WebMD Health - Allergies

May 3, 2011 3:41 PM

Serious Allergies: How to Keep Your Teen Safe

Most of the time, Morgan Smith's serious allergies don't slow him down: he's active in the Boy Scouts, sings in his school choir, and hangs out with his friends. But occasionally, Morgan's allergies get in the way: most of his friends have dogs, for example, and because he is seriously allergic, this rules out most birthday parties and sleepovers.

When his choir took a trip to Disneyland last spring, Morgan had to stay behind because of his food allergies. "We've always felt that whatever Morgan wants to do, we'd try to make it work," says his mother, Nicole Smith. "But on the trip, they were going to eat breakfast at a buffet, and eat at snack bars throughout Disneyland. We said no, even though he really wanted to go, because his safety has to come first."

The risk is real: Research shows that teenagers with food allergies are at higher risk for fatal anaphylaxis than any other age group. If you have a child with severe allergies, how can you ensure his safety as he enters his teen years? Which strategies work and which do not? WebMD consulted several experts to provide some answers.

It's challenging to be the parent of a teenager under the best of circumstances. But if that teenager has serious allergies, parents face a whole new set of concerns. During adolescence, children take increasing responsibility for navigating their environment, with parental support as needed. Many teens spend the majority of their time out of the house, involved with activities, school, sports, and friends.

But the stakes are high for teens with life-threatening allergies, since a small oversight -- a bite of the wrong food or medication left at home -- can have serious health consequences.

Serious Allergies and Asthma

Experts believe that teens with severe allergies are at higher risk for anaphylaxis because, in general, teenagers tend to engage in dangerous behaviors of all sorts. In one recent survey, teenagers with food allergies admitted to engaging in risky behavior, particularly when they were out with friends. This includes leaving their medication at home, trying foods without knowing if they were safe, and failing to tell friends about their allergies.

But pediatric allergist Jacqueline Eghrari, MD, says she rarely sees this kind of risk-taking behavior among her adolescent patients. "In my experience, kids with severe allergies tend to be very mature and cautious," says Ehghari. "Many are embarrassed about their allergy, they won't tell people, or ask for special food, for example. But they don't go to parties and chow down on whatever is offered. That would be a death wish for these kids -- and they know it."

Of course, all kids are different, but many parents of kids with food allergies agree with Eghrari, including Mary Lenahan, whose 15-year-old daughter, Alex, has a peanut allergy. Alex had a severe anaphylactic reaction when she was 4 years old and has never forgotten it. "She won't try food unless she knows it's safe, and if she doesn't have her epinephrine injection, she just doesn't eat," says Lenahan.

Where Eghrari sees her teenage patients with food allergies getting into trouble, she says, is with asthma management. If a food-allergic child doesn't manage her asthma, it can make the consequences of exposure to allergy triggers far more dangerous.

It turns out that many people with food allergies also suffer from asthma. If teens do not manage their asthma by taking daily maintenance medicines and having regular checkups, their lungs are likely to be compromised.

"If your lungs are compromised and you eat something you're allergic to by mistake, you're already on the downward slope, heading toward doom," says Eghrari. "It's like having a burn on your skin and going out in the sun. Your skin is much more sensitive to sunburn because it's already damaged."

Having asthma is another factor that puts a person with food allergies at risk for fatal anaphylaxis, along with being a teenager. (The third risk factor is failing or delaying the use of epinephrine.)

Keeping Your Teenager Safe

If your teen has severe allergies, involve him in managing his allergies and asthma. This empowers him as he matures and becomes more independent. These simple strategies can help keep your teen safe:

  • Manage asthma. Asthma management is important under any circumstances. But it's especially important if your child has serious allergies. Make sure your child takes her daily maintenance medication and gets regular checkups. Eghrari emphasizes that teenagers should not use a rescue inhaler in lieu of maintenance asthma medication. "Many teenagers use their rescue inhaler every day," she says. "They puff and puff on the inhaler, but this can make the situation worse. If your teen needs to use her rescue inhaler all the time, her asthma is out of control."
  • Educate your child early and often. Experts emphasize the importance of educating kids with serious allergies about how to manage their condition from an early age. This shouldn't be a single conversation but an ongoing dialogue that increases in complexity as the child matures. "It is important for parents to prepare kids to be independent," says pediatric allergist Anne Miranowski. "Parents should teach kids how to read food labels, make smart decisions at grocery stores and restaurants, recognize symptoms, and when to call 911. It should be an ongoing educational process."
  • Encourage your child to be a self-advocate. Teach your child how to keep himself safe in unfamiliar situations when a parent isn't there to help. Brainstorm together about how to handle tricky situations and role-play different scenarios. For instance, help your child create "chef cards" that explain his condition, and encourage him to interact with waiters, chefs, and restaurant managers when you go out to eat. Mary Lenahan says her 15-year-old daughter, Alex, who is allergic to peanuts, has become a strong advocate for younger kids with serious allergies. "It was hard for her when she was small because food allergies weren't as common then, and she felt pretty isolated," says Lenahan. "She doesn't want other kids to go through what she did."
  • Involve your child. Nicole Smith and her husband include Morgan in decisions about his safety and have done so since he was very young. "We involve Morgan as much as possible in meetings at school or anything else that concerns his health. He's always known what was happening and why, and that helps him advocate for himself."
  • Find a good allergist. Make sure to find a pediatric allergist who you and your child trust and feel comfortable with. Your child should have regular checkups to manage allergies and update medications. An important part of the allergist's ongoing role is to educate you and your child about his condition and to help him learn to manage his allergy during transitions like changing schools and going to college.
  • Help your teen find peer support. Parents of kids with food allergies recommend helping your child meet other kids who share her condition. If you join a food allergy support group, for example, your child is likely to meet other kids with food allergies there. The Food Allergy and Anaphylaxis Network (FAAN) (www.foodallergy.org/section/support-groups) features a directory of support groups around the country. This organization can help you start your own group if there isn't one in your area. FAAN also has a yearly conference, which includes sessions for teenagers.
  • Model caution, not fear. For parents of kids with life-threatening allergies, it can be difficult to teach a child to be cautious without making her fearful. Allergist Eghrari has seen both extremes: "There are parents who won't let you into their house without practically irradiating you and making you wear a uniform. Other parents don't get it: Their kids run wild and eat whatever, they don't learn how to use an epinephrine injection, and so the kids deal with anaphylaxis over and over. Luckily, the great majority of parents maintain a healthy sense of caution, without being paralyzed, and their kids do, too." Anne Miranowski agrees. "Kids often pick up on their parents' terror," she says. She has seen kids who are so fearful that they develop actual symptoms when they are anywhere near allergy triggers -- even when they are not at risk. "It's important to teach kids to be careful, without instilling an inappropriate level of fear," says Miranowski.

How can parents strike that balance? Nicole Smith, whose web site, AllergicChild.com, provides information on a variety of food allergy issues, says that raising a teen with food allergies isn't that different from raising any other teen.

"I was terrified when my daughter drove the car out of the driveway for the first time, but I didn't forbid her to drive," Smith points out. "Allergies or not, Morgan's is 14 and I can't micromanage him. My goal is to be the best parent I can be to both of my kids, teach them as my much as I can, stay as close to them as I can, within reason -- and then allow them to make their own mistakes."