Food allergies in children: What parents need to know

An increasing number of children are being diagnosed with food allergies. Today, an estimated 10% of children have some sort of food allergy. This translates to one in 13 children, or roughly two kids in every classroom, with a food allergy. Around 40% of children with a diagnosed food allergy are allergic to more than one food.

The most common food allergies for kids include milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, soy and sesame.

When someone has an allergic reaction to food, their body reacts as if that food product was harmful. The body’s immune system, which exists to fight infection and disease, creates antibodies to fight the food allergen. Every time the person eats—or in some cases touches or breathes in—the food, the body releases chemicals like histamine. This triggers allergic symptoms that can affect the respiratory system, gastrointestinal tract, skin, or cardiovascular system. In severe cases this can cause a life-threatening allergic reaction call anaphylaxis. Your doctor will commonly provide an epinephrine injector and advise strict avoidance of these foods.

Read on for advice from pediatric allergist Dr. Warner Carr, on what parents should know about food allergies in children.

Food allergy symptoms

The most common food allergies symptoms that parent should look for in children include:

  • Wheezing
  • Trouble breathing
  • Coughing
  • Hoarseness
  • Throat tightness
  • Belly pain
  • Vomiting
  • Diarrhea
  • Itchy, watery, or swollen eyes
  • Hives
  • Red spots
  • Swelling
  • Lightheadedness or loss of consciousness (passing out)

Food allergy risk factors

Some factors put kids, especially boys, at higher risk for food allergies, including:

  • Vitamin D insufficiency
  • Asian and black race
  • Allergic disease such as eczema and asthma
  • Low consumption of antioxidants and omega-3 fatty acids
  • Increased antacid use
  • Increased exposure to antimicrobial personal care products such as toothpaste and hand sanitizers.

Peanut allergy in children

Less than two percent of children in the U.S. have a peanut allergy. The New England Journal of Medicine published a study in 2016 indicating that feeding peanuts and other allergy-inducing foods to babies is more likely to protect them than to cause problems.

Feeding peanuts to a young child doesn’t guarantee they won’t develop a peanut allergy, but it does decrease the risk. There is a seven-fold increase in the risk of developing peanut allergy if a parent or sibling has peanut allergy, says Carr. There is a 64% risk that a child will develop peanut allergy if his or her twin sibling also has a peanut allergy, he adds.

Food allergy testing

To diagnose food allergies, your child should undergo food allergy testing. Skin and blood tests are commonly done to check for allergies. In these cases, your child’s doctor may prick the skin on their back or arm and expose them to a small amount of the potential allergen. If the skin swells or becomes itchy, that could be a sign of an allergy.

However, parents should be mindful that false positives are common among skin or blood tests for food allergies.

“Many people with positive skin tests to food are not allergic to those foods,” says Carr.

Your child’s doctor will likely evaluate their clinical history and any skin or blood tests before recommending an oral-grade food test. In this case, they will refer you to an allergist who specializes in the treatment of asthma and allergies.

Oral-grade food tests carry the risk of severe allergic reactions and should only be performed by a specially-trained allergist in a clinical setting, Carr says.

During the food test, the allergist will feed your child small but increasing amounts of the suspected food, and closely watch their reaction. If symptoms occur, they will be given medication for relief. If the test confirms a food allergy, they will discuss specific ways you can avoid the food and prescribe any necessary medications.

Can children outgrow food allergies?

It is possible, and somewhat common, for children to outgrow their food allergies at some point.

  • Peanut allergy: Resolves in 20% of cases by age 5, and 16-30% by adulthoods
  • Cow’s milk allergy: Resolves in 42% of children by age 8, in 64% of cases by age 12, and 79% by age 16
  • Soy allergy: Resolves in 45% of cases by age 6, and 69% by age 10
  • Egg allergy: Resolves in 12% of cases by age 6, in 37% of cases by age 10, and 68% by age 16

Fatal food allergies

Every three minutes, an allergic reaction to food sends someone to the emergency department.

Approximately 150 people die per year from food allergies, according to the Food Allergy & Anaphylaxis Network. Several risk factors increase the likelihood of fatality when someone comes into contact with a food they are strongly allergic to:

Delayed epinephrine—Once anaphylaxis, a potentially life-threatening allergic reaction, begins, the drug epinephrine is the only effective treatment. Sometimes anaphylaxis starts as a mild warner-carr-mdreaction and quickly worsens, Carr says. Signs of anaphylaxis can include trouble breathing, throat closing, wheezing or coughing, nausea or abdominal pain, vomiting, racing heartbeat or pulse, and skin itching or swelling. Do not wait until a child has trouble breathing to administer an Epi-pen. If you notice a systemic reaction—inflammation spreading to multiple areas of the body– administer an Epi-pen and seek emergency medical attention. If a child takes beta-blockers for high blood pressure or other health conditions, a doctor needs to reverse that medication before epinephrine may be effective.

Underlying asthma— Children with asthma are more likely to die from food allergies than children without asthma, Carr says. “Accidental exposure means these kids with preexisting conditions are fighting more than one battle,” he says. “They are more likely to have a severe, adverse effect.”

Previous severe reaction—Carr says, “Previous reactions to a food allergy don’t predict the severity of the next reaction unless past reactions have been life-threatening, which will continue.”

Treatment for food allergies:

Historically, the only management of food allergies was to avoid the food and carry an epinephrine injector. However, more treatments are available today, including oral immunotherapy (OIT), which was recently proved effective in a study published in the New England Journal of Medicine

In OIT, the child is fed an increasing amount of the allergy-inducing food (like peanuts, tree nuts, milk or eggs), with the goal being to increase the amount of that allergen that triggers a reaction, Carr says. By decreasing your child’s sensitivity to allergy-causing foods through OIT, any accidental exposure they have to the allergen will produce fewer and less severe symptoms. , While OIT has been linked to long-term remission of food allergies, there is no guarantee of a cure. Not all children are candidates for OIT. To qualify for OIT, a child must have a documented allergy to a certain food. This can be confirmed with a positive skin test or a positive blood test. Your child’s allergist may recommend OIT take place over several months in order to achieve the maintenance dose, or a level ingested that doesn’t trigger an allergic reaction

There are inherent risks with OIT, since the child is being exposed to their allergy-inducing food. OIT should only be performed by a pediatric allergist in a clinical setting.

The standard of care for food allergies remains avoiding the triggering food and carrying an epinephrine auto-injector in the event of an accidental exposure.

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