06/05/2012 07:58 EDT | Updated 08/05/2012 05:12 EDT

How to Manage Your Child's Allergies

I will never forget the day my son was lying sick on the bathroom floor. Usually filled with boundless energy, twenty-two-month-old Addison was wrapped in a towel, his body limp and lethargic. His normally sparkling eyes, full of life, looked weak, and his typically glowing complexion was dull and pale. He was wiped out. I knew something was wrong. Really wrong. This wasn't a little cold or the latest bug going around. Addison's immune system was trying to fight something. My child's sick. Really sick, I thought as adrenaline raced through my body. Just moments earlier he'd been coughing, a deep, persistent cough that sounded like it was being caused by phlegm in his chest. I had turned on the shower and sat with him in the bathroom encouraging him to inhale the steam that surrounded us. I thought this would help break up the phlegm. But five minutes later, his cough was as deep as ever. Actually, it was worse, so I felt I'd made a mistake with the steam. I knew it was time to call our pediatrician.

For the next year, Addison and I were in and out of different doctors' offices.


At that first appointment, Dr. Pescatore did a blood test for food allergies. (The last doctor had done only skin tests, which aren't believed to be as accurate.) Even before that appointment with Pescatore, I knew Addison was allergic to milk and soy, something I'd discovered when he was an infant. I had nursed both of my children, but Addison ate a lot, so I never had enough breast milk to pump and store in the freezer for him. This was a problem if I had to go out and someone else had to feed him. I had needed a backup plan. Our pediatrician had suggested a milk-based formula, but my son broke out with a little reddish-colored rash on his cheeks immediately after I gave it to him. Obviously, he was reacting to something. When I gave him soy milk, the same thing happened.

Dr. Pescatore's more thorough testing revealed that Addison was allergic to more than a dozen foods! The list the doctor handed me, along with a color-coded chart, included black pepper, vanilla, cinnamon, and wheat. This was surprising at first. I'd never heard of anyone being allergic to some of those things (black pepper?). I was even more surprised when Dr. Pescatore told me to omit these foods completely from my son's diet. "Just try it for three months," he said.

He tried to reassure me, but honestly, I wanted to cry. All I was thinking was, How is it really possible to avoid all those foods? I'm no chef. I hesitated, because this was a lot to do. But once I set those feelings aside, I agreed, even though I really wasn't sure that I had it in me to do this. This task felt beyond overwhelming. But I thought about my son and his health instead of thinking about what I wanted to do.

At that point I did know a little bit about food allergies. All my life I'd been allergic (like my mother before me) to tree nuts (the only "nuts" I can eat are peanuts, which aren't technically nuts, but legumes), fish, and seafood.

As a result, I grew up very aware that I had to be careful. My daughter is also allergic to nuts, which I discovered when she was a baby. Still, dealing with nut and fish allergies is very different from dealing with a son with a long list of foods -- common foods that are everywhere -- to avoid.

I'll be honest. I've been doing this for five years now, and at times it is still overwhelming to have to monitor my children's food intake and be on guard for a reaction.

2012-06-04-thrivingchild.jpgExcerpted from the book The Thriving Child by Erica Reid. Copyright © 2012 by Erica Reid. Reprinted with permission of Center Street.


How to Manage Your Child's Allergies

Take Your Time Introducing New Foods

When Arianna was six months old, her pediatrician, Dr. Barbara Landreth, told me she was ready to try eating solid foods. Dr. Landreth gave me a feeding chart and told me to give my daughter just one food for two to three days, because that's a good way to check for food allergies. This was long before I knew Arianna had any allergies and two years before Addison was born.

I'd heard other pediatricians suggest offering your child different foods all at once, but I liked Dr. Landreth's more conservative and careful approach.

This was also the approach I took with Addison, because by the time he was starting to eat solid foods, I knew he was allergic to dairy and maybe sensitive to soy. So I took my time, introduced one food for two to three days, and watched for a reaction. The reasoning behind this is that if you give a child a few foods at a time and he has a reaction, you won't know which food was the problem. I strongly suggest you try this. It is very helpful.

Look for Subtle Signs

With allergies, we all look for the well-known reactions, the ones that are obvious, such as hives, swelling of the face, or the inability to breathe. But there are subtler signs of allergies or asthma. For example, my son ate eggs without a problem until he was around four to five years old. Then one day I gave him a fried egg. Instantly, he started snorting, and his nose was running--something that wasn't normal on an eighty-degree summer day.

This, it turned out, was a subtle sign of an allergy. Other subtle signs of an allergy include sneezing, coughing, throat itching, a headache, a skin rash, and an eczema breakout, among others. After that, I took him off all foods with eggs in them. No cake, no cookies. At that point his diet was already wheat-free, dairy-free, and gluten-free.

Now it was egg-free.

When Addison had that reaction to the fried egg, I thought back to the doctor who'd told me Addison was allergic to eggs, even though he seemed fine eating them. It turns out, as I have since learned, that you can become allergic to a food you've already been eating for a while. (More on this in the "Answers from Erica's Expert" section of this chapter.) Since then I have found out that Addison is allergic not to the entire egg but only to the white part. No doctor had told me that it is possible to be allergic to the yolk of the egg and not the egg white or vice versa. Normally when you think "egg," you don't think to separate the yolk from the white.

Read Food Labels

I read labels carefully and have tried to learn the alternate names for foods and ingredients that my kids and I are allergic to. For example, you can't have palm oil if you're allergic to certain seeds. And a food label that may not explicitly say the food has milk in it may in fact contain milk, as there are other words that mean milk, like dairy, or milk protein, like casein. I discovered this when I gave Addison rice cheese, thinking it was dairy-free, and he had a reaction. I researched the product further and learned that rice cheese contains a milk protein called casein.

If I have any doubts at all about a food, we don't eat it. I like to be on this side of caution. If I'm not clear about what an ingredient means, and I can't Google it or ask someone who knows, then I don't let my kids eat it. Period.

It's just not worth the potentially fatal risk.

Talk to Your Children About Their Allergies

This is important for a few reasons: First, I don't want my children to feel that there's something wrong with them or that their allergies were caused by something they did. Nothing is wrong with them and they did not do anything to cause their problem. Their allergies are just part of them, not something they asked for. I talk to my kids about their allergies. I do not make a big deal about it, but I want to inform them. Second, they need to know about their allergies because that information just might save their lives. For example, my son knows not to eat or drink anything at a playdate, party, or at school, and he knows to ask if a food is okay for him if he's never eaten it before or if he is unaware or unsure he's had it before.

Don't Leave Home Without Supplies

I never want to be caught unprepared. We live in New York City, where many stores are open 24-7 and where there are drugstores every few blocks, but I still keep important medications and other items on me at all times. It's too risky to assume that I can race to the store in the event of an emergency, so I never leave home without the following:

An EpiPen. I keep one in my purse, one in the car, and one in a kitchen cabinet. If my husband, kids, and I are attending an event and I am carrying a smaller purse (the kind that has just enough room to fit a cell phone, driver's license, lip gloss, and cash), I carry with me a few pre-measured, packaged spoons of Benadryl (they are called Children's Benadryl Allergy Perfect Measure pre-filled spoons) and an EpiPen. Get the dual EpiPen package, which contains two EpiPens and a practice EpiPen in one box. That way, if you mess up with one EpiPen, you'll have a backup. I also regularly check the expiration dates of any medications, such as our EpiPens and Benadryl. When they've expired, I make sure to replace them.

EpiPen instructions. You and your child may know how to work your EpiPen--and if you don't, practice, maybe on an orange, before an emergency occurs--but in the case of an allergic attack, you may not be the ones using it. A friend, teacher, or babysitter may be the person on hand to use it on your child, so keeping the instructions with the EpiPen is critical. (Note: Once you've used an EpiPen on your child, take him to the emergency room right afterward, because of the effect the medication can have on the heart and to make sure your child has received enough of the medication. The dose from the EpiPen may not carry him through, so he'll need to be monitored to

stop flare-ups. Though I carried an EpiPen for years, I didn't know this until I was an adult.)

Benadryl. The use of medication is not my first choice, but if my kids' mouths are itching, it may be an allergic reaction. For this, I give them Benadryl. I'm not going to play around. For me, Benadryl is like a credit card: I never leave home without it. This wasn't always the case. It wasn't until I had children with allergies that I thought to carry an EpiPen and Benadryl at all times for my own allergies. I have a few purses I use regularly, so I buy a box of Benadryl and put at least three pills in each purse, so if I switch bags at the last minute, I'm still covered. (And who knows? Someone else may need one, too.) The company that makes Benadryl also makes liquid Benadryl, with pre-measured spoons that are individually wrapped, so you don't have to carry a big bottle with you. Because liquid is absorbed into the bloodstream faster than pills, this is my first choice, so I carry both pills and liquid.

Albuterol inhaler. I rarely ever use this for my son, but you never know what's around the corner. Situations can arise, and I have to be smart, realistic, and prepared. I always take the inhaler on vacations, just in case (and have had to use it on Addison while traveling).

Medical bracelets. My kids wear medical bracelets that list what they're allergic to and give my cell phone number. It's a precaution I take, because you can never know what will happen. For example, if I drop them at a kids' club on vacation, I may tell one caregiver there that the kids have allergies, but another caregiver may come in later and not be given this information. The bracelets are just another precaution, another way to make everyone aware. And nowadays they come in many cute styles, so kids don't mind wearing them.

Your own food. I can't take a chance that a store, birthday party, airport, or plane will have something that my kids can eat, so my purse is always stocked with acceptable snacks. When we're traveling, I bring more than I think we'll need, so I'm ready in case of a flight delay or unexpected traffic. (More on that in chapter 7.) I carry these snacks in my purse because I live in New York City and don't drive a car. But if you're in your car a lot, keep it stocked with snacks. When we travel by plane, I always bring extra food, and this often includes applesauce and soy yogurt. Because these foods have a bit of a liquid consistency, they're not normally allowed through airport security. So I carry a signed and dated letter from Addison's doctor explaining Addison's life-threatening food allergies and that he needs to carry food with him on the plane. This has been a huge help on several occasions.