what next when you have a potential food allergy?

[Anonymous]

Last night 13 mo DD was finishing up her dinner with some freeze dried strawberries which she has had at least a dozen times before. I am in the kitchen with her and my older DD and am tidying up and I look up about 3 min later and her lips are hugely swollen. Long story short, I gave her Benadryl, we went to ER, and doctors determine she is fine but had some sort of allergic reaction (no hives or wheezing). Benadryl is only medicine that is given.

Both ER doctor and pediatrician recommended against going to get allergy testing (they said it is too early). DD did not have anything for dinner last night that she hasn't eaten several times before (pasta with butter, eggs, and cheese + pretzel + freeze dried organic strawberries). ER doctor said it is most likely a reaction to the food she was eating when her lips swelled up, so to avoid strawberries for a while.

I am a little freaked out by how quickly it all happened and how it happened with foods she has had many time before. I am terrified it is going to happen when she is at daycare or with my parents. Would love to hear from other parents this has happened to, specifically about

--what you do next to confirm you had a food allergy to a specific food?
--did you discover other food allergies?
--what is your protocol now for reactions?
--did your other kids end up having any food allergies?

No history of food allergies in the family.

TIA!!

[Anonymous]

First, RELAX. It was scary but relax. A trip to the ER was probably not necessary. Did you call your doctor after the reaction? Did the swelling stop when you washed her hands and moved the strawberries?

We gave our 6 month old peanut butter and he immediately broke into hives and his lips swelled up. We cleaned off his face and hands, called the doctor, and gave him benadryl. We did not go to the ER.

We waited a couple months and then tried again, this time just putting a small, small dab of PB on his cheek (per doctors advice). Immediate reaction. Argh.

We went to the allergist around 10 months old and then confirmed the peanut allergy via the skin test. EVEN STILL, the allergist was very clear in telling us that severe reactions are RARE and we should continue to live our lives and keep peanuts away and epipen on hand. Again, severe reactions are possible but RARE. We do not live our lives terrified that this will happen. Our allergist told us that if we ever start to feel fearful or controlled by the allergy, then we need to come back in and talk to her.

After the peanut incident and before the allergy appointment, we continued to give him a great variety of food, but avoided peanuts (like, peanut butter and crushed peanuts on pad thai). We still went out to eat all the time and gave him everything: indian, ethiopian, pizza, muffins, sandwiches, etc etc. If he ever seemed to have a reaction, we'd wash his hands and face and remove the food. He has never reacted to anything else.

It's tricky because it could have been a bad batch of strawberries.

Relax. Seriously. It'll be fine.

[Anonymous]

I think OP reacted appropriately as reactions can be biphasic (peaks, goes away, then comes back) and it's not like she knew whether or not it would get worse and her DD's breathing would become affected.

A bad batch of strawberries isn't going to cause lip swelling...

It's not too early to do allergy testing, but even if she tests negative, the gold standard is whether or not she has a reaction when she eats the food in question (in office food challenge). Unfortunately, just because she's eaten something before and been fine doesn't mean it won't later cause a reaction. Reactions can get worse over time and with repeated exposure, so I would definitely stay away from strawberries for awhile and consult with an allergist.

[Anonymous]

I don't think it's too early to consult an allergist; my son was diagnosed with peanut and treenut allergies at 15 months and now at 6, he is still allergic to 6 kinds of nuts. In his case, after he had two unusual reactions, I mentioned it to the pediatrician who told me it wasn't an allergy because if it were, he'd be covered in hives from head to toe. Unfortunately, that is incorrect advice, and I'm glad we had him tested by an allergist (actually 3 different ones over the course of the last 6 years). In addition, I agree with 13:42 that a biphasic reaction could happen- it did to my son once, hours later.

While we don't live in fear either, and do eat out a lot, I approach managing his allergies as though I'm preparing for WHEN he has a severe reaction, not if. I think of Natalie Giorgi, the 13 year old who'd only had 2 reactions in her life, the second of which killed her. I guess I liken it to living with the threat of terrorism here- not fearful, but prepared and vigilant.

[Anonymous]

It is not too early to be tested. Push your ped on this. Call the Institute for Allergy and Asthma (not sure if that's the exact name, but something like that), and get in with Dr Economides. We had both kids tested at 9 months and again around 15 months. They did a food challenge in office with my older kud around 18-24 months (can't remember exactly when). There's no reason you can't test. These drs know their stuff and are great.

I'm guessing it was a reaction to strawberies, which can cause reactions. Probably the freeze dried ones are more condensed than fresh and more likely to cause a reaction. It's odd that she's been fine before but not unheard of. Allergies can start up at any time, and sometimes the first reaction is much milder, so maybe you didn't notice it. It's also possible it was an irritation and nit a fully allergic reaction -- hard to tell from your post.

Avoid strawberries but no need to freak out. If there are any common allergens she hasn't tried yet (particularly nuts or peanuts), watch very closely when you give them and give a small bit the first time (and at this age, just nut butters - not whole nuts for choking reasons).

[Anonymous]

Op, this happened to my 1 yo son as well but it turned out to be the sulfur / sulfites / preservatives on the dried fruit. Not saying this is your case but keep an eye out.

No more dried fruit including apples, instant oatmeal with fruit, cereal w dried fruit or store bought lemon concentrate.

When their immune systems flare up they can only handle so much sulfuric foods (naturally found in foods as well such as grapes). Some days they may or may not have a high threshold for sulfur. Look up for a food chart for foods with sulfur. We avoid as much as possible as it won't cause hives but dies cause loose bowels. The hives for us were cause by dried fruit and lemon juice concentrate. I have the same sulfite ad version but if I drink wine or dried fruits my hands and joints itch.

This is also hard to test for since it's not a protein.

Anyways hope this is not your case.

Good luck!

[Anonymous]

Allergy mom here as well. Lost of good advice from the pp not to take no for an answer on waiting for allergy testing. Do it now

Re what she reacted to. Dried fruits are frequently cross contaminated with nuts. Has she ever had any type of nut product before? I'm just throwing it out as another possibility

Hang in there. It's stressful at first but becomes second nature and just having a plan can make a big difference in the stress!

[Anonymous]

OP here - thanks for all the advice. I will push back on my pediatrician again about testing.

To give some more information, DD's lips were *hugely* swollen - maybe 20+ times their normal size - she looked cartoon-ish. I was very concerned that her throat was also swelling up that much which is why I was inclined to go to the ER. I also paged my pediatrician and he told me about the benadryl and to then go to the ER. The benadryl kicked in immediately and by the time we got to the ER she was still really swollen but it was clearly getting better. ER doctor told me I only need to come the next time if she is having breathing problems, so lesson learned about when we need to go.

Also, strawberries were from same bag as she had been having all week (we do freeze dried fruit as "dessert") so unlikely it was a bad batch. I appreciate the tip about the sulfides - the ingredients on the package don't include anything but strawberries and it says it has no preservatives, but I will call the company to ask if the freeze-drying process involves some sort of chemical that isn't listed.

We have already introduced peanut butter, eggs, fish, etc, but I will watch closely the next time she has these, especially peanut butter.

Again, I appreciate your advice!

[Anonymous]

Anonymous wrote:OP here - thanks for all the advice. I will push back on my pediatrician again about testing.

To give some more information, DD's lips were *hugely* swollen - maybe 20+ times their normal size - she looked cartoon-ish. I was very concerned that her throat was also swelling up that much which is why I was inclined to go to the ER. I also paged my pediatrician and he told me about the benadryl and to then go to the ER. The benadryl kicked in immediately and by the time we got to the ER she was still really swollen but it was clearly getting better. ER doctor told me I only need to come the next time if she is having breathing problems, so lesson learned about when we need to go.

Also, strawberries were from same bag as she had been having all week (we do freeze dried fruit as "dessert") so unlikely it was a bad batch. I appreciate the tip about the sulfides - the ingredients on the package don't include anything but strawberries and it says it has no preservatives, but I will call the company to ask if the freeze-drying process involves some sort of chemical that isn't listed.

We have already introduced peanut butter, eggs, fish, etc, but I will watch closely the next time she has these, especially peanut butter.

Again, I appreciate your advice!

OP, please see an allergist. There are some great ones in the area, and given the level of swelling you describe, I would absolutely talk to one. Don't wait to talk to your pediatrician. You need an allergy action plan and an EpiPen; I'm not trying to scare you unnecessarily, but allergic reactions can be unpredictable, and just "go to the hospital" isn't always a sufficient plan. What's the harm in seeing an allergist? You have an EpiPen you never use?

[Anonymous]

My son had an anaphylactic reaction to a nut at 18 months. ER trip, steroids, observations, the whole 9 yards. I really think you should get your kid tested. A pediatric allergist fit us in next business day. Testing revealed he is severely allergic to two tree nuts and peanuts. Food allergies are funny things, the next reaction could be worse. Best to be armed and the testing is not invasive.

[Anonymous]

I agree with the cross contaminates moms: nuts or sulfates.

You also mentioned eggs. Could it have been that?

Every person I know who had a strawberry allergy as a young kid or toddler outgrew it by late elementary school, including my brother 45 years ago.

I wouldn't go into fulk stress mode yet based on what you posted OP.

[Anonymous]

Anonymous wrote:OP here - thanks for all the advice. I will push back on my pediatrician again about testing.

To give some more information, DD's lips were *hugely* swollen - maybe 20+ times their normal size - she looked cartoon-ish. I was very concerned that her throat was also swelling up that much which is why I was inclined to go to the ER. I also paged my pediatrician and he told me about the benadryl and to then go to the ER. The benadryl kicked in immediately and by the time we got to the ER she was still really swollen but it was clearly getting better. ER doctor told me I only need to come the next time if she is having breathing problems, so lesson learned about when we need to go.

Also, strawberries were from same bag as she had been having all week (we do freeze dried fruit as "dessert") so unlikely it was a bad batch. I appreciate the tip about the sulfides - the ingredients on the package don't include anything but strawberries and it says it has no preservatives, but I will call the company to ask if the freeze-drying process involves some sort of chemical that isn't listed.

We have already introduced peanut butter, eggs, fish, etc, but I will watch closely the next time she has these, especially peanut butter.

Again, I appreciate your advice!

ER doctor is wrong.

Lip and mouth swelling as you describe is ER worthy.

So is a full body reaction without wheezing.

So is projectile vomiting along with any mouth/throat reaction.

In those cases, epi immediately, then ER.

If you wait to go to the ER until breathing issues develop, then you might be too late.

Go to an allergist OP. ER doc does not sound like he is informed.

[Anonymous]

Pp here again.

OP, in the past when my kid has had an ER worthy reaction (or severe reaction to early allergy shots) I would snap a picture of the reaction before heading off to the ER. That way, the doc can see the extent of the reaction to help them determine how severe it is.

[Anonymous]

I agree with all these other allergy moms.

My 15 mo old has allergies to treenuts, peanuts, and sesame. It's not too early for skin tests/blood work.

We also love the Insitute of Allergy and Asthma.

I wouldn't panic, but watch foods and avoid any questionable foods in the interim. Keep Benadryl on hand.

[Anonymous]

OP, that must have been so scary! I'm glad she's okay and hope you find the source.