Luis was one year and eight months old when he ate a hazelnut biscuit for the first time, as a dessert after lunch. When, shortly afterwards, he developed a patchy rash on his face, neck and upper chest, his parents didn't think much of it at first: it was a hot summer's day in August and they assumed he was having a reaction to the sun cream.
So the next day, after lunch, he was given another nut stick – and this time the reaction was more severe: hives appeared on his face and around his eyes, he became lethargic and fell asleep shortly afterwards.
If you suspect you have a food allergy, it is important to have this properly investigated.
Marie-Hélène Corajod, Swiss Allergy Centre
When he woke up again, everything was fine. But his parents were certain: Luis had had an allergic reaction to a food. And it had to be the hazelnuts in the nut stick. On both occasions, he had reacted immediately after eating it, and he had eaten all the other ingredients – eggs, almonds and sugar – before and tolerated them well. The paediatrician confirmed their suspicion: using a skin prick test and subsequent blood tests, she proved that Luis was allergic to a hazelnut protein.
Prevention – but done properly
«If a food allergy is suspected, it is important to have this properly investigated,» says Marie-Hélène Corajod from “aha! Swiss Allergy Centre». This is to ensure that an allergy is actually present – and to determine beyond any doubt which food is the trigger. She frequently sees parents removing foods from their children's diet purely on the basis of a suspected allergy, as a precautionary measure.
In this regard, it is important for the prevention of allergies that children are given potentially allergenic foods such as peanuts, nuts, fish, eggs and milk as early as their first year of life – in an age-appropriate form, provided they can tolerate them. This finding was reached in a British study on the prevention of peanut allergies published in 2015.
According to the Swiss Allergy Centre, food allergies affect between two and six per cent of children and between two and four per cent of adults. Most food allergies develop as early as the weaning stage in infancy. However, in principle, a food allergy can occur at any age, including during nursery school or later. The most common food allergies in infants and young children are allergies to milk, eggs or nuts. Allergies to cow's milk and eggs often resolve over time, meaning that from nursery age onwards, nuts and peanuts in particular are common triggers.
At around 60 per cent, food allergies in children are among the main triggers of anaphylaxis, a rapidly onset, severe allergic reaction of the body that affects several organ systems and can be life-threatening without immediate treatment. It typically manifests itself through symptoms such as itchy skin, shortness of breath, gastrointestinal symptoms, a drop in blood pressure and circulatory failure.
Keep the first-aid kit within easy reach
If a food allergy is severe and there is a risk of anaphylaxis, an emergency kit becomes a constant companion. This was certainly the case for Luis. Just a few days after he was diagnosed with a hazelnut allergy, his parents put together several emergency kits so that there would always be one to hand, both at nursery and in several rucksacks.
As well as antihistamine drops for mild reactions, a cortisone preparation for more severe symptoms and detailed instructions on how to use the various medicines, Luis's emergency kits contain two so-called Epipens, which can be used to inject adrenaline into the thigh immediately in the event of anaphylaxis.
At the chemist's, they were also given a practice Epipen without a needle or adrenaline, which allowed them to practise for an emergency and which they used to train nursery staff, grandparents, siblings and the childminder. Everyone who looked after Luis when his parents weren't there needed to know what to do in an emergency.
Parents should inform the nursery teacher about their child's allergy at an early stage.
Sybille Suter, Swiss Allergy Centre
Traces of hazelnuts in food: a detective's work
So the advice was: avoid hazelnuts at all costs. And not just in products such as biscuits or nut chocolate, which quite obviously contain hazelnuts. They had to cut out of their diet all foods labelled «May contain traces of hazelnuts».
«At first, we were a bit overwhelmed,» recalls Luis's father. «But we got used to it quite quickly, and we also had confidence in those around us and the nursery staff that they were taking the situation seriously.» It simply always came down to studying ingredient lists, asking in restaurants and bringing your own dessert to birthday parties. Often, it didn't make sense: depending on the manufacturer, the same product might contain traces of hazelnuts or it might not.
«It was hardest in bakeries,» he says. «And as Luis got older, we always had to be careful when other children playing outside wanted to share their morning snack with him.» For situations like that, they often carried chocolate-coated rice cakes with them as well as their first-aid kit when they were out and about, which they could offer their son instead – here too, only one particular brand was an option, because all the others declared that they might contain traces of hazelnuts.
Communication is key
Whilst parents are usually present during the early childhood years, a new phase begins when children start nursery. For some boys and girls, this is the first time they have been separated from their parents on a regular basis for several hours at a time. The children become more independent and start arranging to meet up with other children without their parents.
To make this new stage of life as safe as possible for a child with a food allergy, good communication is key, says Sybille Suter from the Swiss Allergy Centre: «Parents should inform the nursery teacher about their child's allergy at an early stage.» They should make it clear which foods the child reacts to, the quantities at which a reaction occurs, and what action to take in the event of a reaction or an emergency.
If the symptoms are not treated at an early stage, hay fever can develop into asthma.
Eva Untersmayr-Elsenhuber, specialist doctor
If the child in question has emergency medication, a complete emergency kit should be kept at the nursery and the teachers should be instructed on how to use it. «Experience shows that early, proactive communication helps to make the transition easier, to train all those involved where necessary, and thereby to build confidence,» says Suter. The Swiss Allergy Centre offers relevant workshops for childcare staff to provide support.
It is also important to discuss the allergy with the other children at nursery: «As well as prevention and safety measures in the event of an emergency, inclusion is a key factor in ensuring that a child with an allergy can enjoy their time at nursery.»
Treat symptoms at an early stage
«Nowadays, following comprehensive training from a healthcare professional, it is usually possible to live well with an allergy,» says Eva Untersmayr-Elsenhuber. She is a consultant in clinical immunology at the Medical University of Vienna and conducts research into allergy prevention and treatment options. In addition to avoiding the allergen, she says it is very important to treat even mild symptoms consistently.
She often finds that her patients who suffer from respiratory allergies – for example, those who are allergic to pollen or house dust mites – would prefer to wait to take medication until they can no longer cope.
«But it is very important to treat symptoms at an early stage,» she emphasises. This can prevent an allergy from getting worse and, for example, stop hay fever from developing into allergic asthma. This is because constant inflammatory reactions in the body encourage the allergy to spread.
Symptoms, advice and treatment
- The most common signs of a food allergy are skin reactions such as redness or swelling, sometimes accompanied by feeling unwell, stomach ache or vomiting. In rare cases, severe allergic reactions may also occur.
- If a food allergy is suspected, this should be investigated by a doctor – so that the allergens can be identified beyond doubt and avoided in future, and so that an appropriate course of treatment can be determined, depending also on the severity of the allergy.
- Mild symptoms such as itching, a tingling sensation in the mouth and throat, or redness and other skin reactions can be relieved with antihistamines.
- In certain cases, the doctor may also prescribe a cortisone preparation. This is used as a supplementary treatment and is intended to curb the immune system's inflammatory response.
- Symptoms such as shortness of breath, dizziness or a racing heart may indicate anaphylaxis. In this case, adrenaline must be injected into the thigh immediately and the emergency number 144 must be dialled.
- The «aha! Swiss Allergy Centre» offers free, personalised advice to those affected and their families – either by telephone on 031 359 90 50 or in writing via the online form.
When should desensitisation be carried out?
Anyone who suffers severely from an allergy should consider allergen immunotherapy – also known as desensitisation. This involves administering the triggering allergens over several years in the form of tablets, drops or injections. Although this is time-consuming, says the doctor, it can often reduce symptoms, and some patients find that they become completely symptom-free as a result.
Allergen immunotherapy is available, for example, for pollen, house dust mites and insect venom. In the case of food allergies, the term «oral immunotherapy» is used. For children with a peanut allergy, a suitable medicine is authorised in Europe which significantly reduces the risk of severe reactions. Oral immunotherapy is also used in specialist centres for cow's milk and egg allergies. Several studies also show promising results for other allergens, particularly wheat and various nuts.
Will the allergy stay or will it go away?
Some food allergies do go away on their own – although the chances of this vary depending on the allergen. Whilst the outlook is good for allergies to milk and eggs, peanut and nut allergies often persist for life.
Luis was lucky: after the initial tests, the paediatrician said there was a chance he might outgrow the allergy. So they tested him again when he was three and a half years old. After a skin prick test and blood tests failed to detect the allergy this time, a provocation test was carried out in hospital: together with his mother, Luis spent half a day in a hospital bed, where, under medical supervision, he ate increasingly larger portions of ground hazelnuts.
The most common triggers of anaphylaxis
In Switzerland, around 10 out of every 100,000 people suffer from anaphylaxis each year – a sudden, potentially life-threatening allergic reaction. The most common triggers change with age: in children, food allergens such as peanuts, nuts, cow's milk and eggs are the main causes, whilst in adults, insect venoms are the primary cause of anaphylaxis, followed by medicines and food.
In the end, he had eaten almost 100 grams – and showed no reaction even an hour after his last portion. So, after lunch in the hospital canteen, he was allowed to choose a large chocolate bar with hazelnuts for dessert.
Now Luis eats hazelnuts regularly – so that he doesn't lose the tolerance he's just gained. And when one of his friends brings a cake to nursery for their birthday, he can join in without worrying.
