Approximately 1 in 13 children and 1 in 10 adults in the United States have food allergies. These are common conditions, yet it still feels like an uphill battle to raise awareness and keep my child and me safe. Despite widespread understanding that these conditions exist, there is still open hostility towards measures to protect those suffering from food allergies and a significant amount of misinformation about food allergies.
Here are a few things I wish people understood about food allergies.
1. They are life-threatening conditions.
Yes, many reactions may present as hives, a mildly itchy throat, or some minor swelling. But allergic reactions can be unpredictable, and a history of mild reactions doesn’t exempt someone from anaphylaxis. For that reason, it is said there is no such thing as a mild food allergy, only mild reactions. When anaphylaxis occurs, it is an acute medical crisis. When they occur, failure to identify and treat systemic (i.e., severe) reactions are associated with an increased risk of complications, including death (e.g., here and here).
And, by the way, peanuts are not the only allergen that results in severe reactions. Indeed, any allergen can cause anaphylaxis. Nine allergens account for most food allergies (peanut, tree nuts, egg, milk, soy, wheat, shellfish, fish, and sesame), with peanut being one of the more common food allergens. However, people can be allergic to almost any food. And while peanut allergies are well known and often well accommodated, rarer food allergies are not. That lack of awareness can kill.
2. The best treatment for a severe reaction is epinephrine, and you should never hesitate to administer the drug when in doubt.
Epinephrine (known colloquially by the brand name epi-pen) is a safe and highly effective medication for treating anaphylaxis (when used as prescribed). When patients go to the hospital after administration of epi, it is not because the medication is dangerous. It is to monitor for and treat any ongoing reactions if the medication is not effective enough or in the event of a second reaction once the medication has worn off.
Because epinephrine is generally considered a safe drug, and the consequences of not treating anaphylaxis promptly are severe (see here and here for examples), it is recommended to always administer the medication if there is even suspicion anaphylaxis occurs. Of course, patients should always follow their individualized medical plan developed in consultation with a qualified physician first and foremost, but this is the broad advice available within the medical community.
3. Managing food allergies isn’t as simple as not eating your allergen.
If only it were as easy as not consuming your allergen if you see it in food! Yes, strict avoidance is recommended, but what does that look like in the lives of food allergy patients? In part, it means avoiding cross-contact, which occurs when allergic proteins transfer to an otherwise safe food due to shared prep space, cooking materials, plates, or even during the ingredient manufacturing, packaging, or shipping process. One protein is all it takes, so a slight brush with a problematic product is enough. So, no, don’t just scrape the cheese off the burger of someone with a dairy allergy!
Think food labels should let us know if food is safe? You’d be wrong if you believed that! Companies must only label for top 8 allergens if they are included as part of the recipe (and the top 9 starting 1/1/2023). That means inadvertent inclusion of allergens due to shared production lines is not required to be disclosed. “May contain” statements are neither required nor regulated.
And any allergy beyond that top 8? Those can be included as a sub ingredient if under a certain quantity and included within a larger component such as “natural flavors,” “spices,” “glaze,” etc. The result is food products can include allergens and not disclose them. Such components are considered “proprietary,” Companies do not have to disclose whether your allergen is in the product, even if you contact them to ask.
These labeling regulations also only apply to food regulated by the FDA. Raw meats, bath and beauty products, and other products must label for much, much less. And allergens frequently occur in some of these products; nut and seed oils are ubiquitous in bath and beauty products. My child’s worst reaction was to lip gloss, and there was no indication on the label the product would be a problem.
The result of these labeling loopholes is food allergy patients often have no clue if what they are eating is truly safe. No one should worry doing something necessary to sustain life (like eating) could result in their death.
4. Reactions don’t just look like hives, an itchy throat, swollen mouth, or difficulty breathing
Yes, sometimes allergic reactions look like that. But other times, they look like vomiting, increased heart rate, anxiety, or a wide range of other symptoms. The signs of anaphylaxis are diverse, making determining a reaction challenging.
5. Food allergies are a disability covered by the Americans with Disabilities Act
If you have food allergies, you are generally viewed as entitled to “reasonable accommodations” due to a disability, as dictated by the Americans with Disabilities Act. That nut-free classroom people complain about? It isn’t about being difficult. It is the right of students to go to school in a safe environment because cross-contact can occur as easily as a friend sharing a pencil with a peer after eating peanut butter crackers and not washing their hands well enough (I won’t even start with airborne allergens!) allergen free environments are one way to ensure accommodations.
6. Being inclusive matters and helps those beyond food allergy patients.
Food allergy families often use trinkets instead of food treats for celebrations. But nonfood treats are great for everyone! You ditch the sugar and provide something that lasts longer than food. Plus, trinkets have another advantage of being inclusive of everyone. Those with diabetes, FPIES, EoE, food intolerances, or other medical conditions may also not be able to eat certain foods. Those with sensory processing differences may not like the texture or taste of certain treats. And some kids aren’t a fan of candy (I promise they do exist, even if few and far between). Substituting food for things like stickers, stamps, small toys, etc., ensures a more accessible celebration; remember to be on the lookout for allergens like wheat in playdough, seed oils in sticker adhesives, or latex!
I hope one day we will find a cure for food allergies. Until then, however, we need more than simple awareness. We need a deep understanding of the conditions on a broad scale and compassion towards food allergy patients.
