What are food allergies?
A food allergy is when the body's immune system reacts as if a
certain food is harmful. Food allergies tend to be overdiagnosed,
but about 5% of children have true allergic reactions to food.
Your child may have a food allergy if he or she has any of the
following allergic symptoms within 2 hours after eating certain
foods:
- lips, tongue, or mouth swelling
- stomach cramps, diarrhea, or vomiting
- hives
- itchy red skin (especially if a child already has eczema).
Some less common symptoms are:
- sore throat or throat clearing
- nasal congestion, runny nose, sneezing, or sniffing
(especially if a child has hay fever).
Rarely a child has a severe allergic reaction (called an
"anaphylactic reaction") that may be life-threatening. The
symptoms of a severe reaction generally occur within minutes to 2
hours after contact with the food causing the reaction. Symptoms
of such a reaction are a sudden trouble breathing, sudden trouble
swallowing, weakness from a sudden fall in blood pressure (shock),
or confused thinking.
Children who have other allergic conditions, such as eczema,
asthma, or hay fever are more likely to have food allergies than
children who do not have other allergies. A few children who have
asthma, migraine headaches, colic, or recurrent abdominal pain may
have attacks of these problems triggered by food allergies. If an
attack is triggered by a food allergy the child will also have
some of the symptoms of food allergies listed above. Attention
deficit disorder and behavioral disorders have not been
scientifically linked to food allergies.
What is the cause?
Allergic children produce antibodies against certain foods. When
these antibodies come in contact with the food that causes the
allergy, there is a reaction between the antibodies and the food.
This reaction releases chemicals (such as histamines) that cause
the allergy symptoms.
The tendency to be allergic is inherited. If one parent has
allergies, each child has about a 40% chance of developing
allergies. If both parents have allergies, the chance of food
allergy rises to about 75% for each child. Sometimes a child is
allergic to the same food(s) as the parent.
What are the most common food allergies?
Overall, the food that most often causes allergies is the peanut.
In babies, allergies to eggs and milk products are more common.
Peanuts (and peanut butter), eggs, cow's milk products, soybeans
(and soy formula), and wheat cause over 80% of food reactions.
These foods plus fish, shellfish, and tree nuts cause over 95% of
all food reactions. Chocolate, strawberries, corn, and tomatoes
are often blamed for allergic reactions, but actually these foods
rarely cause allergic reactions.
Will my child outgrow a food allergy?
At least half of the children who develop a food allergy during
the first year of life outgrow it by the time they are 2 or 3
years old. Some reactions to food (for example, milk or soy) are
more often outgrown than others. Although 3% to 4% of all babies
have a cow's milk allergy, less than 1% of them are allergic to
milk for the rest of their lives. Allergies to tree nuts, peanuts,
fish, and shellfish (shrimp, crab, and lobster) often do last a
lifetime.
How is it diagnosed?
Take the following steps to determine whether your child has a
food allergy and what foods cause the allergy.
- Keep a diary of symptoms and recently eaten foods.
If you already know what food is causing an allergic reaction,
go directly to step 2. Otherwise, be a good detective and keep
a diary of foods and symptoms for 2 weeks. Any time your child
has symptoms, write down the foods that he or she ate during
the last meal.
After 2 weeks, look at the diary to see if your child ate any
of the same foods on the days he or she had symptoms. Symptoms
may depend on how much of the food your child ate.
Anaphylactic reactions can be triggered by even small amounts
of foods, but other allergic symptoms (for example, diarrhea)
and their degree of severity usually depend on how much of the
food your child eats.
Reactions to food may be worse when a child is also reacting
to other substances in the environment, such as pollens (hay
fever). Therefore, food allergies may flare up during pollen
season.
- Have your child stop eating the suspected food for 2 weeks.
Record in the diary any symptoms that your child has during
this time. If you have eliminated the correct food from the
diet, your child should stop having allergic symptoms. Most
children improve within 2 days. Almost all of them improve
after 1 week of not eating the food causing the allergy.
- Have your child start eating the suspected food again.
(CAUTION: Never do this if your child has had a severe or
anaphylactic reaction to a food).
This is called "rechallenging" and the purpose is to prove
that the suspected food is definitely the cause of your
child's symptoms. Give your child a small amount of the food
you think is causing the allergy. The same allergic symptoms
should appear within 10 minutes to 2 hours after the food is
eaten. Call your child's healthcare provider before you
rechallenge.
Skin prick tests or a blood test may also be used to help figure
out what food your child is allergic to.
How is it treated?
- Avoid eating the food that causes the allergy.
This should keep your child free of symptoms. If your child is
breast-feeding and is allergic to a food that you are eating,
do not eat this food until your child stops breast-feeding.
Food allergens can be absorbed from your diet and enter the
breast milk. Talk to a nutritionist if you have questions.
- Consider avoiding other foods in the same food group.
Some children are allergic to two or more foods. Occasionally
the foods belong to the same food group. This happens most
often to children who are allergic to ragweed pollen. These
children often react to watermelon, cantaloupe, muskmelon,
honeydew melon, and other foods in the gourd family. Children
allergic to peanuts may react to soybeans, peas, or other
beans. Most nuts from trees are not related to each other. For
example, a child who is allergic to walnuts will probably not
be allergic to other tree nuts.
- If hives or itching are the only symptoms, give Benadryl 4
times a day until the hives are gone for 12 hours.
- Join the Food Allergy and Anaphylaxis Network.
This national organization can help with any food allergy
questions you might have. Contact them at 800-929-4040 or
http://www.foodallergy.org.
- Provide a substitute for any missing vitamins or minerals.
Eliminating single foods from the diet usually does not cause
any nutrition problems. However, if you eliminate a major food
group, you will need to make sure your child gets all the
nutrients he or she needs from other sources. For example, if
you eliminate dairy products, your child will need to get
calcium and vitamin D from other foods or supplements. Talk to
your healthcare provider or a nutritionist about dietary
supplements (such as vitamins).
- For mild reactions, your child can try the food again in about
6 months.
Many food allergies are temporary. If a child is less than
3 years old, he or she should try eating the food every 6
months until the age of 3. If the child continues to react to
the food each time, get an evaluation by a board-certified
allergist before you permanently eliminate the food from the
diet. CAUTION: Never let your child try the food again if he
or she had a severe or anaphylactic reaction to it. In these
cases, the food should be avoided for the rest of his or her
life. You should also keep emergency kits with
epinephrine-loaded syringes at home, at school, and in the
car.
If your child has a severe allergic reaction, you may need to
carry injectable epinephrine with you at all times. Make sure
that child care providers and school staff know that your
child has a severe food allergy, and what to do if he or she
has a reaction.
How can I help prevent food allergies?
If food allergies run in your family, you may be able to delay the
onset of the allergies if you are careful about your child's diet.
Consider cutting out peanuts while you're pregnant. If possible,
breast-feed your baby until they are at least 1 year old. The
breast-feeding mother should avoid eating or drinking milk
products, peanuts, and eggs during this time. If you cannot
breast-feed during the first year, you should use either a formula
made from protein hydrolysate (called an "elemental formula") or a
soy protein formula.
The allergy-prone child should not have any solid foods until the
age of 6 months. Try to avoid milk products, eggs, peanut butter,
soy protein, fish, wheat, and citrus fruits in the child's diet
during the entire first year of life. Try to avoid peanuts and
fish until age 2 years.
When should I call my child's healthcare provider?
Call 911 IMMEDIATELY if:
- Your child develops any serious symptoms, such as wheezing,
croupy, barky cough, trouble breathing, passing out, or
tightness in the chest or throat.
Call during office hours if:
- You suspect your child has a food allergy.
- You want to rechallenge your child with a food you think your
child is allergic to.
- You have other questions or concerns.
Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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