Food allergy advocate, writer, speaker and consultant Erin Malawer helping to take the stress out of living with food allergies by simple, practical solutions, positive parenting, food allergy education, and the best product reviews.
Sony Pictures and the creators of the upcoming movie “Peter Rabbit” are facing a backlash from parents across the globe after it was revealed that the rabbits use a gardener’s food allergy to attack and impair him.
Food allergies are among several disabilities that are used as cheap gags in movies and on TV. Sometimes, such as in the movie “Hitch” and on the TV show “Modern Family,” they garner laughs because the symptoms of anaphylaxis are so severe and fast-acting that they take the audience by surprise. Sometimes they are used to show weakness or to emphasize low social status, like nerdiness. In a recent Party City ad slated to run during this year’s Super Bowl, having a food allergy was deemed “gross” to convey it as annoying.
What makes the “Peter Rabbit” use of food allergies particularly distasteful is that 2017 was speckled with stories of food allergy bullying across the world; including the arrest of two young teenagers who knowingly used a peer’s food allergy against her sending her into anaphylaxis and at least one death – that of a 13 year old at the hands of his classmates who had snuck cheese into his sandwich at lunch.
The exclamation point on the “Peter Rabbit” case is that the rabbits reportedly state that food allergies are “made up for attention.” Unfortunately, this plays on some people’s already-formed perception of food allergies and undercuts how serious they truly are.
The use of food allergies to prompt laughter reinforces stereotypes, spreads misinformation and strengthens the idea that food allergies are a choice meant for self-importance or as an inconvenience to others. The use of food allergies in children’s media prays on the worst fears of children with food allergies and their families. [1 in 13 kids in the United States have food allergies – that’s nearly 20 kids – and about 80 family members – in every screening of “Peter Rabbit” who live with the anxieties of the very severe consequences that just a small crumb of an allergen can trigger.] These children are watching their nightmare come to life on the big screen.
The food allergy community is accustomed to hearing food allergies become the butt of a joke. Jokes, as distasteful as they are to some, may have their place in adult-oriented films and television shows (as is the case with the movie “Hitch” and “Horrible Bosses”). But when it’s placed in children’s programming, it becomes unacceptable. Exposure to such imagery, dialogue and attitudes during such a formative time in their lives can affect young audiences with food allergies (and influence those without) both psychologically and socially. It can scare and scar those with food allergies. And, showing it “even in a cartoonish, slapstick way” (as Sony describes it in their apology) teaches others that food allergies are not to be taken seriously. By watching “Peter Rabbit,” kids are learning that using someone’s food allergy against them is both humorous and without consequence. Meanwhile, children with food allergies are watching – horrified – while the audience jovially cheers the rabbits on. It’s amazing that storylines, such as this one, pass through vast numbers of people for approval without being questioned for their impact on children.
Thankfully, Sony has issued an apology recognizing the insensitivity of the “Peter Rabbit” material. Let’s hope that other production companies learn from this lesson. Apologizing after the fact is the easiest thing in the world. How can we ensure that this doesn’t happen in the first place?
Sometimes a skin prick test and/or a blood test does not give a doctor enough information to know if a patient is truly allergic to a particular food. A food challenge, sometimes known as an Oral Food Challenge (OFC) or just oral challenge, is the best way for an allergist to evaluate a patient’s allergic response.
Food challenges are sometimes used to diagnose a food allergy. While skin prick tests and blood tests are great indicators of a food allergy, they cannot help a doctor or patient understand their individual risk of a reaction. Only the Oral Food Challenge can demonstrate a person’s true sensitivity to a given food.
Oral challenges are also helpful in determining whether a patient has outgrown a food allergy. Doctors will suggest an oral food challenge when they believe an individual may successfully tolerate a food they previously tested allergic to.
How does it work?
For a variety of reasons, doctors may want to test a patient against his/her food allergy. In a doctor’s office or hospital setting, food is given to that patient every 15 to 30 minutes – beginning with a very small amount and increasing with each “dose”. The patient is observed and medically evaluated at each interval to check for symptoms of a reaction. Feeding typically continues until a full portion of that food is consumed safely.
If the doctor see symptoms of a reaction, they will stop the test. If, on the other hand, there are NO symptoms, your doctor may rule out a food allergy and discuss ways to manage that food going forward.
Where do you go for a food challenge? Can I do it myself at home?
OFCs are ONLY conducted in a doctor’s office or hospital setting and should only be done under a doctor’s supervision. It is critical that the patient be checked by a doctor or nurse at each stage in the process for a reaction. And, should such a reaction occur, the medical staff are on-site ready to respond immediately.
You SHOULD NEVER conduct an oral food challenge at home.
How safe are OFCs?
Food challenges have an excellent safety record because allergists and trained professionals follow medical standards and procedures for the test and they are prepared to handle any emergency that arises. Thousands of OFCs have been performed worldwide safely.
Be aware, there is a risk for an allergic reaction with this test which is why it MUST be performed by a doctor in a medical setting. The most common reactions in an oral challenge are mild skin and stomach reactions which are typically treated with antihistamines. Allergists are prepared to use epinephrine and other medications in the unlikely event that a more severe reaction occurs.
That said, most doctors recommend an oral challenge when they believe the patient will pass this test. They try to set their patients up for success.
How do I prepare for a food challenge?
1. Remind yourself and/or your child that there is no “passing” or “failing” an oral challenge – there are only results. In this way, you can keep anticipation and disappointment in check. [But feel free to go crazy celebrating if you’re able to add another food to your diet later!]
2. Have a conversation with your allergist’s office about what to bring and how to prepare it. Allergists typically recommend how to prepare the food you are testing for. For example, when my son tested for soy, we brought soy milk; for wheat, we brought toast; for milk and egg, we were instructed to make muffins and French Toast using a particular recipe. Depending on your child’s age and particular tastes, the allergist may be able to alter the recommended food to make it more palatable.
3. You will need to stop taking antihistamines as well as some other medications for at least one week prior to your appointment. Discuss this with your doctor’s office for further instructions. ALWAYS take emergency medication (such as a rescue inhaler or epinephrine) should you need it leading up to the oral challenge. Oral challenges can be postponed if need be.
4. Prepare for the day. Oral Food Challenges often take several hours. Think about what will amuse you and your child for that period of time. Consider coloring books, small lego sets, matchbox cars, books, a portable DVD player or iPad. And, yes, that means you might arrive with a giant “tote bag of fun,” looking like you’re ready to move into the doctor’s office like I did.
5. Write down questions about the possible results of the test as you go along, You should have a chance to discuss the results after the challenge has finished. Some questions you may wish to ask if you can add a new food:
What do the results tell us about my allergy?
Are there any limits to the quantity/variations of this new food we can add?
Can we add this food in its baked AND unbaked forms?
What symptoms should I look for over the next few hours and days?
Does this alter my Emergency Action Plan? Can you fill out a new plan so that I can copy this information for the school nurse, after care, babysitter, etc?
For those of you who have experienced an oral challenge: what advice would you add?
Last year, a 13 year old with a dairy allergy died after someone allegedly slipped cheese into his sandwich at lunch. He was rushed to the hospital and placed in intensive care where he remained until he suffered cardiac arrest.
80% of parents reported that their children with food allergies have been teased, excluded or harassed by their school mates as well as adults. In a 2010 study conducted by researchers at Mount Sinai Medical Center, most kids felt their bullying had been due to their food allergies alone. Others reported that issues related to their food allergies (such as carrying medication, being set apart at lunch and receiving what appeared to be “special treatment”) were also factors in being taunted or harassed.
The psychological damages associated with bullying are heartbreaking and can last into adulthood: depression, anxiety, eating disorders, self-harming behavior, Post-Traumatic Stress Disorder (PTSD) and suicidal thoughts. Couple these dark emotions and behaviors with the heightened state of anxiety and concerns over safety that those with food allergies already experience as well as the very REAL and severe dangers of anaphylaxis and we’re facing a crisis that needs to be addressed immediately.
Profile of a bully:
According to psychologists, bullies share a few common traits:
Typically bullies act for several reasons including power and perceived popularity;
Their actions are deliberate, repeated and often involve a verbal component; and
Because they tend to lack prosocial skills, they see themselves and their actions positively. In essence, bullies don’t self-identify as bullies.
We’re all familiar with stories of generalized bullying. But what makes food allergy bullying different? A few things:
Bullies who use food to target those with food allergies may not understand the very serious consequences their actions will have;
Teens who speak about being harassed often report that it’s not just their peers doing the bullying. Parents and teachers who make it clear that those with food allergies are an inconvenience are sending a message that kids are receiving and taking personally;
The line between a classmate jokingly waving a peanut at a child with food allergies without understanding the gravity and a bully who uses an allergen to threaten or harm a peer may seem clear. But the psychological implications and possibility of rapid and dangerous health outcomes of both situations can result in the victim feeling unsafe and more susceptible to harassment in the future.
Although many cases of bullying occur at school because of the close proximity of peers, bullying isn’t a problem that can – or should – be resolved entirely by schools themselves. Bullying is a communal problem and it’s one we all must work to prevent.
What can we do about food allergy bullying?
It all begins with education.
Students need to be taught about food allergies formally. With two food allergic kids in every classroom, all students are exposed to this epidemic but few are equipped to truly understand it. Food allergies are mentioned in school but not rarely formally taught. For over a decade, I have taught preschool through 7th grade students lessons about food allergies; a lesson that includes a heavy dose of empathy which results in a stronger sense of fellowship. Empathy is one the key skills psychologists recommend schools and parents teach their children to thwart bullying and build community.
But it’s not just the children who need a lesson in food allergies. So do adults. I recently gave a seminar to educators to raise their awareness of food allergies and help them protect their allergic students emotionally, socially, physically, and academically. Identifying food allergic reactions and understanding protocols, preventing cross-contamination in the classroom, lessons of inclusion and empathy, and the psychosocial issues (like anxiety and stress) that both food allergic students and their parents face have been immensely helpful to teachers who are trying to cater to the whole child. And they have seen these seminars reap great rewards in their schools.
Parents of non-allergic children need to learn about food allergies to keep play dates safe and deepen their empathetic muscle so that they can impart those lessons to their own children. Occasionally (and not infrequently), we hear stories of parents who feel their children are entitled to bring whatever food they want into school regardless of the dangers they might pose on another child. These parents are missing the greater message – which is that we are a community; communities protect each other and THAT is what makes us all stronger. Not peanut butter sandwiches or cheese puffs.
At home, parents of food allergic children need to emphasize and practice lessons in self-advocacy and problem-solving. Kids with food allergies face their fear of reactions several times, every single day. Empowering them to speak up and stand firm to protect themselves and others is an invaluable skill – for them and for life.
Keep communication open between you and your child. Offer stories about when you were their age and include difficulties you may have faced and ways you overcome challenges. Get your children involved in figuring out how you should have handled your childhood issues. This reassures kids in many ways: First, it reminds them that they are not alone in their experiences. Second, it shows them, by example, different perspectives on common issues. And, it helps them self-identify as problem-solvers, instilling in them the confidence and perseverance they need to deal with sometimes complex obstacles.
Signs of Bullying:
Half of kids who have been bullied don’t talk about it with their parents or other trusted adult. Parents and teachers: please take note if you see these classic signs of food allergy bullying occurring to your child/student.
food allergy reactions happening at school
excuses to stay home
physical signs (on the body, books, backpack, etc)
If you’re already dealing with a bully issue, there are a few extra things you may wish to do:
Stay calm and collected. Reassure your child that you will help resolve this conflict. Approach the school first if that’s where the incidents are occurring.
Practice language they can use to deal with bullies without retaliation (which could escalate things). Teach them to say, “STOP” and, ideally walk away.
Identify trusted adults that your child can turn to if they have a problem at school (a teacher, a coach, administrator, the school nurse, etc). In addition to you, are there other adults in your child’s life that could help? It takes a village, now’s a great time to rely on that village.
Children with food allergies are often protected legally under Section 504 of the 1973 Rehabilitation Act, Title II and the Individual with Disabilities Education Act (IDEA). The argument is that harassment and bullying prevents equal access to benefits that education provides. Section 504 covering disability harassment applies to children from elementary school through college and university.
There are a number of ways schools can reduce the possibility of dangerous food allergy bullying. Please contact me directly to discuss programs that work for each stage of education: email@example.com
No Appetite for Bullying
Four food allergy non-profits led by kaléo Pharma have partnered to campaign against Food Allergy Bullying. Please visit No Appetite for Bullying for further information and to stay informed of their upcoming programming.
When you get a food allergy diagnosis, there is so much to learn… including what foods ARE and ARE NOT safe to eat. Let’s clear up some of the confusion surrounding different allergens and which food groups they belong in. As always, speak with your allergist before adding any new food into your diet.
COCONUT: Coconuts are actually a member of the palm fruit family. And, although they have “nut” in the name, they are not officially a nut. That said, the FDA classifies them as a nut so you will see “TREE NUTS” listed on many U.S. product labels when coconut is an ingredient.
Verdict: While some people are allergic to coconut, most patients with a tree nut allergy can safely eat it. Speak with your doctor before trying.
NUTMEG: Nutmeg is a spice that comes from seeds, not nuts. Again, although “nut” is in the name, it’s technically NOT a tree nut.
Verdict: According to the American Academy of Allergy, Asthma and Immunology (AAAAI), it can safely be consumed by those with tree nut allergies.
PINE NUTS: You may have heard the rumor that pine nuts are actually seeds. And, that’s true. BUT, there is some evidence of cross-reaction between pine nuts and peanut and almond allergies. Doctors and researchers cannot isolate whether reactions to pine nuts are due to cross-reaction or to a separate pine nut allergy. The FDA labels it as a tree nut.
Verdict: Those allergic to tree nuts should AVOID eating pine nuts.
WATER CHESTNUTS: Another case of mislabeling. Water Chestnuts are an aquatic vegetable. They are named for their shape that resembles a chestnut. Like any food, occasionally people find themselves allergic to water chestnuts. But they are not tree nuts.
Verdict: Those with tree nut allergies do NOT need to avoid water chestnuts.
SHEA NUT: Shea nut butter and shea nut oil can be found in many skin and beauty products. Both shea nut butter and shea nut oil are derived from the seed of the shea tree’s fruit. The shea nut is a distant relative of the Brazil nut and, as such, FDA considers shea nut a tree nut and will label it as such on ingredient lists. Per Dr. Sicherer (via Allergic Living, read more here), studies have shown that only trace amounts of protein reside in shea nut butter or oil and no reports of topical immediate reaction or ingestion have been reported.
Verdict: Although allergy to shea nut appears to be unlikely because shea nut butter and oil lacks protein, please discuss with your allergist to get individualized guidance.
ARGAN OIL: Argan oil comes from the nut of a tree commonly found in the Moroccan desert. Because the oil is cold-pressed, it is likely to contain protein. Argan oil is becoming an increasingly common ingredient in hair products such as styling oil, shampoo, conditioner as well as other beauty products. You should check out how they’re made; it’s surprising!
Verdict: If you’re allergic to tree nuts, it’s probably best to avoid Argan oil until you discuss with your allergist.
BUTTERNUT SQUASH: Again, it’s a misnomer: there is “nut” in the name, but not in the product. As you guessed, butternut squash is a vegetable.
Verdict: Butternut squash is not only safe for those with tree nuts to consume, it’s also delicious!
THE BOTTOM LINE: Most of the above products are safe for those with food allergies (woohoo!), but you should always discuss your particular allergies with your doctor before adding any food you are unsure of to your diet.
For your reference, here is the US Food and Drug Administration’s list of Tree Nuts:
As part of the process of accepting this award, nominees answer questions. [See additional rules and nominees below.]
1. What is your biggest regret? That’s a tough one. One of the things I regret is not taking more time to travel before I had kids. I’ve lived overseas multiple times and really enmeshed myself in local culture. But I’d love to have spent time in Africa or South Asia while I was living relatively nearby. I guess the kids will have to pack their bags because I’m not done roaming!
2. What is something that your younger self would be most proud of about you?
Great question! Hm… I think my younger self would be proud to know I’ve been bold about pursuing my passions. For example, when I was younger, I wanted to be a writer – now look what I’m doing!
3. What is your favorite fruit and why?
(I love these questions!) Raspberries and summer ripe blueberries are irresistible to me. And, it’s hard not to DROOL over kiwi. Hairy on the outside and sweet, emerald deliciousness on the inside… Mmmm…!
4. If you could play any instrument, what would you play? (Or what can you play?)
I used to play the flute – and wish I had played for longer. But I still play the piano! Now, I just wish I could sing (at all) and play at the same time! Piano takes concentration!
5. What setting from a book or movie would you like to live in or experience? That’s easy! Willy Wonka’s Chocolate Factory. What I wouldn’t do for an hour in that edible room with the chocolate river!
6. Why did you start blogging?
I started writing as a way to find a like-minded food allergy community to connect with. When you get any kind of diagnosis, you tend to feel alone in the world. When you can relate to someone else’s journey, it can sometimes take the stress out of your own.
7. What is something you’re looking forward to?
There’s so much to look forward to over the next year! One thing I’m working on is getting my organization, AllergyStrong, up and running. AllergyStrong is an organization that revolutionizes food allergy information in education, psychosocial impact and advocates on behalf of all patients with food allergies, but particularly for those at-risk and low-income families who could use the additional support.
8. If job availability/money were not factors, what would be your dream occupation? A ballroom dancer! It’s harder than it looks and is so elegant when done well. I’ve taken ballroom dancing from the time I was about 10 through college.
I’d also love to be a television/movie writer or a documentary film maker. I love storytelling and think very visually.
9. If you could start any charity, what would it be? I’m starting one: AllergyStrong!
10. Name a skill you want to learn and why.
I’d love to really learn how to figure skate. I always played around with it as a kid and never lost that amazing sensation of gliding and spinning on ice. It was invigorating!
I’d also like singing lessons… Ooo, and horse back riding! Tap dancing… Speaking Italian… I’ve clearly got to get cracking; I have a lot to catch up on!
The Brotherhood of the World Blogger Award
I nominate these excellent bloggers, whose work is inspiring, insightful and on my short list of must-reads:
As a food allergy consultant to schools, I get asked all kinds of questions and involved in all sorts of projects. Recently, I received a fun assignment! My daughter’s school asked me to find a safe doughnut to help them celebrate Hanukkah while adhering to their strict nut-free policy.
Hanukkah is celebrated over eight nights – recognizing the miracle of the burning oil in the ancient Temple of Jerusalem. Recognizing that miracle, celebrants everywhere look forward to the tradition of indulging in food fried in oil each night, including doughnuts! I mean, if we must…
Traditionally, Jews serve sufganiyot, a jelly doughnut during Hanukkah. The Big Bang Theory‘s Mayim Bialik offers this awesome vegan recipe (which means it’s dairy and egg-free!):
I will acknowledge, doughnut making can be time consuming and messy! Preparing doughnuts from scratch is also tough if you’re trying to feed a crowd. Krispy Kreme used to be the go-to Hanukah doughnuts for my own family as well as for the classrooms I teach in. Now that Krispy Kreme donuts are decidedly not safe, where can you buy a nut-free doughnut?
Enter Katz’s Gluten-Free Donuts. Sold in boxes of 6, these doughnuts are gluten-free, dairy-free, nut-free and soy-free! You can find them in the kosher frozen food section of the supermarket. There’s no preparation necessary – just thaw. Or, for a mouthwatering experience, heat up for a few seconds in the microwave. (I’m drooling as I write this…)
No one should miss out on holiday traditions. But families with food allergies are hesitant to participate in activities that revolve around food, particularly baked goods. Baked goods are often cross-contaminated with nuts and typically contain dairy and eggs – three of the top eight allergens responsible for 90% of allergic reactions.
Now with the options below, there’s no reason to sit out the holidays! Check out these allergy-friendly gingerbread house ideas. Everyone can gather together and decorate a gingerbread dream home safely!
If you’re lucky enough to live in Rhode Island, you might want to pop into A&J Bakery to grab their Allergen Friendly Gingerbread House Kit. Otherwise, you’ll want to place an order now! In addition to being vegan, these gingerbread houses are free from peanuts, tree nuts, sesame, gluten, wheat, soy and dairy. The kit comes with the house (assembly required), five different types of allergen-friendly candy to decorate it with as well as some non-edible decorations.
Finally, a Chanukah-themed house! Manischewitz’s Chanukah House is made with vanilla cookie (a preferred flavor in my house). Plus, it is nut-free, dairy-free and egg-free! We have used this kit and it couldn’t be easier to put together and the walls are very sturdy – it surely could survive a candy hurricane (or a not-so-gentle little sister)!
There are all kinds of ways to make gingerbread houses using milk cartons, like we did in elementary school. You can use icing to stick safe graham crackers to the sides of a small size carton of milk (8 or 16 oz size). (Remember to wash the carton thoroughly before using if you are allergic to dairy.) You could line the carton with candy canes or pretzel rods to make a delicious log cabin. OR, you can line the carton in craft paper and decorate it with stickers, buttons, pipe cleaners, etc using glue!
A NOTE ABOUT ROYAL ICING and RECIPE:
Royal Icing (the kind used to stick candy to gingerbread houses) often contains egg. But making royal icing is fairly easy and fun to do with kids. Try this recipe:
2 cup *sifted* powdered sugar
4-5 tablespoons water
Combine sugar and 4 tbsp of water until smooth. Continue adding small amounts of water until glossy and thick.
As I understand it, powdered sugar and water icings don’t do well in pastry bags (for piping). We usually use a knife to carefully line the edges of the house parts and paint them directly on to the candy before sticking them on to our houses.
(Thank you in advance! A portion of the proceeds of affiliate links go toward AllergyStrong.org – an organization aimed at helping at risk families with food allergies.)
The holidays are a magical time – filled with hope and kindness. But when you have food allergies, holiday gatherings are sometimes filled with the possibility of being excluded, disappointed, or the fear of having a food allergic reaction.
As parents and patients, we feel like we are constantly educating others about food allergies. Our extended families and friends surely should know by now how real and severe a food allergy can be – shouldn’t they?! Unfortunately, many times our family and friends don’t understand. They underestimate the severity of a reaction and the amount of time and energy we put in to preparing for a regular day – never mind a holiday! We often feel let down and angry when others don’t take food allergies into consideration or are set on upholding their traditions at the expense of someone else’s health and safety.
These disagreements around the holidays can set off a chain of unhealthy interactions that could cause relationships to strain. Don’t end your relationship with family or friends. Try these techniques first and see if you can teach them about what your life with food allergies is really like.
It’s actually fairly easy to create a Thanksgiving dinner that everyone can enjoy easily. With just a couple of ingredient swaps, there’s almost no part of this inclusive meal that you’ll need to omit! Try some of the below, post a photo and let me know how it all turns out!
Available at local supermarkets, this gravy is both dairy and egg-free. Another thing it has going for it? You don’t need to prepare it! **This gravy DOES contain almonds (almond butter) – please avoid if you are allergic to tree nuts!**
CREAM OF MUSHROOM SOUP/GREEN BEAN CASSEROLE
Did you know you can make your own dairy-free (and gluten-free) cream of mushroom soup? Why is this important? Because cream of mushroom soup is the base for delicious green bean casserole!
The Kitchen Girl blog posted an easy recipe for Can’t Believe It’s Vegan Cream of Mushroom Soup. Her recipe uses unsweetened almond milk; but if you’re allergic to tree nuts (as we are) you could substitute that for unsweetened soy milk or rice milk. And, as a bonus, her soup is also gluten-free. Looks DELICIOUS!
The magazine Gluten-Free & More posted a recipe for Dairy-free, Gluten-free Green Bean Casserole. It involves creating your own gluten-free breaded onions to top the dish – just like the original recipe. Those onions are my favorite part – I’d double this part of the recipe for my table!
The big obstacle for allergy-friendly stuffing? Gluten! Those pesky bread cubes make it a tough sell for those with a wheat allergy or celiac disease. Enter Williams-Sonoma: they carry Mariposa Baking Co. Gluten-Free Cornbread Stuffing. This rosemary and sage version contains egg and soy (and is manufactured in shared equipment with milk), but is gluten-free and pre-packaged. One less thing to stress about!
Dessert is always tricky for those with food allergies. Holiday desserts are typically filled with butter, egg, gluten and nuts.
But these Allergy-Free Pumpkin Chocolate Chip Cookies have (almost) none of those things! They are easy to make, can feed a crowd, and offer an alternative to make them gluten-free. They combine the delicious, comfort of a regular chocolate chip cookies with the flavor-du-jour pumpkin spice!
Another favorite holiday dessert in our house is Sorbet Pie. It’s light and refreshing (something much needed after a big, savory dinner) and it’s dairy-free, egg-free, peanut and tree nut-free. Be sure to give the pie times to refreeze before serving!
(Thank you in advance! A portion of the proceeds of the affiliate links go toward AllergyStrong.org – an organization aimed at helping at risk families with food allergies.)
Three year old, Elijah Silvera, was attending a regular day of preschool in New York City recently, when preschool workers fed him a grilled cheese sandwich despite school papers which formally documented his severe dairy allergy. Elijah had a severe allergic reaction and went into anaphylaxis. Standard procedure for anaphylaxis is to administer epinephrine and call 911 immediately. Instead, the school called Elijah’s mother, who picked up her child and drove him to the hospital herself. Doctors in the emergency room tried but were unable to save him.
Dairy allergy is the most common food allergy among young children. And, although the peanut can produce some of the most severe allergic reactions (as well as some of the most tragic headlines), an allergy to milk products can be life-threatening. The myth that a dairy allergy is not serious and doesn’t require as much vigilance causes great frustration to many who are allergic to milk, as does the idea that a food is “allergy free” if it does not contain nuts. To those who live with it, a dairy allergy requires an enormous amount of preparation and education since milk is an ingredient in so many products.
Dairy is cow’s milk and found in all cow’s milk products, such as cream, butter, cheese, and yogurt. Doctors sometimes advise patients with a dairy allergy to avoid other animals’ milk (such as goat) because the protein it contains may be similar to cow and could cause a reaction. Reactions to dairy vary from hives and itching to swelling and vomiting, to more severe symptoms such as wheezing, difficulty breathing, and anaphylaxis. Strictly avoiding products containing milk is the best way to prevent a reaction. The only way to help stop a severe food allergy reaction is with epinephrine; patients should always carry two epinephrine auto-injectors with them at all times.
Just like other allergens, cross contamination is a concern for those with a dairy allergy. Even a small amount of milk protein could be enough to cause a reaction. For example, butter and powdered cheese (like the kind you might find on potato chips) are easily spreadable in a pan, within a classroom or on a playground. And, as with other allergens, hand sanitizer does NOT remove the proteins that cause allergic reactions. Doctors recommend hand washing with good old soap and water – but wipes work in a pinch.
Those allergic to dairy must not only avoid food; they often have to look out for health and beauty products too. Dairy can be found in vitamins, shampoo, and lotions. It is critical to read the ingredient labels of every product you buy each time you buy it as ingredients and manufacturing procedures may change.
In the United States, any food product containing milk or a milk derivative must be listed as DAIRY or MILK under the current labeling laws (see The Ins and Outs of Reading Food Labels, Aug. 2016). If you are living or traveling elsewhere, this list of some alternative names for dairy may be useful:
Let’s spread the facts about dairy allergy so that our schools and teachers better understand how to accommodate and care for students with food allergies. I sincerely hope that by informing others we can prevent another tragedy like the one the Silvera family was forced to experience.
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