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House CallApr/May 2013 Issue

Allergies Q & A- Egg in Baked Goods, Allergic Disease, and More!

Medical experts answer your questions about allergies and sensitivities

Egg in Baked Goods

My child is egg allergic. Can he eat baked egg products like cakes, pancakes or muffins?

Dr. Lee The answer to this question shows how medical thinking about food allergies has changed. Several years ago, your doctor would likely have recommended strict avoidance of all eggs, including baked egg products. Today, it’s clear that egg-allergic children have varying levels of tolerance. Some must strictly steer clear of all forms of egg while others can eat egg in baked products.

When an egg is heated, its protein degrades enough that certain youngsters can tolerate it. Mixing egg with flours may also make it less allergenic. Ovomucoid, a heat-stable protein in egg, may be primarily responsible for the differences in tolerance. A low allergy to ovomucoid can help predict if an allergic child may be able to eat baked egg products. At Boston Children’s hospital, we test for levels of ovomucoid-specific IgE in the blood. If that value is low enough, we consider conducting a “baked egg” food challenge. This test isn’t perfect; I’ve seen children with low ovomucoid values develop serious allergic reactions during these food challenges, so great care must be taken.

Dietary recommendations should be specifically tailored to each individual. Anyone with egg allergy should always discuss with their physician how and when to introduce egg into their diet—or not.

Allergic Disease

My niece was just diagnosed with eosinophilic esophagitis. I’ve never even heard of this. What is it?

Dr. Lee Eosinophilic esophagitis, called EoE, is a relatively new disease with first incidences reported in the 1980s. Since that time, prevalence has increased rapidly. Reasons for this are yet unknown

EoE is characterized by an inflammation of the esophagus, defined by the presence of eosinophils, immune cells in the body whose numbers often increase in allergic conditions. Symptoms, which vary from person to person, can include poor weight gain, reflux, vomiting, heartburn or difficulty swallowing. The cause of the inflammation is typically due to food allergies, particularly in children. However, in most cases, children don’t show the classic signs of food allergies, such as hives, wheezing or throat tightness, which makes diagnosing EoE more difficult. It’s essential that the diagnosis of EoE be confirmed since acid reflux disease can have identical symptoms. Treatment strategies range from food-allergy elimination diets to swallowed asthma medications, such as Flovent or Pulmicort.

Several major medical centers now offer multi-disciplinary teams of allergists, gastroenterologists and dietitians who specialize in EoE. Anyone with EoE should be working closely with a physician who is experienced in managing and treating the disease.

Food Taunting

My food-allergic son is starting to get bullied in school. It’s upsetting. Any advice?

Dr. Pistiner It’s challenging enough to manage a food allergy, yet alone get bullied for having one. Unfortunately, being bullied over food allergies is not uncommon. A new study confirms a growing number of children are being taunted and harassed due to their food allergies (see page 72). Just like every other form of bullying, the school should not tolerate this. When it comes to this type of harassment, there’s increased urgency since allergen exposure can lead to a life-threatening reaction. Here are some steps that you can take:

Talk to your son’s school. Call a meeting with the school nurse, teacher and principal. Discuss these incidents and emphasize that this behavior is completely unacceptable. Find out what policies they will put in place to stop this. Then follow up to be sure the changes are implemented.

Encourage your son to share his feelings. The fear of being teased at school can make him feel ashamed about having food allergies. Let him know in very clear terms that there’s nothing to be embarrassed about. Have him understand that bullying can be stopped if he alerts an adult when these episodes occur.

Consult your healthcare provider or a mental health professional if you notice a significant change in your son’s attitude or school performance, a drop in participation in activities, sadness or anxiousness or any other changes that concern you.

Increasing overall awareness throughout the school community is an effective way to ward off further bullying. It comes down to educating students, school staff and other parents about food allergies. Kids get teased when they’re seen as “different.” It helps if students understand why a classmate with food allergies must do things a bit differently to stay safe and healthy. With increased awareness comes support and empathy.

Teachers and other staff are on the front lines in promoting awareness in the classrooms and also monitoring and preventing bullying. Educating staff about food allergy prevention and preparedness gives them the tools they need to teach understanding and empathy. It also makes them more aware of potential situations where bullying may occur.

Some parents may resent food allergy policies, feeling they are arbitrary or inconvenient. The more parents understand about food allergies, the more likely these feelings can be dispelled. It’s then hoped that these parents instruct their own children about the importance of kindness and respect for others and model those behaviors themselves. Ultimately, education fosters an environment of understanding and tolerance throughout the entire school community.

It Takes a Village

What should my neighborhood area know about food allergies? I’m trying to get the word out. Is there a way to simplify the message without watering things down?

Dr. Pistiner There are three important points to get across: Food allergies are real. They have the potential to be life threatening. They are completely manageable with proper intervention.

The local community can play an important role in supporting food-allergic families by taking allergies seriously and understanding the strategies to manage them. It’s good to remember that anyone who has contact with children with food allergies can positively impact their self-esteem and health. Additionally, the community can act as a safety net, helping to protect children (and adults) from accidental exposure and, if trained, assisting with the recognition and proper treatment of allergic reactions.

Simple Safety

Can you give me any tips for preventing an allergic reaction?

Dr. Pistiner The answer is simple but not easy: Avoid your allergen.

Read labels and learn the current labeling laws. Allergens can be “hidden” in food products. If the ingredients in a product aren’t clearly labeled, it is safest not to eat it. Manufacturers can change the contents of their products at any time, so it’s important to always carefully check the ingredients. Some companies include advisory statements like “May contain traces of ….” or “Made in a facility that also produces ….” It’s safest to avoid food items that have these statements on the label. In addition, remember to read labels of skin products and medications, as these can also contain food allergens.

The presence of an unknown or hidden allergen is a frequent cause of allergic reactions. Allergens are not neutralized by heating or drying. Contact with even small amounts can cause serious reactions. Common sources of contamination are serving and eating utensils, cups, dishware, hands, aprons, sponges, dishrags and any objects that have contact with food or saliva. Special attention should be given to young children who frequently explore their environments with their hands and mouths. Clean hands thoroughly with soap and water or hand wipes. Scrub eating surfaces with soap and water or commercial cleaners. Also remember to communicate clearly with anyone responsible for preparing or handling food items that may be eaten by a person with food allergies.

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