When Rachel Chang was growing up in Westchester, New York, Halloween wasn’t always as sweet as it was for other kids. She and her two younger brothers have severe allergies to dairy and nuts, making the holiday—and the treats that go along with it—a challenge. They made their own version of their favorite candies with dairy-free chocolate and her parents would trade candies they knew were safe with the ones she and her brothers collected while trick-or-treating. They never tried new sweets while out and about, knowing the stakes were high because their allergic reactions include vomiting, swelling and difficulty breathing—and, left untreated, the effects can be life-threatening.
“It was hard in school when people would bring in candy,” says Chang. “The kids didn't understand and the teachers didn't understand quite as well as they do now either. So my family had to adapt over the years to figure out ways to still make Halloween fun and inclusive and safe.”
“People don't realize that children have been left out of traditional Halloween parties, or the trick-or-treating process,” says Lisa Gable, chief executive officer of Food Allergy Research and Education. “It can be a very frightening time.”
Navigating food allergies can be tricky any time of the year, but Halloween presents additional pitfalls. A September study in the Canadian Medical Association Journal, led by a team of researchers at the Montreal Children’s Hospital of the McGill University Health Centre, found that the biggest spike in emergency room visits for anaphylactic peanut and tree nut allergies is on Halloween. Mélanie Leung, a fourth-year medical student at McGill University and author of the study, says her team wanted to learn when allergic reactions happen in an effort to better target education and public awareness campaigns. Leung’s team looked specifically at anaphylactic peanut and tree nut allergies, she says, because these cases account for many life-threatening allergies.
To find out if kids were more likely to have reactions during events or holidays, researchers looked at over 1,300 emergency room visits for kids with anaphylactic allergic reactions across four Canadian provinces between 2011 and 2020. Leung and her colleagues discovered that the number of allergic reactions soared on the widely celebrated holidays of Halloween and Easter, while other popular holidays like Christmas, Diwali, Chinese New Year, Eid al-Adha didn’t show an increase in cases. Peanut-trigger anaphylaxis jumped 60 percent on Easter and 85 percent on Halloween. For allergies triggered by unknown nuts—cases where the parents and pediatrician know the allergy was triggered by some kind of nut, but they’re not sure which one—the researchers found a 60 percent increase on Easter and Halloween.
“We did not necessarily expect to find a rise only in Halloween and Easter,” says Leung, because other holidays like Christmas and Chinese New Year are also centered around food. Part of the reason for the sharp spike on Halloween may be the interactions with others who are unaware of the child’s allergy, and because children may be encountering new foods for the first time. Many children vising the emergency room had known allergies, but “oftentimes it was a first allergic reaction,” says Leung.
Food allergies affect over five million children in the United States and can range from minor reactions like an upset stomach to life-threatening conditions. Anaphylactic allergies like Chang’s account for 40 percent of all food allergies in kids. These severe reactions can lead to swelling, difficulties breathing and a sudden drop in blood pressure—all of which can be fatal.
In the United States, anaphylactic food reactions lead to 30,000 emergency room visits and 150 deaths each year in children and adults. One out of every 13 children has a food allergy, and that number is growing. A 50 percent increase in kids’ food allergies occurred between 1997 and 2011, and peanut and tree nut allergies more than tripled in a similar timeframe.
One reason for the jump in allergic reactions on Halloween may be due to the type of food kids are eating: mini and one-bite candies.
“If a child is getting a miniature candy, the ingredients might actually be different than what they are for the full-size version,” says Scott Sicherer, an allergist and the director of the Jaffe Food Allergy Institute at Mount Sinai, who was not involved in the study. “If you actually look at the packaging, sometimes you'll see some differences.” Miniature candies can be manufactured in different locations than their full-sized counterparts and may have slightly different ingredients or allergy labeling as a result. Another problem is that ingredients for bite-sized candies are listed only on the boxes or bags—and not the individual treats.
The Food Allergen Labeling and Consumer Protection Act of 2004 mandates labeling eight common allergens on food packaging: milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans. These top eight ingredients account for 90 percent of food allergies, though Canadian labeling also includes mustard, fish and sulphites.
Another challenge for those trying to avoid allergic reactions is that advisory labeling is voluntary. Companies decide whether to print notices on the packaging like “processed on equipment with peanuts” or “made in the same facility as wheat-containing food.” And that ambiguity leads to confusion, says Sicherer.
First-time allergic reactions are challenging to prepare for and symptoms can appear just minutes after exposure to an allergen. Initial reactions may seem relatively minor, like an itchy throat, flushed skin, or upset stomach, but quickly develop into a more severe reaction, says Leung. Because of this, she recommends parents seek emergency medical care for their child as soon as they suspect a problem.
For parents with children who are known to have anaphylactic reactions, Sicherer suggests they always read labels closely—don’t take a chance on a new food night-of. If the child has an epinephrine auto-injector (EpiPen) or other medication, keep it handy. If children really want to enjoy treats alongside their friends, he recommends parents bring along candy that they know is safe. The Centers for Disease Control and Prevention recommends forgoing or adapting trick-or-treating activities this Halloween to reduce the chances of contracting and spreading the virus that causes Covid-19.
For households that do plan on participating in trick-or-treating this year, small changes can make a big difference for kids with food allergies. Offering candies free from nuts is a good option, but still leaves many kids at risk.
Gable’s Food Allergy Research and Education (FARE), the world’s largest non-profit organization aimed at advancing food allergy awareness and education, started an initiative to make the holidays safer and more inclusive, called the Teal Pumpkin Project. The idea is simple: Place a teal-colored pumpkin or bucket outside your home to show you also offer non-food items for trick-or-treaters. Gable says this can be as easy and inexpensive as printing coloring pages or including small themed toys like bouncy balls, crayons, pencils, stickers and glow sticks.
“Kids just want to dress up and they want to have fun and they want to be included,” says Gable.
This year, more families are looking for alternatives to going door-to-door collecting candy. She says re-thinking how to make the holiday safer during a pandemic might inadvertently make it easier for kids trying to navigate food allergies, too.
Given the pandemic, Sicherer encourages families to look for alternatives to door-to-door trick-or-treating. He recommends organizing a scavenger hunt in a backyard or local park where kids can search for safe treats.
“Maybe this is actually a time where it's easier for people with food allergies to join in on activities that are not so food-centric,” says Sicherer.