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‘Appropriate precautions’ allow children with food allergies to participate in Halloween activities

The activities leading up to Halloween, and the holiday itself, present added risks for children with food allergies, which clinicians should discuss with patients and families to ensure preventive measures are taken.

“The most common allergies to think about are peanuts and tree nuts, followed by milk and then wheat. A lot of candy has nuts; some may have milk or wheat in it,” Pramod S. Kelkar, MD, FAAAAI, an allergist in private practice in Maple Grove, Minnesota, said in an interview.

Fears of an allergic reaction can cause anxiety for parents and feelings of disappointment and frustration for children, but there are steps families can take to decrease the likelihood of exposure to allergens during the Halloween season. In addition, there are initiatives that aim to increase awareness of food allergies and help children with food allergies enjoy the holiday in the same way that children without allergies do. Many lessons learned during Halloween can also be used throughout the rest of the year.

Strategies, increased awareness enable all children to celebrate

The degree to which food allergies will affect children at Halloween can vary depending on the child’s age, according to Mark Holbreich, MD, FAAAAI, an allergist in private practice in Indianapolis.

“Most children who are the age of a typical trick-or-treater, ages 3, 4 and 5 years, have lost, or are losing, some of their early food allergies,” Holbreich told Healio Family Medicine. “Children who have an egg or milk allergy at a year or 18 months of age are beginning to lose that allergy by 3 or 4 years of age, but they won’t lose an allergy to peanuts and nuts. Those are the foods that cause serious allergic reactions. Certainly, though, there are children at that age who still have some significant egg and milk allergies.”

This time of year, “can be anxiety-provoking” for parents with children whose allergies persist, and affected children may feel upset, stressed or even depressed, Jeffrey M. Factor, MD, FAAAAI, of the Connecticut Asthma and Allergy Center and Connecticut Children’s Medical Center in Hartford, said in an interview.

“There are some people who just don’t celebrate Halloween because of a food allergy,” he continued. “I think that’s a shame, since it’s a fun holiday for kids and for parents. To be so paralyzed that they can’t celebrate it is very distressing and unfortunate.”

Increasing awareness of food allergies, as well as initiatives like the Teal Pumpkin Project, will make it easier for affected children to enjoy the Halloween season.

“The Teal Pumpkin Project was started by a group of parents in Tennessee who experienced feelings of anxiety about trick-or-treating and were concerned that their children were sort of excluded from the event,” Holbreich said. “The project encourages people to put teal pumpkins in front of their homes so that families with food allergies know that the house has alternative treats for children, such as pencils or crayons, that are not food-related.”

There are other strategies families can employ that enable children to celebrate without fear of an allergic reaction.

“We are all tempted to eat candy when we are hungry. Try to have dinner before you go trick-or-treating or have a big snack so that you don’t feel hungry, or eat candy before you go out,” Kelkar said. “Eating candy at home that is known to be safe will help kids from feeling like they’re missing out if their friends are eating candy.”

Families with food allergies may also choose to have a Halloween party together so their children can celebrate in a safe environment.

“There are often networks of families with food allergies, either through blogs or support groups,” Holbreich told Healio Family Medicine. “It’s not uncommon for a group of families in that network to say, ‘Let’s have a Halloween party for our kids.’ There may be six, eight or 10 families that get together and have a party so they can completely control what’s in the room. The kids can enjoy themselves, the parents don’t have to be anxious and they don’t make it food-centered. They make it more of a party.”

Finally, for children with food allergies who do choose to go trick-or-treating, safety measures can decrease the likelihood of a reaction.

“The first thing I tell parents is that, if you take appropriate precautions, the chance of having a life-threatening reaction is negligible,” Kelkar said. “Make sure that you read labels, if you are out with your kid, and be prepared with your Epi-Pen and Benadryl. If your kid is older, make sure your kid understands what his or her food allergies are and how to read labels. Tell them not to eat candy if there’s no label or if it has secret ingredients; then they can go trick-or-treating by themselves.”

Fear should not cause food phobia

There are important lessons to be learned from the concerns about allergic reactions that surface around Halloween, according to the clinicians who spoke with Healio Family Medicine. For example, fear of an allergic reaction, and avoidance of situations to prevent such a reaction, can be addressed well before the Halloween season begins.

“Having a board-certified allergist clarify what allergies are real is important, because there are children who can have false-positive skin tests for foods,” Factor said. “It’s up to the allergist and the family to determine whether an allergy real. A food challenge performed in the office may be necessary to rule out whether the child is actually allergic to a certain food or whether they’ve outgrown an allergy. Seeing a clinician who has expertise in food allergies can provide some reassurance to families that they’re not alone and that we understand what they’re going through.”

Initiatives like the Teal Pumpkin Project increase awareness, which will, in turn, lead to progress that allows all children, including those with food allergies, to enjoy celebrations like those that occur around Halloween.

“There is value in raising awareness, even if people don’t participate in events like the Teal Pumpkin Project,” Kelkar said. “When awareness increases through these kinds of programs, the chance of an accidental exposure, and a reaction, decreases dramatically.”

Families should also remember that errors can happen, but fear of a reaction, and avoidance of situations, should not lead to food phobia.

“Parents make mistakes. Every year or so, a parent comes in around Halloween and says, ‘There was so much candy there, we just missed it,’” Holbreich said. “But I think they want their children to enjoy the holiday. The only thing children can do, really, is avoid eating the foods they’re allergic to, or skip trick-or-treating. But most kids do it and find ways to work around it.”

Kelkar encourages families to take a more far-reaching view of the situation.

“Parents are concerned about life-threatening reactions, and rightly so. As a parent myself, I have empathy for what they go through when they have kids with food allergies,” he said. “At the same time, though, life comes with risks. If you’re driving a car, you can get into an accident. It’s the same thing with the food. You have to look at the big picture.”

Food allergies should not lead to food phobia, Kelkar continued.

“I would hate for parents to become food-phobic,” he said. “I think food should be something you enjoy. I try to make sure parents are taking appropriate precautions, but not being fearful about food.” – by Julia Ernst, MS

Disclosures: The researchers report no relevant financial disclosures.