Trick-or-Treat but Hold the Wheat

Halloween tips for the nearly 3 million kids who who have food allergies.

October 22, 2009, 12:19 PM

Oct. 26, 2009— -- Don't let food allergies scare your family out of suiting up in that nylon Batman costume, or partaking in a jack-o-lantern contest this Halloween.

While an estimated 3 million children in the United States have food allergies, with advanced planning and careful execution, celebrating ghosts and goblins can still be realistic for most.

"Not trick-or-treating is just not an option for us. It would devastate him," says Amanda Higgins-Lekebusch, mother of 7-year old Owen, who is anaphylactic to peanuts. "He doesn't get to eat any of the candies, I have safe candy for him and he's fine with that. It's more just the ritual of going to the doors and ringing the doorbell."

For many parents, it all comes down to rethinking Halloween in the traditional sense of the holiday. Find new snacks, check food packing labels and seek out creative alternatives.

Alice Bast is the founder and president of the National Foundation for Celiac Awareness, a nonprofit organization that works to increase awareness of celiac disease. Bast suggests concentrating on what your children can have on Halloween. For those who live with the autoimmune disorder celiac disease, the consumption of gluten, a protein found in wheat, barely, rye and other grains, is harmful to the intestine and therefore must be omitted from one's diet.

"You tell your child early on, listen you're not going to eat that. Why don't we gather those items and donate them to a homeless shelter, a food bank. Look at it as collecting money for UNICEF. So don't make it all about the candy, make it about the sprit as well."

Bast, who has been on a gluten-free diet for 16 years, recalls NFCA's inaugural event, which was incidentally held on Halloween.

"We had a coffin outside a person's house and her son popped out of the coffin with a loaf of bread, and there was a skeleton that said 'I waited too long for my diagnosis,' and a vampire crying, 'I want to test your blood,' and we made people feel like, yes you can do this," said Bast.

With more than 150 foods that can result in allergic responses in those prone to allergies, monitoring a child's diet can certainly be a challenge. The Food and Drug Administration identifies the eight most common allergenic foods as milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybeans. These substances account for 90 percent of food reactions.

According to the National Institute of Allergy and Infectious Diseases, food allergy occurs in 6 percent to 8 percent of children four years of age or under, and in 3.7 percent of adults.

Dr. Amal Assa'ad, professor of pediatrics in the division of allergy and immunology at Cincinnati Children's Hospital Medical Center says most children with food allergies have at least three allergies, but often kids will outgrow their sensitivity.

"It's well-known that egg and cow milk allergy is often outgrown, but it may take up to the age of 15 years to do that. Peanut allergy as well has been established to be outgrown, maybe 20 percent of children do this," said Assad.

Adults, however, are unlikely to outgrow their allergies and are more sensitive to shellfish and tree nuts than some of the other eight allergens.

Safe Alternatives on Halloween

The key to a safe and healthy Halloween for those with an allergy is reading labels and staying vigilant. The Food Allergy and Anaphylaxis Network, a nonprofit organization and community of nearly 30,000 members, provides support and suggestions for those battling food sensitivities.

"We at FAAN put a lot of effort into supporting our members about how they can manage Halloween because it's such a popular holiday for kids with the focus totally on candy," says FAAN CEO Dr. Julia Bradsher. "For most children with food allergies there's an awful lot of candy that's pretty much off limits for them."

Bradsher suggests if your child will be trick-or-treating, it is crucial to establish ground rules before going door to door. Identify candies that should not be consumed and ask the people in your group to help your child stick to the rules. Some families distribute information to the neighbors in advance to educate others about allergen-free products. If you're way ahead of the game, you can prepare goodie bags with allergen-free candy before the holiday and ask your neighbor to hand out these prescreened treats upon seeing your child.

"What you may want to do before these trick-or-treaters go out is you feed them so they're not hungry and then send them out," suggests Bast. "We have our own candy. You may just want to have a variety at home so they don't feel deprived."

It is also important to remember to read the ingredient label on each candy package, as they may vary. In some cases, the ingredients of bite-sized candy may differ from those used in the regular size of the same candy.

The National Foundation for Celiac Awareness recommends the site for information about candy free of many of the top allergens. Top choices include Yummy Earth Organic Lollipops, Jujy Fruits, Jelly Bellys and Super Bubble. While this list provides helpful information as a general resource for parents, every parent should check with his or her child's physician about specific allergies for the best individual guidance.

Stay Vigilant, Read Food Labels

While there is some candy that does not contain one of the eight allergens, families should make sure ingredients are not derived from allergenic food, or processed in manufacturing plants that also package other foods, which could be harmful. Since Congress passed the Food Allergen Labeling and Consumer Protection Act of 2004, which took effect in 2006, all foods regulated by the FDA must have labels that clearly establish the source of all ingredients that are -- or are derived from -- the eight most common food allergens.

FDA Director of Food Labeling and Standards Felicia Billingslea is tasked with surveillance and enforcement of the law and ensures that strict oversight provides a safe environment for consumers.

"We are rigorously enforcing the Food Allergen Labeling and Consumer Protection Act. Our investigators, when they are doing their sections, will look to see if allergens are being used, if they're being used appropriately, being labeled," said Billingslea. "It is an area of emphasis for us during our inspections and is a priory of the center and the agency, one of the higher priorities for us."

That said, the FDA is a post-market surveillance agency, and does not have jurisdiction over labeling before food is packaged. Therefore, in most cases, companies that violate the law will not be identified or reprimanded until after a product is on the shelves.

Food Allergy Dangers

From 1997 to 2007, the prevalence of reported food allergies among children under the age of 18 rose by 18 percent, according to findings of a 2008 study conducted by the Centers for Disease Control and Prevention.

"There's been a trend of increased allergies and that's a big question, whether it's over diagnosis, awareness or an actual increase," says Assad, adding that discrepancies in diagnosis also occur when doctors test allergies by using only a blood test.

"Some of the blood tests may not be accurate because we spread the idea of sensitization versus actual clinical reaction. Some tolerate the food if they eat it, but something can still show up in the blood, that's part of the problem."

Symptoms of food allergies include hives, swelling, vomiting, dizziness, abdominal cramps, wheezing and loss of consciousness. While a resistance to gluten, or celiac disease, is often associated with food allergies, one who is intolerant to gluten should not be mistaken as allergic to gluten.

"The allergy would be the anaphylactic, an immediate reaction, a rash, and it can even be life threatening. The intolerance or autoimmune disorder is your body attacking itself. You may not even have symptoms, but it can still be causing damage to your body," explains Bast.

Allergies can also be life-threatening, causing anaphylaxis, often resulting in shock, suffocation and inability to breath. Each year in the United States, it is estimated that there are approximately 30,000 episodes of food-induced anaphylaxis, which result in as many as 200 deaths.

ABC News' Karin Halperin contributed to this report.

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