Being a teenager is tough, even if you don’t have food allergies. You’re trying to figure out how to navigate a world that doesn’t really understand you and perhaps doesn’t really want to listen. You’re young. You’re naturally driven to break away from your parents and other authority figures.

You have less to lose. You’re invincible, unbreakable, shatterproof! So, what’s up with all the worry, the rules, the restrictions? As a parent of a teenager, you’re probably fighting conflicting emotions and thoughts. You want to loosen the reins to give your child more freedom and responsibility.

At the same time, you want to rein in your teen, set some healthy limitations, and provide guidance on how to make good decisions. When you add food allergy to the mix, the situation can become even more tense and unstable. Out of fear for the health and safety of your teenager, you may try to impose additional limitations.

Your teenager, already saddled with more limitations than he can bear, may tend to react against the additional restrictions — restrictions that many of his friends don’t have. Couple that with normal peer pressure, and your teenager (quite understandably) may place himself in high-risk situations, sometimes just to prove to himself that he can.

Families often become embroiled in battles due to differences in perspective. The parents’ job is to protect their children. The child’s job is to become independent. These two goals are often diametrically opposed, even when it comes to dealing with health issues.

The key to successfully resolving any conflict and effectively teaming up to properly manage a food allergy is empathy. Establish common ground. Work toward understanding one another’s concerns, fears, and needs. Respect the challenges that each of you face.

Only then can you begin to collaborate and see food allergy for what it really is — an inconvenient and sometimes dangerous reality that needs to be supervised and managed. Whether a teenager has a newly acquired food allergy or an allergy that developed in early childhood, the food allergy is a huge burden — physically, socially, and psychologically.

Studies show that food allergy has a marked effect on quality of life, and this typically peaks in adolescence when the effects of being different are always magnified.

No doubt about it, food allergy sucks. As a parent, you may be tempted to soothe your teenager’s angst concerning food allergy by pointing out everything in life that could be deemed as being worse — diabetes, AIDS, blindness, hearing loss, acne, and any other health issue you can think of.

But the fact is that your teenager is dealing with food allergy, and for him or her, it sucks. It also sucks for you, as a parent. I hate to sound like some family therapist on TV, but the fact is that only by admitting how you truly feel about food allergy can you validate one another’s feelings and then work through them to a more logical resolution.

In the perfect world, the most effective way to prevent accidental exposure would be to inform everyone that you have a food allergy, so they wouldn’t accidentally expose you to the food that makes you ill. In junior high and even in high school, telling everyone that you have a food allergy can be like hanging a sign on your back that says “Kick me!”

Any exposed weakness is a vulnerability that the school bully may quickly pick up on and begin to exploit. Teasing can range from minor verbal harassment to really dangerous stuff. I have seen hundreds of incidents in which “harmless” teasing escalated into intentional food exposure or at least an attempt to knowingly expose someone with food allergy to an allergenic food.

I’ve seen peanuts thrown at kids and milk blown through a straw across the lunch table at school into the face of an allergic teen. Nip it in the bud. Work to make your school a tease-free zone. “Harmless” teasing can quickly escalate into ugly scenes, and the more dangerous this becomes, the more aggressively your school needs to deal with it.

Knowingly exposing someone who has a severe food allergy to an allergen is the equivalent of assault with a deadly weapon. Some strategies that I teach my patients, and occasionally have to use myself, are listed here. Note that I use the phrase “have to” rather than “had to.”

Even at this point in my life the teasing hasn’t stopped. Not that long ago a well-educated colleague jokingly offered me a doughnut saying, “Would you like some peanuts?” Here are some strategies to deal with insensitive idiots:

• Just ignore them. Most teasers tease to get a rise out of you — that’s their reward for success. When the teasing starts, just ignore them. It may not be easy but this is usually the best approach.

• Tell them how you feel and ask them to stop. This can be effective, especially if the teaser is generally a friend or at least a decent person. For others, however, this may be just the kind of reaction they were hoping for and may only make things worse.

• Tell an adult. This is essential if the teasing is affecting your life and whenever it crosses the line to the point to being dangerous. A responsible adult needs to know about this.

I always remind my patients that everyone gets teased at some point, whether they have food allergies or not. If it is potentially harmful, it must be taken seriously and reported to an adult. Appropriately, some schools have taken a very tough stand against teasing.

Otherwise, shake it off — don’t let it get to you. If the teasing really bothers you, bring the behavior to the attention of a parent, teacher, guidance counselor, or other trusted adult. No matter how lenient you are as a parent, you’re always too strict for a teenager.

No matter how responsible of a teenager you are, your parents are always going to worry about you. When decisions and disagreements over food allergy are complex only one thing is certain — the parent is likely to be overly protective, and the teenager is likely to take too much of a risk.

I’m not about to tell parents how to raise their teenage children. And I certainly wouldn’t try to tell a teenager how to raise her parents. All families are different, everyone’s allergies are unique, and every family has the right to approach the same situation in its own way.

I offer no one-size-fits-all approach. I know teens with the same food allergy who have never been permitted to ride the school bus, while others have traveled on their own to foreign countries. If you and your teenager lock horns on a particular issue, consider taking the matter to your doctor for discussion.

Your doctor is unlikely to make the decision for you, but he may be able to defuse the emotional dynamite, highlight the facts, and explain the potential risks and rewards, so you can arrive at a more reasonable consensus. Some parents are far too restrictive, and teens are far too prone to taking risks.

The trick is to find a happy medium. The way you approach food allergy may depend on whether the food allergy is something totally new or has been a family issue for some time. For newly developed allergies, the special issues may include:

• The need to learn about food allergies from scratch, at a time in life when medical concerns are hardly a favorite topic.

• Potentially intense frustration and anger generated by the eternal question, “Why me?”

• A positive realization that this is a serious problem that needs to be dealt with. If the reaction was relatively recent, it could lead to less risk taking and a determination to learn about and take control of the food allergy . . . at least as long as the reaction is still fresh in mind.

With long-standing food allergies, other issues are more likely to bubble to the surface during the teenage years:

• Some teenagers accept their food allergy as a part of their lives. They take the necessary precautions to avoid the problem foods, and they remain prepared for emergencies.

• Some teenagers may become too complacent, especially if they haven’t had a reaction in some time. They may doubt whether the allergy is real or still present, which may lead to more risk taking.

• Unexpressed frustration and smoldering anger may find expression in unpredictable ways. The teenager may not even realize that the root cause of some unacceptable behaviors lies with resentment over having a food allergy.

• Long-term parent-child issues may arise if parents have been overprotective and the teen suddenly finds himself in a situation in which he’s expected to take on more responsibility.

The teenage years are a transitional period — a bridge from childhood to adulthood. As such, teenagers often demand more freedom, while parents encourage them to take on more responsibility in just about every aspect of their lives — homework, jobs, driving, dating, and health.

With food allergy, the challenges are amplified but should certainly be manageable. Here are some suggestions that may help you weather the storm:

• Avoid the blame game. Both parties are attempting to achieve the same goal — successful management of the food allergy. As long as you keep this in mind, you may be able to avoid the blame game.

• Transfer ownership of the allergy. This can be tough, especially for parents who’ve been managing their child’s allergy for several years. At some point, parents need to transfer ownership of the allergy, and the teenager must accept more of the burden. Agreeing to a slow, gradual transition may work. As parents see that the teen is able to handle small responsibilities, they will be more comfortable letting the teen handle the big ones.

• Ask the doctor. Teenagers can play a more active role during office visits by asking questions about medications, treatment options, whether certain situations are safe, and so on.

• Transfer responsibility when dining out. Most teenagers are perfectly capable of communicating with a restaurant server or cook. The next time you dine out, encourage your teen to ask the questions about ingredients and food preparation, or, if you’re the teenager, ask your parents to let you do the talking.

• Hand over control of the medications. The key to success is the ability of the person who has the allergy to responsibly manage her own medications. Teens need to prove that they will always have their medicines with them when they leave the house. I give parents permission to nag their teens until the teens show that they’ve fully assumed the responsibility.

• Discuss common scenarios. Talk about the best way to handle specific events, such as a school dance, summer camp, hanging out at the mall, or going to parties. By drawing up a game plan well in advance, you may be able to avoid some risky surprises and create an experience that’s less stressful and more enjoyable.

• Rehearse difficult situations. Knowing how to react in a specific situation before that situation arises is often critical in helping a teen make the right decisions and take the right actions. Role-play different scenarios — for example, say you’re at a party with friends and someone offers you a cookie, what do you do? If you have a severe reaction, what would you do? If the teen might need epinephrine, have them use an expired autoinjector on an orange or grapefruit to demonstrate its use.

• Analyze past mistakes. Teens should open up to their parents about situations they’ve encountered and mistakes they’ve made without the threat of punishment hanging over them. Parents can then suggest a potentially more effective course of action for the next time a similar situation arises.

• Analyze past reactions. Discuss what happened and how you can prevent it from happening again. This proves to parents that the teen is mature enough to use past mistakes to build future successes. I tell all my patients that we all make mistakes and that reactions happen no matter how hard you try to prevent them. Success is measured not simply by the ability to prevent a reaction but also by the ability to learn how to more effectively prevent and deal with future reactions.

We all need to recognize that gaining independence is a process for both the teen and the parents. Teenagers are often ready, willing, and even able to be independent all at once. Parents may not be ready, willing, or able to accept that independence, and they’re rarely willing to accept it all at once. Take it one step at a time and be patient with one another. Realize that in a way, you’re both raising each other.

Getting a Little Help

Managing a food allergy is a team sport. Naturally, as a teenager, you may want to cut your parents from the team and take on more of the responsibility yourself. When you choose to do that, however, fill the empty slot with someone who’s more capable, at this stage of the game, to assist you.

You don’t have to tell everyone that you have a food allergy, but let your closest friends know about it. Describe the symptoms of an allergic reaction, review prevention strategies. And explain what they should do if you experience a reaction when you’re together.

Having a responsible friend keep an eye on you may calm your parents and make them more willing to let you wander a little farther from their protective embrace. Friends can form a protective shield around you without making you feel like a little kid.

I frequently see friends who are far more willing to speak up about the food allergy than the person with the allergy. I see friends who will virtually attack a restaurant waiter and even go in to inspect the kitchen while the allergic teen is too shy to ask a single question.

I see friends show up at appointments to learn more about food allergy. I’ve even seen friends head off to college together, so the friend can keep her pal safe on campus. Ask one of your closest friends to be a pal.

Risk Taking

Unrestrained joy, unfettered impulse, and a fair amount of risk taking are part of the beauty of youth. Unfortunately, risk taking often manifests itself in unacceptable and life-threatening ways, particularly with food allergies.

A recent study reveals that an alarming number of teenagers with food allergies admit to purposefully ingesting problem foods, and that many teens also fail to carry their medications with them. Perhaps this is why fatal food reactions are most common among adolescents and young adults.

Now, I’m not one to throw a wet blanket on spontaneous teenage exuberance, but I do get more than a little concerned when I hear about teenagers knowingly ingesting suspect foods and not carrying their medications. In fact, I’m dumfounded when I hear such things, because in order to continue taking risks as a teenager, living another day is rather important.

By figuring out how to take less life-threatening risks, you can pack a lot more acceptably risky activities into your life. Teenagers rarely intentionally take risks with their food allergies. Few teenagers knowingly ingest problem foods to see what will happen or head out of the house without their epinephrine autoinjectors for the thrill of it.

In most cases, they simply have an overwhelming and very understandable need to fit in and be “normal.” The best way to achieve a sense of normalcy is to make food allergy feel more normal.

Increased education and open communication between food allergic teens and their parents, friends, and doctor can increase the sense of normalcy and help teens master their independence while at the same time staying happy, relaxed, and safe.

While life is never entirely risk-free, knowingly ingesting a suspect food or conveniently forgetting to carry life-saving medications is never acceptable. The key is to find out which risks are okay and which are not and then do whatever you can to limit the risks.

While eating out may never be risk free, for example, carefully choosing a restaurant and asking the right questions can make eating out an acceptable risk. Eating dessert, however, no matter how tempting or how much your date pushes you to do so, may never be an acceptable risk.

Safe Dating Guidelines

A food allergy can certainly cramp your style on a date. Fortunately, by agreeing to a few key dating rules up front, you can make your date safer, more enjoyable, and perhaps even make you slightly less anxious:

• Let your date know about your allergy. In addition to assisting you in avoiding problem foods, your date may need to know about your food allergy to save your life in the event that you experience a severe reaction. If you’re nervous about what to say, practice with a friend what you should say and how to say it.

• Keep your explanation brief. No need for a full medical history or a dissertation on food allergy. Your date should understand, however, that an allergic reaction could be very serious.

• Discuss the limitations up front. Let your date know which foods you can and cannot eat and which restaurants you can eat at. Clearly explain other restrictions before the date moves too far along. You may, for example, tell your date that you are allergic to peanuts and she needs to avoid eating peanuts and to brush her teeth and wash her hands if she has eaten peanuts before the date.

I know, telling your date to be sure to brush her teeth and wash her hands may take some of the romance out of the evening, but it may also keep you out of the emergency room, which is not the most romantic place, either.

Eating out

Eating out, especially on a first date, always generates some anxiety. In a public restaurant, few people like to call attention to themselves, particularly when trying to impress a date. The trick here is to follow the rules discussed in earlier article in a way that’s a little less obvious but just as effective.

Here are some suggestions that can make your dinner out safe without making you feel as though you’re eating on stage in the spotlight:

• Steer clear of risky restaurants. If you’re allergic to fish or shellfish, and your date or your friends seem to be leaning toward seafood, steer them in a different direction before the decision process gets too far along. (This is when it really helps to have a PAL on your side.) The same goes for Asian foods and peanut allergy. If you have a milk allergy, your date needs to know up front that finding a safe restaurant may be very difficult.

• Pick a restaurant well in advance. Do as much legwork as possible before you even get to the restaurant. If possible, pick a place you’ve dealt with before and always call ahead of time and speak with the manager or chef. Preparation well in advance streamlines the ordering process.

• Keep your date and your friends at ease. To handle unplanned meetings at restaurants, let your friends or your date know that they should not be offended if you join them for dinner without ordering anything. You may simply order a soda or water or eat a snack you brought from home.

• Carry a chef’s card. The first chef’s card was created by a very smart teenager who had severe food allergy and hated to ask too many questions publicly. A chef’s card does not replace calling ahead and asking questions but it can streamline the process of ordering your meal and may allow you to get a safe meal without calling much attention to your allergy.

Safe-Kissing Skills

Not to be an alarmist, but when you have a severe food allergy, even a “harmless” kiss can be fatal. In 2006, a teenager in Canada died of an apparent allergic reaction that may have occurred after kissing her boyfriend who had just eaten peanut.

Before this incident occurred, I warned my patients about kissing. Now, this is often the first question that parents of teenagers ask me. The teens themselves don’t ask the question. In fact, they’re often mortified when their parents ask this embarrassing question, but they do listen intently to the answer.

When you’re just getting to know someone, you may not feel quite ready to tell the person about your food allergy. That’s perfectly understandable. Until you’re ready to open up about your food allergy, however, stay on the safe side by following these precautions:

• Avoid food-related activities. For example, plan dates before or after mealtimes.
• If you eat, make sure you both eat only safe foods. Consider packing a picnic lunch.
• Hold off on the kissing. Avoid kissing until you can be honest with your date and feel that your date will respect your food restrictions.

When you do get ready to kiss, make sure your date knows how serious your food allergy is and what he or she needs to do in order to prevent you from having a reaction. Many teens tell me that their date has agreed to avoid the allergy-causing food on days when they will be hanging out together.

Others say their boyfriends or girlfriends have cut the allergen out of their diets entirely. Dating is all about spending time with a person you like to learn whether you are comfortable with each other. If your date isn’t understanding or is pressuring you to take chances that might harm you, he may not be right for you!

On the other hand, if your new boyfriend makes an effort to learn about food allergy and is genuinely concerned, he should automatically score a few points with you (and your parents).