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Children's Food Allergies Require Vigilance

Whenever Dr. Joseph T. Inglefield Jr. newly diagnoses a child with a food allergy he spends two- to two-and-half hours educating the parents.

First and foremost, he tells the parents to teach the child to not eat anything that did not specifically come from the child's mother. Foods offered from grandparents, aunts and uncles and even dad are off limits. That's because moms tend to be more vigilant about their child's allergies.

"There are so many misconceptions out there," said Inglefield, a pediatric allergist with Inova Fairfax Hospital. "This is a life-long thing. It can be really, really serious."

The rules can change however, once the child enters preschool and mom is no longer around to select the child's lunch or prevent him or her from eating something that could cause an allergic reaction.

"The food allergy needs to be well-known to the school," said Dr. Sheryl E. Lucas, an allergist with Kaiser Permanente of the Mid-Atlantic States with practices in Springfield and Washington D.C. "It is important that everyone taking part in the child's supervision knows about special allergies, the level of allergy and how to treat a reaction."

THE MOST COMMON children's food allergies are cow's milk, eggs and/or egg whites, wheat, peanuts, soy bean and fish, said Lucas. A misconception is that lactose intolerance is an allergy to milk. Actually, it simply means a person cannot digest milk, however, a milk allergy has similar symptoms.

Another misconception is that food allergies are on the rise. Inglefield said allergies are hereditary and are no more common than in the past. The difference is people are more aware of them than they had been in the past.

"We're talking about a specific number of 5 to 10 percent of children or less have food allergies," Lucas said.

Even so, the reactions from food allergies can range from an itchy rash and nasal congestion to swelling inside the mouth and throat and wheezing to a loss of consciousness or death.

And it is not always enough to teach the child to avoid eating certain foods. In some cases, just being near the food can cause a reaction.

"With peanuts, you don't have to eat them, but the odor on someone's breath could cause an asthmatic attack in a child," said Inglefield. "That's why there are peanut-free flights."

In addition, headaches and skin rashes could be a sign a child has food allergies. Inglefield said it is important for a parent to know the family history and have the child tested if there is a suspected allergy to food.

To help ensure children are not eating the foods that could be harmful to them, the Fairfax County school system works with parents whose children have food allergies.

"We require the parent submit a form from the child's physician for the allergies, such as milk, and then make a substitute. For example, vitamin-enriched juice instead of milk," said Penny McConnell, director of the school system's Office of Food and Nutrition Services.

McCONNELL SAID the school system makes a 33-page ingredients list available to parents, upon request, that includes the ingredients of every item served at county schools. In addition, items containing nuts are not available at the elementary-school level and menus are sent home to parents every month. Menus are posted in classrooms at the middle- and high-school levels. Moreover, small marks can be placed on the back of a child's lunch card so the cashier or lunch manager can ensure the child did not choose a food he or she should not have.

"Education is the key," McConnell said. "With the little kids we have to help a little more. In elementary school, they tend to want to share. That's why we have no-sharing tables."

New menu items will also be highlighted so parents can notify the school if a substitution is necessary.

"At about grades two and three, the kids are pretty sure what they can have and parents are vigilant about letting them know what they can eat," McConnell said.

Even despite precautions, problems can occur, said Lucas, especially with older children who can typically leave campus for lunch.

"I know of a child in Fairfax County that left campus and had a fatal reaction last year to a cookie that had peanuts. She asked if the cookie had nuts and was told no," Lucas said.

McConnell said items containing nuts are labeled in county schools. She said the industry has also begun including disclaimers when an item was made in the same factory as other foods that may contain ingredients known to be common allergies.

"It really requires a partnership. Parents need to work with the schools if their child has a severe allergy," McConnell said.

To request a complete ingredients list from the Office of Food and Nutrition, call 703-813-4800