Forethought is necessary as is the ability to educate those around you and in some cases such precaution may lead to limitations on the child's activities, especially in cases where those who are ignorant of the seriousness of the issue discount and do not respond to offered education. Another mom who is managing a child with a peanut allergy stresses the two hardest things about having a child with this condition:
What has been the hardest part about dealing with your child's peanut allergy for you? / Two things. First: Trust. Trusting that whoever is watching your child (be it at daycare or school or babysitting) REALLY understands the ramifications of her allergy. It doesn't matter if it's family or not, it's hard to trust another person with your child's care when they have a special need like this. I'm not worried about my daughter eating peanuts or peanut butter directly. I AM worried about her trusting an adult who doesn't know how to read a label (or won't bother to). / Second: Mortality. There's nothing more sobering than facing your child's mortality at an early age. Sure most parents deal with general fears about their kids getting hit by a car or talking to strangers. But having a child with a food allergy that involves anaphylaxis makes you think about your child dying. Alot. It isn't fun. (Peterson)
Fundamental education regarding the seriousness of food borne allergies is an essential aspect of helping individuals with allergies and other stakeholders appropriately deal with food borne allergies, especially when the allergens are exceedingly common, like in the case of peanuts. Full parental and caregiver education about the seriousness of the disorder is also something that still seems to be lacking. (Smith) (Peterson)
Broad Education is the Key
Individuals frequently report the feeling that the condition was downplayed or not given significant time and attention when diagnosis was made and achieving the point of diagnosis was not always easy either, as often with children exposures are not always so clear and allergy testing might not be seen as an option of first resort. With serious allergies it is also considered difficult to test as skin prick test are the safest method but a less safe less controlled option, food challenge testing might be seen as a better option for a child because of the traumatic nature of the prick testing, but this may not really be the case. Food challenges are commonly suggested in literature and elsewhere when food allergies are suspected as the cause of certain symptoms, and yet with the seriousness of single exposures to some food allergies at home, ad hoc and difficult food challenge testing can be very dangerous. A brief explanation of each type of test is needed:
Prick test; is a topical testing process where a long list of potential allergens are topically applied to the skin with a minor abrasion or even a very small needle, in a recorded patterned grid, usually on a person's forearm, though testing can be conducted elsewhere. The exposure of a minimal amount of the allergen is then reviewed by looking at the skin reaction and judging it by a predetermined scale of reaction seriousness. The test is then recorded and allergens are identified. Usually such tests are relatively conclusive and albeit minor can seem seriously traumatic for a child, but as has been stated they are done in a controlled environment with trained medical staff present. (Sicherer, Munoz-Furlong and Sampson) (O'B Hourihane, Dean and Warner)
Food challenge test; usually takes place over a longer period of time, and is often administered at home. The food challenge consists of exposing the child to a single new food for a set period of time, isolating new foods from others that have not yet been tested and when one produces symptoms of allergy removing it from the child's diet. The record keeping can be minimal and the length of the testing can vary, as can the exposure of the child to other exacerbating allergens during the test phase, which completely challenges the observer and can of course be dangerous as single exposures by people with serious food borne allergies can cause breathing related reactions. (Sicherer, Munoz-Furlong and Sampson)
Finally, a child may simply be diagnosed with a food born allergy after a known exposure that has caused a mild to serious allergic reaction, but especially if such a reaction is indicative of the type of reaction that can progress to anaphylaxis, head and/or neck swelling or any trouble breathing. All of these diagnostic options are likely to elicit some data that will help in the diagnosis but either can be potentially dangerous and could also produce inconclusive results. The protocol of pediatric and emergency physicians has swayed in the direction of administering (or prescribing) epinephrine, and asking questions later or in some cases diagnosing or referring to an allergy specialist upon any suspicion of a serious food born allergy. Yet, these protocols are not universal and again are relatively new, isolated to pediatric doctors and triage doctors who are at the battle lines of the problem and see serious cases on an almost daily basis. One thing that is very important is that a parent or caregiver must become an advocate for a child with a peanut allergy and if they do not feel they are getting the right treatment or answers from a particular health care provider they may need to simply go to someone else. Any individual with a suspicion of a serious food born allergy should be taken to see a specialist, who will guide the individual and his or her caregivers through the process of gaining the knowledge needed to manage the allergy, including but not limited to explaining the seriousness in no uncertain terms and in teaching identification of serious progressive symptoms. A brief synopsis of recognizing allergic reaction is offered by Dr. Michael C. Young:
4. How can I tell if a child is having an allergic reaction? What should I do?
The most common reaction is a feeling of itchiness and a red rash, particularly around the mouth where the food comes in contact with the skin. If the rash and itchiness are self-limited and not associated with other symptoms, your doctor may recommend treatment with an antihistamine such as Benadryl®. If the rash is widespread and other symptoms emerge, the reaction is considered systemic or anaphylactic. Swelling of the tongue and throat, difficulty breathing, abdominal pain, vomiting, and a change in the level of alertness are all danger signs of possible life-threatening anaphylaxis. A child displaying these symptoms needs immediate medical attention. If the child has a prescribed EpiPen®, it should be used promptly. Once the EpiPen® is used, the child must be brought to the nearest medical facility for observation as there is the possibility that a delayed reaction (up to 4 to 6 hours later) may occur, requiring additional treatment. (Young)
This synopsis offers a great starting point for global discussion about the issue and should be offered to everyone that an individual child, suspected of a food allergy is around. This should include, teachers, playmates, parents of classmates and anyone else who might unwittingly expose the child to the allergen. For many children there are second chances with regard to exposure to allergens but for others there are not and every means should be employed to ensure the safety of the child. Broader community awareness campaigns are also an important aspect of reducing mortality in these cases. (Smith) (Peterson) (Clark) (Young)
This work has offered significant insight into the seriousness and the increasing prevalence of peanut allergy among children. Issues associated with lifestyle affect as well as, recognition, diagnosis and management of the condition were fully explored. The causation of the disorder and the increasing incidence were discussed and at least one possible "cure" was discussed. Changing the manner that individuals affected and the broader community views the issue of peanut allergy is the key to reducing the number of premature deaths in children, which has been associated with it. Parents of children with the condition, as well as expert researchers and clinicians express that the seriousness of the problem has been downplayed and that this should be mitigated with broader and more specific education regarding the condition. There is no doubt that solving the riddle of the causes of this condition is going to take some time, if it ever occurs but in the mean time effectively managing the condition is absolutely essential.
Clark, Dr. Andrew. Interview: Childnen's Peanut Allergy Cure on Its Way eNotAlone.com. http://www.enotalone.com/article/21156.html, 3 March 2010.
Grundy, Jane, et al. "Rising prevalence of allergy to peanut in children: Data from 2 sequential cohorts." Journal of Allergy and Clinical Immunology 110.5 (2002): 784-789.
Lack, Gideon, et al. "Factors Associated with the Development of Peanut Allergy in Childhood." The New England Journal of Medicine 348.11 (2003): 977-985.