In one out of every nine cases in which a child is given food that sets off an allergic reaction, it is not an accidental exposure. Parents are giving their children known food triggers, a new study suggests.
Authors of the study, published Monday in the journal Pediatrics, said they are not completely sure why it's happening.
"In terms of purposeful exposures, those percentages haven't been reported before," said Dr. David Fleischer, assistant professor at National Jewish Health in Denver, the lead author of the study. "Maybe parents were testing their children to see if they had outgrown their allergy. There's going to be a follow-up study, going back to families and asking exactly why caretakers were giving these foods on purpose."
Another finding was that at least 70 percent of the 500 infants followed in the study had at least one allergic reaction over the study period, and more than 50 percent of the infants had more than one reaction -- despite the fact that parents or caregivers had already been informed of the child's allergy.
Taken together, the findings suggest that even after a food allergy diagnosis is made, children with allergies are still at risk.
Elizabeth Goldenberg of Ontario, Canada, is intimately familiar with these risks. Her 10-year-old son, Jacob, loves basketball, enjoys computer games, and is learning to play the piano. But with even the smallest exposure to nuts, he could die.
Jacob has a severe allergy to peanuts and tree nuts, confirmed by a certified allergist. When the diagnosis was made, Goldenberg realized that there was much she had to learn about how to keep her son safe.
"When he was diagnosed, I understood a little bit about food allergies," said Goldenberg, who is also author of the Onespot Allergy Blog. "But I was at the bottom of a very steep learning curve. I was actually sitting in the allergist's office with a snack containing trace amounts of peanuts. I was about to give him the exact thing he shouldn't be eating…I had no idea what to do next."
With nearly 8 percent of children in the United States affected by food allergies, researchers across the United States are trying to better understand how to counsel parents, such as Goldenberg, in dealing with the diagnosis.
The new study is the first of its kind to look at the frequency and circumstances of food reactions after families were counseled on avoidance. The researchers wanted to identify areas for improvement in parent education, as well as the specific reasons why children with known allergies were developing reactions.
Unlike most studies, which use surveys of allergic reactions, this research followed infants prospectively, or over the course of years.
"There really aren't a number of large studies that have reported reactions in a prospective way," Fleischer said. "There also aren't a lot of studies looking at this very young age population."
What the researchers found was that most food exposures leading to allergic reactions were accidental, with milk, egg, and peanut being the most common culprits. The majority of reactions were attributed to a lack of vigilance -- forgetting to check ingredients, for example -- but over half of these incidents occurred when food was being provided by caretakers other than parents.
Dr. Scott Sicherer, professor at Mount Sinai Hospital and co-author of the study said the study may serve as a wake-up call for some who care for food-allergic children.
"The bottom line is that you have to maintain a high level of vigilance," he said. "That applies to the parents, but also to other people taking care of the child: grandparents, siblings, babysitters, teachers. Basically everyone who is around the child needs to know about the allergy and understand what to do to keep the child safe."
There have been changes in recent years that safeguard against the threat of food allergy complications. Food allergy advocacy groups have been at the fore, urging airlines to stop serving peanuts on planes and discouraging mothers from bringing peanut butter and jelly sandwiches to the soccer field. Familiarity among caregivers with the sole medication known to save a person from life-threatening anaphylaxis -- epinephrine, otherwise known as an EpiPen -- has grown. Awareness has grown to the extent that some parents, out of fear their child may have food allergies, will give them peanut butter for the first time in hospital parking lots.
"In the scheme of the things, it's a partnership between parents and health professionals," said Dr. Clifford Bassett of New York University's School of Medicine. "If parents want to reintroduce foods, they should make a plan with a food allergy expert. Some patients will need a food challenge in the office in a supervised environment, and some can trial foods at home. It's all about education, collaboration, and preparedness."
As for Goldenberg's son Jacob, he likely won't be trying pecan pie or walnut brownies anytime soon. His family runs a completely nut-free household, and they have only allowed him to eat in similarly safe environments.
Until now. Jacob is currently away from home at a conference for gifted children.
"It's the first time I've let him out of a secured zone," his mother said. "But I think at age 10, you need to let that happen. Given his age and preparedness, you have to trust that you've done everything you can to prepare your child to function well in the world."