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The Honolulu Advertiser
Posted on: Tuesday, April 18, 2006

When food is feared

By Zenaida Serrano
Advertiser Staff Writer

Top allergy-causing foods: Clockwise, from left, eggs, wheat, milk, tree nuts (walnuts, almonds, cashews, pistachios and pecans), fish, peanuts; and below left, soy.

Advertiser and Gannett library photos

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WHAT SHOULD YOU DO?

Tips for parents with children who have food allergies:

Avoid the specific foods that trigger the allergy.

Ask about ingredients when eating at restaurants or others' homes.

Read food labels and become familiar with technical or scientific names for foods. For example, milk may not be listed as an ingredient on a label; rather, the label may list casein (a milk protein), sodium caseinate or milk solids. Wheat may be listed as gluten. Similarly, egg white is frequently listed as albumin.

Prepare for emergencies. Those who have experienced an anaphylactic reaction to a food should carry with them medication — injectable epinephrine and antihistamines — to treat reactions from accidental ingestion. School teachers or day care workers should also know to use the injectable epinephrine. Those with food allergies should wear an identification bracelet that describes the allergy.

Source: American Academy of Allergy, Asthma and Immunology

Learn more

www.aaaai.org: The American Academy of Allergy, Asthma & Immunology explains allergic conditions and a referral directory for local allergists and immunologists.

www.acaai.org: The American College of Allergy, Asthma & Immunology site includes a glossary of allergy terms, interactive quizzes, and tips on when to see an allergist and how to find one.

www.aap.org: At the American Academy of Pediatrics site, search "food allergies" for dozens of articles and studies on the topic.

www.foodallergy.org: The Food Allergy & Anaphylaxis Network answers questions about food allergies, allergy-free recipes, and links to sites specifically for kids and teens.

Allergen-reduced birthday cake

Food allergy-prone children may be able to have cake — and eat it, too. Here's a recipe for cake and frosting that's milk-free, egg-free, peanut-free, soy-free and nut-free. Please note: the frosting is wheat-free, but the cake is not.

Double Layer Birthday Cake

3 cups cake flour

1 3/4 cups sugar

1 1/4 cups water

1/2 cup shortening

3 tablespoons water, 3 tablespoons oil and 2 teaspoons baking powder — mixed together

2 1/2 teaspoons baking powder

1 teaspoon salt

1 1/2 teaspoons vanilla extract

Note: Baking powder is intentionally listed twice in this recipe. The combination of 3 tablespoons water, 3 tablespoons oil and 2 teaspoons baking powder mixed together is the substitution for two eggs.

Preheat oven to 350 degrees. Grease and flour two cake pans. In a large bowl, combine all ingredients. Using an electric mixer, beat until well mixed, approximately 4 minutes. Pour batter into cake pans. Bake 40 to 45 minutes, or until toothpick inserted in center comes out clean. Cool in pans 10 minutes before removing to wire racks. Frost when completely cooled.

Cocoa Frosting

1/2 cup milk-free, soy-free margarine, softened

1/2 cup Hershey's unsweetened cocoa powder

2 2/3 cups unsifted confectioners sugar

1/4 cup water

1 teaspoon vanilla extract

Beat margarine on medium speed in large mixer bowl until softened, about 1 minute. Add remaining ingredients. Beat on low speed until ingredients are moistened. Beat on medium speed until creamy.

Source: The Food Allergy News Cookbook, The Food Allergy & Anaphylaxis Network

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Mila Gaston, 7, has outgrown her sensitivity to wheat and soy, but still struggles with some dairy products and eggs.

REBECCA BREYER | The Advertiser

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A breakfast of eggs, pancakes and milk may sound like an acceptable meal for most children, but not for Mila Gaston.

As a toddler, Mila could not eat milk, wheat, soy and egg products, or else she'd suffer an itchy, allergic reaction.

"I see her sometimes when she's itchy she has real sensitive skin and I feel so bad about that," said Mila's mother, Monya Gaston, 40, of Mililani.

The condition was not only an uncomfortable nuisance to Mila, it proved costly to her parents, who had to buy special milk- and soy-free formula for their daughter until she was 4 years old.

"She couldn't have normal formula, either," Gaston said. "We had to buy really expensive formula."

Mila, now 6, is among nearly 2 million school-aged children nationwide who have food allergies, which also affect one in every 20 children younger than 3, reports The Food Allergy & Anaphylaxis Network, a worldwide nonprofit organization.

Food allergies among children are on the rise. For example, a study by Mount Sinai School of Medicine in New York found that peanut allergies in children doubled from 1997 to 2002. While scientists don't know for sure what's behind the jump, they lean toward environmental effects, such as air pollution, and what is called the Hygiene Hypothesis that children's immune systems are hypersensitive in a cleaner, largely indoor world.

"Allergy reactions to foods actually can go anywhere from getting a mild itch all over the body to an anaphylaxis, which could be fatal," said Dr. Franklin Yamamoto, a pediatric allergist and immunologist. Anaphylaxis is a severe allergic reaction that can involve swelling and closure of the throat, a severe asthmatic episode or shock.

PREVENTIVE MEASURES

"Most of the reactions, fortunately, are mild," Yamamoto said. "They include just a little bit of itching, a little bit of rash and maybe hives." Such reactions often can be treated with over-the-counter medications like Benadryl, an antihistamine that can neutralize the reaction.

"But anytime you have any sense that there's trouble breathing, any sense, then you should call 911 immediately," he said.

While there are treatments for allergic reactions, there is no cure for food allergies. However, there are measures parents can take to try to prevent their young children from getting food allergies, Yamamoto said.

"To become allergic, you have to be exposed to the foods," he said.

Mothers who breast feed may be able to keep their babies from getting food allergies, Yamamoto said. Breast milk reflects what a mother eats, so if a parent is careful about her diet not eating too many peanuts or breads, for example she can use breast milk as her child's main source of nutrients until about 6 months.

Another way to keep babies from developing food allergies is to wait to feed them foods that often cause allergies, reports the American Academy of Allergy, Asthma & Immunology.

The organization recommends waiting until babies are 6 months old before giving them solid foods; waiting until they are a year old before giving them milk and other dairy products, such as cheese and yogurt; avoiding eggs until age 2; and avoiding peanuts, nuts or fish until age 3.

Sandy Natori's son, Lane, developed a severe peanut allergy after eating peanut butter when he was a little more than a year old, Natori said. Lane broke out in hives all over his body several times as a baby. But his worst allergic reaction happened at his 2nd birthday party, when Lane's eyes swelled shut after eating kaki mochi that his family didn't know was fried in peanut oil.

"I was a wreck in the beginning," said Natori, 43, of Waipi'o Gentry. She felt she had to keep a close eye on her son, "because I thought if he's not with me, he's going to die."

LEARN ABOUT ALLERGIES

If parents suspect their children have a food allergy, a pediatrician can refer them to a pediatric allergist for an allergy skin test. After a child has an allergic reaction to an unknown food, parents should write down in detail the past three meals the child had. Such a record could help doctors identify the possible food allergy, Yamamoto said.

Once the food allergy is identified, parents can take several steps to protect their children.

Children should wear an identification bracelet or necklace that describes the allergy, and parents should teach their children to reject foods they're unsure about, Yamamoto suggested.

"And (parents) really shouldn't keep foods that the child is allergic to around the house," Yamamoto said.

Monya Gaston, Mila's mother, is careful about how she stocks her kitchen.

"We don't have ice cream in our freezer, even though that's one of my favorite foods in the world, just out of sensitivity to her," Gaston said.

It's also important to prepare for when the child is in school, advised Dr. Jeffrey Okamoto, a pediatrician and school health specialist. "Children with severe allergies, especially those that require epinephrine for hives and severe anaphylaxis, should have an emergency action plan for school ... that is clear to the teachers and school administration."

Lane, now 13, carries a fanny pack with his injectable epinephrine and oral antihistamines, and a "peanut protocol paper," with instructions on medication and important phone numbers.

Meanwhile, Gaston continues to be cautious about the foods she introduces to Mila. While Mila has outgrown her sensitivity to soy and wheat, she still has problems with certain milk products and egg. To play it safe, they avoid foods like seafoods and nuts because of Mila's history.

"It's kind of hit and miss," Gaston said. "You have to try and see how it goes."

Reach Zenaida Serrano at zserrano@honoluluadvertiser.com.