We do not have adequate studies to state the general risk of chickpea allergy among children with peanut allergy. Peanut is a legume and it shares similar proteins with many other beans. However, in a U.S. study performed many years ago, only 5 percent of children with a peanut allergy had allergic reactions to other beans tested.

A tricky problem is that if you use blood or skin tests to beans for a person with a peanut allergy, about half the time the tests are positive even though 95 percent of the patients can eat the beans. The tests are affected by immune responses to shared bean proteins that are not important when it comes to allergic reactions.

Studies of chickpea and lentil allergy emanating from Mediterranean countries do note a high correlation of allergic reactions among pea, chickpea and lentil. Over two-thirds of children reactive to one of these three, reacted to another of the three. However, peanut allergy was uncommon in these children.

It appears that if a child with peanut allergy has already been tolerating peas, there is a much lower chance of having allergy to chickpea. Conversely, if peas caused a reaction, the risk of chickpea and lentil allergy is quite high.

Individual advice may vary, but if chickpea was already eaten and tolerated, there would be no reason to avoid it because of a peanut allergy. Lastly, a positive allergy test to chickpea in a person with peanut allergy does not prove an allergy and a medically supervised feeding (e.g. a food challenge) may be warranted.

Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Mount Sinai School of Medicine in New York. Together with Dr. Hemant Sharma, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.

Dr. Susan Waserman: Most food allergies start in childhood, but you’re right, they can develop at any time in a person’s life.

Factors that favour the development of food allergy in adults include sensitization to pollens and house dust mites, as well as occupational sensitization (which occurs when people who regularly handle and inhale food become sensitized to it due to repeated exposures).

As well, adults with birch pollen allergy may develop “oral allergy syndrome,” which leads those affected to experience itchy mouth when they eat certain raw fruits and vegetables. This is the result of cross-reactivity between the food and the pollen.

Interestingly, those sensitized to house dust mites may end up with shrimp allergy because both contain the protein tropomyosin.

Occupational sensitization is also associated with crab and pork allergies.

Dr. Susan Waserman is an allergist and Professor of Medicine in the Division of Allergy and Clinical Immunology at McMaster University in Hamilton, Ont. She is also a past president of the Canadian Society of Allergy and Clinical Immunology.

We welcome your question to Allergic Living’s Ask the Allergist. Thank you for understanding that the specialists aren’t able to answer every question received.

He was diagnosed with the food allergies when he was 9 months old, and has no recollection of getting sick from the foods. I think he is getting curious, trying to experiment, and I am worried about him at school. Do you have any suggestions about dealing with his curious nature?

Dr. Scott Sicherer: You are describing behaviors that represent age-appropriate natural curiosity and some element of “testing boundaries”. I recommend responding the same way you would if he attempted other dangerous actions such as running into the street or playing with electric sockets. In other words, take stronger actions to ensure he does not eat the avoided food, including extra supervision and placing temptations out of reach.

Reasoning with a 5-year-old about the consequences of the actions is not likely to be fruitful, although it is appropriate to say “Eating the food could make you sick and we don’t want you to get sick.”

Assuming a child is otherwise developmentally normal, positive reinforcement for appropriate behavior may be helpful, including verbal praise (“We are so proud of our big boy for not touching those cookies”) or a sticker chart (“Look, you got two stickers for twice not touching those cookies and eating your safe ones instead. Now you can choose a special toy to play with”).

One exercise you can try: Ask an adult friend to offer your son food and teach him to say, “No thanks, I have an allergy and my mom or dad has to make sure it is OK.” Provide positive reinforcement when he does a good job. Reading stories
about children with food allergies and pointing out how others have restrictions may help him understand and accept the differences, but also recognize that he is mostly doing the same things as others.

Next: Sending a curious food-allergic child to school

Dr. Hemant Sharma: This is a great question, and one that many parents of children with cow’s milk allergy have as they search for a suitable substitute for cow’s milk. Unfortunately, because goat’s milk protein is similar in structure to cow’s milk protein, more than 90 percent of  the time, the immune system will mistake the two and cause a reaction to goat’s milk or goat’s cheese in someone with a cow’s milk allergy. So goat’s milk is not a safe alternative to cow’s milk, and for the same reason, neither are sheep’s milk nor buffalo’s milk.

You can discuss with your child’s allergist what might be an acceptable cow’s milk substitute. An option for an infant would be an extensively hydrolyzed, cow’s milk-based formula, in which the cow’s milk protein is extensively broken down, making it less recognizable by the immune system and less likely to cause a reaction. Since these formulas are also good sources of nutrients, many allergists will recommend children on restricted diets remain on them beyond the age of one year.

Once ready to wean from a formula, options at that point might include soy milk or rice milk, assuming your child does not also have allergies to those foods. To be sure that all nutritional requirements are being met, it definitely is a good idea to discuss your options with your child’s allergist or a dietitian.

Dr. Sharma is an allergist, clinical researcher and Assistant Professor of Pediatrics. He is Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington D.C. and Director of the Food Allergy Program. He is also the site director for the National Institutes of Health Allergy and Immunology fellowship program. He writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.

Dr. Scott Sicherer: Being able to recognize the need for epinephrine and to actually self-inject in an emergency are beyond the capability of most children your son’s age. The readiness to self-administer requires the appropriate developmental level, understanding about symptoms of a reaction, and then the willingness to inject the epinephrine.

Before you consider the readiness of your child, speak with your allergist to be sure you are comfortable with recognizing symptoms and understand when and how to inject epinephrine. Since barriers to using the auto-injector include “needle phobia” and unfounded worries about side effects, have a discussion with the allergist about the safety of epinephrine, and perhaps practice with an old injector and an orange. Achieving your own comfort is the first step in preparing the right message to give to a child who will eventually take on this responsibility.

The notion of self-treatment can be taught early on, but granting full independence is a much more gradual process. For all children, I generally instruct that a responsible adult should be available to make treatment decisions and ultimately inject epinephrine. For teenagers, having their friends aware of the food allergy and how to inject epinephrine can add another layer of safety.

Gradually include your child in allergy management, with guidance from your doctor. Having him practice with an epinephrine self-injection trainer is a good first step. The road toward independence also includes having him play a part in reading labels on packaged foods, speaking up about allergy at restaurants, and eventually discussing when epinephrine would be required.

Dr. Sicherer is a practicing allergist, clinical researcher and Professor of Pediatrics. He is Chief of the Division of Allergy and Immunology, Jaffe Food Allergy Institute, at the Mount Sinai Medical School of Medicine in New York. He is also a member of the FAAN medical advisory board. Together with Dr. Hemant Sharma, Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine.

To submit a question, write to ask@allergicliving.com. Write “The Food Allergy Experts” in the subject field, and keep your question brief.

Dr. Scott Sicherer: You are not alone in developing shrimp allergy as an adult. In our U.S. prevalence studies and studies in Canada that tracked peanut, tree nut, fish, shellfish and sesame allergies, shellfish was the most common self-reported allergy.

We know food allergies are affected by the immune system, heredity, environmental factors, and the characteristics of the foods themselves. We know that many food allergies are outgrown, so there are clearly differences between children and adults. What we are missing are the exact details underlying each factor and how the factors interrelate. We only have theories to address your question.

The characteristics of food proteins likely play a role. Proteins responsible for persistent and severe allergies are more resistant to digestion and more likely to be recognized by the immune system. It may be that the child’s immature gut or immune system is more prone to attack the proteins, but shrimp may be an example of a protein that is particularly capable of triggering an immune attack even for adults.

A route of exposure other than through the mouth may be a contributing problem for adult-onset allergy. Most food allergies that begin beyond childhood are mild reactions to raw fruits and vegetables. This type of allergy is called oral allergy syndrome and is related to proteins in pollens. For example, apple shares similar proteins with birch pollen. Thus, becoming allergic to similar proteins in the air starts the trouble. A theory has also been proposed that environmental exposure to peanut, without actually eating peanut, may increase the risk of peanut allergy. Interestingly, shellfish proteins are similar to ones found in dust mite and cockroach, although most people with those allergies tolerate shellfish.

Next: Digestion Changes

Dr. Watson: There are many factors that contribute to the development of asthma in children. Having a mother or father with asthma is only one of the risk factors.

There are studies looking at an index called the Modified Asthma Predictive Index. In children with three or more wheezing episodes, one of which is documented by a physician, major risk factors include family history, personal history of allergy and allergies to inhalant allergens.

You also ask whether taking precautions will prevent asthma. There isn’t enough evidence to support any recommendations. For example, exposure to pets in children has been  protective in some studies, yet contributed to the onset of asthma in other studies. For children who developed asthma or hay fever, month of birth seemed a risk factor.

The bottom line is that these are things you really cannot control. If you have pets, there is not enough evidence to say to keep or get rid of them. The only option would be if your child develops symptoms around the pets, then you should give them away.

As far as the springtime, there are no special precautions to protect your child. Watch instead for early symptoms and, should you have concerns, speak to your doctor. As a father of an 18-year-old and a 22-year-old (and an empty-nester), the most important piece of advice I can give you is to relax and enjoy your child.

We welcome your question to Allergic Living’s Ask the Allergist. Thank you for understanding that the specialists aren’t able to answer every question received.

Dr. Wade Watson is a pediatric allergist and Professor of Pediatrics at Dalhousie University. He is also the head of the Division of Allergy at the IWK Health Centre in Halifax.

Dr. Waserman: Daffodils are considered “allergy-friendly,” since plants with showy flowers are generally pollinated by insects rather than the wind. Daffodils produce less pollen, and symptoms such as allergic rhino-conjunctivitis and asthma aren’t commonly associated with them.

However – handling daffodils is another story. Among florists and flower pickers, allergic contact dermatitis, irritant contact dermatitis (from sap) and hives are quite common.

Your daughter may have had an allergic or irritant contact dermatitis reaction or urticaria (hives). I recommend that she not handle daffodils and related narcissus varieties.

While unusual with daffodils, the throat symptoms might be an acute reaction, or anxiety as you suggest. Your daughter needs to be assessed by an allergist. If her symptoms and testing indicate allergic rhinitis, the allergist likely will prescribe intranasal steroids to alleviate the allergy.

We welcome your question to Allergic Living’s Ask the Allergist. Thank you for understanding that the specialists aren’t able to answer every question received.

Dr. Susan Waserman is an allergist and Professor of Medicine in the Division of Allergy and Clinical Immunology at McMaster University in Hamilton, Ont. She is also a past president of the Canadian Society of Allergy and Clinical Immunology.

Dr. Sicherer: The allergic form of eczema, also known as atopic dermatitis, is related to other allergic illnesses including asthma, allergic rhinitis (hay fever) and food allergies. These illnesses are inherited and often occur together in the same person.

Infants and children who are known to be allergic to milk are more likely to have atopic dermatitis and other allergies. Infants with atopic dermatitis are more likely to have positive allergy tests to milk as well as other food and environmental allergens such as dust mite and cat dander.

Milk allergy is not necessarily directly linked with the eczema, but both are more likely to occur in allergy-prone individuals.

The more severe the allergic skin rash and the earlier the onset, the greater the chance that the infant may have, or develop, other allergies, including food allergies. Again, this probably reflects a person’s general allergic inclination, rather than being a direct link between a food and the skin rash.

But could there be a direct link between allergy and eczema? One theory is that the broken, rashy skin allows proteins to be “seen” by the immune system, while normal skin keeps out the allergens. This might make it easier for the immune system to attack the proteins that land on the broken skin, causing more allergies. However, this is just a theory.

Next: One direct link between eczema, milk allergy

Dr. Watson: Parents are always concerned about introducing highly allergenic foods, especially if they or other children have food allergies. There is very little data in the medical literature to support any advice. You are correct that skin testing an individual who has never been exposed to a food doesn’t make much sense. False positive reactions occur up to 50 per cent of the time, so a positive test means little. The only rational is that if the test is negative, you can be relatively comfortable giving the first exposure at home, as the risk of a reaction is no greater than in the general population.

As a person with peanut allergy, you should not be the one feeding your son peanut. You can be close by. There are different options on how to introduce an allergen, but it’s generally recommended to start with a small amount of peanut butter on the lip. If that’s tolerated, then your son can try a small amount in his mouth. If he refuses to eat it, or if you are worried, don’t push him.

If he tolerates the peanut, he should eat it at least once per week, as the chance of developing an allergy to a food eaten regularly is less than if the food is eaten rarely. If the thought of this procedure keeps you awake at night, talk to your allergist about trying peanut in his or her office.

We welcome your question to Allergic Living’s Ask the Allergist. Thank you for understanding that the specialists aren’t able to answer every question received.

Dr. Wade Watson is a pediatric allergist and Professor of Pediatrics at Dalhousie University. He is also the head of the Division of Allergy at the IWK Health Centre in Halifax.