House CallDec/Jan 2012 Issue

Pediatric Allergies Q & A - Peanut Allergy, Heat-lable Proteins, & Mustard Seed Allergy

Toting Tots

My 8-year-old child is very allergic to peanuts. Is he old enough to carry an EpiPen?

Dr. Leo It depends. Some parents train their youngster from a very early age to wear a little backpack or fanny pack (to carry epinephrine) whenever he or she leaves the house. The child grows up accustomed to this idea and sees it as part of everyday life. Other parents don’t give that job to their child until they perceive he or she is old enough to handle it responsibly.

When this question comes up in my medical practice, I have a long discussion with parents about their food-allergic child’s personality and level of maturity. There is no standard that indicates all 8 year olds are ready to self-carry medication.

As much as I treat food allergies every day, I personally learned a lot about this topic from my daughter, who is nut allergic and happens to be 8.

This past summer, my wife and I participated in a family camp where the kids had free rein during the day. We allowed our daughter to carry her EpiPen and other medications in her backpack while she attended the camp events.

The camp counselors and staff did a great job making sure the kids were safe and that meals were eaten in a supervised environment but my wife and I spent the majority of the week dealing with lost backpacks. Over four days, we had to track down numerous EpiPens, in addition to various jackets, shoes and hats. Even after talking with our child and reinforcing the importance of keeping her medications close, there continued to be misplaced items. (Full disclosure: We had plenty of EpiPens and the staff carried them, too.)

Despite our child’s maturity in many areas, expecting her to be responsible for carrying her own EpiPen turned out to be unreasonable. We’ll continue to work with her in a loving way to improve responsibility but she may not have sufficient maturity for a while. What this means in other places like school, field trips and friends’ houses, of course, is that we as her parents must continue to remain very closely engaged.

By the way, allowing a child to carry his own medications is a very different thing than expecting him to self-administer them.

Change Reaction

What are heat-labile proteins?

Dr. Leo Proteins are the building blocks that make up many of the foods we eat. In a very general sense, they’re the molecules that our immune system recognizes and this recognition is the basis of food-allergic reactions.

Proteins can be affected and their shape changed by temperature, enzyme activity or chemical conditions. When they change shape, their chemical properties can change. Temperature is a common force for change in proteins that are heat labile.

The best example of a heat-labile protein is an egg. When a raw egg is heated and becomes hard boiled, the process can’t be reversed due to changes in the chemical structure of the egg proteins. The immune system that recognizes and reacts to egg protein may not recognize it after it’s cooked inside a cake because heat changes the protein structure. This is why some egg-allergic people can tolerate highly baked items like muffins but have difficulty with lower baked products like brownies.

Egg proteins are heat labile. In contrast, peanut proteins are heat resistant. They retain their chemical properties even after cooking—obviously, a challenge for peanut-allergic people.

Scientists and doctors are working to understand more about the properties of heat lability in order to help children and adults overcome their food allergies. Testing proteins on food-allergic individuals should never occur outside a closely supervised medical setting.

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Mustard Seed Allergy

Can you be allergic to mustard? My 6 year old had a reaction (hives and lip swelling) after he tasted mustard.

Dr. Leo Yes. Mustard is a known allergen. The allergy is much more common in Europe and parts of Asia where mustard is frequently used as a spice and condiment. There are several varieties of mustard but yellow mustard is most common in the United States.

Condiment mustard is actually made of the crushed seeds of the mustard plant. Since seeds (like sesame seeds) can often be allergenic to those genetically sensitive, some nut- and seed-allergic individuals may find they are also allergic to mustard.

Asian and Indian foods can be a source of mustard seed reactions, particularly in curries where the presence of mustard isn’t always recognized.

Mustard seeds are being considered part of food-allergy labeling efforts in countries like Canada, a major world producer of mustard.

Harvey L. Leo, MD, is a pediatric allergist with Allergy and Immunology Associates of Ann Arbor and an assistant research scientist with the Center for Managing Chronic Disease at the University of Michigan.

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