When doctors diagnosed Elizabeth Pagel-Hogan's son with a peanut allergy at age 7, she was surprised, worried -- and stressed. "I didn't know anything about food allergies," she says. "I thought we'd be limited or constantly on edge."
Now that her son is 11 and she has a few years of experience under her belt, she says she understands better what precautions to take to help her feel less anxious and more confident. "I've slowly become less scared-aware and more calm-aware," she says.
When it comes to a potentially life-threatening peanut allergy, knowledge -- and preparation -- are power. The more you know about your child's allergy and how to prevent and treat a reaction, the better. Ready yourself with these tips:
Complete a Food Allergy Action Plan
A food allergy action plan -- also called a "food allergy and anaphylaxis emergency care plan" -- is a document that outlines exactly what to do in case of an allergic reaction. Your doctor should give you one at the time of your child's diagnosis. If not, you can get them online from sites such as Food Allergy Research & Education (FARE).
"They're especially useful for kids, because they list your child's weight and the correct doses of medications to give them," says Megan O. Lewis, pediatric nurse practitioner and program manager at the Food Allergy Center at Children's Hospital of Philadelphia. "It also lists the symptoms that could occur in each body system, so you can check to see if the child is having an allergic reaction."
The form also explains whether to start with an antihistamine or go right to epinephrine to treat an allergic reaction. The last part lists who to call and what to do once you've given the medications.
"It's really helpful if families can keep that anaphylaxis management plan with the child along with their epinephrine auto-injector so it's all together," Lewis says.
You can laminate a copy to keep in your medicine cabinet or on your fridge. Your child's school or day camp should also have a copy.
Pagel-Hogan says she's more selective about who to share the plan with now that her son is a little older. "We have a written plan for school, but not for soccer or birthday parties, for example," she says. "My son and his older brothers all know what to do if he has a reaction."
Learn About Prevention Measures
A type of preventative treatment called oral immunotherapy can help reduce the severity of your child’s allergic reaction to peanuts. The FDA has approved a capsule of peanut powder called Palforzia. The generic name of this medication is "peanut (Arachis hypogaea) allergen powder-dnfp." It has a specific amount of peanut powder your child takes. It works by slowly introducing the body to small quantities of allergens.
In an allergist’s office, your child gets small, increasing amounts of peanut protein through the capsule. Then they come back the next day and start on a daily dose. They continue on that dose at home for about 2 weeks and then come back to the allergist to increase the dose under medical supervision.
“The goal is to reach low-dose daily maintenance, for instance 1 peanut per day, or 300 mg,” Lewis says. “Some families just want to just be safe and worry a bit less, while others want their child to be able to eat a peanut butter and jelly sandwich.”
There are a few risks. Lewis says oral immunotherapy works in about 80% of people, but about 20% have reactions such as abdominal pain or anaphylaxis. Close supervision from a doctor is critical for safety and success.
Educate Your Child
Even very young children can understand their peanut allergy to some degree. As they age and spend more time on their own away from you, they'll take on more of the responsibility for the allergy, too. You can start talking honestly with them as soon as you get their diagnosis.
"You can say that their body doesn't like peanuts, and that eating them will make their body react in a way that doesn't feel good," says Amal H. Assa'ad, MD. She's associate director, Division of Allergy and Immunology, at Cincinnati Children's Hospital Medical Center.
Help your child understand that certain people are OK to accept food from, like their parents, grandparents, or other caregivers who know about their allergy. Kids may need to be told that they can say "no" to offers of food from others.
"Teach them to ask if foods have peanuts in them when someone other than their trusted adults offer," Assa'ad says. And let them know that sharing food is a no-no.
Take Treatment Seriously
Be sure you know exactly how to use your child's epinephrine auto-injector. Use the practice device that comes with the actual medicine to get comfortable with how it works. Teach the key adults, siblings, and friends (who are old enough) in your child's life how to use it. And most importantly: Keep it near your child at all times.
"We try to impress upon parents that people who have had adverse outcomes from severe allergic reactions to peanuts were the ones who did not get epinephrine within the first half hour," Assa'ad says.
Make it a habit to pick it up along with your keys or bag whenever you leave the house with your child, so you have it with you wherever you are.
"For a lot of families, what works is to keep a grab bag by the back door," Lewis says. But be sure you don't leave it in a place where it will get very hot or very cold, or the medication won't work the way it should.
"There are lots of aids available online to help keep your medicine from going bad, too, like ambient temperature packs," Lewis says.
When peanut proteins mix into another food after touching it, it's called "cross-contact." Someone may have used a jelly knife in the peanut butter jar before you get to it, for example, and even if they've wiped most of it off on a napkin, some peanut protein can still stick around. That can be enough to set off a reaction.
Washing utensils and dishes with warm soapy water, rinsing, and letting them air-dry is the best way to be sure they're allergen-free.
Lewis says it's important to know that if the allergen gets on your child's skin, you don't need to worry about a full-blown allergic reaction. "They might get some redness on the skin, but you can remove it by just washing it off," she says.
Also important to know: Hand sanitizer doesn't remove allergens, so stick with soap and water to get them off your skin.
Talk to your child's allergist about food labels, too. Some kids need to be cautious with products made in facilities with peanuts, for example, while other kids may not.
"It really depends on the child's level of sensitivity," Lewis says. "Precautionary labeling wasn't around 10 years ago; families just learned to do without. So while it's well-intentioned, it's made things a little more complicated, I think."
A good understanding of your child's specific limitations can help you have more confidence about what you're feeding them.