When food harms: navigating the scary world of food allergies

When Sarah Ortega’s son, Walter, was just a few weeks old, she noticed he would throw up and have issues after nursing.

The Harrisburg mom took him to multiple doctors, but each one had a different explanation for his vomiting – reflux, not eating enough, eating too much, in need of formula, needing to be burped.

“It was pretty torturous hearing my weeks old baby cry and knowing he was going to throw up all the time,” she says.

When he was around 1 to 2 months of age, Ortega took her son for a gastrointestinal scan. He was diagnosed with high-level reflux and prescribed a medication for that.

“It fixed nothing,” she says. “So, we were given two medications. Again, no difference.”

Frustrated, Ortega attended a local breastfeeding group to vent. Almost immediately, other moms suggested her son may be allergic to something she was eating and passing through her breast milk. After visiting a lactation consultant – where she discovered he was overeating naturally, though correcting this didn’t fix the vomiting – she ceased all reflux medication and started a food diary.

“I used the free Cara app to track what I’d eaten and then what his symptoms were,” she says. “Pretty quickly I was able to diagnose problem foods. After only a few days, I decided to eliminate dairy and soy from my diet. A month later, he was better.”

Ortega gradually added dairy back in her diet and her son was fine. The culprit was soy.

“I discovered soy is in everything,” she says. “If I ate anything with soy, even soy lecithin, his problems came back.”

It’s been a few months, and Ortega has a better feel for what she can eat.

“Sometimes it still surprises us,” she says. “You get comfortable buying things and stop checking labels, then figure out the ingredients changed and now my son is vomiting again.”

Evolving recommendations

Researchers at Food Allergy Research and Education (FARE) estimate that 5.6 million children in the United States under the age of 18 have a food allergy. According to the FARE website, that’s one in every 13 children, or roughly two in every classroom.

“Ninety percent of food allergies in children come from six foods – milk, eggs, peanuts, tree nuts, soy and wheat,” explains Dr. Anthony Arlotti, a pediatrician at Geisinger Holy Spirit Pediatrics in Mechanicsburg. “It’s estimated that 80-90 percent of children with a milk, egg, soy and wheat allergy will outgrow them by age 5.”

In March 2019, the American Academy of Pediatrics (AAP) released new guidelines for preventing childhood food allergies and other allergic conditions, such as eczema. According to the AAP website, this includes introducing allergenic foods to babies as young as 4 to 6 months of age, in an effort to help reduce their risk of developing food allergies. For many parents, these new guidelines were alarming.

“If you go back as recent as five years ago, it was thought delaying the introduction of peanuts was the best route to go [to prevent peanut allergies]. So our recommendation had been to wait until after age 3 to introduce peanuts,” Dr. Arlotti says.

But observations of baby feeding practices in Israel actually influenced new standards for introducing peanuts specifically, he says.

“What they found is that in Israel, there is a lower percentage of kids with peanut allergies,” Dr. Arlotti says. “At around 8 or 9 months of age, they give their babies a puff snack that is a peanut-based product. And what was taken from that, is that the earlier introduction actually reduced the likelihood of a peanut allergy.”

The new recommendation to introduce peanuts earlier is one that can be met with hesitation.

“It’s not even a generational difference,” Dr. Arlotti says. “It’s been a change in the last 10-year period. So, what you did for your last child may not be what you do for your new baby.”

Around 9 months of age, Dr. Arlotti advises parents that their child can have any food – except honey which needs to be given after age 1 for an infectious reason – assuming they can get it in a form the child can handle.

“In terms of introducing peanut, I typically say to water down peanut butter and give it off a spoon,” Dr. Arlotti says. “It needs to be watered down because it can be a choking hazard. There are baby foods out now that contain peanut and they are also an option.”

Staying safe at school

 For many parents of children with food allergies, ensuring safety at daycare or school can be nerve-wracking. Julie Reichard, RN, a school nurse at Bellaire Elementary in Carlisle Area School District, assures parents that as long as the school is informed of the allergy, they do everything in their power to make sure the child is safe.

“First and foremost, we need parent participation,” she says. “We have an online form that parents fill out each year that has contact numbers, allergies, medical issues, medications allowed to have a school, medications they carry, medications they take home, etc.”

With the initial form returned, Reichard follows up with the families of children with allergies to have them complete an allergy action plan.

“This form is signed by their doctor and lists medications we are to give depending on the severity of their allergy,” she says.

If a student needs an Epi pen as part of their allergy action plan, the school will have one on hand along with an order for school permission to administer it in case of emergency. Reichard then works with teachers and cafeteria staff to create safe areas in the classroom and at lunch time.

“We inform teachers of the students’ allergies and based upon severity, we may need to make allergen-free zones in that specific class, with signs, and also in the cafeteria,” she adds. “The staff in our cafeteria also have lists I provide with the names of students and their allergies.”

An allergen-free table (or zone, depending on severity) in the cafeteria will be cleaned between classes to ensure safety during lunch.

Communication is key when there is a student with an allergy.

“If the class is an allergen-free zone – let’s say for example, peanuts – a sign would be placed in the classroom and anytime there is a class party, a notice would go home to remind parents they may not send anything with peanuts or anything that has been made in a facility with exposure to peanuts,” Reichard says.

In case of an allergen emergency, all school staff know how to care for the student in need – they are mandated to complete education on recognizing allergic reactions and Epi pen training each year.

“If a child has an allergic reaction, we refer to their allergy action plan and act accordingly,” she says. “If there is no allergy plan in place or this is a new onset, the school would administer an Epi pen as needed, and be in contact with the parents and call for an ambulance.”

The challenges of eating

Beth Martini of Mechanicsburg has a daughter with a tree nut allergy diagnosed shortly before her second birthday.

“We always have an Epi pen and Zyrtec with us wherever we go,” she says. “We barely went out to eat or went to the same places we knew were safe.”

Martini and her husband are both pastors, so church potlucks were initially really scary. “Our congregation has gotten really good at putting labels out like ‘contains nuts’ or ‘gluten free’ for the people with celiac disease.”

She acknowledges that navigating the allergy when her daughter was youngest was the hardest period.

“The scariest time so far was when she was littlest and we had to watch what she’d put in her mouth,” Martini says. “Not that she’s 4 years old, she is very good at asking about nuts and telling people about her allergy.”

Sykes advice for parents? Embrace the new normal.

“My struggle was learning how to make meals for my family again that weren’t boring and to embrace cooking from scratch,” she says. “I kept trying – and failing – to recreate dishes that we had eaten before like macaroni and cheese. Once I accepted that part of our life was behind us and embraced learning a new style of cooking, life became easier.”

Ortega makes sure to always pack food for her son and helps to educate people on reading food labels.

“Foods you wouldn’t think about checking can have soy,” she says. “My advice to any new parent is to trust your gut and find a good support group. Living with dietary restrictions isn’t easy and it can seem overwhelming. But having a group to recommend restaurants or foods your child can eat is wonderful. Or even just being able to talk about symptoms and get feedback from people who have been through it.”

Cassandra Davis, a communications coordinator and freelance writer, is a frequent contributor to Central Penn Parent.