Pharmacists Can Play An Important Role in Food Allergy Education

As a pharmacist and a mom, I never thought too much about food allergies. Luckily, my 3 children have never had any allergic reactions to foods.

Since there is no school this week, I thought it would be fun to take my kids to see the movie 'Peter Rabbit.' All I knew was that it looked like a cute kids’ movie about a rabbit. I asked a friend, with children of similar ages, to join us, and was surprised when she informed me she was boycotting the movie.

I had no idea why anyone would boycott a children’s movie, but she explained that food allergy advocacy groups everywhere are doing it. The reason is a scene where rabbits attack an allergic enemy with blackberries. The enemy has an anaphylactic reaction, struggles to use his EpiPen, and collapses.

In an open letter to Sony, Kenneth Mendez, president of the Asthma and Allergy Foundation of America, explained that not only is this scene inappropriate, but the film alludes that food allergies are made up. Mendez also stated that Sony has made light of food allergies in previous movies, 'The Smurfs' and 'Cloudy with a Chance of Meatballs.' Mendez asked for Sony to refrain from future programming that mocks food allergies.

The filmmakers and Sony apologized, saying “Food allergies are a serious issue. Our film should not have made light of Peter Rabbit’s archnemesis, Mr. McGregor, being allergic to blackberries, even in a cartoonish, slapstick way.” And added, “We sincerely regret not being more aware and sensitive to this issue, and we truly apologize.”

After initially hearing this, I could understand why there would be outrage, from the 4% of adults and 5% of children (and their families) in the United States who live with food allergies.¹ (Other estimates put the number of children at up to 8%)

Despite this, out of curiosity I took my children to the movie today, and was surprised to see much more violence than I expected. The blackberry in this case was used in self-defense, as the bunnies tried to protect themselves from being killed and ending up baked into a rabbit pie, the fate Peter’s father suffered. Overall, food allergies and the accompanying bullying that often occurs, are very prominent and worth a discussion.

A little background on food allergies:

• A food allergy is an immune system reaction that occurs after eating a certain food (not to be confused with food intolerance, which is bothersome but less severe). Even a very small amount of food can trigger problems in those with food allergies, from digestive issues to hives and life-threatening anaphylaxis.
• Food allergies, which can occur minutes to hours after eating the food, can include these symptoms—tingling of the mouth, hives, eczema, and swelling of the lips, face, tongue and throat or other parts of the body, as well as wheezing, nasal congestion, trouble breathing, abdominal pain, diarrhea, nausea or vomiting, dizziness, lightheadedness, or fainting.
• Signs of anaphylaxis, which is life-threatening, may include constriction and tightening of the airways, swollen throat or sensation of lump in throat, difficulty breathing, shock with rapid blood pressure drop, rapid pulse, dizziness, lightheadedness, or loss of consciousness. Without emergency treatment, anaphylaxis can lead to a coma or death.²
• In children, the most common foods that cause allergies are peanuts/tree nuts, eggs, cow’s milk, wheat and soy.
• Food allergies are often confused with Celiac disease, lactose intolerance, or food additive sensitivity.
• Those at higher risk for food allergies include individuals with a family history, individuals with other allergies, age (allergies are more common in children, as many individuals outgrow allergies), and individuals with asthma.
• Those with higher risk of anaphylaxis include—history of asthma, age 13 and below, delaying use of epinephrine, and not having hives or other skin symptoms.

It is very difficult to have a food allergy, especially when out at restaurants or in social situations, because many food allergens are hidden or unknown. It is a good idea for those with food allergies to wear a medical ID bracelet, carry an EpiPen at all times, and be very careful at restaurants by asking questions to the chef. Many of these children attend birthday parties with their own snacks to avoid food allergens.

Childcare providers/school officials should be made aware of the child’s allergy and able to recognize symptoms of a reaction. They should also have an action plan for emergency treatment.

I spoke with Heidi, a mom who has a son with severe food allergies, about life with a peanut allergy. He was diagnosed at age 2, and his peanut allergy level was in the very high range. From the beginning, Heidi taught him to say, “I am allergic to peanuts and I will go into anaphylaxis and die if I have any”. She explained that when an adult hears a toddler saying that very clearly and distinctly, they know it is serious. She taught him to ask about all food that was given to him. He always ordered his own food and told the wait staff about his allergy.

At school and at parties, Heidi always provided her son with safe snacks. At class parties, the children were not allowed to bring in food with peanuts; however, he also does not eat food manufactured on equipment shared with peanuts. Heidi would always worry that someone would just give him something to eat and not really know if it was safe for him. He doesn't remember a time where he didn't have his allergy and has always been mindful and asks questions, even now as a teenager.

His friends are all aware and supportive; however, there was one incident in first grade where another child told him he had peanut butter on his hands and he was going to touch him. Later that day, there was a discussion with the school nurse about how this is not a joke.

To diagnose food allergies, doctors consider many factors, such as family history, symptoms, physical exam, skin allergy testing, IgE blood testing, and elimination diet. For a minor allergic reaction, treatment may be OTC or Rx antihistamines. A severe reaction may require an EpiPen injection and trip to the emergency room.

EpiPen counseling is very important and is a place where pharmacists can be a great resource, helping patients and their families learn correct use, reminding patients/parents to carry one at all times (keep an extra at school), and reminding them to replace pens before the expiration date. As of now, there is no proven treatment to prevent or completely relieve symptoms, and experimental treatments are being studied.³

Campaigns such as PAL—Be a Pal, Protect a Life, by the Food Allergy Research & Education (FARE) program, aim to educate the public about the dangers of food allergies as well as provide resources for parents, troop leaders, etc, on how to be a good friend to those with food allergies.⁴ FARE's website provides statistics on the incidence of food allergies and bullying.

It is upsetting to note that more than 1/3 of children ages 8-17 with food allergies have encountered bullying by classmates due to their food allergies, leading to more distress and lower quality of life. Bullying is a serious issue in general and should not be tolerated under any circumstances. Bullying children with food allergies is extremely dangerous and consequences can be fatal. This is where pharmacists can be a great source of information.

I often thought it would be a great community service event to talk to children in elementary schools, but never knew what to talk about. I think this would be a very good topic that is relatable to everyone. There are even presentation guides that pharmacists can follow, and great supplemental materials, such as coloring pages and bookmarks to color.

Almost everyone knows someone with a food allergy. We must all stand up to protect each other’s children from all forms of bullying and pharmacists can be a great resource to educate children on food allergies and food allergy bullying.

References

• Allergy Statistics and Facts. Web MD. www.webmd.com/allergies/allergy-statistics. Accessed Feb 18, 2018.
• Food Allergy: Symptoms and Causes. Mayo Clinic www.mayoclinic.org/diseases-conditions/food-allergy/symptoms-causes/syc-20355095. Accessed Feb 18, 2018.
• Food Allergy: Diagnosis and Treatment. Mayo Clinic www.mayoclinic.org/diseases-conditions/food-allergy/diagnosis-treatment/drc-2035510. Accessed Feb 18, 2018.
• Food Allergy Research & Education www.foodallergy.org/education-awareness/be-a-pal. Accessed Feb 18, 2018.