Food for Thought: A Current Look at Children’s Food Allergies

David Jeong, MD

Pediatric allergist David Jeong, MD, works with Benaroya Research Institute to explore the basic science of food allergies in children.

Whether or not we have a personal connection to food allergies, most of us are familiar with their impact. From peanut restrictions in schools to the prolific advertising of emergency auto-injectors, there’s a wider awareness of how severe food allergies can disrupt and even threaten lives.

It’s not our imagination that food allergies have spiked in recent years. According to a 2013 study by the Centers for Disease Control and Prevention, allergy rates in children increased approximately 50 percent between 1997 and 2011. What accounts for such a steep increase?

“First we must get away from the notion that just one thing causes food allergies,” says pediatric allergist David Jeong, MD. “The hygiene hypothesis, which points to excessive cleanliness skewing immune system development, may have some validity, but there’s a bigger picture. We see differences in food allergy rates by regions and cultural factors, such as the way food is prepared. For example, in the U.S. peanuts are often roasted which impacts how allergenic they are. Another difference among diverse populations is when foods are first given to children.”

Dr. Jeong notes that prior to 2008, the American Academy of Pediatrics recommended potentially allergenic foods – such as peanuts – not be given to children before three years of age. Yet studies of cultures that introduced peanuts earlier showed fewer food allergies than their peanut-delaying counterparts. Current guidelines now recommend delaying any solid food until four to six months of age, but there are no suggested delays for giving allergenic foods beyond six months.

Because food allergies can come on in infancy, Dr. Jeong recommends introducing one new food at a time in the first six to 12 months. That way a trigger food will be easier to identify. Even if it seems clear a certain food causes a reaction, it’s important to visit a pediatrician or allergist to have a test confirming the allergy.

As food allergies have no cure, avoidance of the trigger food remains the best defense, with antihistamines or epinephrine injectors on hand in case of accidental exposure. But promising new treatments are on the horizon, says Dr. Jeong, with some of the most advanced research and clinical trials happening right here in Seattle.

The Seattle Food Allergy Consortium (SeaFAC) is a collaboration of six institutions committed to world class food allergy treatment and research, and includes Virginia Mason, Benaroya Research Institute at Virginia Mason, Northwest Allergy and Asthma Center, UW Medicine, Seattle Children’s and  ASTHMA Inc Clinical Research Center.

“SeaFAC clinical trials are underway to discover if patients can be safely desensitized to food allergens, a type of immunotherapy,” says Dr. Jeong. “Immunotherapy has been around for many years in the form of allergy shots for environmental and bee venom allergies. In the future we may learn that controlled exposure to food allergens over time can reduce the severity or eliminate allergic reactions from foods.”

Dr. Jeong acknowledges some medical practices may be administering immunotherapy for food allergies “off-label,” but he cautions the treatment is still experimental and patients must understand the risks. Dr. Jeong suggests interested parents of children with a confirmed diagnosis of peanut, tree nut, milk, and/or egg allergy contact Benaroya Research Institute at Virginia Mason to learn about eligibility for clinical trials. Email allergy@benaroayresearch.org, or call
(877) 202-5200. To explore more food allergy research, education and local community resources provided by SeaFAC, visit seafac.org

 

Celebrate Safely with Food Allergies and Celiac Disease

Ah, the holidays – a fun-filled time of good food. That is if you’re free from a food allergy  or celiac disease. Last April, I was diagnosed with celiac disease and joined the millions of others who view the holiday feasting season with more dread than anticipation.

On the bright side of celiac disease, I don’t have to eat any fruit cake.

On the bright side of celiac disease, I don’t have to eat fruit cake.

Food allergies and celiac disease have different causes and reactions. In allergies, the immune system reacts to an outside substance that it normally would ignore. Celiac disease, an autoimmune disorder, causes the immune system to attack healthy intestinal lining when exposed to gluten, a protein in wheat, barley and rye. I may not know for days that I’ve been exposed to gluten, but my cousin, who is allergic to tree nuts and peanuts, could end up with hives, swelling or even an anaphylaxis reaction if he nibbles on a nutty cookie.

In short, those of us with food issues can be hard to have as holiday guests. But, never fear, the Home Food Safety program, a collaboration between the Academy of Nutrition and Dietetics and ConAgra Foods, has tips to keep you from causing your cousins, aunts, uncles or other assorted relatives to have an unhappy holiday. Their tips are:

Safety Starts at the Store

  • Learn which ingredients are problematic and read ingredient labels on foods.
  • When shopping, keep problematic foods in plastic bags or place them in a second cart, and keep them separate at checkout and in the car.
  • Avoid foods from bulk bins,  salad bars and the deli counter, as these are common sites for cross-contact.

Set Up a Storage System
If you can’t keep the entire house free from the problematic food:

  • Label allergen-free and gluten-free foods to avoid confusion and place gluten- and allergen-containing foods on shelves below allergen/gluten-free foods.

Conscious Cooking is Key

  • Use separate sets of utensils, cookware and cooking tools, and small appliances (toasters and blenders).
  • Prepare and cook allergen-free and gluten-free dishes first and in/on cleaned equipment and surfaces.
  • If possible, dedicate a kitchen space to allergen-free and gluten-free preparation.

Wash and Sterilize

  • Wash and sterilize everything coming into contact with the allergen-free and gluten-free foods being prepared.
  • Wash hands with warm, soapy water for 20 seconds.
  • Change gloves and aprons.
  • To clean surfaces and larger appliances, use a dry towel to wipe down crumbs first, then wash or sterilize.

Avoid Cross-Contact While Serving

  • Serve allergen-free and gluten-free guests first and carry their dishes separate from others.
  • Cross-contact with an allergen or gluten through condiments is common due to double dipping with a utensil. Choose squeeze bottles when possible to eliminate double dipping, and clearly label the option that is free from the allergen or gluten.
  • Avoid “make-your-own” dishes with high risk for cross-contact, including sundaes, salads and topping bars.

In addition, I’d like to add some special cautions for celebrating with those with celiac disease. Eight foods account for 90 percent of serious allergic reactions: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts. The Food Allergen Labeling and Consumer Protection Act requires that labels must clearly identify the food source names of all ingredients that are — or contain any protein derived from —the eight most  common food allergens. But gluten is not one of the eight. Gluten is also found in barley and rye, so don’t depend on a product just being free of wheat if you have a celiac guest at the table. Gluten can hide in unexpected places: soy sauce, non-dairy whipped toppings, canned soups, gravy mixes, seasonings and even self-basting turkey – the list goes on and on. So before you whip up your famous green bean casserole with cream of mushroom soup, remember that this is a favorite hiding spot for devilish gluten and check your soup can for a “gluten-free” on the label. (Oh, and hold the crispy onions, please.)

Most importantly, despite the backlash against the gluten-free trend and ignorance about food allergies, believe your relatives and friends when they say they can’t eat something. We’re not being picky; we’re being safe.