I can tell you exactly where I was when the field of allergy and immunology first stole my heart. I was in my first year of medical school sitting in an overly cool classroom taking notes as fast as any human hand could. My pathology lecture was just ending and immunology was up next. I rubbed my sore fingers and prepared to write down, verbatim, the next lecture.

But shortly after my professor started to speak, I realized that I had completely stopped taking notes. I had allowed myself to be drawn into the story that she was weaving, a story of T cells and B cells and their physical and chemical conversations with each other. It was amazing.

Little did I know that she was introducing me to a cast of cellular characters that would soon become not only important for me to pass my next immunology test, but also to complete my subsequent fellowship training and to my understanding of the mechanism of food allergy, an immunological disease that would affect three of my four children.

In 2005, after completing a pediatric residency, I started my fellowship in the field of allergy and immunology at the Children’s Memorial Hospital in Chicago. I had a 7-week-old baby boy at home so I was knee-deep in motherhood, but I was ready. I was excited to finally be seeing patients with the allergic and immunological disorders that I had been so interested in during medical school.

These diseases, including chronic sinusitis, seasonal allergies, and immune deficiencies, were all challenging and interesting, but what drew me in the most was food allergy. There was something so cruel and senseless about a disease that denies a child a bakery cookie – it made me want to break its code.

Patient Emotions
As fellows, we were taught to take a detailed history of the allergic reaction from the patient and the parent, paying exquisite attention to what food was ingested, the timing of the ingestion in relationship to the symptoms and what symptoms occurred.

Patient histories would often become complicated, a fusion of facts and feelings. We would then perform skin-prick testing with the suspected food protein and draw blood for the same allergen. Combining the history and the results of the testing, a diagnosis was made.

We would review an allergen avoidance sheet with the family, explaining the importance of reading food labels, and discuss an emergency health-care plan, teaching the families how to recognize and treat an allergic reaction. We provided them with a short list of support services and asked them to follow up in one year. It was a good system, at least as far as I knew.

By the end of my first year of fellowship, we had twin boys (yes, we had three boys in 13 months!) and one of them, Gino, literally had hives on his skin only a few days after he was born. He would soon be covered in itchy, bleeding eczema and more often than not, vomit, so I made an appointment with an allergist.

Next page: The diagnosis: a powerful blow

Gina Clowes, a Certified Life Coach and founder of AllergyMoms.com; Beatrice Povolo the director of marketing and communications for Anaphylaxis Canada and Susan Clemens, the moderator of AllergicLiving.com’s Forum and an allergy advocate. All three have children who live with multiple food allergies.

Here’s a sampling of the advice they had to offer:

Step 1 Initial Reply to the Invitation

It’s important to call soon after receiving the invitation.

The Call: Start with a gracious thank you and acknowledgement that your child is thrilled to be invited. Now move into the key points:

• Politely ask where the party will be held. For instance, will it be at a venue or the hostess’s home?

• With this information to guide you, bring up (or remind of) your child’s food allergies. Ask if now is a good time to go over a few details to both keep your child safe and resolve any initial concerns about child’s attendance.

• Stress that you’re happy to help in any way, and calmly move onto:

- Will the party involve a meal or snack?

- What activities will take place? Might there be a risk of exposure to allergens? Look for solutions to minimize any risks.

- What will be the order of activities? For instance, if the party starts with a pizza lunch and your child’s dairy allergic, could the hostess and her helpers ensure the kids have all washed up, and then your child will arrive post-lunch but pre-cake presentation?

• If the party includes lunch at a home, discuss that you’ll send your child with something safe to eat. More in Step 2.

• Discuss cake arrangements. See Step 4.

• Ask the parent if she is familiar with an auto-injector or EpiPen. Ask to set a date closer to the party to grab a coffee with her and demonstrate the use of the auto-injector and do a review of the anaphylaxis emergency plan (also called the food allergy action plan). Step 5 details that conversation.

Step 3 What You Can Do

• Why not offer to help supervise the party? Many parties require extra adult eyes, such as mini golf, play gym and kids’ theatre outings. This is also true of larger home parties.

• Whether you drop off your child or stay depends on the party situation, the hostess’s level of comfort managing allergies, and your child’s anxiety level and ability to manage his or her allergies. Trust your instinct on this.

• If the party will be at a facility, such as an indoor playground, wave pool, museum or beading venue, contact the management to inquire about allergen policies. (Quite a few facilities catering to kids now have peanut/nut restrictions.)

• Restaurants don’t usually permit outside food. But if you explain the allergies in advance, you’ll often be allowed to bring along safe food from home.

Step 6 Drop Off or Stay?

• Povolo advises staying if the child’s: unusually anxious or not ready to be left (there is no magic age for this), or when the host parent asks that you do.

• Now that her son is 9, Clowes will still attend a party if it takes place at a public venue her son’s not familiar with. At house parties when he was younger, she would just be frank about her feelings. “I’d say, ‘I’m a little nervous to leave Daniel. He is still impulsive sometimes about what he eats. I can hang out and read, but I’d also be so happy to help. Anything I can do?”

• Clemens often goes and takes fun, candid photos of the kids. She presents a CD of the snapshots to the parents as a thank you for letting her attend. Given her daughter’s list of allergies, “when I delicately ask if I can be allowed to stay, the response is usually one of relief.”

Step 8 Prepping Your Child

• Before the call to the hostess, Clemens likes to ask her 8-year-old what issues she would raise. “By involving the child, you ensure she or he feels safe, and it limits anxiety. It becomes less of “Mommy has to keep me safe,” and more “I can keep myself safe.”

• Instill confidence: remind the child that he has his auto-injector and knows how to use it. Get the child repeat the allergy rules known by heart (no sharing, no eating unknown foods, wash after eating). The message? See, you know this stuff.

• Remind that you’re nearby and have your cellphone if there are any problems. If child thinks he or she is getting symptoms, tell the hostess right away.

• Clowes has emphasized to her son that “he never has to eat anything that he has a question about.” That’s a great anxiety diffuser.

• Role play can be helpful: Ask “what will you say?” if an adult at the party (or anywhere) offers a food the child can’t eat. Clowes has suggested several turn-down options to her son, from “no thank you” and “I’m allergic” to “I just ate” in a situation where he doesn’t want to stand out. (The point is, he turns down the food.)

• Matter-of-factly ask the child for his or her thoughts on the party. If there are lingering concerns, discuss and resolve.

• Don’t just talk allergy issues. Be enthused about the party and celebrating the birthday friend. Get the child to bring up gift ideas. With food allergies, we “prepare” for fun, but we want fun all the same.

Next Page: Sidebar “Allergy Talk“

Read all the steps to Birthday Party Bliss in the Fall 2010 issue. Click to order an issue or to subscribe to Allergic Living magazine.

1. Never eat without your auto-injector, period.

2. If you’re a child, never eat food that one of your parents hasn’t approved. If you’re an adult, don’t even think about that mystery food.

3. Read labels. Always. Know the ingredients of every food that enters your (or your child’s) mouth.

4. Learn to cook – well. No. 3 isn’t difficult if you do No. 4. And you’ll enjoy your food more knowing it’s safe.

5. Organize and Plan. Think through what’s to eat whenever you or your child will be eating away from home.

6. Always carry a safe snack. That way, you’re never stuck without anything to eat.

7. Speak up about your allergies. Always discuss menu items with waiters or chefs. Tell that guy you started dating that even a nutty kiss can have unintended consequences.

8. Parents: Teach your allergic children to manage their own allergies. Prepare them, but don’t scare them about peanut butter as a “loaded weapon”.

9. Don’t dwell upon what you can’t have; focus on what you can.

10. Manage food allergies, don’t allow them to run your life.