House CallFeb/Mar 2013 Issue

Allergies Q & A- Nut Allergies, EpiPens, Dating with Allergies, & More!

Medical experts answer your questions about allergies and sensitivities

Smooch Carefully

I’d like to ask out a girl who has nut allergies and I’m wondering about kissing. Would I have to watch what I eat?

Dr. Pistiner Yes, food allergens can be transferred through saliva. There are reports of allergic people experiencing symptoms after kissing. A study conducted a few years ago by Jennifer Maloney, MD, and colleagues backs this up. It showed that soon after eating peanut butter, salivary levels of peanut protein were high enough in some to cause a reaction. The same study found that some mouth-cleaning methods, like tooth brushing and using mouthwash, didn’t completely get rid of the peanut allergen. (Several hours later and after eating a peanut-free meal, salivary levels of peanut were no longer detected.) Sharing utensils, cups, water bottles or anything else that comes in contact with saliva should also be avoided. Before and during your date, play it safe and stay away from nuts.

Safety in Two’s

My doctor insists that I carry two EpiPens. Is this really necessary?

Dr. Lee Many physicians prescribe enough epinephrine autoinjectors so that there always will be two with the child at all times. There are reasons for this recommendation.

If you’re experiencing a life-threatening allergic emergency and not comfortable with using your autoinjector, mistakes can happen. I know of people, even those trained on the appropriate use of an autoinjector, who held it upside down in moments of high anxiety and accidentally injected their finger (rather than their child) or they didn’t keep it pushed against the thigh for a full 10 seconds. A second autoinjector is useful in these instances. The point here is to prepare as best as you can by regularly practicing and training others how to use your autoinjector—and to have a backup, just in case something goes wrong.

The other reason to have a second epinephrine autoinjector is that you may require an additional dose. Symptoms of anaphylaxis can respond very rapidly with epinephrine. However, in some cases, these symptoms can return quickly. There can also be a biphasic reaction, where symptoms reoccur a few hours after the initial reaction.

A few years ago, a study found that 12 percent of children seen in the emergency room for anaphylaxis required more than one dose. This is why guidelines established by the National Institute of Allergy and Infectious Diseases state that a repeat dose may be required 5 to 20 minutes after the initial one.

Cupid Day

My little boy was just diagnosed with multiple food allergies. I’m worried about all the Valentine’s Day activities coming up with his friends and in his classroom. Any advice?

Dr. Pistiner Work closely with your son’s allergist to gain full understanding of all safety issues and food allergy management strategies. Also, touch base with your son’s teacher and school nurse to determine classroom and school food-allergy policies and avoidance measures. It’s safest if classroom celebrations are food free but this isn’t the case in most schools.

It’s hard for food-allergic children to watch as their friends devour delicious-looking goodies that they can’t eat. Have a supply of safe, suitable treats available for your child so that he doesn’t feel left out. It’s also important to empower and prepare your child to advocate for himself. Have open discussions about the particular challenges he may encounter on Valentine’s Day and teach age-appropriate strategies to deal with these. Instruct him to avoid eating foods unless he knows they are safe. Role-play with him so that he has lots of practice and is comfortable saying, “No, thank you,” in various scenarios.

You should be aware that common Valentine treats and chocolates are notorious for containing hidden ingredients, especially peanuts and tree nuts. Mini-candies are sometimes processed in different facilities than larger versions of the same candy brand, so ingredients can change unexpectedly. If your child is not yet reading, teach him to wait until a trusted adult checks labels and tells him a product is safe.

Much like Halloween, Valentine’s Day offers increased chances for cross contact with allergens. Knowing the risks and preparing for them before February 14th lowers the likelihood of accidental exposure and allergic reaction.

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