Counsel Patients About Pediatric Allergy Risks, Precautions On Halloween

In an interview with Pharmacy Times, allergist with AllerVie Health, Maxcie Sikora, MD, discussed some risks associated with Halloween for children with food allergies. She also discussed precautions that parents can take as well as alternatives to candy.

Q: What risks are associated with Halloween for children with allergies?

Maxcie Sikora, MD: I would just say from a food allergy perspective, Halloween is very daunting for families of patients with food allergy. In general, you know, as you mentioned, it really does depend on the age. In the younger age group, they're much more likely to have the common kind of food allergy triggers like milk, egg, wheat, soy, and those allergens are typically outgrown as they become older. So, in the older child population, you know, meaning like elementary school and above, that's when the majority of those children should start outgrowing their food allergens, but they still have food allergies. As we all know, nut allergy, whether it's peanut or tree nut, is a major allergen. But then there are also still children who have milk and egg and wheat and soy. And then you also have children who have sesame allergy, you have some other rare allergies. And you also have children who have food intolerances that don't fall under that allergy spectrum, that may not have anaphylaxis to the foods, but will have other complaints such as gastrointestinal complaints when they ingest these foods.

Q: What are some precautions parents can take for particularly young children, who might not completely understand their allergy or which foods could be dangerous?

Maxcie Sikora, MD: Absolutely. So, just in case parents and watchers of this video want to look at that the Food Allergy Research and Education (FARE) Organization, they have a website called FoodAllergy.org. And so, they have some great tips on there and I gleaned a lot of this from them just to have kind of a standard protocol. But mainly, you know, the biggest thing for children, both young and old, is to not eat the candy while they're trick-or-treating. That's a huge deal. No eating of candy while you're out trick-or-treating. Like right when you get the candy, don't eat it, because that candy needs to be evaluated to make sure that it does not contain the allergens to which they're allergic. And as we all remember from childhood, as soon as we received our favorite candy, we wanted to eat it immediately. So, I'd say that's the number one rule.

In the past, I've had parents tell me that what they've done in neighborhoods in which they live for young children is distribute safe candy to their neighbors, like a goodie bag just for their child. And especially in a community where you know your neighbors, then when your child goes to the door for trick-or-treating and does their trick-or-treat and, you know, is excited about receiving their candy, they are given candy that is specifically for them, that is safe for them, provided by the parents ahead of time. So, that's another option.

The other thing that I highly recommend is that you don't eat candy that doesn't have the ingredients on the label because the snack-size candies that are that are given out at Halloween sometimes contain different ingredients than the full-size candies. So even if you've, you know, eaten this particular candy before and not had any problems with it, the snack sized candy still may contain some of those allergens that you're trying to avoid. So that for sure is a big deal. And then also just not ingesting candy that you can't see the label because the labeling on candies or foods in general are also going to tell you if it's processed with other major food allergens, and so some children and adults can have food reactions from cross contact with allergens to which they're allergic and they wouldn't even think about it by eating this particular candy that obviously doesn't have their food allergens in that particular candy.

Q: How do precautions change as children get older?

Maxcie Sikora, MD: Obviously, as children get older, we're not always out there with them, observing them and trick-or-treating. I think definitely the not eating the candy while trick-or-treating goes for any age, just so they're aware that they need to wait until they get to a space where they can sit down and look at everything and look at the labels. Definitely, as children age, if they've had food allergy from a very early age, they're even better than their parents usually at being able to read a label and identify what they can and cannot have, to the point where some of them will even pick the candy that they want from the actual house in which they're visiting that doesn't contain a food allergy. Then, I think the biggest thing that parents and people, neighbors who are providing candy and other things to trick-or-treaters, is to have a teal pumpkin like what's behind me, that allows you to have other things to give out for Halloween that are not allergenic. Meaning like non-food items, you know, like little trinkets, stickers, or you know, glow in the dark bracelets, you know, things like that, that are easily obtained that you can keep in that bucket. And it actually can be, if you don't use them all, you can reuse them. So, it's nice that you can offer something that isn't candy to somebody with a food allergy. And I think to people who have the teal pumpkin, most food-allergic parents recognize that and appreciate that. And, you know, they kind of also try to steer their children towards the teal pumpkin items versus like the food items, if that makes sense.

So, I think there's definitely ways to keep children safe and, like we all know, it definitely takes a village to have a healthy child. And in this case with, you know, one in 13 children having a food allergy, that's 2 in every classroom. So, it's a huge deal. And especially if you live in a neighborhood where many trick-or-treaters come by your home, it is super-duper important to have something available that is safe for a child with food allergy to enjoy and to not feel left out in a in a wonderful holiday such as Halloween.

Q: Are there any medications or anything parents should have on hand in case of an allergic reaction?

Maxcie Sikora, MD: So, in general, many of us who are pediatric allergists, probably all of us actually, recommend that the parent always carry an EpiPen, no matter what the situation is. And in this case, this is a situation that could potentially lead to some sort of accidental exposure, even with them being as cautious as possible. So, for sure, they should have their EpiPen. And, you know, for severe allergic reaction that is your first line of defense. And so, I would definitely recommend that it varies on what everybody else chooses to carry. But most parents carry their EpiPen and also carry like Benadryl as well. But in the case of any suspected severe allergic reaction, your EpiPen is your first line of treatment and then seek care at an emergency center.

Q: What is the role of pharmacists in educating parent and children about the risks and precautionary steps to take?

Maxcie Sikora, MD: So, I think there's a huge role in pharmacy for this, the first being the importance of their EpiPen. Because you guys in the pharmacy world are the gatekeepers for their epinephrine. So, the epinephrine devices are majorly important. And also, I know that you guys also are wonderful at reminding them about when their epinephrine device expires, which is also super important because, you know, they may have their epinephrine device, but it may actually be already expired. And I would prefer that in a situation with high risk such as trick-or-treating that they have their current and in-date epinephrine device. So that, for sure, is an important thing that pharmacists can do.

The other thing is just reminding them about the precautions, you know, just things that we talked about—not eating the candy while they're out trick-or-treating, reading labels. Things that you guys already tell people because you're giving them the information on side effects of medications all the time and cross reactivity of medications, and it's a very similar thing, except in this case, you're protecting them from their food allergy and you're providing them with extra care which is part of our need in health care as to help care for our all of our patients.

Q: Do you have any tips for approaching these conversations?

Maxcie Sikora, MD: I think that it's really important when somebody addresses or ask about an allergy, especially to food, that people are very open minded about it. I find that a lot of parents and people with food allergy are not respected or believed when they tell somebody that they're allergic to a food. You know, people generally kind of blow that off or make it less important than it actually is. And I think just a little bit of compassion and sympathy for the day-to-day life where they're really living in fear of encountering something that could cause major health problems and sometimes, in certain situations, the possibility of death if they ingest it. It's just so important that we really respect others and show compassion every day, whether or not you know anybody that has a food allergy—which I find very hard to believe now that the ratio is 1 in 13—that we just try to help others and really see the need in the community and step up and try to protect those children and adults that have this food allergy. And one of those things we can do is help enjoy a holiday, you know, that a lot of us participate in and fully enjoy and allow these people to not feel ostracized because of their food allergy, they you know. They’re able to trick or treat, dress up, visit other houses, and feel safe in those communities doing so. The FARE Organization also has a teal pumpkin map on their website. So, if you are a person who has a teal pumpkin at your house, you can add your address to the list. And parents with children with food allergies actually utilize that list in order to know where to go to be safely trigger-free. So that's another thing that we all can do to help out.

Q: Is there anything you’d like to add?

Maxcie Sikora, MD: I think, you know, my whole spiel about compassion with food allergy, I just find that that is something that I really feel like puts a lot of stress and strain and anxiety on both parents and people suffering with food allergy, the lack of understanding and the lack of compassion of the general public, to where they don't feel safe, in their community. Sometimes they don't feel safe going to grab a cup of coffee or going to a local restaurant or a cafe. And so, it's really important to understand that this is a serious issue. It's definitely a health problem that is growing throughout the world. And unfortunately, it doesn't seem to be going away. So, we need to understand that and help try to facilitate a safer lifestyle for these people who have this problem.