like anything else, education is the key. Once you learn what others have done and begin to incorporate food allergy into your family and your lifestyle, it does get easier.
SC: Once food allergies are diagnosed, should the patient always be in the care of an allergist (specialist)?
AM-F: An allergist is a pediatrician or internist with additional training specializing in allergy. Some families get a diagnosis from an allergist and then go back to their primary care physician for ongoing care. If a child is very allergic, an allergist may be the best option for managing the child’s allergies.
SC: Do you have any advice on avoiding hidden allergens in products – tips on being a good label-reader?
AM-F: The best tip for being a good label reader is to never take short cuts. Ingredients can change without warning. So, read the label for all foods before you buy them. Some families read the label three times – once at the grocery store, once before storing the food at home, and once before cooking the food. They tell us that they often see an allergen they missed the first two times they read the ingredient label. Don’t forget to read ingredient statements for bath and beauty products, too; many of these include foods such as almonds, milk, wheat or eggs.
SC: Should families forego going to restaurants, birthday parties, etc? Should the child always bring her own food?
AM-F: There is no reason families should let their food allergies stop them from going to restaurants, visiting friends or attending birthday parties. The key here is to plan ahead. Call the restaurant and ask about ingredients or visit their Web site to be sure there is something your child can eat. When visiting other people’s homes, tell them in advance about the food allergy. Offer to bring food with you so you know your child will not go hungry and you don’t have to worry about a reaction. As children get older, some opt to leave before food is served during a party; others eat before leaving home and simply enjoy the games and activities without worrying about the safety of the food being served. Involve the child in making these decisions and always carry a snack with you in case you are delayed or having so much fun you don’t want to leave the party.
SC: Are there tips for working with your children so that they don't feel deprived and resentful about not being able to eat certain things?
AM-F: Involve children in decisions about parties to attend, how to handle food, and who should know about their food allergy. Empowering children in this way makes them feel in control and allows them to build self confidence – two great traits that will serve them well as they approach their teen years and spend more time with friends, away from home.
Some families allow their child to select favorite treats that can be traded for candy or goodies they receive from friends. This type of system allows the child not to feel deprived when turning food down.
SC: What are the guidelines for carrying antihistamines and epinephrine?
AM-F: Your child’s doctor will be able to provide guidance on what medications to take and when to use them if a reaction occurs. It is best to have written instructions that can be shared with anyone caring for your child, so that there is no guesswork if a reaction occurs. The FAAN Web site (www.foodallergy.org) contains a sample Food Allergy Action Plan in the download section. Keep in mind that managing food allergies is a process, not an event. You will have to change your management plan as your child ages and is able to take on more responsibility.
SC: Do you have advice for dealing with family members or friends who may downplay the allergies and say parents are turning their kids into
“picky eaters”?
AM-F: It is not uncommon for families to encounter someone who “doesn’t get it.” Try not to engage emotionally. Rather, spend your time trying to show them educational resources that explain food allergies, so that they learn you aren’t making this up. Have them go to Web sites such as FAAN’s, tell them about meetings they can attend, or invite them to go to a doctor’s appointment with you so they can ask the doctor about their concerns.
Local Parents Share Insights
Although she was at first overwhelmed by her daughter Danyel’s extensive allergies, Chay Bigger of Bellevue approached the diagnosis with a positive attitude and optimism.
“It changed the way we ate as a family – for good,” Bigger says. They all stick to the diet Danyel, 8, needs, although Chay and her husband Shawn do not have food allergies and Josie, 5, has milder allergies.
“We can save money by not going out to eat,” Bigger says, adding that there are only two restaurants where they can go and feel safe. A nutritionist guided them into a food rotation plan, in which permitted foods are eaten on a four-day rotation. “It totally simplifies meal planning and shopping. I always know exactly what we’ll have. It’s been a blessing,” she says. For dessert, she serves sorbet, popsicles and whole fruit bars, often homemade.
Bigger role-plays with her girls, so that they understand what to do if they see food sitting out or are offered foods they can’t have at another house. A snack goes with them wherever they go, including birthday parties. “Other kids want what they have because it’s different,” she says.
On a more serious note, she says Danyel always carries her own epinephrine and “takes ownership” of that. Bigger emphasizes being prepared for a disaster by having what the kids need ahead of time, including their foods and medications. “Make sure your friends and family understand the seriousness of it,” she says. “I know I can trust some family members and not others.”
Jen Costigan of Seattle is just beginning to deal with her 3-year-old son Will’s allergies to gluten, dairy products, nuts and pineapple. The entire family has gone dairy- and gluten-free, and her son will be re-tested in six months to see how things are going.
“Things we really rely on as a family are fresh fruits and veggies, organic meats, rice milk, sweet potatoes, rotated grains and gluten-free products (sparingly),” Costigan says. I’m resisting the idea of trying to remain on the ‘American’ diet (cereals, sandwiches, pasta, cheesy foods, baked goods) by substituting with processed gluten-free or modified soy foods. Something about that just doesn’t seem like a healthy option. I’d rather that my son just learn to eat whole foods and rotated grains, etc., than to try to fit himself into the unhealthy American diet mold.”
Costigan has already begun to empower her young son. “Will is learning to ask if things are ‘gluten free’ and proudly announced to his teacher the day after his testing that he could not eat any ‘glue’.”
Heather McCrone, the Bellevue mother of Aubrietta, 8, and Kelsey, 6, discovered Aubrietta’s allergy to tree nuts when her daughter was 2. Her allergy is so severe that 1/8 of a pecan could send her into anaphylaxis and kill her without immediate medical intervention. Because of that, McCrone carries an Epi-Pen® (a self-injectable device containing epinephrine) with her at all times and is very attuned to Aubrietta’s first signs of exposure.
“Aubrietta wears a medic alert bracelet and has been taught to go to an adult and point urgently to her bracelet if swelling in her mouth makes her unable to talk,” McCrone says. “I accompany her on all field trips and to class parties in school when parent volunteers bring in food. When she goes on play dates or to birthday parties when I cannot be present, she is only allowed to eat fruit and cheese or treats I send along with her.”
As Munoz-Furlong says, many families consider food allergies when making any decisions. “The biggest impact has been when we travel,” McCrone says. “On our week-long ski and camping trips, where we will be more than half an hour from a hospital and out of cell phone range, I pack from home all the food that she will eat for the week. We save a lot of money by not eating in restaurants when we travel! Before we leave on a trip, I go online and map out where all the hospitals are, just in case. I also make sure that 911 service is available in the more rural areas we might pass through.”
McCrone finds the hardest part of her daughter’s allergy is in “dealing with well-meaning people who believe that allergies are just food preferences.
“Some have told me that I’m indulging my daughter in being a picky eater and if I snuck some nuts into her food, she’d learn to like them. A friend who practices alternative medicine keeps urging me to let her administer some Chinese herbs that would supposedly cure her. I’ve come to avoid these people – some of them close family members – because I fear that they will act on their suggestions to prove their point.”
Judgmental comments are the last things parents of allergic children need, Munoz-Furlong agrees. She and others recommend finding other parents who can be part of a support system.
“What I needed at first was encouragement,” Bigger says.
Wenda Reed is a Bothell writer and mother of two.
Editor’s Note: To learn about food allergies and their symptoms, why the incidence is rising, how to ward off food allergies, and how to receive a diagnosis, read “Food Allergies: When Food Becomes an Enemy."
Food Allergies: When Food Becomes an Enemy
FULL PLATE
The baby’s tiny back was full of welts, another rising each time her skin was pricked.
At 3 months old, Danyel Bigger had horrible colic and skin rashes, says her mother, Chay Bigger of Bellevue. The baby was being breastfed, but friends thought maybe she was allergic to the cow’s milk her mother was drinking. Chay and her husband, Shawn, took her to an allergist.
“They did a skin prick test, and she was allergic to every single thing – wheat, dairy, eggs, chicken, soy, nuts, rye …,” Chay Bigger says. It was a shock because neither of the parents, nor their family members, had any food allergies. “I remember how overwhelming it as when I first found out,” she says.
“I cut all those things out of my diet. I had to learn to eat what I wasn’t used to,” she adds. She limited the offending foods while breastfeeding Danyel, now 8, and her sister, Josie, now 5. Josie also has allergies, but not as many as Danyel has. The whole family eats a rotating diet of the many foods Danyel can eat, including all vegetables, most fruits, most meats, potatoes, oats, rice, sweet potatoes and more exotic grains, such as quinoa and amaranth. “They’re tasty and you get used to them,” Bigger says.
The Food Allergy & Anaphylaxis Network (FAAN) estimates that 12 million Americans, including 3 million children, have food allergies – about 4 percent of the population (and 6 percent of the children under age 3). Because the line between true allergies and food sensitivities is blurred, figures can vary. The U.S. Food and Drug Administration estimates food allergies affect 11 million people in the United States. The National Institutes of Health states that less than 1 percent of the population has true food allergies.
Rates are higher for small children because many kids outgrow food allergies, especially to milk, eggs, soy and wheat. Allergies to peanuts and tree nuts are more likely to persist into adulthood. Fish and shellfish allergies may develop later in life and are rarely outgrown.
What’s a Food Allergy?
A true food allergy is an immune system reaction to a particular food.
An allergic response is always a reaction to a protein, explains Dr. Clifton Furukawa of the Northwest Asthma and Allergy Center, affiliated with Children’s Hospital and Regional Medical Center. As member of FAAN’s national medical advisory board, he helps insure that information about food allergies is medically accurate.
The immune system mis-interprets carbon-based trains of proteins as foreign, potentially harmful substances and sends out antibodies, most commonly immunoglobulin E (IgE).
The next time a person comes in contact with the food by touching or eating it, or even inhaling its particles, the body releases chemicals, including histamine, to “protect” itself, according to information dispersed by Children’s Hospital and Regional Medical Center. These antibodies cause rapid inflammation which shows up in some of these ways:
• Skin: itchy red bumps or hives, eczema, swelling and redness of the face or extremities, tingling, or itching and swelling of the lips, tongue or mouth;
• Gastrointestinal tract: abdominal pain, nausea, vomiting, or diarrhea;
• Respiratory tract: runny or stuffy nose, sneezing, watery eyes, coughing, congestion, wheezing, or shortness of breath;
• Cardiovascular system: lightheadedness, or fainting;
• Anaphylaxis: a sudden, potentially life threatening allergic reaction involving two or more of the body areas listed above, accompanied by swelling of the airway, difficulty breathing, a drop in blood pressure, loss of consciousness or (very rarely) death.
With a true allergy, there is always a response to the offending food. Symptoms typically appear within minutes to two hours after eating the food. (Eczema may seem to be a delayed response, but the actual itchiness occurs right away and the repeated scratching leads to the patches of eczema visible in the next few days, Furukawa clarifies.)
In addition to the symptoms above, colic, frequent illnesses – with the child never seeming to get better – or stomach aches can also be an indication of a food allergy, adds Sheila Kingsbury, N.D., R.H., a faculty member at Bastyr University. Some naturopaths also see a link between food allergies and learning disabilities, such as ADHD, possibly because the antibodies are communicating with nerves, she says.
Food sensitivities and intolerances are often placed under the general label of food allergies. However, they do not involve the immune system, and the onset of symptoms may be delayed. The sensitivities may be caused by a deficiency in enzymes needed to digest certain foods – the most common being lactose intolerance, in which the person lacks the enzyme to digest milk. In my own case and in many others, when the enzyme deficiency is addressed, the allergic reactions disappear. Celiac disease, an inability to digest gluten, can also mimic food allergy.
Food sensitivities and intolerances produce many of the same symptoms of true allergies, especially in the gastrointestinal tract, but they are rarely life-threatening. They may produce other symptoms such as achy joints, skin rashes, fatigue, depression, headache and attention deficit disorders.
Why Is the Incidence of Food Allergies Increasing?
“I never once knew a kid who had allergies when I grew up,” Bigger comments. “I talk to my friends and they say the same thing. Why is there such increase?”
Most experts, including FAAN, agree that there has been an increase in food allergies over the past 50 years, especially in the life-threatening ones that can cause anaphylaxis. Allergies to peanuts and tree nuts have definitely increased. “I don’t think there’s a study showing that other allergies – such as milk and wheat – have gone up,” Furukawa says.
In the last 10 to 20 years, tests to detect allergies have improved and that accounts for some of the increase, Kingsbury adds.
“We eat a lot more processed food which drives more inflammation in the body,” Kingsbury says. “If you make it inflamed, the body will react to foods more than it would otherwise. If the gut is inflamed or immature, gaps open up – we call that ‘leaky gut syndrome.’ Food proteins, which normally go through the gut, gets absorbed (into the blood stream) before they’re all digested. The body puts out antibodies.”
Furukawa points to the fact that as we’ve improved cleanliness and use products to kill bacteria, our babies’ immune systems are moving from an anti-bacterial system to an anti-parasitic one. “The antibodies attack the big protein molecules because they think they’re parasites,” he says.
“Peanut is its own unique story,” Furukawa says. “When peanuts were first eaten, they were boiled. Then they were roasted in oil. Now we have dry roasting.” The increase in peanut allergies corresponds to the move to dry roasting, which uses much higher temperatures. “In dry roasting, the peanut allergen binds into groups of three. It becomes a super-allergen. It looks more like a parasite,” he explains.
Most doctors and naturopaths believe there is a genetic component to many allergies. “One inherits a tendency to develop allergies from a bunch of immune response genes, not just one gene,” Furukawa elaborates. “Development of a specific allergy is a question of exposure, timing and luck.”
The frequency of allergies to a particular food depends on the degree of exposure. “In Japan, there are more children allergic to soy; in the United States, it’s cow’s milk because that’s what children get more of,” he says. He points out that during the Sputnik era, orange juice was promoted as a health food for astronauts, and more babies and toddlers developed allergies to oranges. About 30 years ago, a baby formula based on bananas came out, and banana allergies spiked.
Timing is important because until age 2, a child’s gastro-intestinal system is immature and leaky. Complex proteins that are not fully digested will get into the blood stream and get attacked by antibodies, Kingsbury and Furukawa explain.
“La Leche League is right. Babies don’t need anything else but mother’s milk for the first six to 12 months,” Furukawa adds. “But parents get bored. Americans like to play with babies and stick foods in their mouths.”
Can I Ward Off Food Allergies?
If a child is born with multiple allergies, as Danyel Bigger was, it is difficult to prevent them, except by cutting out the eight highest-offending allergies from your diet while breast-feeding.
However, being careful with the introduction of new foods during the first two or three years often reduces the likelihood of a child developing allergies. Most new allergies develop in the first three years of life, and fewer will arise by the school age years, according to Furukawa.
The American Academy of Pediatrics recommends breast milk alone for the first six months. It recommends introducing solid food as a complement to breast milk, in the next six months.
Although the usual recommendation is to begin with rice cereal, Kingsbury says research from the last four years indicates that no grains should be introduced before 9 months of age to prevent allergic reactions. She recommends beginning with fruits and vegetables such as apples, blueberries, carrots, squashes, bananas, sweet potatoes and apricots. Introduce one a week and look for any reactions. “It often takes three days to see any reaction (the first time),” she says. “We won’t know which food is causing a problem if we’re introducing them too fast.”
At 9 months, she recommends looking at whole grains such as quinoa and brown rice, as white rice has little nutritional value. The timing for introducing wheat depends on whether there’s a family history of wheat allergy, she adds.
She recommends caution in adding cow’s milk to the diet. “In half the infant problems we see, dairy is a problem; it increases mucus in the body and leads to more ear infections,” she says. “Our bodies aren’t designed to digest it.” It can be introduced at 12 months, but Kingsbury prefers using soy, oat or hazelnut milk until 2 years of age.
To meet a baby’s protein needs, meats can be introduced at 12 months and eggs a little earlier, as long as there’s no egg allergy in the family. Nine to 12 months is also a good age to introduce nuts such as sesame and sunflower seeds, but she recommends avoiding peanuts and tree nuts until much later.
“If there’s a family history of an allergy to anything, avoid it in the kids for as long as possible,” she adds.
Furukawa agrees that “not being in too much of a rush to introduce foods would help a lot.” He recommends the more traditional introduction of solids, beginning with rice cereal and progressing to yellow and green vegetables and fruit, added one at a time.
“Listen to your pediatrician; you don’t want to advance beyond what he or she says in regards to food introduction,” he concludes.
Should My Child Be Tested for Food Allergies?
If your child is experiencing some of the symptoms listed under “What is a Food Allergy?” it may warrant a visit to a pediatrician, nutritionist, allergist or naturopath for further evaluation. FAAN and Children’s Hospital in Seattle recommend keeping a food diary to tell your health care practitioner about your child’s symptoms, how often reactions occur, the time between eating a particular food and the start of the first symptoms, and how long the reactions lasted. It’s also helpful to include information on family members’ allergies or conditions such as eczema and asthma.
“Elimination is the gold standard for determining food allergies,” Kingsbury says. “We remove a (suspected) food for a month, reintroduce it, and see what happens.” She emphasizes that we should eliminate only one food at a time, under the direction of a medical practitioner, so that children do not miss out on necessary nutrition.
If the allergy is not matched with one of “the big eight” allergens and there isn’t an obvious, severe reaction to one particular food, finding the allergens can be “like finding a needle in a haystack,” Kingsbury says. Skin or blood tests may give more answers.
A prick skin test is done in a doctor or naturopath’s office. The medical provider places a drop of the substance being tested on a patient’s forearm or back and pricks the skin with a needle, allowing a tiny amount to enter the skin. If the patient is allergic to the substance, a wheal or bump will form in about 15 minutes. The test only detects true allergies, which prompt a release of immunoglobulin E (IgE) antibodies.
A RAST test (radioallergosorbent test) is a laboratory blood test which measures the levels of IgE antibodies to a panel of foods.
The tests are not infallible, Kingsbury says. “Some doctors may just do a prick test and if nothing reacts, they say, ‘You don’t have allergies.’ That may not be true.” The RAST test may also yield some false positives, but could give some clues into which foods to try eliminating.
Given the thousands of foods available and the impossibility of testing for them all, Bigger rubs a tiny amount of a new food on Danyel’s face to see if there’s a reaction. If there isn’t, she will give her a tiny bite and see if her throat starts itching. She also uses this method for food that seems safe, but which may contain unlabeled fillers.
“What applies to one child doesn’t necessarily apply to another,” Furukawa warns. “So don’t believe someone who says, ‘This worked for my kids; this should work for yours.’ Every child is unique.”
Wenda Reed is a Bothell writer and mother of two.
The baby’s tiny back was full of welts, another rising each time her skin was pricked.
At 3 months old, Danyel Bigger had horrible colic and skin rashes, says her mother, Chay Bigger of Bellevue. The baby was being breastfed, but friends thought maybe she was allergic to the cow’s milk her mother was drinking. Chay and her husband, Shawn, took her to an allergist.
“They did a skin prick test, and she was allergic to every single thing – wheat, dairy, eggs, chicken, soy, nuts, rye …,” Chay Bigger says. It was a shock because neither of the parents, nor their family members, had any food allergies. “I remember how overwhelming it as when I first found out,” she says.
“I cut all those things out of my diet. I had to learn to eat what I wasn’t used to,” she adds. She limited the offending foods while breastfeeding Danyel, now 8, and her sister, Josie, now 5. Josie also has allergies, but not as many as Danyel has. The whole family eats a rotating diet of the many foods Danyel can eat, including all vegetables, most fruits, most meats, potatoes, oats, rice, sweet potatoes and more exotic grains, such as quinoa and amaranth. “They’re tasty and you get used to them,” Bigger says.
The Food Allergy & Anaphylaxis Network (FAAN) estimates that 12 million Americans, including 3 million children, have food allergies – about 4 percent of the population (and 6 percent of the children under age 3). Because the line between true allergies and food sensitivities is blurred, figures can vary. The U.S. Food and Drug Administration estimates food allergies affect 11 million people in the United States. The National Institutes of Health states that less than 1 percent of the population has true food allergies.
Rates are higher for small children because many kids outgrow food allergies, especially to milk, eggs, soy and wheat. Allergies to peanuts and tree nuts are more likely to persist into adulthood. Fish and shellfish allergies may develop later in life and are rarely outgrown.
What’s a Food Allergy?
A true food allergy is an immune system reaction to a particular food.
An allergic response is always a reaction to a protein, explains Dr. Clifton Furukawa of the Northwest Asthma and Allergy Center, affiliated with Children’s Hospital and Regional Medical Center. As member of FAAN’s national medical advisory board, he helps insure that information about food allergies is medically accurate.
The immune system mis-interprets carbon-based trains of proteins as foreign, potentially harmful substances and sends out antibodies, most commonly immunoglobulin E (IgE).
The next time a person comes in contact with the food by touching or eating it, or even inhaling its particles, the body releases chemicals, including histamine, to “protect” itself, according to information dispersed by Children’s Hospital and Regional Medical Center. These antibodies cause rapid inflammation which shows up in some of these ways:
• Skin: itchy red bumps or hives, eczema, swelling and redness of the face or extremities, tingling, or itching and swelling of the lips, tongue or mouth;
• Gastrointestinal tract: abdominal pain, nausea, vomiting, or diarrhea;
• Respiratory tract: runny or stuffy nose, sneezing, watery eyes, coughing, congestion, wheezing, or shortness of breath;
• Cardiovascular system: lightheadedness, or fainting;
• Anaphylaxis: a sudden, potentially life threatening allergic reaction involving two or more of the body areas listed above, accompanied by swelling of the airway, difficulty breathing, a drop in blood pressure, loss of consciousness or (very rarely) death.
With a true allergy, there is always a response to the offending food. Symptoms typically appear within minutes to two hours after eating the food. (Eczema may seem to be a delayed response, but the actual itchiness occurs right away and the repeated scratching leads to the patches of eczema visible in the next few days, Furukawa clarifies.)
In addition to the symptoms above, colic, frequent illnesses – with the child never seeming to get better – or stomach aches can also be an indication of a food allergy, adds Sheila Kingsbury, N.D., R.H., a faculty member at Bastyr University. Some naturopaths also see a link between food allergies and learning disabilities, such as ADHD, possibly because the antibodies are communicating with nerves, she says.
Food sensitivities and intolerances are often placed under the general label of food allergies. However, they do not involve the immune system, and the onset of symptoms may be delayed. The sensitivities may be caused by a deficiency in enzymes needed to digest certain foods – the most common being lactose intolerance, in which the person lacks the enzyme to digest milk. In my own case and in many others, when the enzyme deficiency is addressed, the allergic reactions disappear. Celiac disease, an inability to digest gluten, can also mimic food allergy.
Food sensitivities and intolerances produce many of the same symptoms of true allergies, especially in the gastrointestinal tract, but they are rarely life-threatening. They may produce other symptoms such as achy joints, skin rashes, fatigue, depression, headache and attention deficit disorders.
Why Is the Incidence of Food Allergies Increasing?
“I never once knew a kid who had allergies when I grew up,” Bigger comments. “I talk to my friends and they say the same thing. Why is there such increase?”
Most experts, including FAAN, agree that there has been an increase in food allergies over the past 50 years, especially in the life-threatening ones that can cause anaphylaxis. Allergies to peanuts and tree nuts have definitely increased. “I don’t think there’s a study showing that other allergies – such as milk and wheat – have gone up,” Furukawa says.
In the last 10 to 20 years, tests to detect allergies have improved and that accounts for some of the increase, Kingsbury adds.
“We eat a lot more processed food which drives more inflammation in the body,” Kingsbury says. “If you make it inflamed, the body will react to foods more than it would otherwise. If the gut is inflamed or immature, gaps open up – we call that ‘leaky gut syndrome.’ Food proteins, which normally go through the gut, gets absorbed (into the blood stream) before they’re all digested. The body puts out antibodies.”
Furukawa points to the fact that as we’ve improved cleanliness and use products to kill bacteria, our babies’ immune systems are moving from an anti-bacterial system to an anti-parasitic one. “The antibodies attack the big protein molecules because they think they’re parasites,” he says.
“Peanut is its own unique story,” Furukawa says. “When peanuts were first eaten, they were boiled. Then they were roasted in oil. Now we have dry roasting.” The increase in peanut allergies corresponds to the move to dry roasting, which uses much higher temperatures. “In dry roasting, the peanut allergen binds into groups of three. It becomes a super-allergen. It looks more like a parasite,” he explains.
Most doctors and naturopaths believe there is a genetic component to many allergies. “One inherits a tendency to develop allergies from a bunch of immune response genes, not just one gene,” Furukawa elaborates. “Development of a specific allergy is a question of exposure, timing and luck.”
The frequency of allergies to a particular food depends on the degree of exposure. “In Japan, there are more children allergic to soy; in the United States, it’s cow’s milk because that’s what children get more of,” he says. He points out that during the Sputnik era, orange juice was promoted as a health food for astronauts, and more babies and toddlers developed allergies to oranges. About 30 years ago, a baby formula based on bananas came out, and banana allergies spiked.
Timing is important because until age 2, a child’s gastro-intestinal system is immature and leaky. Complex proteins that are not fully digested will get into the blood stream and get attacked by antibodies, Kingsbury and Furukawa explain.
“La Leche League is right. Babies don’t need anything else but mother’s milk for the first six to 12 months,” Furukawa adds. “But parents get bored. Americans like to play with babies and stick foods in their mouths.”
Can I Ward Off Food Allergies?
If a child is born with multiple allergies, as Danyel Bigger was, it is difficult to prevent them, except by cutting out the eight highest-offending allergies from your diet while breast-feeding.
However, being careful with the introduction of new foods during the first two or three years often reduces the likelihood of a child developing allergies. Most new allergies develop in the first three years of life, and fewer will arise by the school age years, according to Furukawa.
The American Academy of Pediatrics recommends breast milk alone for the first six months. It recommends introducing solid food as a complement to breast milk, in the next six months.
Although the usual recommendation is to begin with rice cereal, Kingsbury says research from the last four years indicates that no grains should be introduced before 9 months of age to prevent allergic reactions. She recommends beginning with fruits and vegetables such as apples, blueberries, carrots, squashes, bananas, sweet potatoes and apricots. Introduce one a week and look for any reactions. “It often takes three days to see any reaction (the first time),” she says. “We won’t know which food is causing a problem if we’re introducing them too fast.”
At 9 months, she recommends looking at whole grains such as quinoa and brown rice, as white rice has little nutritional value. The timing for introducing wheat depends on whether there’s a family history of wheat allergy, she adds.
She recommends caution in adding cow’s milk to the diet. “In half the infant problems we see, dairy is a problem; it increases mucus in the body and leads to more ear infections,” she says. “Our bodies aren’t designed to digest it.” It can be introduced at 12 months, but Kingsbury prefers using soy, oat or hazelnut milk until 2 years of age.
To meet a baby’s protein needs, meats can be introduced at 12 months and eggs a little earlier, as long as there’s no egg allergy in the family. Nine to 12 months is also a good age to introduce nuts such as sesame and sunflower seeds, but she recommends avoiding peanuts and tree nuts until much later.
“If there’s a family history of an allergy to anything, avoid it in the kids for as long as possible,” she adds.
Furukawa agrees that “not being in too much of a rush to introduce foods would help a lot.” He recommends the more traditional introduction of solids, beginning with rice cereal and progressing to yellow and green vegetables and fruit, added one at a time.
“Listen to your pediatrician; you don’t want to advance beyond what he or she says in regards to food introduction,” he concludes.
Should My Child Be Tested for Food Allergies?
If your child is experiencing some of the symptoms listed under “What is a Food Allergy?” it may warrant a visit to a pediatrician, nutritionist, allergist or naturopath for further evaluation. FAAN and Children’s Hospital in Seattle recommend keeping a food diary to tell your health care practitioner about your child’s symptoms, how often reactions occur, the time between eating a particular food and the start of the first symptoms, and how long the reactions lasted. It’s also helpful to include information on family members’ allergies or conditions such as eczema and asthma.
“Elimination is the gold standard for determining food allergies,” Kingsbury says. “We remove a (suspected) food for a month, reintroduce it, and see what happens.” She emphasizes that we should eliminate only one food at a time, under the direction of a medical practitioner, so that children do not miss out on necessary nutrition.
If the allergy is not matched with one of “the big eight” allergens and there isn’t an obvious, severe reaction to one particular food, finding the allergens can be “like finding a needle in a haystack,” Kingsbury says. Skin or blood tests may give more answers.
A prick skin test is done in a doctor or naturopath’s office. The medical provider places a drop of the substance being tested on a patient’s forearm or back and pricks the skin with a needle, allowing a tiny amount to enter the skin. If the patient is allergic to the substance, a wheal or bump will form in about 15 minutes. The test only detects true allergies, which prompt a release of immunoglobulin E (IgE) antibodies.
A RAST test (radioallergosorbent test) is a laboratory blood test which measures the levels of IgE antibodies to a panel of foods.
The tests are not infallible, Kingsbury says. “Some doctors may just do a prick test and if nothing reacts, they say, ‘You don’t have allergies.’ That may not be true.” The RAST test may also yield some false positives, but could give some clues into which foods to try eliminating.
Given the thousands of foods available and the impossibility of testing for them all, Bigger rubs a tiny amount of a new food on Danyel’s face to see if there’s a reaction. If there isn’t, she will give her a tiny bite and see if her throat starts itching. She also uses this method for food that seems safe, but which may contain unlabeled fillers.
“What applies to one child doesn’t necessarily apply to another,” Furukawa warns. “So don’t believe someone who says, ‘This worked for my kids; this should work for yours.’ Every child is unique.”
Wenda Reed is a Bothell writer and mother of two.
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