By Michael Pistiner, MD
Halloween treats don't have to be tricky business for parents of children with food allergies. There are simple steps you can take to eliminate the trick from trick or treat.
Wonder how to identify and avoid common allergens -- like peanuts, tree nuts, dairy and egg -- in a Halloween bag overflowing with sweets? Or what about knowing how to determine if that plain chocolate bar was manufactured on equipment also used to make candy containing peanuts and tree nuts?
According to Allergy & Asthma Network, a leading patient education and advocacy nonprofit, 15 million people -- including 6 million children -- have food allergies. Exposure to a food allergen can trigger a life-threatening allergic reaction, also called anaphylaxis. Symptoms can include itchy, red hives on the skin, swollen lips and/or tongue, vomiting, coughing and wheezing, shortness of breath, dizziness, and loss of consciousness.
Reactions can be truly scary -- and not something to be careless about. Prevention is key.
Parents should inspect their children's Halloween candy and check each label carefully. Federal law requires food labels -- even mini-size candy bars -- to list any common food allergens. If one child in a family has food allergies and another does not, be sure to separate the candy with allergens so there's no chance of accidental exposure.
Do not try to guess if a candy contains an allergen. Call the manufacturer if you're uncertain. If the label includes an advisory statement such as, "May contain..." or "Produced in a facility with..." there's a chance the food allergen is present. Follow the advice of your healthcare provider. For many, avoiding these products is the way to go.
More safety measures include:
* Consider putting together a Halloween route consisting of family, friends, and neighbors, and ask them to put allergy-safe treats (apple, bubble gum, lollipops) in your child's bag. Or request alternatives to snacks and candy, such as temporary tattoos, stickers, or novelty toys.
* Consider trading in collected candy for other safe treats, prizes, or rewards.
* Set a "No Eating During Trick-or-Treating" policy so children don't eat a piece of candy before you can inspect it.
* Teach children to politely refuse baked goods and homemade treats, such as cookies, cupcakes, or muffins. In addition to nuts, dairy, and eggs, baked goods may contain wheat and soy, two more common allergens.
* Don't leave Halloween candy lying around your home where food-allergic children can easily find it.
If there's an accidental food allergy exposure and anaphylaxis symptoms occur, the first line of treatment is an epinephrine auto-injector. This shot of adrenaline is safe, fast-acting, and helps treat allergic reactions.
Always carry two epinephrine auto-injectors -- including on your Halloween route -- in case a second reaction occurs. Seek follow-up medical care right away by calling 911.
Food allergies are not the only allergens to be aware of on Halloween
Dressing up is one of the best parts of the holiday, but before reusing old costumes stocked away in your attic or basement, give them a thorough washing. They could be full of allergens, such as mold or dust mites, which can cause respiratory problems.
Many costumes and masks are manufactured with latex. Parents of children with a latex allergy should verify what a costume or mask is made of before buying it or dressing up their child. Check the label for latex or latex products, but it's best to contact the manufacturer directly.
Halloween makeup may contain preservatives, including formaldehyde, which can cause a rash, swelling of the skin, or breathing problems. Again, check the product label and packaging for any warnings or call the manufacturer. Or you can test the makeup on a very small area of skin in advance of Halloween; if a rash occurs, do not use the makeup, advises the American College of Allergy, Asthma & Immunology.
Also, for kids with nickel and other metal allergies, check costume accessories such as crowns, wands, or fake jewelry that may contain nickel or cobalt, two increasingly common allergens that can cause a rash.
Michael Pistiner, MD, MMSc, is director of Food Allergy Advocacy, Education and Prevention for MassGeneral Hospital for Children's Food Allergy Center. He also an allergist with Allergy & Asthma Network, as well as co-author of Living Confidently With Food Allergy and is a voluntary consultant with the Massachusetts Department of Public Health, School Health Service Unit.