Our children have been allergic to peanuts since they were babies, breaking out in hives when there were even trace amounts in any food they ate. So we’ve listed their allergy in all the forms we fill out each year for the school, and avoided bringing peanuts into our home.
This year one child brought home a form that asked us to provide the school with an EpiPen, or get documentation from a doctor that showed he did not need it.
Mylan, the company that makes the EpiPen with injectable epinephrine for anaphylactic reactions caused by food allergies, has been marketing the device so effectively that in many schools, if a child is listed as having food allergies, parents are asked to supply the school with an EpiPen every year as a precaution.
But not everyone needs it, as we found out. Children do outgrow food allergies — even severe ones — and it’s better to get them retested, rather than assume they are still allergic and keep refilling expensive prescriptions. Aside from hives, our children had no life-threatening reaction to peanuts, thankfully, so we had never gotten a prescription for an EpiPen. When the school sent the request home, that’s when we went to an allergist.
After a skin prick test, a blood test to double-check results, and an oral sample of peanut butter that was given while in the clinic, we found out both children had outgrown their peanut allergy and would not need any medication.
This was an eye-opener for us. Children do commonly outgrow dairy and egg allergies, but statistics show it’s possible to outgrow other food allergies too.
“Eighty percent of kids will outgrow egg, soy, milk and wheat allergies, about 20% will outgrow peanuts, and 15 to 20% of those with fish and shellfish allergies will outgrow it,” says Stephanie Leonard, MD, director of the food allergy center at Rady Children’s Hospital in San Diego.
This is why it’s important to get children tested. Allergists recommend retesting, every year or every other year, depending on the severity of the allergy, before filling prescriptions for allergy medicines and restricting food habits.
Why Test? Impact on Quality of Life & Nutrition
But on checking with many friends and acquaintances whose children have food allergies, we found that very few actually went in for retesting. On the soccer field, at school events and at birthday parties, parents routinely caution kids to not eat specific foods, and alert the organizers.
“I’m often surprised when someone is told they have an allergy 7 to 8 years ago, especially with milk and egg, and they haven’t had it tested since then,” says Andrew MacGinnitie, MD, an allergist-immunologist with Boston Children’s Hospital. “If [cakes or cookies are] very well baked with egg and milk in it, about two-thirds of kids with those allergies can eat them… but parents don’t know that. It’s no fun to not be able to eat egg when it’s in cakes and cookies.”
Indeed, our friend’s son, who is allergic to egg but has never been tested, has to forgo cake and ice cream at birthday parties, while all his friends dig in.
Leonard concurs, pointing out that studies have shown having food allergies decreases quality of life, and it’s something you have to think about every time your children have food in public. Avoiding the food is safest, but if they’ve outgrown it, it’s worth retesting to see if they still need to carry the emergency medication. Plus, needlessly avoiding certain foods for an allergy a child may not even have any more robs them of essential nutrition.
Lack of Guidelines for Testing
Part of the reason many parents don’t realize they should periodically retest is because of misinformation — many assume severe allergies cannot be outgrown.
“There is an emotional and psychological cost, not just economic cost, to allergies. Sometimes there’s lack of knowledge or experience about getting tested. It used to be easier for people to say, why don’t you just avoid it? But that attitude is changing rapidly,” explains Brian Schroer, MD, a pediatric allergist with Cleveland Clinic Children’s Hospital.
It’s not just the public that’s misinformed. Parents might check with pediatricians who may not be aware of the need to retest more often, and advise them to wait a few years.
“Many primary care doctors, pediatricians, and even some allergists were trained 10, 15, or 20 years ago, when these allergies were not so common,” Schroer says.
And as he points out, allergy tests themselves are not 100% conclusive, which is why allergists sometimes go a step further after the routine skin prick test and order a blood test. As a final step, they administer a small oral sample of the allergic food, such as egg, peanut butter or soy, and have the patient wait in their office and observe reaction. If there is no reaction, they give a larger amount and repeat the cycle, until they know for sure.
For younger children, allergists recommend testing once a year, since reactions can change rapidly. For older children who show high levels of reaction in tests, they recommend testing every 2 to 3 years.
MacGinnitie referred to a study that showed that for every year that patients did not retest, and parents delayed introducing certain foods, the costs for medication like the EpiPen and other costs associated with avoiding allergic foods added up to about $4,000 per year, per patient.
“I’m skeptical about the numbers, but even if it’s half of that number, it’s still too much,” he says.
While there is more awareness about food allergies, thanks to all the marketing literature in the public domain, there’s not enough awareness about what constitutes a severe allergy, what’s not severe, and how to deal with it, he explains.
“There aren’t any published guidelines saying you should retest peanut allergies every two years or for wheat… so you need an allergist to sort it out, and often it takes some time for that to happen,” says Kimberly Leek, MD, a pediatrician with the University of California, San Diego’s Academic Pediatrics and Adolescent Medicine. “I think allergists need to guide us on when to suggest testing and retesting.”
Why Are Food Allergies on the Rise?
More and more people seem to be allergic to one food type or another, although the causes are not clear.
“One wrinkle I would add to that is that some patients were never even allergic in the first place,” says Schroer. “I won’t blame the parents, but when kids have skin rashes like eczema, doctors attributed it to food, which we now know is not because of food but a skin disease.”
Allergies can be based on fuzzy knowledge, Leek agrees. “They could be allergies that never existed and allergies that were misdiagnosed. You have a parent with a baby who has cow’s milk allergy, which should be outgrown in 9 to 12 months, but parents interpret a sensitivity as an intolerance, such as diarrhea after eating nectarines.”
When a parent tells Leek that their child has an allergy, she immediately asks them how they know, how it was diagnosed, who told them they had an allergy, have they seen an allergist, what kind of testing was done and what allergy plan they have in place.
Another cause for rising food allergies is delaying the introduction of certain foods. One mistake the medical community made in the past, MacGinnitie says, was in telling parents to delay introducing common allergens such as dairy, soy, egg and nuts to children. New research shows that introducing peanuts early can actually help avoid allergies to them.
The bottom line is even if your children have been tested in the past for food allergies, it’s a good idea to get them tested again to see if they have outgrown them. If they have, not only will they be happy to eat foods again they have long avoided, you won’t have to worry about carrying around an EpiPen. And now that they’ve been cleared of food allergies, our boys are enjoying an all-American treat that they never could before, peanut butter and jelly sandwiches.
Padma Nagappan is a San Diego-based health and environment reporter. Find her on Twitter at @SavvyWordsmith and on muckrack.com/savvywordsmith.