I’m writing this as both a registered nurse who works for an allergist, and also as a food allergy and EOE mom with over a decade of experience.
Nurses are caregivers, teachers, advocates, scientists, artists, healers and problem solvers. The ironic part is, so are food allergy moms!
Nurses, my Food Allergy Mamas need your help!
What’s the big deal, anyway?
The statistics recently changed and are impressive: 32 million Americans have food allergies, 1 in 13 children and 1 in 10 adults. An allergic reaction to food can quickly become life threatening.
When my daughter received this diagnosis, I was stunned. Not only did I have to re-learn how to feed her, I also had to learn how to keep her safe. I quickly realized this also impacted our entire family and how we lived everyday life.
I never expected this to happen to my child!
I was angry.
Like many of you amazing & highly skilled nurses, I never learned anything about food allergy management in my education or training.
I thought there was a lot of hype, and not many facts.
I was wrong!
Many health care professionals, including nurses, do not understand how to care for patients with food allergies or food allergic related conditions. This includes basic care needs like feeding, administering medications, and even using skin, hair, and hygiene products on such patients.
April 4, 2019, An 11 year old child with a milk allergy died from anaphylaxis after being given a whitening toothpaste by her dentist.
The toothpaste contained milk protein. Not one person noticed this critical ingredient- not the dentist, nor the parent or the child.
Quite frankly, I’m not sure I would have noticed it either. Milk in toothpaste? I will never forget this beautiful child or the difficult lessons we learned in the food allergy community after her death.
Toothpaste! This is how serious food allergies are, and it shows the constant vigilance that is required to stay safe.
I have worked on medical floors, procedural areas, intensive care units and the emergency room setting. Patient trays, turkey sandwiches, peanut butter and graham crackers would come and go. I never heard the words: Food Allergy.
I’m afraid to admit it, what if I did?
Would I have rolled my eyes and thought to myself, “This is not a hotel!”
My daughter and I were told that by a nurse, when my then 12 year old was hospitalized and kept in isolation with the flu.
I tried to explain to the nurse her food allergic related condition called, eosinophilic esophagitis. She never heard of it. Neither did I, until my child was diagnosed! This is why I share our story.
I do understand how a busy nurse might think such patients are being high maintenance, but they’re not.
To help my nursing colleagues, here are 5 ways to Take Better Care of Your Food Allergic Patients:
1. Believe them.
If they land in your ER, please do not lecture or tell them they over reacted, or should have given an antihistamine first. This is a myth.
If they have given epinephrine, I will tell you from my first hand experience, they are truly shaken by this whole ordeal.
Tell them they did a good job!
They made the difficult decision to administer this life saving drug, call 911 and land in your care. They did their best to stop an anaphylactic reaction from potentially becoming fatal.
Our life saving mantra is: “Epi First, Epi Fast” if suspecting anaphylaxis!
Next, please monitor these patients. This is why we call 911 and go to the Emergency Room after administering epinephrine. It’s not because epinephrine is dangerous.
Allergic reactions can return! A second and more serious reaction, called a biphasic reaction, can happen up to 72 hours after the first! This is an important fact to know for discharge teaching.
2. Please to not eat in patient care areas.
There’s nothing more unsettling than coming into the hospital or doctor’s office and seeing a jar of mixed nuts or treats open, on the desk.
We are not joking when it comes to something called cross contact. We know nurses need to eat on the go, and breaks are few and far between. But please, wash up after eating.
Like microbes, food proteins love to hang around on surfaces until thoroughly wiped away with a commercial cleaner.
Please wash your hands before examining us or touching our things. Remember, hand sanitizers do not remove food proteins, only soap and water or hand wipes do! Thank you!
3. Do not give your food allergic patient ANYTHING to eat or drink without asking first.
Allergens love to hide in the most unsuspecting foods, like ice pops! Yes, even some ice pops contain common allergens or may be made on shared equipment with other allergens.
We are not rude or picky eaters. We have to read every label for possible allergens and may even have to contact companies to find out if their products are safe for us. This is a standard part of food allergy management.
We do appreciate any help we can get on this, especially with the hospital’s dietary department and kitchen.
Allergic Living Magazine did an excellent piece on this topic. It’s an eye opening read about being hospitalized with food allergies. Hospitals are realizing this is a patient safety issue. You can read it here.
4. Ask the Pharmacist if medications contain allergens.
Allergens hide in the strangest places! They are found in medications, injectables, inhalers, eye drops, ointments, etc. These are technically called excipients.
Please double check with the pharmacy. Ask if any prescribed medications contain your patient’s allergens. We need your voice to help keep us safe.
5. Ask your patient if they have an Anaphylaxis Emergency Action Plan & a Board Certified Allergist.
An Anaphylaxis Emergency Action Plan tells the patient exactly what to do if they accidentally eat or bite into something containing their allergen, or are experiencing signs of anaphylaxis.
While discussing this topic, this is also an excellent time to review with your patient how to administer their epinephrine auto injector.
If your patient doesn’t have a board certified allergist managing their care, or if this is a new diagnosis, it’s time for a referral!
Food allergy management is a specialty area of medicine. A board certified allergist is the expert on this topic. Having an allergist can really help improve patient care and quality of life through ongoing education and support.
I hope these 5 tips help you provide the best care possible to your food allergic patients!
As we like to say in this food allergy life, “We’re not crazy. We’re Vigilant.”
If you come across a patient who could use some extra support, please send them to FAACT, The Food Allergy & Anaphylaxis Connection Team: www.foodallergyawareness.org
or to the support group I co-lead, Friends Helping Friends Food Allergy Support Group.