Why Food Allergies Are Considered to Be a Hidden Disability

Food allergies are considered one type of disability because they can be defined by a restriction in diet, and they may be hidden. Mostly, this definition applies to children in school or daycare situations. Older children, young adults, and adults typically are aware of their food allergies as they get older. In other words, food allergies are no longer unknown, but they can still be hidden, or not obvious.

Food allergy reactions can vary in duration and severity. Mild reactions can last minutes, while more severe reactions can last hours or days. Food items that need extra caution around allergies include fish, shellfish, peanuts, tree nuts, eggs, milk, soy, and wheat. Food allergies can occur when a person’s body has an abnormal response to a certain food, triggering an allergic reaction.

Healthcare providers need a detailed history, physical examination, and appropriate allergy testing to warn about potential adverse food exposures. Food allergy management, particularly the prevention of anaphylaxis, remains a challenge, particularly in schools and institutional settings. It is estimated that in the average school classroom, there may be several children with food allergies that they or their parents are not aware of or are hidden.

What is a hidden disability?

A hidden disability is defined by the fact the person may not have physical signs of the disability. Food allergies may be considered hidden because of the potential physical and mental impairment from inadvertent exposure which can be disabling.

In other words, food allergies may be invisible and not easily conceptualized. To take the logic further, a child may have a known peanut allergy, but the allergy remains hidden since the child has no symptoms or disability until he or she is exposed to peanuts.

Other examples of hidden disabilities include multiple sclerosis, epilepsy, partial sight or hearing loss, and brain injuries. Proper labeling of foods and food ingredients has lessened the impact of hidden food allergies and disabilities. Still, there can be unknown factors such as cross-contamination and improper or incomplete labeling of foods.

What can be done for allergy management?

What can healthcare providers, parents, and families do about food allergy management, particularly in schools and daycares?

The best strategy is always to try to reveal the hidden food allergy so that it is known. For infants and children, this may mean introducing new foods one at a time for early identification.

As a general rule, peanuts and peanut products should not be introduced until babies are at least six months of age. Babies with mild to moderate eczema should have a further evaluation from their healthcare provider first.

Other food items that should be introduced slowly and with caution include honey (before age one), cow’s milk (before age one), unpasteurized drinks or foods (can put babies at risk of E. coli infection), hard candy, popcorn, whole nuts and grapes (need to be cut into small pieces and avoided before age three due to the risk of choking), juice (if it contains added sugar, it should be avoided before age one), and foods with lactose as they can cause stomach upset.

Healthcare providers and allergists need to be aware of the scope of food allergies and the potential effects on infants and children and the role of legislation intended to protect the rights and safety of these children.

Why communication is important

What are the important aspects of communication between patients, parents, families, and schools or daycares?

Once the child has been identified as having a food allergy, the allergy may no longer be unknown, but it may still be hidden. But there are precautions to be taken regardless of whether an allergic reaction has been witnessed. A team approach must be taken. There should be clear communication among all those involved to prevent untoward events.

One of the biggest factors to take into consideration is parental anxiety. Some parents have other children with known allergies, and they may express concern about hidden allergies in their younger children when first attending school or daycare.

Unintentional allergen exposures can occur despite the best efforts at prevention. There should always be an emergency plan established which includes access to epinephrine.

Avoidance of hidden allergies must also consider the minimal risk of allergic reaction from casual skin contact or even airborne methods in addition to food ingestion. Awareness, for example, must extend to unusual circumstances such as a Friday fish fry in the cafeteria and a child having a hidden allergy to fish and the potential airborne allergens.

Tips to reduce the risk

What are some general tips for reducing the risk of allergen exposure for young children and students?

Allergen avoidance is the most obvious in decreasing food allergy reactions. The problem is if the child has a hidden allergy or one that has yet to be diagnosed. What can be done about that?

Checking ingredient labels and managing potential cross-contact of allergies is vital. Strict avoidance of certain potential allergies such as peanuts in small children is a good preventative step. Peanut-allergic patients can have reactions at exceptionally low levels of exposure before their parents, teachers, or even healthcare providers know.

In some cases, school-wide bans may be implemented to prevent food allergen exposure. This depends on the situation and past experience in many locations. While this can put significant burdens on the school, it may be necessary. One potential problem in schools that have strict school-wide bans is that it may cause a false sense of security. There may be less vigilance for specific potentially dangerous food exposures.

It should be emphasized that most severe allergic reactions or anaphylaxis occur as a result of food ingestion, not cutaneous or airborne exposure. However, there are exceptions to this rule, particularly if the allergy is hidden in certain individuals.

Food allergens can be effectively eliminated from surfaces with common household cleaners. Most severe allergic reactions to foods are from ingestion rather than skin contact or respiratory aerosol means.

Allergies to certain foods is considered to be a hidden disability, especially when a reaction can cause anaphylaxis. In the case of children, parents, schools and healthcare providers should communicate effectively about the allergy, and have a medical plan in place in case of emergency.