Allergies & the Immune System

Quick action will help your child during a serious allergic reaction. Kind of like a fire drill, it’s smart to occasionally review the instructions your doctor gave you and run through the steps you would take in an emergency.

Here’s a checklist for any parent of a seriously allergic child:

1. If your doctor has prescribed an epinephrine injector for emergencies, make sure it is always with your child or with an adult who is in charge of your child: at school, at a birthday party, on vacation — everywhere. Work with the school to decide where the injector will be stored and how your child will get it quickly, if needed.
2. Know the signs of a serious reaction, such as difficulty breathing and wheezing, and be ready to act quickly. Follow the instructions your doctor has given you. Teach your child and those who care for your child to do the same.
3. Regularly practice how to use the epinephrine injector, so you don’t forget. Are there caps to remove? Which end rests on the skin? Where on the body is the injection site? How do you hold the syringe and release the medicine? Ask for a demonstration at your doctor’s office. Visit the manufacturer’s website to get detailed instructions. Manufacturers also may supply a trainer syringe that is not loaded with epinephrine, so you can practice all the steps safely. If your child is in charge of carrying the injector, make sure he or she practices, too.
4. If your child has a reaction and needs the epinephrine injector, give it right away. Have someone call 911 while you are giving the injection. If you are alone, call 911 after giving the injection or get to the nearest emergency room as soon as possible. Your child may have a second wave of symptoms. Take the used epinephrine syringe to the hospital with you.
5. Store the epinephrine injector according to the manufacturer’s directions. Note its expiration date and get a new one when the one you have expires.

Ben had just started eating his lunch when his mom noticed him trying to scratch an itch in his mouth. After he vomited and began wheezing, his mom took him to the doctor. Ben was diagnosed with a food allergy — in this case, to peanuts.

Along with milk, eggs, soy, wheat, tree nuts, fish, and shellfish, peanuts are among the most common foods that cause allergies.

Learning how to recognize an allergic reaction will help you get your child the medical care needed if a reaction occurs. If your child has already been diagnosed with a food allergy, it’s important to know:

• how to manage your child’s dietary needs
• what emergency preparations to make in the event of an allergic reaction

About Food Allergies

With a food allergy, the body reacts as though that particular food product is harmful. As a result, the body’s immune system (which fights infection and disease) creates antibodies to fight the food allergen, the substance in the food that triggers the allergy.

The next time a person comes in contact with that food by touching or eating it or inhaling its particles, the body releases chemicals, including one called histamine, to “protect” itself. These chemicals trigger allergic symptoms that can affect the respiratory system, gastrointestinal tract, skin, or cardiovascular system. These symptoms might include a runny nose; an itchy skin rash; a tingling in the tongue, lips, or throat; swelling; abdominal pain; or wheezing.

People often confuse food allergies with food intolerance because of similar symptoms. The symptoms of food intolerance can include burping, indigestion, gas, loose stools, headaches, nervousness, or a feeling of being “flushed.” But food intolerance:

• doesn’t involve the immune system
• can be caused by a person’s inability to digest certain substances, such as lactose
• can be unpleasant but is rarely dangerous

According to the Food Allergy Research and Education network (FARE), 1 in every 13 children in the United States under age 18 have food allergies. They are less common in adults but, overall, food allergies affect nearly 15 million people in the United States.

Common Food Allergens

A child could be allergic to any food, but these eight common allergens account for 90% of all reactions in kids:

1. milk
2. eggs
3. peanuts
4. soy
5. wheat
6. tree nuts (such as walnuts and cashews)
7. fish
8. shellfish (such as shrimp)

In general, most kids with food allergies outgrow them. Of those who are allergic to milk, about 80% will eventually outgrow the allergy. About two-thirds with allergies to eggs and about 80% with a wheat or soy allergy will outgrow those by the time they’re 5 years old.

Other food allergies are harder to outgrow. Only about 20% of people with allergies to peanuts and about 10% of those allergic to tree nuts outgrow the allergies. Fish and shellfish allergies usually develop later in life and are even more rarely outgrown.

Food Allergy Reactions

Food allergy reactions can vary from person to person. Some can be very mild and only involve one part of the body, like hives on the skin. Others can be more severe and involve more than one part of the body. Reactions can happen within a few minutes or up to a few hours after contact with the food.

Food allergy reactions can affect any of the four following areas of the body:

1. skin: itchy red bumps (hives); eczema; redness and swelling of the face or extremities; itching and swelling of the lips, tongue, or mouth (skin reactions are the most common type of reaction)
2. gastrointestinal tract: abdominal pain, nausea, vomiting, or diarrhea
3. respiratory tract: runny or stuffy nose, sneezing, coughing, wheezing, shortness of breath
4. cardiovascular system: lightheadedness or fainting

A serious allergic reaction with widespread effects on the body is known as anaphylaxis. This sudden, potentially life-threatening allergic reaction involves two or more of the body areas listed above. There also can be swelling of the airway, serious difficulty with breathing, a drop in blood pressure, loss of consciousness, and in some cases, even death.

Diagnosing a Food Allergy

If you suspect that your child might have a food allergy, contact your doctor. To diagnose an allergy, the doctor will ask about:

• your child’s symptoms
• how often the reaction happens
• the time it takes between eating a particular food and the start of the first symptoms
• whether any family members have allergies or conditions like eczema and asthma

The doctor will look for any other conditions that could cause the symptoms. For example, if your child seems to have diarrhea after drinking milk, the doctor may check to see if lactose intolerance could be the cause rather than a food allergy. Celiac disease — a condition in which a person cannot tolerate gluten, a protein found in wheat and certain other grains — also can mimic the symptoms of food allergies.

If the doctor suspects a food allergy, you’ll likely be referred to an allergy specialist, who will ask more questions, perform a physical exam, and probably order tests to help make a diagnosis.

One of those tests might be a skin test. This test involves placing liquid extracts of food allergens on your child’s forearm or back, pricking the skin, and waiting to see if reddish raised spots (called wheals) form within 15 minutes. A positive test to a certain food only shows that your child might be allergic to that food — the allergist may do other tests for confirmation.

The allergy specialist also might do blood tests to check the blood for IgE antibodies to specific foods. If the skin test and blood test results indicate an allergy, no further testing is needed and the person is diagnosed with a food allergy.

If the test results are still unclear, the allergist may do a food challenge. (More often, though, this test is done to determine if someone has outgrown a certain allergy.) During this test, a person might be given gradually increasing amounts of the potential food allergen to eat while being watched for symptoms by the doctor. The test must be done in an allergist’s office or hospital that has access to immediate medical care and medications because a life-threatening reaction could happen.

Treating a Food Allergy

After diagnosing your child with a food allergy, the allergist will help you create a treatment plan. No medication can cure food allergies, so treatment usually means avoiding the allergen and all the foods that contain it.

You’ll need to read food labels so you can avoid the allergen. Since 2006, a new food labeling law has made this a little easier. Makers of packaged foods are required to clearly state, in or near the ingredient lists, whether the product contains milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, or soy.

Although there’s no cure for food allergies, medications can treat both minor and severe symptoms. Antihistamines might be used to treat symptoms such as hives, runny nose, or abdominal pain associated with an allergic reaction.

If your child wheezes or has asthma flare-ups (also called attacks) as the result of a food allergy, the doctor will likely recommend that a bronchodilator such as albuterol (which can be inhaled from a handheld pump device) be taken right away to reduce breathing difficulties.

But remember: If your child experiences an allergy-triggered asthma attack, it’s important to consider also giving epinephrine and seek emergency medical treatment immediately in case the asthma symptoms are part of anaphylaxis.

Epinephrine is often used to treat severe allergic reactions, or anaphylaxis. If your child has severe food allergies, your allergist will want you to have two epinephrine autoinjectors (commonly called EpiPens) on hand at all times in case of a life-threatening reaction. This will mean keeping epinephrine in your home, briefcase or purse, and also at relatives’ homes and your child’s day care or school.

Signs and symptoms of anaphylaxis that would require epinephrine include:

• hoarseness
• sensation of tightness in the throat
• difficulty breathing
• any symptoms from two or more of the body systems, such as hives and abdominal pain, or any other combination of two or more symptoms that affect different parts of the body

If your child starts having serious allergic symptoms, give the epinephrine auto-injector right away. Seconds count during an episode of anaphylaxis. Then call 911 or take your child to the emergency room so additional treatment can be given, if needed. Also, your child needs to be under medical supervision for at least 4 hours because even if the worst seems to have passed, a second wave of serious symptoms (called a biphasic reaction) often happens.

You and your child’s allergist should work together to develop a written food allergy emergency action plan to give to the school, childcare provider, and any other caregivers.

Young kids with food allergies can stay safe at school, but it takes organization, preparation, and education.

Here are tips on keeping your child safe during the school year — and all year long:

Springtime:

Now’s the time to make a summertime appointment to see your child’s allergist. And set up a meeting for the end of the summer with the school principal, the school nurse, and your child’s teacher.

Summertime:

At the allergist appointment, discuss and update the food allergy emergency plan, so that you have copies available for the school. Make sure the plan has a current photo of your child and updated contact information for you and the doctor. Check your medicine supply to make sure you have what you need to send to school. Ask the allergist for any prescriptions you need.

Order a medical alert bracelet, which can take several weeks to arrive. In addition to your child’s name and type of allergies, consider including that epinephrine should be given in case of a severe reaction and listing your emergency contact number.

At the school meeting, remind everyone that if there is a severe allergic reaction, they should give epinephrine immediately, then call 911. Make plans for different scenarios, such as snack time, lunchtime, classroom parties, and field trips.

Ask about:

• where food will be kept
• where your child will eat
• who will clean the table
• who oversees lunchtime and snack time
• who will be responsible for hand washing
• who will train substitute teachers and special-subject teachers to recognize and treat a reaction
• where epinephrine will be kept and who will be responsible for giving it, if needed

Ask the school to:

• Educate the staff about how kids describe allergic reactions (they may say food tastes spicy, their tongue feels hot, their tongue or mouth feels itchy or funny, or their lips feel tight).
• Discourage food sharing among all children.
• Encourage all kids to wash their hands with soap and water before and after eating (hand sanitizer gels do not get rid of allergens).
• Wipe down lunch tables with a disposable disinfecting wipe rather than a sponge, which could spread allergens. This should be done by an adult, not a child.
• Ask teachers not to use food as rewards in the classroom, and to give you several days’ notice of food-related events, including birthday parties.
• Look out for non-food items that could contain allergens, such as materials for art, class projects, or class pets and their food.

Back-to-School Time

Along with the pencils and backpacks, you’ll want to put together your child’s medical supplies. Double check that you have all of your child’s medicines ready to go. If possible, give the school medications that won’t expire until after the school year ends. If that’s not possible, make a note on the calendar now so you’ll be alerted before they expire and can replace them.

If your child won’t have the epinephrine auto-injector on hand at all times, be sure that it’s available in the nurse’s office, the classroom, and anywhere else your child might spend time, such as an after-school room. Label the epinephrine container with your child’s name, photo, and your emergency contact information. Also, give your child’s teacher a supply of hand wipes and safe food options for your child to use.

Write a letter to the other parents in your child’s class. Explain which allergies your child has, what this means, and how serious a reaction could be. Explain the idea of cross-contamination, and clearly state how they can help keep your child safe. Be reasonable (don’t ask for things that aren’t necessary) and be honest (don’t make things seem more serious than they are). If you can, offer to help with birthday celebrations so treats will be safe for your child.

Consider including a handout that explains how others can help those with food allergies. The Food Allergy Research and Education network (FARE) offers one.

During the School Year

1. Once school starts, consider speaking at “Back to School” night or whenever you will first meet other parents. Meeting you in person can help get others to participate in keeping your child safe.
2. Touch base with the teacher regularly to see how things are going. Encourage the teacher, principal, and nurse to call you with any questions that come up or to brainstorm on ways to make things safe and inclusive for your child. If there will be cooking going on, provide recipes, and possibly ingredients, to make safe foods. Consider providing bowls, spoons, and other supplies just for your child’s class so that equipment is not cross-contaminated by unsafe foods prepared by other classes.
3. Let the teacher know he or she can call you anytime to check ingredients. Always review ingredients on any snacks that the school will be providing, and make sure to keep a well-stocked supply of safe foods in the classroom. Consider sending your child’s snacks and lunch from home each day in order to ensure safety.

All Year

No matter how cooperative your child’s school and teacher are, the most important preparation you can do is with your son or daughter. With time and education, your child will be able to take more responsibility for his or her safety.

1. Frequently review with your child what he or she is allergic to and which foods can be eaten and which foods can’t.
2. Remind your child to never accept food from anyone else in the class and never to eat something if he or she doesn’t know if it is safe. This may mean eating only foods you packed from home or you have approved.
3. Teach your child to wash his or her hands before and after eating, and after playing outside.
4. Review signs of an allergic reaction to watch for. And always make sure your child knows who to tell when not feeling well.

At first, Tyler developed red patches and raised spots that turned purple and looked like bruises all over his legs and buttocks. Then he complained that his stomach and knees hurt. When his parents took him to the doctor to find out what was wrong, the doctor said that Tyler had the classic signs of Henoch-Schönlein purpura.

About Henoch-Schönlein Purpura

Henoch-Schönlein purpura (HEH-nok SHOON-line PURR-puh-ruh) — usually just called HSP — is a condition that causes small blood vessels to become swollen and irritated. This inflammation, called vasculitis, usually occurs in the skin, intestines, and kidneys. Inflamed blood vessels in the skin can leak blood cells, causing a rash called purpura. Vessels in the intestines and kidneys also can swell and leak.

The condition was named after two German doctors, Eduard Henoch and Johann Schönlein, who first described the disease in the 1800s. Sometimes it’s also called allergic purpura, anaphylactoid purpura, or IgA vasculitis.

HSP occurs much more often in kids than in adults, usually between ages 3 and 10. It is one of the most common forms of vasculitis in children, and boys get it about twice as often as girls.

Causes

Although no one really knows what causes HSP, doctors do know that it occurs when the body’s immune system doesn’t function as it should. A protein called immunoglobulin A (IgA) is a type of antibody that works to fight infections. In HSP, IgA also gets placed in the blood vessels and causes swelling and bleeding.

It is unclear why this immune reaction occurs. It often happens after a bacterial or viral infection of the upper respiratory tract (sinuses, throat, or lungs). It is seen more often in fall, winter, and spring. Although less common, other possible triggers include certain medicines, food reactions, insect bites, and vaccinations.

HSP cannot be passed from one person to another.

Signs and Symptoms

Common signs and symptoms of HSP include:

• purpura, a raised, reddish purple rash
• joint pain and swelling
• stomach pain
• blood in the urine (pee) or other kidney problems
• fever
• headache

The rash occurs in all cases and is what helps doctors diagnose HSP. It may take the form of purpura, pinpoint red dots called petechiae, bruises, or sometimes blisters. The rash usually occurs on the legs and buttocks, but can also appear on other parts of the body, such as the elbows, arms, face, and trunk.

Most kids with HSP also have joint pain and swelling. These symptoms can happen before the rash appears. HSP most commonly affects the ankles and knees, but other joints like the hands, elbows, and feet may be affected.

Stomach pain usually starts a week after the rash appears. Pain may come and go and can be accompanied by nausea, vomiting, or diarrhea. Some kids will have blood in the stool (caused by leaky blood vessels), but it may not be visible.

HSP can affect the kidneys in some cases. Small amounts of blood or protein might be found in the urine, and the urine may look bloody.

Diagnosis

When the characteristic rash on the legs and buttocks is present, especially if accompanied by abdominal or joint pain, doctors can easily diagnose HSP. A diagnosis may be more difficult if joint pain or abdominal symptoms are present before the rash appears, or if symptoms take several weeks to show up.

The doctor also may request routine blood tests to look for signs of infections, anemia, or kidney disease. If abdominal pain is severe, imaging tests (like X-rays or ultrasound) may be needed. A stool sample can check for blood in the stool (poop). A urine sample can reveal blood or protein in the urine.

Up to half of kids who develop HSP will have problems with their kidneys, so the doctor will probably check kidney function over several months. If the doctor suspects that HSP has caused kidney damage, your child may need to see a kidney doctor (nephrologist).

Treatment

Symptoms of HSP usually last for about a month. Most of the time, it goes away on its own without treatment. To help your child feel better, the doctor may recommend certain medications, such as:

• antibiotics, if an infection is causing the HSP
• painkillers (such as acetaminophen)
• anti-inflammatory medicines (such as ibuprofen) to relieve joint pain and inflammation
• corticosteroids (such as prednisone) for severe abdominal pain or severe kidney disease

Also, the doctor may tell you to stop giving your child certain medications if there’s a chance that they caused the HSP.

While at home, try to keep your child as comfortable as possible. Be sure your child gets plenty of rest and drinks fluids. If your child stops eating or drinking, or develops severe abdominal pain or kidney problems, hospitalization might be necessary.

What to Expect

Most children with HSP fully recover within a month and have no long-term problems. Kids whose kidneys are affected will need to see a doctor for regular checkups to monitor kidney function.

About one-third of those who have HSP get it again, usually a few months after the first episode. If HSP does come back, it’s usually less severe than the initial episode.

My child has food allergies — what should I look for when reading food labels?
– Alyson

Carefully reading food labels is one of the most important things parents can do when their child has a food allergy.Always avoid any food whose label says it contains your child’s allergen. And keep these tips in mind:

1. Check ingredient lists and look for advisory statements such as “Contains peanuts.” Some companies also voluntarily share cross-contamination warnings, such as “May contain soy,” “Processed in a facility that also processes shellfish,” or “Manufactured on equipment also used for tree nuts.” But manufacturers do not have to list cross-contamination warnings. Since products without advisory statements also might be cross-contaminated and the company chose not to label for it, it is always best to contact the company to see if the product could contain ingredients that your child is allergic to.
2. In the United States, companies must state, in understandable language, if a product contains one of the eight most common food allergens: peanuts, tree nuts, eggs, milk, wheat, soy, fish, and crustacean shellfish.
3. Know the limits of food labels. Not all allergens will be included in ingredient lists or named in a recognizable way. Sometimes, an allergen could be hidden in a long list of scientific-sounding ingredients or included in “natural flavors,” “coloring,” “spices,” or other additives.
4. Double-check every package of food you give your child — once in the supermarket and once before you give it to your child. This is important even if your child has had the product many times before. Ingredients and cross-contamination risks may change over time. Different size products may have different ingredients or be made in different facilities.
5. Remember to check non-food items, too, because they’re not subject to labeling regulations. Allergens may be found in cosmetics, bath supplies, cleaning supplies, sunscreens, art supplies, kitchen sponges, and gardening supplies. Look up any ingredient that you’re not sure about, and call the company with any questions.

About Insect Sting Allergy

Insect stings usually are minor annoyances. But they can cause serious and sometimes even deadly reactions in kids who are allergic to them.

Insects that can trigger allergic reactions include honeybees, yellowjackets, hornets, wasps, and fire ants. When they sting, they inject venom into the skin.

Allergic reactions to stings usually don’t happen when a child is stung for the first time, but rather when the child is stung for a second time, or even later.

If your child has been diagnosed with an insect sting allergy, keep injectable epinephrine (a medicine that your doctor can prescribe) on hand in case of a severe reaction. Share emergency plans with anyone who cares for your child, including relatives and school officials. Also consider having your child wear a medical alert bracelet.

Talk with your child’s doctor about seeing an allergy specialist to discuss the possibility of allergy shots. These can help the body react less to insect venom, which can make a serious reaction less likely.

If you think that your child might have had an allergic reaction to an insect sting, call your doctor, who can help you understand the difference between a typical reaction and an allergic reaction. The doctor also can see if an insect sting site is infected, which requires different treatment than an allergic reaction.

If the doctor thinks your child might have an insect sting allergy, you’ll probably be referred to an allergy specialist for testing.

What Happens in an Insect Sting Allergy

When someone is allergic to insect stings, the body’s immune system, which normally fights infections, overreacts to proteins in the insect’s venom. When stung, the body sees these proteins as harmful invaders.

The immune system responds by working very hard to fight off the invader. This causes an allergic reaction, in which chemicals like histamine are released in the body. The release of these chemicals can cause someone to have these symptoms:

• wheezing
• trouble breathing
• coughing
• hoarseness
• throat tightness
• stomachache
• vomiting
• diarrhea
• itchy, watery, or swollen eyes
• hives
• red spots
• swelling
• itching
• a drop in blood pressure, causing lightheadedness or loss of consciousness

If a stinger remains in the skin, use your fingernail or a credit card to scrape the stinger from the skin. Removing the stinger quickly can help prevent more venom from going into the body. Don’t use tweezers because they can cause more venom to be released.

Anaphylaxis Is a Life-Threatening Reaction

Insect sting allergies can cause a severe reaction called anaphylaxis. Anaphylaxis can begin with some of the same symptoms as a less severe reaction, but these can quickly become worse, leading someone to have trouble breathing or to pass out. Anaphylaxis that’s not treated can be life-threatening.

If your child starts having serious allergic symptoms, like swelling of the mouth or throat or difficulty breathing, give the epinephrine auto-injector right away. Every second counts in an allergic reaction. Then call 911 to take your child to the emergency room. Your child needs to be under medical supervision because even if the worst seems to have passed, a second wave of serious symptoms often happens.

An epinephrine auto-injector comes in an easy-to-carry container about the size of a large marker or a smartphone. It’s simple to use. Your doctor will show you how to use it. Kids who are old enough can be taught how to give themselves the injection.

School staff should know that your child has an insect sting allergy. Together, agree on a plan in case of a serious reaction at school, including making sure that injectable epinephrine is available at all times. If your child is old enough to carry the epinephrine, it should be in a purse or backpack that’s with your child at all times, not in a locker.

Your child’s allergy plan also could include giving an over-the-counter antihistamine for milder allergy symptoms. But the antihistamine should be given after the epinephrine in the case of a serious, life-threatening reaction.

Insect Sting Allergy Safety Tips

The best way to prevent allergic reactions to insect stings is to avoid getting stung in the first place. Teach your child to:

• Avoid walking barefoot while on the grass.
• Avoid playing in areas where insects like to be, such as flower beds.
• Avoid drinking from open soda or juice cans and be sure to keep food covered when eating outside. Check for insects in drink cups and straws when outside.
• Remain calm and quiet around stinging insects. Moving slowly, back away without any arm-waving or swatting.
• Never disturb an insect nest. Have an exterminator get rid of nests near your home.
• When in wooded areas, keep as covered up as possible. Long-sleeved shirts, long pants, socks, and closed-toe shoes can help keep the bugs away. (Loose clothing can allow insects to get between the clothes and skin.)
• Avoid perfumes, scented body products, and brightly colored and flowered clothing because they all attract insects.

Kawasaki disease is an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under age 5. The cause is unknown, but if the symptoms are recognized early, kids with Kawasaki disease can fully recover within a few days. Untreated, it can lead to serious complications that can affect the heart.

Kawasaki disease is most common among children of Japanese and Korean descent, but can affect all ethnic groups.

Signs and Symptoms

Kawasaki disease can’t be prevented, but usually has telltale symptoms and signs that appear in phases. The first phase, which can last for up to 2 weeks, usually involves a fever that lasts for at least 5 days.

Other symptoms include:

• severe redness in the eyes
• a rash on the stomach, chest, and genitals
• red, dry, cracked lips
• swollen tongue with a white coating and big red bumps (called “strawberry tongue”)
• sore, irritated throat
• swollen palms of the hands and soles of the feet with a purple-red color
• swollen lymph nodes

During the second phase, which usually begins within 2 weeks of when the fever started, the skin on the hands and feet may begin to peel in large pieces. This can even happen in children who have already been treated. A child also may have joint pain, diarrhea, vomiting, or abdominal pain.

If your child shows any of these symptoms, call your doctor.

Complications

Doctors can manage the symptoms of Kawasaki disease if it’s caught early. Most kids will feel better within 2 days of starting treatment. Heart problems usually won’t develop if Kawasaki disease is treated within 10 days of the start of symptoms.

Untreated cases can lead to more serious complications, such as vasculitis, an inflammation of the blood vessels. This can be particularly dangerous because it can affect the coronary arteries, which supply blood to the heart.

Besides the coronary arteries, the heart muscle, lining, valves, and the outer membrane around the heart can become inflamed. Arrhythmias (changes in the normal pattern of the heartbeat) or abnormal functioning of some heart valves also can occur.

Diagnosis

Kawasaki disease can look similar to other common childhood viral and bacterial illnesses. No single test can detect Kawasaki disease, so doctors usually diagnose it by checking the symptoms and ruling out other conditions.

Most kids diagnosed with Kawasaki disease will have a fever lasting 5 or more days and at least four of these symptoms:

• redness in both eyes
• changes around the lips, tongue, or mouth
• changes in the fingers and toes, such as swelling, color change, or peeling
• a rash in the chest, stomach, or genital area
• a large swollen lymph node in the neck
• red, swollen palms of hands and soles of feet

If Kawasaki disease is suspected, the doctor may order tests to monitor heart function (such as an echocardiogram) and might take blood and urine (pee) samples to rule out other conditions, such as scarlet fever, measles, Rocky Mountain spotted fever, juvenile rheumatoid arthritis, or an allergic drug reaction.

Treatment

Treatment should start as soon as possible, ideally within 10 days of when the fever begins. Usually, a child is treated with intravenous (IV) doses of gamma globulin (purified antibodies), an ingredient of blood that helps the body fight infection.

A child also might be given a high dose of aspirin to lower the risk of heart problems. Some kids with Kawasaki disease are put on a low dose of aspirin for a long time to prevent heart problems. It’s very important for these children to get their annual flu shot to help prevent viral illnesses while they are taking the aspirin. This is because there’s a risk of Reye syndrome, a rare but serious illness, in children who take aspirin during a viral illness. Always talk to your doctor before giving any of your kids aspirin.

Most children with Kawasaki disease start to get much better after a single treatment with gamma globulin, though sometimes more doses are needed. Most kids recover completely, but some (especially those who develop heart problems after Kawasaki disease) might need need further testing and treatments with a cardiologist.

About Milk Allergy

Allergy to milk is sometimes confused with lactose intolerance, because both can cause problems after drinking milk — but they are very different and unrelated.

Lactose intolerance is annoying and can cause discomfort, but it is not life threatening. Milk allergy, though, can cause someone to become suddenly and severely ill, and can be life threatening. That’s why milk and other dairy products must be completely avoided if your child has a milk allergy.

Milk allergy is the most common food allergy in young kids, affecting about 2%–3% of those younger than 3 years old. Many kids outgrow it, but some remain allergic for a lifetime.

A milk allergy can cause a range of symptoms, from mild to severe. If your child has been diagnosed with a milk allergy, keep two epinephrine auto-injectors available in case of a severe reaction. An epinephrine auto-injector is a prescription medicine that comes in an easy-to-carry container about the size of a large marker. It’s simple to use. Your doctor will show you how to use it. Kids who are old enough can be taught how to give themselves the injection.

The doctor can also give you an allergy action plan, which helps you prepare for, recognize, and treat an allergic reaction. Communicate emergency plans with anyone who will be taking care of your child, including relatives and school officials. Also consider having your child wear a medical alert bracelet.

What Happens in a Milk Allergy

When someone is allergic to milk, the body’s immune system, which normally fights infections, overreacts to proteins in the milk. Every time the person drinks or eats milk or other dairy products, the body thinks these proteins are harmful invaders.

The immune system responds by working very hard to fight off the invader. This causes an allergic reaction, which releases chemicals like histamine in the body. The release of these chemicals can cause someone to have symptoms like:

• wheezing
• trouble breathing
• coughing
• hoarseness
• throat tightness
• stomachache
• vomiting
• diarrhea
• itchy, watery, or swollen eyes
• hives
• red spots
• swelling
• a drop in blood pressure, causing lightheadedness or loss of consciousness

Allergic reactions to milk can vary. Sometimes the same person can react differently at different times. Some reactions to milk are mild and involve only one system of the body, like hives on the skin. But, even when someone has had only a mild reaction in the past, the next reaction can be severe.

Anaphylaxis Is a Life-Threatening Reaction

Milk allergies can cause a severe reaction called anaphylaxis. Anaphylaxis can begin with some of the same symptoms as a less severe reaction, but then can quickly get worse. The person may have trouble breathing or pass out. More than one part of the body might be involved. If it isn’t treated, anaphylaxis can be life threatening.

Every second counts in an allergic reaction. If your child starts having serious allergic symptoms, like swelling of the mouth or throat or difficulty breathing, give the epinephrine auto-injector right away. Also give the epinephrine auto-injector right away if your child’s symptoms involve two different parts of the body, like hives with vomiting. Then call 911 or take your child to the emergency room. Your child needs to be under medical supervision because even if the worst seems to have passed, a second wave of serious symptoms can happen.

Keep Allergy Medications Handy

Notify your child’s school if your child has a severe milk allergy. You should agree upon a plan in case of a serious reaction and two epinephrine auto-injectors must be available at all times. If your child is old enough to carry the epinephrine, it should not be in a locker, but in a purse or backpack that’s with your child at all times.

Milk Allergy Safety Tips

To prevent allergic reactions to milk, your child must avoid any foods that contain milk, milk products, or milk proteins. Read food labels to see if a food contains milk.

Milk may be found in unexpected places, such as processed meats, canned tuna, and baked goods, so it’s important to read labels on all foods, even ones that are not dairy foods. Words like casein, whey, and lacto- mean the product contains milk. For detailed information about foods to avoid, visit Food Allergy Research & Education (FARE).

Even if a food is labeled “milk-free” or “nondairy,” it could still contain allergy-causing milk proteins. Manufacturers of foods sold in the United States must state in understandable language whether foods contain any of the top eight most common allergens, including milk. The label should list “milk” in the ingredient list or say “Contains milk” after the list.

Some foods look OK from the ingredient list, but while being made they can come in contact with a food your child is allergic to. This is called cross-contamination. Look for advisory statements such as “May contain milk,” “Processed in a facility that also processes milk,” or “Manufactured on equipment also used for milk.” These are cross-contamination warnings, but manufacturers are not required to list them.

Since products without precautionary statements also might be cross-contaminated and the company simply chose not to label for it, it is always best to contact the company to see if the product could contain milk. You might be able to get this information from the company’s website or by emailing a company representative.

Food makers sometimes change ingredients, so ingredients in a new package may be different from ingredients in an older package. So, labels should be checked every time.

Milk Alternatives

Milk from other animals (such as sheep, goats, and buffalo) are not good alternatives for those with cow milk allergy because the proteins are similar. Sometimes, people with an allergy to cow’s milk are also allergic to soy milk.

But many other milk-free alternatives are available, including ones that are fortified with calcium and vitamin D. The allergist can tell you which milk substitute is best for your child. Some options are:

• rice milk
• almond milk
• coconut milk
• oat milk
• hemp milk

Eating Away From Home

Cross-contamination often happens in restaurants, where many people often accidentally consume milk products. This happens when milk or milk products get into a food product because the staff used the same surfaces and utensils (like knives, cutting boards, or pans) to prepare both dairy products and other foods. This is particularly common in fast-food restaurants, so some people find it safer to avoid these restaurants altogether.

Buffet-style restaurants also pose a cross-contamination risk, with cheeses and salad dressings dripping over non-dairy food platters. When eating at restaurants, it may be best to avoid fried foods or foods with batter on them. Even if the batter doesn’t contain milk products, the oil used to fry the foods might have been used to fry something else that contains milk.

When your child eats in a restaurant or at a friend’s house, find out how foods are cooked and exactly what’s in them. It can be hard to ask a lot of questions about cooking methods, and to trust the information you get. If you can’t be certain that a food is milk-free, it’s best to bring safe food from home.

Also talk to the staff at school about cross-contamination risks for foods in the cafeteria. It may be best to pack lunches at home so you can control what’s in them.

If your child will be eating at a restaurant, take these precautions:

• Tell the restaurant wait staff that your child has a milk allergy.
• Carry a personalized “chef card” for your child, which can be given to the kitchen staff. The card details your child’s allergies for food preparers. Food allergy websites provide printable chef card forms in many different languages.
• Don’t eat at a restaurant if the manager or owner seems uncomfortable about your requests for a safe meal.

It can be overwhelming to find out your child has a milk allergy. But you can keep your child safe by learning about the allergy, making changes to your child’s diet, and being well-prepared.

About Milk Allergy

People of any age can have a milk allergy, but it’s more common in infants (affecting about 2% to 3% of babies). Many kids outgrow it, but some don’t.

When a baby is allergic to milk, it means that his or her immune system, which normally fights infections, overreacts to proteins in cow’s milk (the basis for most commercial baby formulas). Every time the child has milk, the body thinks these proteins are harmful invaders and works very hard to fight them. This causes an allergic reaction in which chemicals like histamine are released in the body.

Babies often show their first symptoms of a milk allergy days to weeks after they’re first given cow milk-based formula. Breastfed infants have a lower risk of having a milk allergy than those who are formula fed. If they are allergic, though, they can have symptoms if mom has dairy products in her diet.

A milk allergy is not the same thing as lactose intolerance, which is when the body has trouble digesting milk.

Some babies with a milk allergy have an allergic reaction soon after having milk; others have problems hours or days later. If your baby has a milk allergy that causes symptoms soon after he or she has milk, keep two epinephrine auto-injectors on hand in case of a severe reaction (called anaphylaxis). An epinephrine auto-injector is an easy-to-use prescription medicine that comes in a container about the size of a large pen. Your doctor will show you how to use it.

Symptoms of a Milk Allergy

In children who show symptoms shortly after they have milk, an allergic reaction can cause:

• wheezing
• trouble breathing
• coughing
• hoarseness
• throat tightness
• stomach upset
• vomiting
• diarrhea
• itchy, watery, or swollen eyes
• hives
• red spots
• swelling
• a drop in blood pressure causing lightheadedness or loss of consciousness

A milk allergy can cause different symptoms at different times. Some reactions are mild and involve only one system of the body (like hives on the skin). But mild reactions in the past do not mean a child won’t have a serious allergic reaction next time.

Children who do not have symptoms shortly after they have milk can have a different type of reaction that causes problems hours to days later, such as:

• loose stools (possibly with blood)
• vomiting or gagging
• refusal to eat
• irritability or colic
• skin rashes, like eczema

If Your Child Has a Serious Reaction

If your child starts having serious allergic symptoms, like swelling of the mouth or throat or difficulty breathing, or symptoms involving two different parts of the body, like hives with vomiting:

• Give the epinephrine auto-injector right away. Every second counts in an allergic reaction.
• Then, call 911 or take your child to the emergency room. Your child needs to be under medical supervision because, even if the worst seems to have passed, a second wave of serious symptoms can happen.

Diagnosing a Milk Allergy

If you think your infant is allergic to milk, call your baby’s doctor. He or she will ask you questions and talk to you about what’s going on. After the doctor examines your baby, some stool tests and blood tests might be ordered. The doctor also may refer you to an allergist (a doctor who specializes in treating asthma and allergies).

The allergist may do skin testing. During skin testing, the doctor or nurse places a tiny bit of milk on the skin, then pricks the outer layer of skin or makes a small scratch on the skin. If your child reacts to the allergen, the skin will swell a little in that area.

If the allergist finds that your baby is at risk for a serious allergic reaction, epinephrine auto-injectors will be prescribed.

Avoiding a Milk Allergy Reaction

If You’re Breastfeeding

If your breastfed infant has a milk allergy, it’s important for you to avoid dairy products because the milk protein that causes allergic reactions can cross into your breast milk. Be sure to read food labels carefully. All food makers are required to clearly state whether a food contains milk or milk-based products — look for this in or next to the ingredient list on the packaging.

You may want to talk to your doctor or a dietician about finding alternative sources of calcium and other vital nutrients to replace what you were getting from dairy products.

If You’re Formula Feeding

If you’re formula feeding, your doctor may advise you to switch to an extensively hydrolyzed formula in which the proteins are broken down into particles so that the formula is less likely to trigger an allergic reaction.

You also might see “partially hydrolyzed” formulas, but these aren’t truly hypoallergenic and can lead to a significant allergic reaction.

Do not try to make your own formula. Commercial formulas are approved by the U.S. Food and Drug Administration (FDA) and created through a very specialized process that cannot be duplicated at home. Other types of milk that might be safe for an older child with a milk allergy (like rice milk, almond milk, or coconut milk) are not safe for infants.

If you have any questions or concerns, talk with your child’s doctor.

About Peanut and Tree Nut Allergies

First grade has been a difficult parenting year for Anne. Her 6-year-old son, Justin, began eating lunch in the cafeteria with hundreds of other students armed with their peanut butter sandwiches, peanut butter crackers, and all those hidden peanuts in their processed foods.

For Justin, who has an extremely severe allergy to peanuts, it means sitting at a peanut-free table. But Justin isn’t alone: About 5% of school-aged kids have some kind of food allergy, putting them at risk of an allergic reaction at home or, even more dangerously, away from home.

Peanuts are among the most common allergy-causing foods, and they often find their way into things you wouldn’t imagine. Take chili, for example: It may be thickened with ground peanuts.

Peanuts are actually not a true nut, but a legume (in the same family as peas and lentils). But the proteins in peanuts are similar in structure to those in tree nuts. For this reason, people who are allergic to peanuts also can be allergic to tree nuts, such as almonds, Brazil nuts, walnuts, hazelnuts, macadamia nuts, pistachios, pecans, and cashews.

Allergic Reactions

An allergic reaction happens when someone’s immune system mistakenly believes that something harmless, such as a tree nut or peanut, is actually harmful. The immune system responds by creating specific antibodies to proteins in that food. These antibodies — called immunoglobulin E (IgE) — are designed to fight off the “invading” proteins.

IgE antibodies trigger the release of certain chemicals in the body. One of these is histamine. The release of histamine can affect the respiratory system, gastrointestinal tract, skin, and cardiovascular system, causing allergy symptoms like wheezing, stomachache, vomiting, itchy hives, swelling, and a drop in blood pressure.

Reactions to foods, like peanuts and tree nuts, can be different. It all depends on the person — and sometimes the same person can react differently at different times. Some reactions can be very mild and involve only one system of the body, like hives on the skin. Other reactions can be more severe and involve more than one part of the body.

Most reactions last a few hours or less, and affect any of these four body systems:

1. Skin. Skin reactions are the most common type of food allergy reactions. They can take the form of itchy, red, bumpy rashes (hives), eczema, or redness and swelling around the mouth or face. A rash can happen when a nut or peanut comes in contact with the skin, without the person even eating it.
2. Gastrointestinal system. Symptoms can include belly cramps, nausea, vomiting, or diarrhea.
3. Respiratory system. Symptoms can range from a runny or stuffy nose; itchy, watery eyes; and sneezing to the triggering of asthma with coughing and wheezing.
4. Cardiovascular system. A person may feel lightheaded or faint and lose consciousness.

In really bad cases, an allergy can cause anaphylaxis, a sudden, potentially life-threatening reaction. Besides the symptoms mentioned above, anaphylaxis can make airways swell and blood pressure drop. As a result, a person may have trouble breathing and could lose consciousness.

Even a small amount of peanut or tree nut protein can set off a severe reaction. But allergic reactions just from breathing in small particles of nuts or peanuts are rare because the food needs to be digested to cause a reaction. Most foods with peanuts in them don’t allow enough of the protein to escape into the air to cause a reaction. And just the smell of foods containing peanuts won’t produce a reaction because the scent does not contain the protein.

In very rare cases when people do react to airborne particles, it’s usually in an enclosed area (like a restaurant) where lots of peanuts are being cracked from their shells. The person inhales and then swallows the protein, which can lead to a reaction when the protein gets digested. Although some people outgrow certain food allergies over time (like milk, egg, soy, and wheat allergies), peanut and tree nut allergies are lifelong in many people.

Living With Peanut or Tree Nut Allergy

If allergy skin testing shows that your child has a peanut or tree nut allergy, a doctor will provide guidelines on what to do.

The best way to prevent a reaction is to avoid peanuts and tree nuts. Avoiding these nuts means more than just not eating them. It also means not eating any foods that might contain tree nuts or peanuts as ingredients.

The best way to be sure a food is nut-free is to read the label. Manufacturers of foods sold in the United States must state on their labels whether the foods contain peanuts or tree nuts. Check the ingredients list first.

After checking the ingredients list, look on the label for phrases like these:

• “may contain nuts”
• “produced on shared equipment with nuts or peanuts”

People who are allergic to nuts also have to avoid foods with these statements on the label. Although these foods might not use nut ingredients, the warnings are there to let people know they might contain traces of nuts. That can happen through “cross-contamination,” when nuts get into a food product because it is made or served in a place that uses nuts in other foods.

Some of the highest-risk foods for people with peanut or tree nut allergy include:

• Cookies and baked goods. Even if baked goods don’t contain nut ingredients, they might have come in contact with peanut or tree nuts through cross-contamination. Unless you know exactly what went into a food and where it was made, it’s safest to avoid store-bought or bakery cookies and other baked goods.
• Candy. Candies made by small bakeries or manufacturers (or homemade candies) may contain nuts as a hidden ingredient. The safest plan is to eat only candies made by major manufacturers whose labels show they are safe.
• Ice cream. Unfortunately, cross-contamination is common in ice cream parlors because of shared scoops. It’s also a possibility in soft-serve ice cream, custard, water ice, or yogurt places because the same dispensing machines and utensils are often used for lots of different flavors. Instead, do as you would for candy: Buy tubs of ice cream at the supermarket and be sure they’re made by a large manufacturer and the labels indicate they’re safe.
• Asian, African, and other cuisine. African and Asian (especially Thai, Chinese, and Indian) foods often contain peanuts or tree nuts. Mexican and Mediterranean foods may also use nuts, so the risk of cross-contamination is high with these foods.
• Sauces. Many cooks use peanuts or peanut butter to thicken chili and other sauces.

Always proceed with caution. Even if your child has eaten a food in the past, manufacturers sometimes change their processes — for example, switching suppliers to a company that uses shared equipment. And two foods that seem the same might have differences in their manufacturing.

To help reduce contact with nut allergens and the possibility of severe reactions in someone with a peanut or tree nut allergy:

• If you keep peanuts and nuts in your home, watch for cross-contamination that can happen with utensils and cookware. For example, make sure the knife you use to make peanut butter sandwiches is not used in preparing food for a child with a nut allergy, and that nut breads are not toasted in the same toaster as other breads.
• Don’t serve cooked foods you didn’t make yourself, or anything with an unknown list of ingredients.
• Tell everyone who handles the food your child eats, from waiters and waitresses to the cafeteria staff at school, about the allergy. If the manager or owner of a restaurant is uncomfortable about your request for peanut- or nut-free food preparation, don’t eat there.
• Consider making your child’s school lunches, as well as snacks and treats to take to parties, play dates, sleepovers, school functions, and other outings.
• Work with the childcare supervisor or school principal to create a food allergy emergency action plan.
• Keep epinephrine accessible at all times — not in the glove compartment of your car, but with you, because seconds count during an anaphylaxis episode.

With a little preparation and prevention, you can make sure that your child’s allergy doesn’t get in the way of a happy, healthy everyday life.