Living with Severe Allergies
Living with Severe Allergies
Being a parent to a child with allergies can cause a great deal of stress and anxiety, the constant checking of labels, trying to suss out what it all means and how risky ‘may contains’ could be. It can feel like a living nightmare, especially if you don’t have access to the right information.
That’s why when Nigel from The Hersham Hub approached the Anaphylaxis Campaign to write a short guide for parents of children with allergies we were happy to help. But, from years of experience, we understand that a huge article about everything that you should and should not do can be time consuming for busy parents and can go over your head, so we’ve created an easy to use FAQ guide, to make access to information quick and simple.
As a charity supporting those with and at risk of severe allergies this guide mainly discusses anaphylaxis, however mild allergic reactions are also mentioned, as well as intolerances.
How do I know if my child’s allergy is severe or not? Could it just be an intolerance?
Food allergy is a well-defined reaction of the immune system, food intolerance may or may not involve immune system mechanisms and has different features.
- cannot be confirmed by standard allergy tests.
- requires larger amounts of food, usually eaten over a period of time.
- can be resolved by careful elimination of the problem foods.
- Symptoms may be different to those of allergy (allergy symptoms listed below).
There is no single cause of food intolerance so there is no simple method of diagnosis other than elimination and reintroduction of the suspect foods. This involves excluding the foods from the diet to see if symptoms clear, and reintroducing them again to see if symptoms are provoked. This must be done under the supervision of a doctor or dietitian.
- can be confirmed by allergy tests such as skin prick tests
- can be triggered even without eating or even touching the allergen, this is called airborne allergy
- symptoms include; rash, swelling, vomiting, diarrhoea, abdominal pain and low blood pressure
There is a wider range of symptoms which occur if you have food intolerance than in the case of food allergy.
Someone with food intolerance may suffer migraine and unexplained fatigue (central nervous system), abdominal pain, bloating and frequent diarrhoea (gastrointestinal system), unexplained muscle and joint pains (musculoskeletal system) and unexplained nasal congestion and discharge (upper respiratory system).
In the case of food allergy the symptoms are more likely to be a swelling of the tissues (e.g. in the face or throat), a skin rash or hives, asthma, or – in extreme causes – a fall in blood pressure.
If you suspect your child to have an allergy or intolerance they should see their GP to have the cause identified.
If allergy is diagnosed rather than intolerance and the person is assessed as being at risk of severe allergic reactions then adrenaline will be prescribed to use during the event of a severe reaction.
How do I know whether to administer adrenaline or not?
Always discuss treating your child with their doctor or specialist as they know your case best, however as a general rule of thumb, if you are not sure it is better to use the adrenaline. It is very safe if administered correctly. If medication was not required the heartbeat could increase and the child may have palpitations for a few minutes. But there should be no serious side effects unless the child has coexisting heart problems. If adrenaline is used the child should always be taken to A&E.
A handy way to know if your child needs medication is to “Think ABC”
Airway – persistent cough, hoarse voice, difficulty swallowing, swollen tongue
Breathing – difficult or noisy breathing, wheeze or persistent cough
Consciousness – persistent dizziness, pale or floppy, suddenly sleepy, collapse, unconscious
If any one of these symptoms appear lay the child flat (if breathing is difficult allow to sit), inject with adrenaline and call 999.
A helpful resource, approved by BSACI, is allergy action plans available to download that your child can carry so you, and others, know when to administer adrenaline.
What if my child is still reacting after adrenaline has been administered?
If, after 5 – 10 minutes, the ambulance hasn’t arrived and your child’s symptoms have not improved, a second dose of adrenaline can be given
How many injectors should my child have at school?
The UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) advised in June 2014 that anyone who is at risk of suffering anaphylaxis should have at least two adrenaline injector devices immediately available for use. The MHRA report (May 2014) said: “It is acknowledged that in some cases, a single injection is not sufficient to achieve a response for a number of reasons, including severity of attack as well as the possibility that a dose has not been effectively administered; a second injection may therefore be needed.”
In cases where the risk of anaphylaxis is thought to be low, there is a difference of opinion among members of the medical community. While some doctors agree two injectors must always be immediately available, others believe it is sufficient to have one, arguing one injection is likely to be enough to treat symptoms until emergency medical help arrives.
This is a matter you should discuss with a doctor or specialist.
There are several different types of adrenaline auto-injectors (or AAIs) that are prescribed to those considered at risk of severe allergic reactions (or Anaphylaxis). These are Emerade, Jext, and Epi-Pen. A simple google search can help you locate their websites or you can speak with your doctor about the different options available for your child. Each brand also provides trainer pens so you, your child and other significant people can practice using their medication so they are prepared in the event of an emergency.
If your child’s allergy is not considered severe by a doctor or specialist antihistamines can help reduce symptoms.
What if my child doesn’t have their injector with them and they have an anaphylactic reaction?
We are aware that even though you can remember to take their medication everywhere and keep them away from their allergen mistakes can be made and medication can be forgotten. In the event of an anaphylactic reaction and medication is not accessible the most important thing to do (even if you only suspect a reaction) is to call 999 immediately and say your child is having an anaphylactic reaction, lay the child down (or sit them if having difficulty breathing) and raise their feet. If you have other relevant medication such as antihistamines and/or an asthma inhaler, these may help with some symptoms until the ambulance arrives.
We would like to eat out but are too anxious about my child’s allergy, what can we do to reduce risks?
Our website offers an exclusive member benefit ‘Tried and Trusted’, a forum where allergic individuals and their family members can review airlines, hotels, pubs, and restaurants in terms of how they cater for allergy dietary requirements.
Other recommendations to reduce risks when eating out are:
- Always ask the waiter and chef how their food is cooked and whether your child’s allergen is present – since the introduction of the *Food Information Regulation in 2014 all restaurants, cafes, takeaways, and delis must know what their food contains
- Call the restaurant before your visit and explain your child’s allergy and its severity, ask them to check whether the chef can cater for your child
- Ask the waiter to write down the allergy and ask them to give the note to the chef – this prevents miscommunication/forgetting as well as helping to prevent cross-contamination
- If you are in doubt about a dish or restaurant it is better to be safe than sorry, pick a different dish or go elsewhere
*Our website has an FAQ guide for more information about the Food Information Regulation
I’m travelling abroad with my allergic child, how do I reduce the risks?
There are several things you can do to reduce risks when travelling with an allergic child.
- Make a check list of all the medication your child will need and pack it into your hand luggage when you leave and return. Check expiry dates before you travel.
- Take translation cards containing useful phrases to explain your child’s allergy. These are available from: dietarycard.com, Allergy UK, and allergyaction.org
- Carry at least two auto injectors when travelling, especially when flying
- Call the airline and explain your child’s allergy and its severity and explain their medication too, ask for email confirmation to be sent and take this with you on the day. Ensure everything is in place when checking in
- Stick to plain, simple foods and if you do not know what is in it do not let your child eat it
- Find out how to contact the emergency services in the country you are visiting
- Do not leave adrenaline pens in direct sunlight. Excessive heat or light can cause the adrenaline to be less effective. Do not refrigerate them. Bags are available to maintain medication at a correct temperature. Please refer to the patient information leaflet accompanying the device
- Take wet wipes to clean surfaces such as the fold-down tray
- Speak to your child’s doctor or specialist before you travel
- Carry medication at all times
- Take non-perishable, safe snacks with you
The Food Allergy and Anaphylaxis Alliance (FAAA) have compiled a document comparing how well airlines care for allergic customers. It can be accessed here
I don’t understand labelling, can I just ignore ‘may contains’?
First and foremost we advise people to always heed warnings; many are there for a reason. “May contain” labelling is so widespread many people suspect it is a substitute for cleaning production lines thoroughly. For that reason many people choose to ignore these warnings. In our view, that is risky behaviour. Although some manufacturers may regard “may contain” as a convenient get-out, many of them do their best to minimise risk and use warning labels only as a last resort.
The use of “may contain” warnings is voluntary and not required under food labelling laws. However, industry is aware that General Product Safety Regulations, place a requirement on suppliers to communicate any risk associated with their product to consumers.
Other advice about ‘May contains’ labelling:
- If your child eats a product carrying a warning and does not have a reaction this does not mean they will not every time.
- Alternate wording can read “not suitable for nut allergy sufferers’ or ‘made in a factory where nuts are handled’
- Allergens should be highlighted on packaging so it is clear, sometimes it may appear in Latin so make sure you are aware of this. A list of Latin translations for some popular allergens can be found here.
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