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Should You Ban Problem Foods?
Some families decide to allow problem foods in their home, but take precautions to keep the family member who has food allergies safe. Others find it easier to implement a total ban.
Highly allergenic foods such as peanut butter, fish and eggs can be introduced to babies between 4 and 6 months and may even play a role in preventing food allergies from developing.
The recommendations are a U-turn from 2000
Is there a clinical reason to do this, or does he just think it's not OK emotionally for them? They have no food allergies now but maybe I am putting them in danger? They don't like having dairy and don't like nuts so it's not a big deal to them, but maybe it's the wrong path?
The American Academy of Pediatrics reversed its recommendations in 2008, but Chan said not enough Canadian family doctors and parents have heard about the change.
Once parents introduce a new food to babies, doctors recommend giving it several times per week with a soft mashed consistency to avoid the risk of choking to maintain a child's tolerance.
When Stephanie Schick's four-year-old daughter eats yogurt, she gets fully washed down to help protect her six-year-old sister, who has a dairy allergy.
Is there a clinical reason to do this, or does he just think it's not OK emotionally for them? They have no food allergies now but maybe I am putting them in danger? They don't like having dairy and don't like nuts so it's not a big deal to them, but maybe it's the wrong path?
The allergist is telling us that we can trigger an allergy by delaying introduction, but he doesn't know of any safe way to introduce them either. :/ This is also the exact opposite of what he told us 7 years ago, when the consensus was to wait to avoid allergy. This is where I struggle, because the docs just don't know what is really causing allergies or if they can be prevented.
I have no idea what is the right path to follow. :(
There's a few ways you could handle this. I'm assuming you have to protect the long term relationship with the allergist?
A home isn't a lab and kids aren't cooperative test subjects. You could point out a couple of items posted by Dr. Wood, a Johns Hopkins allergist who himself has a peanut allergy. On his site is a note about how hard it is in reality for younger kids to manage allergens because they will spread allergens. He himself had his worst reaction from cross-contamination from a colleague's wife's cookies, who assured them they were peanut free. Turned out to be a spatula used to lift pb cookies off a tray were used for the non-pb cookies.
If it were me I'd tell him I can do a lot but I can't control the world, my house is not a lab, my kids are not test subjects and I don't get to punch out on food allergies at 5:00 pm.
Having said that we do live with most of our allergens in the house. I say 'most' because we have so many, particularly my youngest child. There are two we are most careful about: peanut and milk. I don't have either of those in the house because my children's eliciting doses to anaphylaxis are so minute. I also have to go according to a management style that is possible for my kids given their age and developmental stage.
Roasted peanut proteins tend to be the most durable. It takes more wiping, chewing, washing than baked egg or baked milk. It's also a much more narrow category of food item than dairy, egg, wheat, soy (because it's used in so many things). That's something to consider. Now if your child has a wide threshold for peanut then that's different, and no matter how high the numbers they tell you absolutely nothing of threshold. If all you have are high numbers but no history of reaction, especially anaphylactic you may have more room for contamination.
The allergist is going on conventional wisdom based on correlation, I don't believe there's been any publications that provide a direct causation from delayed introduction. In fact, I believe that never became truly set amongst the entire medical community if for no other reason that no one knows how sensitization in allergic disease happens exactly and why some proteins and not others. He's mistaken outright if his idea is that specific allergens run in families rather than allergic disease itself. It would behoove him to keep an open mind about that and not assume because you're not introducing lobster at age 2 then your child will become allergic to lobster. If it were that simple this whole thing would be solved already.
Dr. Sicherer was our previous allergist. I asked him about the idea of highly allergenic foods, introduction and 'keeping them in the diet'. His response (which I am paraphrasing) is he believed that was a slight misinterpretation of OIT data where tolerance was cultivated. He said although sensitization can occur at any time as a reasonable butt-covering possibility, that if you're not allergic to something to begin with there's no value in 'keeping it in the diet'. One simply isn't allergic to it. For reference I was asking about crustaceans and the idea that our son will eat them but not consistently. He did not see that as a concern. This was probably mid 2011.
One good compromise could be if older child is peanut allergic only to start using tolerated tree nuts that all the kids can eat. That should ease the allergist's emotional state a bit, open up new foods for all. The kids w/o allergies could avoid overt peanut until a little older when all the kids can take more responsibility. It's not healthy to create a situation where kids get disciplined due to allergen management.
I would for sure want to find out about peanut for the other kids by school age.
If he's really insistent, maybe tell him he can set up oral food challenges for nuts in the office for your nonallergic kids. Twice a week :).
Thank you for responding. She has reacted to peanuts once, on one ingestion. She had swelling of the lips and vomitting from one bite of a peanut butter cookie. She hasn't had exposure to nuts (that we are aware of) since then. We have not done a food challenge at this point to see if she is able to ingest other types of nuts and the allergist said he isn't concerned about those and won't worry about a challenge until a later (unspecified date). At this point we treat her as though she were allergic to all nuts. It simplifies things for us and for her at this point.
If an allergist pushed on kids must eat peanut or it's mom's fault for not introducing it sooner then it would be logical for doctor to help patient determine if all, some or no tree nuts must be avoided. So simpler for him doesn't translate to goals if the goal is to not delay introduction of allergenic food. Why push you solely on peanut? That makes no sense.
Boo and TwinTurbo have given you excellent advice.
I'd seriously press your allergist on the subject of food challenges to some tree nuts. Find out (for certain) what you can-- and cannot-- have in your home. The advice you've been given sounds VERY much like "let them eat cake" coming from your allergist; some of them truly can't quite grasp what it is to live with food allergy, and others can't quite grasp what it means to live with a very low threshold dose (we've had both experiences with allergists, even very good ones).
So ultimately, day-to-day management and avoidance? Your allergist isn't the expert. YOU are.
So gather information, but then make your own decisions about risk/benefit, IMO.
Some allergens we keep in the house, and some we don't.
Not in the house: crustaceans, cashew, pistachio, peanut-- the reasoning is that the eliciting doses involved are either too unpredictable or too scary-low and/or the reaction history is very, very scary-severe. A major-- or in a couple of cases, minor-- error with one of those could cause death no matter what transpired afterwards. So.
Not in the house because they simply don't NEED to be, and they are likely anaphylaxis triggers-- mango and walnut.
Not in the house in some FORMS: soy, almond, egg.
In the house, just avoidance for those who are allergic-- several things, mostly fruits and vegetables; milk.
I mention this to let you know that most of us have a highly idiosyncratic household protocol surrounding this stuff. Mostly, it's stuff that we've figured out taking into account our own life experience, the needs and desires of OTHER members of the family, cultural preferences, etc. etc.
I grew up in a house that did NOT restrict my allergens-- ever. Now, did that force tolerance? Well, maybe. But I developed a shellfish allergy as an adult, and I'd been eating shrimp and other crustaceans regularly my entire life.
Allergic is allergic, and if you aren't destined to be, then so be it, IMO.
While topical reactions to things like poison ivy are not in the same category as IgE-mediated food allergy, it's an instructive example-- additional exposure just racks up ticks on your life-o-meter there. About 80% of people are born with a magic number. Reach that and you're allergic. For some unlucky souls, it's 0 or 1. For some others, it's 987, or 46. No real way to know until you learn the hard way.
I do wonder about that given the number of ADULTS with nut or shellfish allergy that seemed to develop after a period of exposure. If exposure is protective then that shouldn't happen-- but it clearly DOES.
I think it's a fallacy to assume most shellfish allergy is adult-onset and therefore different from peanut (though there may be research suggesting such that I'm not aware of). Personally, I know equal numbers of people with adult-onset peanut allergy as I do adult-onset shellfish allergy. My kids and I are all childhood-onset shellfish allergy.
However, if it's true that shellfish allergy is statistically likely to be adult-onset, then that could suggest the possibility of sporadic exposure leading to sensitization since shellfish allergy isn't more prevalent in coastal regions or populations who consume higher than average quantities of shellfish. I'd be curious to know if adult-onset shellfish allergy is caused by different protein sensitization (perhaps one in chitin) than the sensitizing protein(s) of childhood-onset shellfish allergy.
Oh, as are we all, really-- just opinions. :) Conversation, that's all. Things to muse upon.
Oh, as are we all, really-- just opinions. :) Conversation, that's all. Things to muse upon.
:yes:
Interestingly enough, DD's shellfish allergy manifested early and behaves more like a severe peanut/egg/etc. allergy. Her first exposure to shellfish was when she was 3 years old. We were out to dinner and DH ordered shrimp. DD was sitting next to him and ate two french fries from his plate (from the side of the plate furthest from the shrimp) which resulted in hives and vomiting. When she was 4, she put two fingers in the touch tank at the aquarium and reacted with full-body hives. At age 6 we attempted the ocean - after about 45 minutes the first hives started to pop up. Grocery shopping, she gets blotchy and wheezy when we're near the seafood counter. That's why I was wondering if different proteins might be involved with adult-onset (exposure sensitization) and childhood-onset presentations like DD.
Adults who have adult-onset food allergies have just always had that be so-- most people with adult-onset, there's this weird opening phase of things where even stuff you ARE NOT allergic to, you react to-- it's like your immune system views everything with some degree of suspicion, and some days, some things... more than others. But unpredictable.