Families Managing Food Allergies

From the Show: Healthy Children
Summary: Effective food allergy management is necessary at all times and in all situations.
Air Date: 5/20/15
Duration: 10
Host: Melanie Cole, MS
Guest Bio: Michael Pistiner, MD, MMSc
Mike-Pistiner-Portrait-BW-300pxMichael Pistiner, MD, MMSc is a pediatric allergist from Boston. He has a special interest in food allergy and anaphylaxis education and advocacy and is the father of a child with food allergy. Dr. Pistiner is a fellow in the American Academy of Pediatrics, where he is a member of Section on Allergy and Immunology, Council of School Health and the Project Advisory Committee for the Medical Home Chapter Champions Program on Asthma, Allergy and Anaphylaxis. He is also a member of the American Academy of Allergy Asthma & Immunology and the American College of Allergy, Asthma and Immunology.
Families Managing Food Allergies
The pillars of food allergy management are prevention and emergency preparedness.

Very small amounts of food allergen can cause anaphylaxis (severe, life threatening, allergic reaction).

To prevent accidental exposure those responsible for kids with food allergies must effectively read labels, prevent cross contact, use efficient cleaning strategies, and communicate clearly.

Those responsible for children with food allergies must be able to recognize an allergic reaction, have epinephrine (first line, treatment of choice for anaphylaxis) available, know when and how to use it, and know to contact emergency services immediately.

These strategies are always necessary. Anyone responsible for caring for a child with a food allergy must ensure that these strategies are in place.

Michael Pistiner, MD, a pediatric allergist from Boston, is here to discuss the importance of preparedness when dealing with a child with food allergies. 

More information about Medical Home Chapter Champions Program on Asthma, Allergy and Anaphylaxis

RadioMD PresentsHealthy Children | Original Air Date: May 13, 2015
Host: Melanie Cole, MS
Guest: Michael Pistiner, MD

This is Healthy Children brought to you by the American Academy of Pediatrics on Here's Melanie Cole, MS.

MELANIE: It's not uncommon today to find children with food allergies. If you're family has discovered that your child has food allergies, how do you go about coping? Letting your child be a normal child? Hosting and letting them go to play dates and birthday parties? What about sports and things that they want to do? Can you let them go off on their own? These are all scary questions for a parent with a child with food allergies because food is everywhere. My guest today is Dr. Michael Pistiner. He's a pediatric allergist from Boston. He has a special interest in food allergy and anaphylaxis education. He is also the father of a child with a food allergy.

Welcome to the show, Dr. Pistiner.

So, if you have a child with a food allergy, as you do, I don't know how old your child is, but how do you go about being that parent? I mean, I would think you'd want to stick next to your child everywhere, whether they're at school or at a party or on the playground, because you never know.

DR. PISTINER: You know, it is hard. I, personally, had a really hard time when we were trying to teach him how to ride a bike, to let go once those training wheels came off. So, that is one of the biggest challenges, is empowering and educating our kiddos. So, by the time they are going to be responsible for themselves, in their health in general, and their daily lives, but, especially, in their own food allergy management skills, that's a challenge to let go and to get them to the point where they're going to be confident and competent in food allergy management and to be able to do it when we're not around. That keeps a lot of people up at night, but at the same time, it's completely achievable, and it's exciting to be able to let our kids be kids and, ultimately, grow up to be completely confident, competent adults who happen to have a food allergy.

MELANIE: I would think, at night when they're sleeping is the only time a parent like that can relax. Now, do you teach your child how to use that Epi-Pen? Do you teach them? At what age? I mean, you, obviously, have to know your child and what they can handle, but as you say, when you're taking those training wheels off, you teach them. Can a child who's going through a shock like that give themselves a shot?

DR. PISTINER: Yes. Well, you know, that is where we, as parents, and me, also, from the perspective as a healthcare provider, we need to understand the developmental capabilities of kids and, specifically, understand our own kids, and that's where parents are masters of that. Parents know their kid. They know what they're capable of. They know if they get anxious, they know if they get nervous, they know if they sometimes risk-take. And, them understanding their kids, but then learning and knowing developmentally what a kid is capable of. With the little ones, when it comes to food allergy management, we can't expect the little ones to be responsible for label-reading. We can't expect them to know what symptoms they need to give their emergency medicine, their Epinephrine, to themselves. We can't expect them to be responsible to know how to give the auto-injector. But, there are certain things that we can start teaching our kids and start showing and sharing with them so they can gradually learn these skills and, ultimately, when they're out on their own, they will be skilled, they will be competent, they will be confident in being able to do what they need.

So, the little ones are going to have to know that a grown-up needs to read the label before they give them the okay to eat food. They need to know that a grown-up has their emergency medicine nearby. They need to know that they can't necessarily accept a food gift from somebody without it being cleared by a grown-up who understands their food allergy and understands how to read labels and other important concepts. They need to get someone if they think that they're having an allergic reaction. They have to get a grown-up if they think they may have accidentally eaten food and they need to share their feelings and if they're scared, if they're worried, tell someone. Talk about it because, oftentimes, kids can fill their own uncertainty in the unknown with a reality that may be . . . or, with their own thoughts that are much scarier than reality and talking through these and being able to voice themselves can really reassure.

MELANIE: I'm sure that's true, and we're going to put a link to the website , the Medical Home Chapter Champions Program on Asthma, Allergy, and Anaphylaxis that's from the website and I'm sure they have it on, as well. But, you can find it at and just search asthma, allergy, anaphylaxis, or you can just link to it at It will be on the Healthy Children page at It's the Medical Home Chapter Champions Program on Asthma, Allergy, and Anaphylaxis.

So, children would probably be a little bit afraid, but, you know, kids are naturally curious. They see all these kids grabbing the brownies. They see all these kids grabbing the cake. They see, "Oh, ice cream!" You know, is it possible to teach your kid "You're not allowed to touch that, unless Mommy says you can?” That's got to be so hard for the child.

DR. PISTINER: And that's where it really does take a partnership between families, between their healthcare providers who can help teach the parents what it is that we need to ultimately be doing to prevent an allergic reaction. These pillars of food allergy management are something that the grown-ups will need to understand first, and then, ultimately translate into a developmentally appropriate way that happens to be matched to the kid's personality to make them feel good about it and not be afraid and be able to pull it off. Then, later, when they're older and teenagers, ultimately, not succumb to peer pressure and continue to do the right thing to take good care of themselves.

And so, these pillars are the pillars of prevention and emergency preparedness. For prevention, ultimately, someone needs to competently read a label. People need to know about hidden ingredients that you can't necessarily know what’s in something until ultimately a label is read. People need to prevent cross-contact when allergens can inadvertently get in something that it wasn't meant to be in, and even small amounts can cause an allergic reaction.

Then, people need to be very comfortable and master emergency preparedness--being prepared for an allergic emergency. That would be being able to recognize anaphylaxis, which is a severe, life-threatening, allergic reaction and then being able to respond swiftly with the appropriate treatment, which is Epinephrine. And, being able to know when to give it, know how to give it, and have it available. And so, these are things that are simple enough to say and sometimes a little challenging because prevention and preparedness needs to be done at all times and in all circumstances, whether the children are with Grandma and Grandpa, whether they're at school, whether they're with the coach, whether they're at baseball practice, or the swim meet. These are going to be strategies that ultimately need to be implemented at all times and in all circumstances.

MELANIE: An absolutely great way to put it, too. Prevention and preparedness. Parents need to be really on top of it, work with your children, teach your children what they can and can't do. Learn to read labels really, really properly so that you make sure you don't miss any, as Dr. Pistiner says, hidden ingredients. You have 30 seconds, Dr. Pistiner: your best advice for families out there?

DR. PISTINER: Partner with your healthcare team, get plugged in with your pediatrician and an allergist, if you can, and any questions, any concerns, if your child is worried, if you're anxious, then talk to them. Ask them. No question is silly and there's no reason to be worried, and if you are feeling anxious and worried about it, get the facts. It'll make you feel better. So, get plugged in with your healthcare team, your pediatricians and your allergists.

MELANIE: That is great advice, and you can see more information at We're putting the link to the Medical Home Chapter Champions Program on Asthma, Allergy, and Anaphylaxis. Thanks for listening.

You're listening to Healthy Children right here on RadioMD.

This is Melanie Cole. Stay well.
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