Also called: Pediatric Food Allergies
A food allergy involves a person’s immune system reacting to a specific kind of food or food component in such a way that potentially deadly allergy symptoms are triggered. Food allergies are more common in children than they are in adults, with about 6 to 8 percent of young children suffering from the condition. The treatment of food allergies involves the complete elimination of the problem food from the diet.
Children who are severely sensitive to a food should be aware of the potentially deadly condition known as anaphylactic shock. An allergic child can have an anaphylactic reaction after consuming even a tiny portion of a food allergen. The parents and the child should know how to deal with this condition, should it occur. Anaphylactic shock is treated with an injection of epinephrine.
The most common food allergies in children are cow’s milk, eggs, peanuts, wheat, soy and tree nuts. Sesame is also a common food allergen among children. Reactions to eating these allergens can include itchiness, runny nose, hives, headache, vomiting and shortness of breath.
Physicians can use a variety of tests to determine whether a child is sensitive to a particular food. After the problem food is determined, children should completely remove the food from their diet. This requires a great deal of effort on the part of the parents and the child. Parents, child and caregivers will need to learn the alternate names of problem foods. All should also become comfortable with checking food ingredient labels, restaurant food preparation policies and school cafeteria menus. Alternate sources of nutrition may be necessary as well.
Most children outgrow their allergies by about the age of 10. Allergic reactions to peanuts and seafood are less likely to go away as the child grows older. Children and adults should never attempt to eat a food to which they were once allergic without consulting a physician.
Generally, children who come from families that have a history of allergies are more likely to develop food allergies. For this reason, mothers with a family history of allergies may need to follow special instructions through the first few years of their child’s life.
Many physicians recommend breastfeeding exclusively through the first year of life to limit exposure to allergens. After the child’s immune system has matured, foods that are potential allergens can be introduced gradually. Nursing mothers also need to eat conscientiously, as they can pass along food allergens to their children through breast milk.
Some children who appear to suffer from a food allergy actually have food intolerance, which is much more common and usually not as severe. With a food intolerance, the body usually lacks a specific enzyme needed to break down a substance (such as lactose in milk intolerance or gluten in gluten intolerance). Allergies, while often producing similar symptoms as food intolerances, actually involve the immune system’s response to a perceived danger and the production of histamines. Though a food allergy can be deadly, a food intolerance is generally not as dangerous.
About food allergies & children
A food allergy is a potentially life-threatening allergic reaction by an individual’s immune system to a certain type of food or food component. These kinds of allergies are found more commonly in children than in adults. The only effective treatment for a food allergy is to completely avoid problem foods. Parents should help their children understand that food allergies must be taken very seriously.
The most common causes of allergic food reactions in young children are cow’s milk, eggs, wheat, soy, peanuts and tree nuts. Sesame is also a common food allergen among children. About 6 to 8 percent of young children suffer from food allergies, though the number affected diminishes to only 2 percent after the first few years of a child’s life. While most early food allergies are only temporary, older children and adults are likely to remain allergic to foods such as peanuts and seafood. However, only a physician is qualified to decide whether a food should be reintroduced to an adult or child.
A food allergy is triggered when a susceptible individual comes into contact with a problem food – usually by eating it. The immune system, incorrectly interpreting the food as dangerous, releases immunoglobulin E (IgE) antibodies to fight back against the food. The circulating IgE triggers the release of histamines, which usually results in the symptoms most people associate with allergies (e.g., hives, swelling, nausea, diarrhea, shortness of breath). Even a tiny amount of a food allergen can cause a child to experience life-threatening anaphylactic shock, which can lead to severe difficulty breathing, swelling of the throat, fainting or even death. Therefore, it is necessary to take extremely close care to avoid problematic foods.
Parents and (older) children need to be constantly aware of which foods might be dangerous. They also need to learn the many different names of problem foods and pay close attention to how foods are prepared. Caregivers, schools and other types of supervision should all be notified of the child’s condition and treatment methods.
Like younger children and infants, older children who suffer from food allergies should also remove problem foods from their diets completely. However, about 30 percent of the time, children are able to resume eating the food after one or two years – once a physician has determined that the food is safe.
For newborn babies, some physicians recommend continued breastfeeding until the child reaches 1 year of age to better avoid many of the foods that are commonly food allergy triggers. Nursing mothers should be aware that they can pass an allergen on to their own children while breastfeeding, though the benefits of breastfeeding may outweigh the risks.
For women who cannot breastfeed or choose not to breastfeed, studies indicate that hydrolyzed casein or whey formulas may help prevent at-risk infants from developing food allergies. These formulas, however, are not an option for parents who suspect their infant may already have a food allergy because these breast milk alternatives could potentially cause a reaction.
Some children who appear to have an allergic reaction to food actually suffer from food intolerance. This condition is more common and usually less severe, although the symptoms can closely resemble those of a food allergy. With food intolerance, the body is unable to properly digest a specific type of food (such as lactose in milk intolerance), usually because it lacks a certain type of enzyme.
Potential causes of food allergies in children
Infants and young children are often susceptible to a range of different food allergies. These allergens frequently include (but are not limited to):
- Cow’s milk. Includes cheese, butter, cream, casein (a milk protein) and whey. A milk allergy should not be confused with a milk intolerance, which is an inability to digest the sugar lactose and not a true allergy.
- Egg Allergies. Includes commercially processed cooked pastas and some brands of egg substitutes.
- Wheat. Includes crackers, pastas, bread and malt. A wheat allergy should not be confused with gluten intolerance, which is a sensitivity to the protein gluten and not a true allergy.
- Peanuts. Includes peanut butter, peanut oil, many types of ethnic foods (especially Chinese) and some flavorings.
- Soy. Includes lecithin (a food ingredient often made from soy), some types of baked foods, canned tuna, sauces and baby formulas.
Older children often outgrow the food allergies they suffered from as young children. However, some kinds of food allergies, such as peanut allergies, are usually not outgrown. Others include:
- Tree nuts. Includes hazel, cashew, almond, sesame seed and Brazil nuts.
- Fish. Includes yellowtail, salmon, mackerel, tuna and hake.
- Shellfish. Includes crab, crayfish, shrimp, scallops, oysters and lobster.
Some children are sensitive to the additives put in many types of food. These additives are put in for better preservation, taste and color. These kinds of sensitivities are rarer than food allergies.
Food allergens may be found in nonfood sources. Pediatric skin care products have been found to contain common food allergens such as cow’s milk and tree nuts, according to the American Academy of Allergy, Asthma and Immunology (AAAAI).
Related allergies and conditions
There are several kinds of conditions that may predispose a child towards food allergies. A personal or family history of hay fever, asthma, hives or eczema typically increases the likelihood of a child developing food allergies. People with asthma also tend to have more severe allergic reactions.
Infantile colic (excessive crying) is sometimes associated with food allergies. An allergy to milk or soy may be responsible for up to one in five cases of colic in infants. Though the exact causes of this condition are unknown, it may come as a result of the immaturity of the immune system in infants with these allergies.
Allergic reactions to food can be deadly, and any type of reaction to food should be taken seriously. Individuals who suspect they may be having an allergic reaction to a food should seek immediate medical attention. However, it is important to note that not all reactions to food are actually allergic reactions, though only a physician is qualified to make the distinction. Although symptoms can be similar, the cause may be related instead to one of the following:
- Food intolerances. Usually the result of a child’s lack of a specific enzyme and inability to digest a certain food.
- Food poisoning. A reaction to bacteria, chemicals or other toxins found in contaminated or spoiled foods. Symptoms may be similar to those of a food allergy.
- Stress or psychological issues. The relationship between stress and allergy symptoms is not entirely clear. However, children may feel “sick” simply by thinking about a certain type of food.
- Other causes. A number of other conditions may be confused with a food allergy, but are less common in children.
Signs and symptoms in children
A food allergy will often produce the same kinds of symptoms in a child as it does in an adult, with the nose, throat, lungs, skin and gastrointestinal tract all affected. The symptoms of a food allergy can be deadly, and should never be treated lightly.
The most severe type of allergic reaction involves anaphylactic shock, which can be life-threatening and should be treated immediately. Symptoms of this type of allergic reaction include:
- Shortness of breath or wheezing
- Tightening in the chest or throat
- Dizziness, lightheadedness or fainting
Food allergy symptoms usually appear within 30 minutes of ingesting the problem food, though it is not unheard of for a reaction to take place up to six hours later – or immediately. Symptoms commonly associated with a food allergy include:
- Runny nose
- Skin conditions, such as itching, rashes, hives or raised bumps
- Itchy or watery eyes
- Swelling, commonly around the lips and mouth (angioedema)
- Itchy throat
- Abdominal cramps
- Nausea or vomiting
Diagnosis methods for children
The first step in diagnosing a food allergy involves the careful review of the child’s medical history, as well as the medical histories of the parents. Children who are born into families that have a history of allergies are more likely to develop a food allergy themselves.
The physician will also perform a physical examination to help identify or exclude medical problems that may be causing the child’s symptoms. By gathering this basic information, a physician can get a better idea of where to proceed with further evaluations. This may include attempts to identify the specific allergen to which the patient is sensitive. Such procedures are not definitive, but can provide information that is relevant to the patient’s condition and useful in designing treatment plans. These measures may include:
- Skin test. This test involves pricking the child’s skin with food extracts. The tested area will react with redness or swelling to indicate an allergic reaction to the extract.
- RAST (radioallergosorbent test). This type of blood test allows a laboratory to directly test a blood sample from a child in an attempt to detect antibodies that correspond to specific foods.
- Oral food challenge. Different foods are placed within capsules to hide their identity. The patient consumes the capsules and the physician looks for signs of an allergic reaction. This is considered the most effective way of determining the cause of a food allergy because it supplies the most convincing results.
- Elimination diet. This diet involves removing suspect foods from a child’s diet to see if allergic reactions persist. This trial-and-error approach can take weeks before it achieves results, but it is effective at removing a problem food.
When identifying a food allergy in children or even recognizing that there is a problem, it is important to understand that a child may describe an allergic reaction in different terms than an adult. Very young children may react by placing their hands in their mouths or scratching at their tongues. Children may also slur their speech when experiencing an allergic reaction, or begin to sound hoarse or squeaky. Some specific symptoms a child might describe during an allergic reaction include:
- Hot or burning tongue
- Tingling in the mouth or tongue
- Itchiness in the tongue
- Sensation that something is stuck in the throat (or throat feels thick)
- Tongue feels heavy
- Tongue feels as if there is hair on it
- Tongue feels as if there is a bump on the back of it
- Lips feel tight
- Ears feel itchy inside
- Food is too spicy
Treatment and prevention for children
For those infants and young children in a family with a history of allergies, physicians often recommend several measures to help reduce the risk of food allergy development.
- Infants should be exclusively breastfed until they are at least 1 year old. Though this belief is highly debatable, some physicians recommend limiting an infant’s contact with potentially problematic foods. Nursing mothers who wish to adhere to this may want to avoid eating highly allergenic foods (e.g., milk, eggs, fish, nuts), as they could pass on these allergens through their breast milk. However, it is important to talk with a physician before changing one’s diet.
- Infants should not be exposed to any solid foods until they reach 6 months of age. This reduces the likelihood of children encountering a problem food at a very young age – when they are most susceptible.
- Children should not have any contact with cow’s milk or other dairy products until they are several months old. Some physicians recommend waiting until a child is nine to 10 months old, while others suggest waiting a full year. Patients should discuss the introduction of milk into an infant’s diet with a physician.
- Eggs should be avoided for the first two years.
- Peanuts, tree nuts and fish should not be introduced until a child is at least 3 years old.
- Parents need to be aware of any alternate names a problem food might be called, to better limit their child’s exposure to it.
As children grow, their immune system matures and they will often outgrow food allergies. By the age of 4, most children who suffered from an early allergy to milk are no longer allergic. In some cases, such as eggs, increased exposure to the food may lead to desensitization as the child ages. In addition to eggs, allergies to soy and milk are also commonly outgrown. Reintroducing a child to a food should be done very carefully, and always under the direction of a physician.
Educating a child on the selection of proper foods and convincing them to remain vigilant can be a challenge, but it is very important. Parents need to educate both themselves and their children on the various names a problem food might have, and constantly check ingredient labels for its presence. Parents also need to work closely with their children’s school or daycare center (or anywhere food might be served) to make sure these facilities are able to handle special dietary needs. Many schools and child care facilities have procedures in place for children with special diets; however, many do not. Parents should always check to be sure.
Parents are encouraged to meet with the staff of their child’s school and tour the school’s facilities. Parents should always check to make sure adequate cleaning methods are being used wherever their child is eating. Equipment or facilities can be cleaned of lingering food residues with warm soapy water or most kinds of wet cleaners. The chlorine solutions used in some schools are also adequate for cleaning. A fair amount of hard scrubbing should be involved with any of these solutions. Kitchen staff washing their hands after handling food is also an important part of prevention.
Parents should be aware that certain responsibilities fall on different parties when a child with food allergies starts school. The family, the school and the child should all be aware of their roles to minimize risks. For the family, the responsibilities include:
- Notifying the school of the child’s condition
- Working with the school to find a plan that meets the child’s needs in the classroom, in the cafeteria and in any after-school or school-sponsored activities
- Providing all contact information, medical documentation, written instructions and medications the school might need
The school’s responsibilities include:
- Knowing and following all federal laws pertaining to this subject – such as ADA, IDEA, Section 504 and FERPA – as well as any state laws
- Being familiar with the health records submitted by the child’s parents or physician
- Including food allergic children in all school activities
- Working with a child’s parents in order to create a prevention plan
- Making sure all staff who regularly come into contact with the child know about the food allergy and can spot symptoms and properly react in an emergency
- Ensuring that the school nurse can properly store the child’s medications and treat the child as needed
Those students who are old enough should be responsible for:
- Not switching food with other students
- Not eating those foods which they know to be risky or of an uncertain origin
- Immediately notifying an adult if they believe they have eaten a food to which they are allergic, or believe they are having an allergic reaction
Parents should also be aware that by avoiding certain foods, children may also be missing important nutrients. For example, a child on a dairy-free diet must find other foods to make up for the missing calcium, protein and vitamin D. Parents are encouraged to discuss their children’s dietary needs with a physician or dietitian.
Epinephrine (allergy kit) is used to immediately treat the most severe allergic reactions involving the life-threatening condition known as anaphylactic shock. Epinephrine is a synthetic form of adrenaline that, when injected, works as a powerful bronchodilator, opening breathing tubes and restoring normal respiration quickly. Most physicians recommend that children who are susceptible to severe reactions carry an injection of epinephrine with them at all times and understand how to self-administer the drug. In the case of infants or young children, anyone watching or supervising the child should have immediate access to an epinephrine shot, as well as know how to properly administer the drug. Epinephrine should be used at the first signs of a strong food allergy reaction. A medical alert bracelet or necklace is also a good idea for these children.
Symptom relief for reactions in children
Once an allergic reaction to a food has occurred, there are a number of treatments available to relieve symptoms. These medications can help alleviate symptoms somewhat, but are by no means a cure for the condition. These medications should not be viewed as a countermeasure or effective antidote for food allergies. Only avoidance of problem foods can successfully treat a food allergy.
Though some medications for the relief of allergy symptoms are available over-the-counter, they should be used only under the direction of a physician. Some medications that may be recommended include:
- Antihistamines. Medications that provide relief for more common allergy reactions such as hives, sneezing, runny nose and gastrointestinal symptoms.
- Bronchodilators. Medications that open the airways of the lung, relieving symptoms such as shortness of breath or wheezing.
- Corticosteroids. Medications that reduce inflammation. These medications are commonly used to treat severe allergic reactions in infants.
Questions for your doctor
Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Parents may wish to ask their child’s doctor the following questions about food allergies and children:
- Do my child’s symptoms suggest a food allergy?
- What tests will you use to determine if my child has food allergies?
- What types of foods should my child avoid?
- Are there any treatments available that will allow my child to eat a food allergen safely?
- What should I do in the event my child accidentally consumes a problem food?
- Will my child ever outgrow the food allergy? How will we know if this has happened?
- What steps should I take to ensure my child’s safety at daycare/school?
- Can I prevent my other children from developing allergies?
- Will I have to alter my child’s diet to make up for lost nutrients?
- Are my children more likely to develop food allergies because I have them?