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For parents and caregivers of a child with a suspected food allergy, each bite your kiddo takes can put you on alert. Dr. Javen Wunschel, DO, an allergist with The Iowa Clinic, shares tips and tricks for having a food-allergy friendly fall.
Between back-to-school lunchrooms and spooky Halloween treats, fall can bring extra variables to the table. A few proactive measures and education about what can trigger a reaction can help keep your child safe. Scheduling allergy testing is the first step to a diagnosis.
What causes food allergies?
A food allergy reaction is the body’s immune system identifying a food or ingredient as a “danger,” initiating a protective response. These reactions can range from developing a few hives to life-threatening anaphylaxis, which impairs your child’s breathing and causes their blood pressure to plummet.
Although any food has the potential to cause an adverse reaction, the American College of Allergy, Asthma and Immunology identifies these nine food types as accounting for 90 percent of reactions:
- Eggs
- Milk and Dairy
- Peanuts
- Tree nuts
- Fish
- Shellfish
- Wheat
- Soy
- Sesame [present in products that contain tahini]
What should you do if you suspect your child has food allergies?
Food allergies are estimated to affect 4% – 6% of children, according to the Centers for Disease Control and Prevention. Allergies can be hereditary, but it typically takes having experienced a reaction to initiate a diagnosis. Recognizing the signs and symptoms of food allergies is important, especially when you’re introducing new foods to your child.
“The typical signs and symptoms would be—within minutes of ingesting the food—development of lip, tongue, or eye swelling, breaking out in hives, profuse vomiting or diarrhea, throat closing sensation, wheezing, shortness of breath,” Dr. Wunschel says.
As very young children wouldn’t have the vocabulary to describe their symptoms, you should watch at and following meal and snack times for any signs of distress or discomfort that might indicate an allergy. Significant symptoms warrant an immediate trip to the emergency room or urgent care.
For symptoms that aren’t life-threatening, Dr. Wunschel says over-the-counter antihistamines can help in the moment. Then, she recommends avoiding that food until you can get your child into the allergist to be tested. This can happen either through a referral from a pediatrician, or you can schedule an appointment directly. (You may want to check on whether your insurance requires a referral to reimburse a visit.)
What can we expect from allergy testing?
At the initial visit, your child will undergo a skin prick test (SPT), which can also be known as a “scratch test.” This measures the presence of antibodies for the suspect food by placing small drops of solution containing the allergen on the child’s forearm or back.
“Typically, we'll give instructions to hold off on antihistamines for at least 5 days before that visit,” Dr. Wunschel says.
SPT involves the doctor gently pricking or scratching the skin using a small plastic probe or needle to allow a tiny amount of the solution to enter just below the surface. If the test area results in a raised bump surrounded by a small circle of itchy red skin, this likely indicates an allergy. This test, which takes 15-20 minutes, can check for immediate allergic reactions.
A brand-new diagnosis can involve lifestyle changes like eliminating food from the child’s diet, and parent education is a big part of the visit.
“There's no such thing as a mild food allergy,” Dr. Wunschel says. They don’t categorize based on severity. When an allergy is present, she says slight symptoms could build into something serious. “It's that you either have [an allergy], or you don't. So, if we determine based on their history and their testing that a child has food allergies, then we're going to give strict avoidance guidance. We help parents understand how to do that because even in very small amounts, the child could have the potential for an anaphylactic reaction.”
Carrying an epinephrine device and any other allergy medications in case of accidental exposure can help address any life-threatening reactions on-the-spot.
Avoiding allergens when your child is out and about.
After you give your own pantry and refrigerator an overhaul to eliminate foods with ingredients that might trigger a reaction, controlling exposure outside of the home can be tricky. Homemade treats aren’t often labeled with potential allergens, and it’s hard to know whether holiday goodies like the kinds that are handed out on Halloween are allergy friendly.
“Frequent ingredients in several candies would be milk, egg, peanuts, tree nuts, and those are some of the most common food allergens,” Dr. Wunschel says. “That can provoke a lot of anxiety, either for the food allergic kids or the parents. Halloween is certainly a time when we specifically watch out. We help coach food allergic kids and parents around what to do.”
For school-based occasions or parties, it can be helpful to send a stash of pre-approved treats as an alternative to what the rest of the class or group is enjoying. Otherwise, instituting a rule and routine that encourages your child to get parent permission before accepting a food can help keep them safe.
Reading labels is critical for caregivers of kids with food allergies, but during trick-or-treating that might not be practical or even possible. Dr. Wunschel says eating dinner and perhaps even enjoying an approved treat at home before heading out can help curb the desire to gobble candy on the go. Children should wait until after they’re home and treats can be sorted.
“It's okay to touch that peanut butter cup wrapper; they’re not going to get anaphylaxis from that,” Dr. Wunschel says. But it’s a good idea to encourage your child (whether they’re living with allergies or not) to wash hands with soap and water after they’ve been out. Only allow them to consume candy that is clearly labeled.
“Sometimes the mini or ‘fun size’ versions don't have the ingredient label on individual pieces, because it's on the larger package and the recipes [for smaller pieces] can vary from the full size,” Dr. Wunschel says. “It can be tough to feel confident about allowing your kid to eat that when you can't read through the ingredient list.”
She suggests that this is when having safe swapping options on hand can once again be a good strategy, and suggests the Food Allergy Research and Education (FARE) website, foodallergy.org as a free resource for other food allergy management ideas, such as the Teal Pumpkin Project.
A teal pumpkin placed on a doorstep indicates that, in addition to candy, the home offers non-food trinkets and treats, like glow sticks or pencils. With one in 13 children living with food allergies, and many others impacted by intolerances and other conditions, it’s a growing movement toward a more inclusive way to celebrate. Kids with allergies might also consider carrying a teal pumpkin as a treat bucket to signal they’d prefer a non-food treat.
What if I think my child has outgrown an allergy?
It is possible for children to develop a tolerance for foods that have triggered reactions in the past. Dr. Wunschel says each different food allergen has its own prognosis in terms of whether a child would be likely to outgrow it or not. Annual visits will help keep tabs on their immune system response.
“It's important to continue to follow up with the allergist because if it's looking like they're outgrowing [a food allergy] we may be able to reintroduce the food in their diet,” she says. But that step should be done under strict supervision, in a safe setting. A “food challenge” is conducted in the doctor’s office, using very small amounts of food administered over a set period, in a stepwise fashion, while the child is closely observed by the medical team.
Whether you’re visiting for a first-time diagnosis or to follow-up on known food allergies, The Iowa Clinic care team is committed to helping you navigate each step.
“We're going to guide you through this,” Dr. Wunschel says. “You're not going to be alone. We've got great resources to help parents.”
Schedule your child’s appointment with an allergy specialist today.
JavenWunschel , DO
Javen Wunschel, DO joined The Iowa Clinic in 2022 after practicing as an allergist for three years in Mason City. She was drawn to the Clinic because of the people, the culture and opportunities to expand the Allergy department.
Dr. Wunschel’s favorite thing about her job is the patients — every person has different allergies and a unique immune system. She finds great reward in finding the root of their problem, working together to manage their condition and getting them back to living their best quality of life.
Outside of the clinic, Dr. Wunschel can be found spending time with her husband and three children. They enjoy spending time on the lake, playing games and baking.