(May 26, 2009 - Insidermedicine) In this video, Dr. Scott SIcherer, MD, a Pediatric Allergist from Mount Sinai School of Medicine, discusses what he would do if he had a child with a food allergy. Dr. Sicherer is Associate Professor of Pediatrics at Mount Sinai School of Medicine, as well as a clinical researcher from the Jaffe Food Allergy Institute.
At American Academy of Allergy Asthma and Immunology's annual meeting in Washington we spoke with Dr. Scott Sicher. Dr. Sicher is a pediatric allergist and associate professor of pediatrics at Mount Sinai School of Medicine. He is also a researcher at the Jaffe Food Allergy Institute.
If I had a child with a food allergy...
Dr. Sicherer: Part of the good news for going shopping having to manage a food allergy is that the current food labeling laws in the United States are under guidelines that were established as a law in 2006. The Food Allergen Labeling and Consumer Protection Act requires that if there is an ingredient that is milk, egg, wheat, soy, peanuts, tree nuts (like walnuts almonds brazil, cashews), fish or shell fish (crustacean shellfish e.g. shrimp, lobster); then those have to be labeled in plain English on the ingredient label. It could within the list of ingredients. It might be "contains peanut and milk". But it has to be in plain English terms so it should be relatively easy to find those. The things that you have to know about within that law are that it doesn't cover every possible allergen. If your child is allergic to garlic for example, that’s not part of the law. It’s only the list of foods that I just mentioned that are going to be under the guidelines of the law to be on that label. They also have to mention the specific type of shellfish fish or tree nut. They would have to say shrimp, for one of the crustacean shellfish, or walnut or almond as the tree nut. Labeling has gotten easier from that perspective.
There are some nuances you have to be aware of when you are shopping and that also has to do not only with the things that aren't covered that I already mentioned but something called advisory labeling. Another name for that would be "May contain" labeling. You will see a lot of products these days, a lot of them actually, that may say: "may contain peanuts” or "processed in a facility that also processes milk", any of those types of warnings. Right now that is not part of any regulations. What you have to be aware of as a parent shopping for your child, is that when you see those labels it is a warning sign, it is a red flag that this could be contaminated. Talk to you allergist about exactly what is right for your child but my bottom line now would be to avoid the foods with the advisory labels as well
What should I do if my child accidently eats an allergen?
Dr. Sicherer: If your child accidentally eats an allergen, which you are avoiding and you know that they eat it, you have to be prepared for an allergic reaction. An allergic reaction could be anything from mild to severe. I would start off by saying make sure you talk with your doctor ahead of time to discuss this potential eventuality. If your child has a potentially severe allergy, a potentially life threatening allergy, then your doctor (typically an allergist) should have prescribed an emergency care plan or an emergency action plan so that you know what to do I case something like that happened. This is typically a plan that includes self-injectable epinephrine. Epinephrine is the medication that reverses the severe symptoms of a reaction and basically gives you time to get to an emergency room, for example by calling 911 because even if the shot of adrenaline or epinephrine reverses the symptoms, sometimes they can come back and you would need to get to an emergency room to be watched for several hours. We often say at least 4 hours to make sure that the symptoms really are gone and aren't coming back.
What are the symptoms of an allergic reaction?
Dr. Sicherer: An allergic reaction can include symptoms that are anything from mild to severe but it could include skin symptoms like itchy skin, skin rash, hives (which look like mosquito bite), and flaring of pre-existing rash like eczema. It can also include stomach problems like pain, vomiting, or diarrhea. It can include breathing problems like trouble speaking, hoarseness, and throat tightening. It can include asthma symptoms like wheezing, coughing, and a difficulty of getting breath. It could also include heart/circulation problems, and those would be: feeling faint, passing out or losing consciousness, having poor pulse, looking pale or discolored, sometimes red or even blue. There could be a feeling of impending doom. Sometimes reactions start with milder symptoms like the feeling of something tingling in the mouth or itchiness, and can progress to more severe symptoms. Anaphylaxis is a severe allergic reaction that is pretty rapid in onset and includes some of the severe symptoms I mentioned and can be fatal.
Is tongue swelling one of the first signs of an allergic reaction?
Dr. Sicherer: Part of the symptoms can include swelling of the lips, face, tongue, throat, or other parts of the body. The progression isn’t always predictable, it’s rare but sometimes people will have every symptom except skin symptoms. And that is actually important to recognize because if you have someone who is having an allergic reaction you might say "... do I see hives?" And it turns out that there have been fatalities where there weren't skin symptoms, there were just a lot of the other symptoms that I mentioned and yet a progression to a severe reaction without the hives. People with food allergies have to also be aware that that can be circumstance and you still should treat with the right medications.
Are there any new treatments on the horizon?
Dr. Sicherer: One of the food specific types of therapies that are being researched most vigorously right now is something we call Oral Immunotherapy; and there is another version of it called sublingual. What that means is that the food that you are allergic to is being given in very tiny and gradually increasing amounts over weeks and months. Either straight into the mouth and swallowed, or sometimes under the tongue. These therapies, which are currently experimental, so far in the preliminary pilot studies show promise because some of the people who are undergoing this therapy are able to gradually get up to amounts of the food, lets say milk, that would beyond what you would might come across in an accidental expose. Actually for some people, to the level that are essentially meal size amounts of the food. Its very exciting to try to progress people through this, but there are a few caveats. We can sometimes for some people push these small amounts and gradual increase to these larger amounts but not everyone tolerates that. Both the people who seem to tolerate it and the people who can’t have reactions along the way. While you are trying to give them these treatments, some people will have allergic reactions to the therapy itself. We also don't know yet who this is going to work for, work for best, or what level of protection they might receive. Also, very importantly we are pushing something into the body that gets to a level where the patient can be protected to a certain level, but what would happen if they stop the daily treatments. You are pushing to the point where you are getting the food you are allergic to almost as a medicine. We have to figure out who has a permanent treatment, a cure, who is protected only while on the treatment, and who has to watch out for the various side effects while they are on this treatment. So this is not ready for prime time yet but it is very encouraging. My main message in the end is not to try this at home but watch for the final results of the studies.
Dr. Sicherer: If your child has been diagnosed with a food allergy you need to talk to your doctor about a few key things. One is keeping them away from food that they are allergic to. There is a lot to that, but one thing is learning how to read labels and understanding labeling laws. Secondly when your child is avoiding the food there could be an accident. You have to have an emergency action plan, which for someone with a life threatening food allergy includes knowing how and when to use the key medicine, which is self injectable epinephrine. And although the treatment is avoiding the foods and being ready to treat if there is a reaction, we are hopeful that a lot of the studies going on these days, which include various trials of trying to desensitize someone to the food, maybe that will be a rescue down the road.