Food Allergy Treatments

The best treatment for a food allergy is to completely avoid the problem food.  Being diagnosed with a food allergy has a massive impact on the whole family. 

Eating is such a central part of day to day life that having to be absolutely sure that a child has no contact with a particular food effects mealtimes, going to school, holidays and social occasions.  A simple supermarket trip has been shown to be almost 40% longer when shopping for a food allergic child.

Parents also need to be able to recognise reactions and know exactly how to deal with them when they occur.  This usually involves carrying antihistamines everywhere the child goes and also, for those children at risk of anaphylaxis, adrenaline injections (see below). 

Children with food allergies are also at risk of missing out of the essential nutrients that they would otherwise get from the food they are avoiding especially in the case of infants with milk allergy.  Fortunately, there are now many specially designed milk substitutes suitable for these children and with the help of a dietician, a nutritious diet can be achieved even in children with multiple food allergies. Dieticians can help parents with ideas about how to make sure that a child with a food allergy has a varied and nourishing diet, and this ensures healthy growth and development. It can also play an essential part of minimising the impact on your lifestyle by offering acceptable foods. It is also possible to obtain special foods for your child, such as wheat-free alternatives to bread and pasta; a member of the allergy team can advise you as to where to buy this, and if it can be obtained on prescription.

Many food allergies, such as egg and milk, are outgrown during childhood whilst allergies to peanuts, nuts, fish and shellfish tend not to go away.  Children with food allergies also have a high chance of having other allergic problems such as asthma, eczema and hay fever.

It is essential that children with food allergies continue to be seen by their doctors as they grow up. Repeating allergy tests can help predict if the allergy has been outgrown so that the food can be carefully reintroduced into the diet.  It is also essential that the child is carefully examined for any signs that they are missing out on any essential nutrients due to their restricted diet, or if they are developing signs of other allergic problems.

Unfortunately, there are no cures for food allergy in the immediate future although exciting research does promise real progress over the next 5-10 years, not only in our understanding of how to prevent allergies occurring in the first place but also for helping those who already have them.

Food allergy can potentially have the greatest impact upon the lifestyle and choices made by a child and their family. However, with clear understanding of the issues, and through having good routines in place to cover both food choices and emergency situations, the impact of food allergy can be kept to a manageable level.

Adrenaline Auto-Injector Pens

Adrenaline injector pens are used for severe allergic reactions where the child may suffer from anaphylaxis and allow adrenaline to be injected quickly and easily to combat the allergic symptoms. The pens are prescribed according to the weight of the child, and are sometimes designated as junior or senior injector pens.

There are now a number of different adrenaline devices available, but they all contain exactly the same medication. They are made by different manufacturers and have a slightly different mechanism in how they are administered.

How to use

• Appropriate training is needed to administer an adrenaline auto-injector. Ask your GP, allergist or nurse to show you how and your child (if old enough) to administer the auto injector; they will probably have ‘dummy’ pens that you can use to practice with
• Injector pens come with instructions and are easy to administer, but it is essential that anyone caring for your child understands exactly when and how to use them, and know that immediate follow up with medical care is necessary
• Training injectors which do not contain adrenaline or a needle are available to registered auto-injector users, from both the Epipen, Jext and Anapen websites
• Contact Allergy UK for further information about training as well as information on available videos that show how to administer adrenaline via the pens. (Alternatively: A training video is available for viewing on the Epipen and Jext websites)
• Sometimes a second dose of adrenaline may be required, and for this reason it is important to have more than one auto-injector
• It is advisable to have between two and four auto-injectors (i.e. two at home and two at school). It can be difficult to get these prescribed but if you explain to your treating doctor your requirements then hopefully this will be achievable
• An ambulance should always be called following administration of adrenaline as sufferers of anaphylaxis can go on to have a later secondary reaction and the hospital can then administer additional treatment. The hospital can also provide a replacement for the auto-injector you have used once they have checked your child and monitored them
• Storage is important and injector pens should be in an easily accessible place that everyone at home knows about. In school the pens should be in an unlocked area which the child knows well. Some older children may carry the pens themselves

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Good Practice

• Ask your treating doctor for a management plan that details your management of the condition and also what to do in an emergency
• Talk to a dietician for information on your child’s diet and adequate provision for nutritional needs. Dieticians can be accessed via your hospital doctor or GP and can also provide information on alternative foods and recipe adaptations
• It can be a good idea to have designated members of staff at school so that your child knows who to go to. All staff should be made aware of your child’s allergy so that if they develop any symptoms they can be monitored
• A protocol should be drawn up detailing treatment and advice and staff training (given by a medical professional) should be undertaken regularly
• A child’s photograph should be kept on the protocol form which should be inside any auto-injector box and staff should familiarise themselves with the photos and names of any children who are at risk of anaphylaxis 
• Always talk to your doctor or dietician about reintroducing foods that have previously been avoided 
• Remember that it is very important to be aware of potential cross-contamination when preparing food for allergic children. It is essential that all utensils and food preparation surfaces which are used to prepare foods that may be harmful to your child are not then used for preparing food for your child without thorough cleaning. In the same way cutlery for eating and dishes should not be shared between your child and other individuals

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Tips

• Get together a list of foods that are safe and foods which must be avoided. Try to adapt recipes so you are able to include your child safely. Details of allergenic recipe books are available from Allergy UK and you can ask your local library to order them in for you
• Have a box of treats at home that always has something to eat in it, so that you will always have ‘safe’ foods available and your child does not feel that they are missing out on treats
• Think about packed lunches and carry spares in the car in case you are longer than you anticipate
• Try to be organised, pre-arrange your menus and shopping, freeze and bake essential supplies
• Make a note of new foods and products that are suitable for your child and where to access them. This can make shopping easier as you will probably find you cannot obtain all the special dietary products from one store
• Don’t let children share their food with others. Make sure they have suitable alternatives if they are going for example to parties or there are school activities involving food, and keep these supplied so that the teachers are confident they can provide something without having to isolate them due to their allergy
• Obtain a list of the different names used for food types, for example, food products containing dairy products are sometimes labelled as containing whey or casein. More advice on this can be obtained from the Allergy UK Helpline

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Self Help

• Try to help your child develop confidence in what they eat by helping them check menus and food labels for safe items (free from logos) and allergens. Also help them to learn how to ask about suitable foods when they are out
• Make sure your child will tell you if they have accidentally eaten something or if they are unsure about the safety of any foods. It is important that they are not frightened by their condition, but they understand that watching what they eat will allow them to stay healthy
• Some children, especially if they are forming friends, do not want to ‘tell’ on a friend if they have been given a snack which they should not have. Try to encourage them to tell you that way you can manage the situation and let them know there won’t be any repercussions with their friends
• Some children can feel pressured by their friends and general peer group to try foods that they are unsure of, or to go hungry rather than show that they are different because they have an allergy. A number of books are available that give advice on how you can help and encourage your child to cope with their condition and encourage them to resist peer pressure. For more information on the books available contact Blossom
• A number of organisations exist that can give advice on how to help children at risk of anaphylaxis. Allergy UK can provide you with help to access this support, as well as further information on precautionary measures that your child and anyone caring for your child can take to minimise exposure to allergens
• Translation Cards can prove useful when travelling abroad; they provide details of the food allergy in the language of your choice and are available from Allergy UK

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Treatment Strategies

Some parents see such changes in their children once treatments are in place that they decide that their child is better. However, it is a mistake to then stop giving the medications and treatments that have been prescribed. 

Improvements are seen because the treatment prevents the allergy symptoms from starting, or reduces the severity of the symptoms. Stopping treatments without the help of your GP, or specialist, can cause a sudden escalation in symptoms.

The treatments for allergy are usually very straightforward, safe and effective. If your child has been diagnosed with an allergy they may be prescribed one of the following common treatments:

• antihistamines
• emollients / moisturising creams
• steroids
• adrenaline

Other allergy treatments include:

• antibiotics
• immunotherapy
• cromoglicate
• anti-leukotrienes
• anti-IgE drugs
• Calcineurin inhibitors

Medications and treatments help to control the symptoms of allergy rather than cure the underlying allergy itself. However, allergy can be an unpredictable condition, and sometimes treatments become less effective over time. This can be due to a change in the nature of a child's condition, or because as they have grown they need an increased dose or a different medication because their symptoms have changed.

Treatment regimes can take time to become established and the routine and medications your child has been prescribed can also take time to take effect. Remember to write positive and negative changes in symptoms in a symptom / treatment diary.

Always follow the medical advice about treating your child's allergies and do not stop prescribed medications without appropriate medical advice. Even when medication seems to be controlling symptoms it is not advisable to stop the medication without first checking with your GP, or to follow other prescribed or self-medicating instructions.

It is also an important part of managing your child's treatment that they understand their conditions and why the treatments are important. Chatting and talking to your child about their symptoms and treatments could lead them to have an increased ability to manage their symptoms themselves as they get older.

Reviewing Treatments

• It is important for children’s medicines to be reviewed at regular intervals because their bodies are growing and changing.
• Rapid growth and development may mean that a treatment which was working previously suddenly becomes less effective, and symptoms may return or increase.
• A child may need a higher dose, or a different kind of medication or treatment, as they get older and bigger in order to keep symptoms controlled effectively, and enable them to enjoy their childhood.
• GPs, allergy specialists, allergy nurses, practice nurses and health visitors are all there to help you understand and maintain treatments; they will also monitor and review your child’s treatment.
• Talk to these people so that medication and treatment options can be kept going, adapted or changed if necessary; this will lead to your child having a happy childhood where the effects of allergic conditions are kept to the minimum.
• As well as making sure that children are given their treatments, you should always make sure that medications are reviewed at regular intervals. Ask your doctor how often this should be.

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Allergic Reaction Diagnosis and Self-Care at Home

Allergic Reaction Diagnosis

For typical allergic reactions, your health-care provider will examine you and ask questions about your symptoms and their timing. Blood tests and X-rays are not needed except under unusual circumstances.

In case of severe reactions, you will be evaluated quickly in the emergency department in order to make a diagnosis. The first step for the health-care provider is to judge the severity of the allergic reaction.

• Blood pressure and pulse are checked.
• An examination determines whether you need help breathing.
• Often, an IV line is placed in case you need anti-allergy (antihistamine) medications quickly.
• If you can speak, you will be asked about allergy triggers and previous reactions.

Self-Care at Home

Avoid triggers! If you know you have an allergic reaction to peanuts, for example, do not eat them and go out of your way to avoid foods prepared with or around peanuts (see Food Allergy).

Self-care at home is not enough in severe reactions. A severe reaction is a medical emergency.

• Do not attempt to treat or "wait out" severe reactions at home. Go immediately to a hospital emergency department.
• If no one is available to drive you right away, call an ambulance for emergency medical transport.
• Use your epinephrine auto-injector (Epi-Pen, Auvi-Q) if you have been prescribed one by your doctor due to previous allergic reactions (see "prevention" below).

Slight reactions with mild symptoms usually respond to nonprescription allergy medications.

• Oral antihistamines
• Loratadine (Claritin or Alavert), cetirizine (Zyrtec), and fexofenadine (Allegra) are nonsedating antihistamines that can be taken over the long term.
• Diphenhydramine (Benadryl) can also be taken but may make you too drowsy to drive or operate machinery safely. It can affect concentration and interfere with children's learning in school. These medications should be taken for only a few days.
• For rashes or skin irritations, an anti-inflammatory steroid cream such ashydrocortisone can be used.

For small, localized skin reactions, use a cold, wet cloth or ice for relief. Apply a bag of frozen vegetables wrapped in a towel as an ice pack.

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When to Seek Medical Care

When to Seek Medical Care

Because allergic reactions can progress and worsen in minutes causing complications, medical attention is always recommended for all but the most minor and localized symptoms.

If the symptoms of your reaction worsen over a few days, or if they do not improve with recommended treatment and removal of the allergen, call your health-care provider.

Tell your health-care provider if you have any allergic symptoms after using a drug or other treatment prescribed for you (see Drug Allergy).

Allergic reactions can be dangerous. Sudden, severe, widespread reactions require emergency evaluation by a medical professional. Call an ambulance if you or someone around you has any of the following with an allergic reaction:

• sudden, severe, or rapidly worsening symptoms
• exposure to an allergen that previously caused severe or bad reactions
• swelling of the lips, tongue, or throat
• wheezing, chest tightness, loud breathing, trouble breathing, or hoarseness of voice
• confusion, sweating, nausea, or vomiting
• widespread rash or severe hives
• lightheadedness, collapse, or unconsciousness

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