Parents, Clinicians Can Take Steps to Manage Food Allergies During the Holidays

In an interview with Pharmacy Times, AllerVie Health allergist Maxcie Sikora, MD, discussed steps that parents and clinicians can take to minimize the risk of food-induced allergic reactions during the holiday season. Parties and get-togethers often present challenges for patients with allergies, particularly with home-cooked food that may have unclear ingredients. To avoid allergic reactions, Sikora suggested some steps families can take, including hosting events themselves and teaching children to ask before eating food from others.

Aislinn Antrim: Perfect. So, just to get started, what potential allergens do you see at kind of the Thanksgiving and holiday type of gatherings?

Maxcie Sikora, MD: Well, you know, just like we talked about before, the incidence of food allergy is so incredible. As we mentioned in our Halloween discussion, 1 in 4 children in a classroom basically have a food allergy. One in 13 people in general have a food allergy or a food intolerance. So, you know, the likelihood, especially at large family gatherings, that you're going to have somebody there that actually has a food allergy or food intolerance is quite high. So, you know, for young children, especially children under the age of 2, you still have the most common food allergies as problems, which are milk and wheat, soy, peanuts, seafood—those are all major allergens. So, you know, knowing that is of utmost importance if you're hosting a big gathering, that you ask people if they have any food allergies or food intolerances that you need to be aware of. I think that's just classy as a host, and responsible as a host to just know that.

I know in our last conversation we discussed that it was really important to really look at how to deal with those situations. As a parent, I think, you know, unfortunately, kind of the best way to deal with a group setting situation as a parent when you're dealing with a big holiday such as Thanksgiving or Christmas is to host it yourself. I wish that I could say there was a better way to do it. But I think from a from a control standpoint—and if you read any of and I'm sure parents who are listening this know this, if you read any of the major food allergy blogs, etc., they're really discussing like how to deal with holidays. Their biggest recommendation is that you host whatever the event is, so that you have control of the food that's there. Because unfortunately, you know, so many people that haven't dealt with a child or a family member with food allergy, they don't really understand the implications of even trace quantities of that food allergen being in some of those products. And they might not even recognize that traces of certain food allergens are actually in those products. So, it kind of takes that responsibility off of those people, and basically allows you to have control of the situation.

One of the things that I read somewhere, and also I had thought about, is the way to kind of make that happen to where you're still having a family gathering and still having people participate is potentially inviting family members and friends over to help you prepare the meal. You know, it doesn't have to be you doing all of this yourself. But maybe having it be a fun thing where you provide the ingredients, they come over and help you cook for the holiday, and then you have the meal there and you have control. And it's also a great way to educate people who aren't fully aware of what you deal with on a regular basis. How to educate them on reading labels and knowing hidden sources of food allergens. As we age, the adult population, the biggest food allergens for them are nuts and seafood. Seafood is not such a big deal during the holidays, unless you live in a coastal area, like where I grew up, because you know, definitely around New Orleans and like in Charleston, the bigger cities that are coastal, you know, there are seafood dishes that we prepare for holidays. But in general, all over our country, it's more nut products that people use and holiday dishes that we don't even think about potentially as being very harmful to people who are allergic. But in a lot of cases, those are the major food allergens where people can have anaphylaxis and sometimes even die from trace amounts. So, it is it is definitely a time of year where those things are prolific. And you definitely can harm people at your family meals or your friend meals. Now granted, most of those people that have food allergies, they're very aware of this and they're going to alert you before they even come to your home regarding this, but I think it is important to be mindful of that when hosting a big gathering.

Aislinn Antrim: Yeah, absolutely. We talked about packaged candy before, which a lot of them have the ingredients listed, but homemade food can present different challenges. I know for myself, I don't even know the ingredients half the time in something. How can parents make sure they’re safe?

Maxcie Sikora, MD: They basically, unfortunately, can't. They shouldn't allow their children to eat things made by other people. I mean, I hate to say that, but it's one of those things where it's very difficult to know what is in homemade candies. And as we know, that's such a lovely gift to give people because it's so thoughtful, and it's something that you've given and made from the heart for other people. So, I guess one of the things I would say is don't be offended if people say that they can't take that home, because it's probably not because they don't want to eat it. It's just because they're trying to protect other family members that potentially have a food allergy. But really, truly, even like processed foods, you know. There was an article on foodallergy.org, which I talked about in the Halloween discussion we had, just recently talking about candy canes, like some candy canes actually are processed with other food allergens. So, even though you think candy canes are basically just sugar and food coloring, in certain places where those candy canes are produced, they're actually produced on lines of things that have milk and have nuts. And so, you know, even our best thought processes, we were thinking, “Oh, a candy cane should not be a problem, or peppermint shouldn't be a problem.” To somebody who's food allergic, you really have to be mindful of reading those labels. And just like with our Halloween discussion, snack size things sometimes contain different ingredients, even in pre-packaging, than their full-size sisters and brothers do when it comes to candy.

So, you really do have to read those labels very, very mindfully and know that truly, in our country, the standard food allergens—milk, egg, wheat, soy, peanut, and all the tree nuts—those should be in bold print on the label. But sometimes that doesn't happen, especially with specialty foods and specialty candies. And so, in general, I would just say if you know this ahead of time, and you know you're providing things for a household with food allergy, you may want to give them gifts of non-food items. And I would also say that for parents who are trying to deal with the holidays with their children, like stocking stuffers and things, just like with Halloween with the Teal Pumpkin Project, it may be better to do stocking stuffers that aren't candy derived, you know, non-food items for fun, versus food items for fun. And then with the knowledge that if you do have a family gathering, that you kind of see, well, you definitely need to be the person supervising and overseeing the food preparation. And you know, if people ask what they can bring, just ask them to bring themselves to enjoy the holiday, that this is your gift to them to provide a meal without any stressors, or they can bring ice, or they can bring, you know, bottled beverages, you know, nothing really homemade, because you just never know. But that's what I would say.

Aislinn Antrim: Yeah, that makes sense. How can parents have these conversations with family? We talked before about kind of meeting some resistance or people just not understanding, so how can they do that?

Maxcie Sikora, MD: I think, you know, it's mainly just education. And maybe it also is, like we talked about, like helping them prep the meal. I mean, I don't think that people understand how hard it is for parents and people with food allergy to plan a meal and to prepare a meal. I mean, it's a whole different level, it's not just opening like your favorite cookbook and going through and finding these fabulous recipes. You really have to be mindful of all the ingredients you're using, reading labels for everything, really knowing where they're sourced. And the general public I don't feel understands the gravity that goes into prepping a meal for somebody with a life-threatening food allergy. So, potentially, it is more allowing them to be part of the process, knowing, kind of sharing in that, and sympathizing with everything that goes into that, because that's a huge deal.

I also think it is good to have like other resources to allow them to realize kind of the gravity of it. Just like some of the parent-run websites, as I've mentioned before, foodallergy.org. There's a lot of good data to allow family members to just kind of look at, and even posting. I think families do really well, families with food allergy do a lot. You know, whether or not we agree with all the social media platforms or not, you know, there is a lot of good from the standpoint of posting informative articles and videos through your social media to potentially allow some of your friends and family to see what you deal with on a regular basis, through an educational and informative post, not negative post.

Aislinn Antrim: Yeah, that's wonderful. How can parents start educating the really young children who just want to grab everything?

Maxcie Sikora, MD: So, I think the biggest thing is that, you know, you kind of unfortunately have to instill a tiny bit of fear and respect, just to start allowing them to understand that they can't have certain foods or things in certain foods that it could harm them. And that if they are uncertain about what is in the food—or, actually, don't even give them that choice, especially, you know, under the age of 2- to 3-year-old range, you know. Unfortunately for them, they don't always have that discernment, they just want to eat the candy, or eat the goodie that somebody has given them. So, anything that's not given to them by their parents, they really should be taught to ask before they eat whatever that item is. And, you know, at Halloween, we discussed don’t eat your candy before you get home, and your parents can look at it. It’s kind of the same thing with this. If you guys go to a social gathering at church or at a friend's house, or at a party or at a community center where they're giving out candy, you know, if you haven't been part of the organizational aspect of it and had something provided for your child that was allergen free, you really want to tell your children before you guys even get there. Like, “Okay, we need to see all the candy that you've been given before you eat it, so we can check it and make sure that it won't hurt you.” And it is one of those things that’s very difficult from the aspect of you want them to enjoy the holiday. You don't want them to be frightened about the holidays, you want them to enjoy this and feel the love and laughter and brightness of the holiday season. But they also have to be a tiny bit fearful that something that they are given by others might cause a reaction. And so that's the fine line that you have to deal with. And it really is probably more of an issue to make it less about food, and more about festivities and non-food items. And that's hard, because we eat all the time during the holidays. But it's probably more just changing the social group that you're in, it’s mindset, where it's probably really better in your case to do more activity-driven things versus food-driven socialization.

Aislinn Antrim: What medications should parents have on hand? What should they know in case something goes wrong.

Maxcie Sikora, MD: Absolutely. So, you know, obviously, the epinephrine device is key. Any person—child or adult—who has a food allergy should have an epinephrine device that can be provided. The prescription can be provided by your provider, whether it be your primary care provider, your specialist, whomever, and then that epinephrine device is then filled by the pharmacists of the world. And so, and if you have a question about how to use that device, you then can ask your primary care office, you can ask your pharmacist, you can ask anybody how to use it. And there's also videos online for that as well. So definitely that, and then for other minor type reactions that you can discern, probably have some generic Benadryl, which would be diphenhydramine, with you. But the mainstay of treatment for any sort of severe allergic reaction is going to be your epinephrine device and administering that and going to your local emergency room following the administration or the reaction, not because you gave epinephrine, but because those symptoms can sometimes come back after an allergic reaction, and you need to be monitored by medical professionals for a few hours after the reaction to make sure that no symptoms return.

Aislinn Antrim: Is there anything you want to add anything that I didn't ask about?

Maxcie Sikora, MD: Just like with our Halloween discussion, I just think that we all could do, meaning the world could do with some patience and love and empathy and sympathy for others. And so, in this situation, this is a large group of people that sometimes is not truly identified or sometimes marginalized, that we really need to reach out and try to understand and know that this is very difficult for parents and for adults with food allergy during holiday seasons, because they are fearful of ingesting something or coming in contact with something, even if it's a cross contamination, you know, like preparing a meal. And their allergen just happens to have the same utensil used and there's a small amount of it, that small amount could trigger a life-threatening allergic reaction. We just need to be mindful of that and if a parent or a friend says, “Look, you know, I appreciate you inviting me to this dinner. But do you mind if I just hosted at my house? It would make me feel more comfortable,” that you're not offended by that. It's just an understanding that it's their safety measure to try to provide safe a safe environment for their children, their spouse, their partner, or them themselves, you know that they want to spend time with you, but they need that security measure as part of the process.

Aislinn Antrim: Yeah, absolutely. Thank you so much for talking with me about all of this.

Maxcie Sikora, MD: No problem. Thanks. Again, this is a good platform to do this.