Kids with food allergies: checklist for a safe school year

Back to school can be both exciting and nerve-wracking. For parents especially, the return to school routine is a relief after summer days of nonstop activities. But if your child has food allergies, back to school can also mean some real worries about their health.

If your child is just entering kindergarten or preschool, this may be the first time they’ve had to manage their allergy without you, and it’s normal to feel anxiety. So, how can parents protect their children from food allergies? With the proper steps, you can make your child’s return as safe as possible.

What are food allergies?

Allergies are the body’s overreaction to an otherwise harmless substance. When you have a food allergy, your body misidentifies a certain food (or foods) as a threat. Eating or coming into contact with your food allergen triggers your body to release histamines, provoking an immune response.

The symptoms of a food allergy can include hives, rashes, wheezing, vomiting, and full-blown anaphylaxis, which is a life-threatening allergic reaction that constricts your airway.

While it can feel natural to lump them into the same category, food allergies are very different from food intolerances. Food intolerance has to do with difficulties digesting or metabolizing certain foods and doesn’t involve the immune system. In contrast, allergic reactions are unpredictable and can cause a severe anaphylactic reaction after exposure even to trace amounts of the food.

Food allergies are serious, and if your child has one, they should receive medical support. If you’re looking for assistance with navigating your child’s allergies, Maple can help. Maple is an online virtual care platform that connects you to a Canadian-licensed doctor or specialist from your phone, tablet, or computer. Consultations with our allergists are available at a time that’s convenient for you.

They can review your child’s allergy plan, provide necessary prescription medications, and order additional testing as needed.

Most common food allergies in kids

While some children do grow out of their food allergies, many retain theirs for their entire lives. These are the foods that trigger allergies most commonly in children:

1. Peanuts

Peanut allergies are infamous and for good reason. According to Food Allergy Canada, two in 100 Canadian children have a peanut allergy, making peanuts the number one cause of allergic reaction in the under-18 group. As a result, many schools and child-centred facilities are now peanut-free, though you’ll want to double-check that your child’s school is.

2. Tree nuts

Tree nuts are a large category that includes almonds, cashews, hazelnuts, walnuts, pine nuts, and more. And although they’re grouped under the same allergy heading, being allergic to one tree nut doesn’t mean your child will be allergic to all of them. More confusingly, while peanuts aren’t even nuts — they’re legumes — about 40% of children with a tree nut allergy also have a peanut allergy.

3. Milk

Having a milk allergy isn’t the same as being lactose intolerant. Lactose intolerance is the result of your digestive system’s inability to process lactose, the sugar found in milk. Lactose intolerance can cause stomach pain, bloating, and diarrhea but it’s not life-threatening, or an allergy.

A milk allergy, on the other hand, is triggered by your immune system’s response to cow milk protein. The proteins in cow’s milk look similar to those in sheep, goat, and buffalo milk and these can cause similar allergic reactions when consumed. This immune reaction can range from hives to an anaphylactic response and everything in between.

The good news is that many children with milk allergies outgrow them as they age. And, some people with this allergy can tolerate dairy when it’s fully baked as the baking process denatures, or changes, the protein. This doesn’t apply to everyone though so always work with your allergist before consuming baked dairy.

4. Eggs

Egg allergies are surprisingly common, but they’re also one of the allergies your child is most likely to outgrow, and about half do so by age six. Whether skin testing determines your child is allergic to egg whites or egg yolks, they shouldn’t eat either part of the egg as both contain minute amounts of the other.

While some children can tolerate baked or cooked eggs in food items, your child’s allergist should provide clarity on foods to avoid. Frittatas might be clear candidates for the do-not-eat list, but eggs are also present in less obvious places. Battered and fried foods and the yellow fever vaccine are more surprising sources of egg and its protein.

5. Shellfish

Shellfish can be a bit of a misnomer, as this category isn’t limited to just shellfish — it actually encompasses bivalves and mollusks. This usually means that those affected by this allergy react to not only shrimp, lobster, clams, crabs, oysters, and scallops, but also to things like octopus and snails.

While fish are fine to eat, anything without fins should be off-limits, especially because shellfish allergies aren’t just triggered by eating. Your child may also have a reaction from handling or even inhaling the cooking vapours of these seafoods. And, unlike milk and egg allergies, the majority who experience a shellfish allergy don’t outgrow it.

6. Soy

Soy is a tricky food to avoid. It can be found in everything from chewing gum to baby formula, and also makes an appearance in some cosmetics, seasonings, and even vitamins. Luckily, many children with a soy allergy do outgrow it.

7. Wheat

Having a wheat allergy is different from having Celiac disease or being gluten intolerant. Celiac disease is an autoimmune condition that affects your intestines’ ability to absorb nutrients from your food.

A wheat allergy by contrast, triggers an immune system response to wheat proteins. Wheat is found in a range of products making it difficult to avoid. Luckily, however, it also falls into the category of allergens many children outgrow.

8. Fish

Fish contain a different protein than shellfish meaning that a fish allergy and a shellfish — or bivalves and mollusks — allergy isn’t the same. Allergies to both are possible, as is cross-contamination, but many with a shellfish allergy can eat fish and vice versa.

Keep in mind that if your child has food allergies, management and treatment from an allergist is an option. And, you can get additional support online. There are tons of great online food allergy resources offering information for parents of kids with food allergies. Many even have recipes and ideas for allergy-friendly foods for kids, helping to make mealtimes a snap.

Back-to-school allergy checklist

You can’t go to school with your child but you can help to set them up for an allergy-safe school experience. Here’s how:

• Children with food allergies need a prescription for an epinephrine auto-injector, often known as an EpiPen. If your child is old enough, make sure they know how to self administer it. Review and practice this regularly and check their EpiPen expiration dates each time you do.
• If your child hasn’t seen their allergist recently, make an appointment. Food allergies require annual follow-ups to ensure your child’s anaphylaxis action plan is current. This plan details what your child’s allergies are, what their symptoms look like, and what to do in the event of an anaphylactic reaction.
• Your child’s school must be aware of their allergy. To this end, meet with your child’s teachers, school administration, or both to discuss their action plan. Provide multiple copies of it along with current photos of your child.
• Your child needs two EpiPens at school — the second one as a backup in case the first doesn’t work, or in case they experience a second wave of symptoms after their first injection. Each should be labelled with their name, allergy, and photo. Demonstrate how to use the device and make sure their teacher feels comfortable doing it.
• Determine who’s responsible for carrying the EpiPen around. Some older children are responsible enough to take charge of it themselves. Teachers of younger children, however, will likely carry a bag containing it with them. Either way, every moment counts in an allergic reaction so one needs to be accessible within seconds.
• Ask about the school’s allergy procedures and their health and safety guidelines regarding mealtimes. The school should be able to share where the children eat, who wipes down the tables and how often, and whether there’s an allergy table and someone to supervise handwashing. All this info can help you guide your child through school mealtimes as seamlessly as possible.
• Review your child’s allergies with them regularly and remind them not to take food from other children. They should be aware of which foods are safe for them to eat and which they need to avoid.

Can food allergies develop at any age?

Weirdly, yes. While most allergies begin in childhood, you can develop an allergy at any point in your life, even to a food you’ve eaten many times. Luckily, you can also outgrow an allergy. Many children with milk and egg allergies, for example, grow out of them as they age.

Scientists don’t know why certain people develop allergies and others don’t. Genetics play a role as you’re more likely to have an allergy if an immediate family member has one. But they also think there’s an epigenetic component as well. This means that while you may have the gene for an allergy, if certain environmental factors don’t trigger that gene you won’t end up with one.

What happens if you ignore food allergies?

Food allergies should never be ignored. Not only can they make you sick, but allergic reactions aren’t static. This means that you can’t predict how your child will respond to a subsequent ingestion of the food. Your child could have an initial allergic reaction that involves only breaking out in hives. Their next reaction, however, could be much more severe and include vomiting, wheezing, and even anaphylaxis, which requires an immediate call to 911.

There’s so much possibility for change that allergists prefer not to qualify a food allergy as moderate or severe. Regardless of their symptoms, your child should see an allergist if they have an allergic reaction to a food. They’ll benefit from food allergy testing for kids and will also require a prescription for the right dose of epinephrine in their auto-injector to protect them in the event of a more severe future reaction.

When to start talking about food allergies with your child

Explaining your kid’s food allergies when they’re young but able to understand is also one of the most important things you can do to help keep your child safe. You can do this by:

• Telling your child that the food (or foods) they’re allergic to can make them sick. Try referring to the food allergen as an “unsafe food”, and tell them they only want to go for “safe foods”. Stay calm while you’re explaining all of this — you don’t want to invoke fear or anxiety.
• Teaching them the name of the unsafe food and showing what it looks like in pictures or pointing to it at the grocery store
• Explaining how they can recognize an allergic reaction in case they were to come into contact with their food allergen and what they should do
• Letting them know that they’re not alone — plenty of kids have food allergies and can stay safe by being unafraid but cautious

Treatment and preventing food allergies

Parenting a child with food allergies can come with certain stresses — and preventing allergies isn’t always possible. Research does suggest, however, that introducing common allergens to babies as early and often as possible may help keep your child from developing food allergies. If you’re concerned about starting certain foods with your baby, a conversation with their pediatrician can help you develop a realistic plan you feel comfortable with.

For managing and treating your allergies, seeing an allergist online is a great first step. An allergist can work with you to develop an appropriate treatment program. This may include prescription medications like antihistamines or epinephrine auto-injectors as needed.

An allergist can also refer you for additional testing or immunotherapy if necessary. Immunotherapy involves exposure to tiny amounts of your allergen, and gradually increasing the dose as your body adjusts to it. While it sounds straightforward, immunotherapy is incredibly precise and should never be attempted on your own.

If you’re looking to understand more about your child’s or your own allergy, consider seeing an allergist today. With the proper prevention and treatment, you can live a happy and healthy life with your allergies.