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.

Get important health and parenting tips sent straight to your inbox.

Kids Health, delivered monthly, offers “healthful” information for parents:



Related posts:

Dealing with Food Allergies Around the Holidays

The holiday season is a festive time, but can present unique challenges for children with food allergies and their parents. We spoke to Vanessa Chrisman, a clinical pediatric dietitian at CHOC Children’s, who has advice for parents on navigating a season often filled with parties and treats while managing their child’s dietary restrictions.

What are some of the most common food allergies/dietary restrictions that children face?

The most common food allergies that children face include: wheat, dairy, egg, soy, peanuts, tree nuts, shellfish and fish. They are known as the top eight, as these foods account for 90 percent of all allergic reactions to food. The severity of an allergic reaction really varies from one child to the next. An example of a mild reaction would be a small rash on one hand that goes away in a couple hours. A more severe reaction could involve swelling of the face, vomiting and diarrhea, and/or coughing or wheezing. Severe reactions can be life-threatening.

How does suffering from food allergies complicate festive occasions such as holiday celebrations?

Children with food allergies often are restricted from eating the foods that are offered at holiday parties. As a result, these children may feel like they are missing out or being punished for having food allergies. To help ease this problem, parents need to be proactive and plan ahead when it comes to approaching holiday parties and meals. Bringing allergen-safe food along to parties or preparing special baked good for the child with food allergies are two examples of how to deal with this.

What can parents do in their own home to accommodate dietary restrictions that one child faces, when there are other children in the home without that allergy or restriction?

Depending on the food allergen, parents can decide whether or not they will keep food allergens out of the home or not. Labeling areas as safe zones (allergen-free) both in the pantry and the refrigerator is helpful. Keeping unsafe foods tucked away and stored in air-tight containers is also advised. Everyone in the family should learn how to read food labels and ingredient lists. To prevent the transfer of food allergens, all family members should wash their hands before and after eating. Practicing safe food preparation is important for avoiding cross-contamination. Counters and tables should be scrubbed down before and after meals. When eating or serving food use separate utensils that have not come into contact with allergens. Parents can educate their children on food allergies, as well as the importance of keeping food allergens away from the child who is allergic.

How can parents accommodate their child’s allergies when partaking in festive events outside the home?

Parents should talk to their child’s teacher and school nurse at the beginning of each school year so they can be prepared for any celebrations at school where food is involved. When their child is going to a birthday party or to a friend’s house, parents need to talk with the parents who will be watching over their child. Explain your child’s food allergy, what foods to avoid, what symptoms to look for, what specific foods are safe to give and how to practice safe food handling. Parents can also send their child with special “safe foods” to be consumed when outside the home. For those with a prescription for an epinephrine injection for anaphylaxis, ensure your child has it with them at all times and that other care providers know how to administer it.

Related posts:

 

Kids and Living with Food Allergies

Girl WatermelonSIGNS AND SYMPTOMS

A food allergy usually occurs in the first two years of life, says Dr. Ellis, a CHOC Allergy and Immunology Specialist. “It’s important to know that allergic reactions to food typically occur immediately or within two hours of eating the food,” Dr. Ellis explains. “The child might have skin issues like hives (itchy red spots) or develop itchy skin, or the child might throw up. All the organ systems can be involved. The child might wheeze or become short of breath. In severe cases, the cardiovascular  system can be involved and the child could have a drop in blood pressure, feel light headed and faint.”

MANAGING FOOD ALLERGIES
There is no cure for food allergies and the best way to avoid getting sick is avoiding the food. “You have to find out what the child is allergic to. This comes from the family history and then we take a blood test or a skin test to confirm what the family has told the doctor,” says Dr. Ellis. With a serious reaction, an adult should inject the child with epinephrine (adrenaline that reverses the symptoms) and call 9-1-1. “Always have an epinephrine auto-injector. Learn how to read food labels and be careful at high-risk eating areas such as buffets, ice cream parlors and Asian restaurants.”

FOOD FOR THOUGHT
Any food can cause an allergy but a small number of foods are most commonly associated with food allergies. In fact, eight foods/food types account for 90 percent of all allergic reactions. They are: milk, eggs, peanuts, tree nuts (such as walnuts and almonds), soy, wheat, fish and shellfish. Even trace amounts of a food allergen can cause a reaction, including a severe or life-threatening reaction. Peanuts, tree nuts and fish are the most common causes of severe reactions, says Dr. Ellis.

FAST FACTS

  • Estimated number of American children and adults with food allergies: 15 million
  • Annual cost to the U.S. economy related to children’s food allergies: Almost $25 Billion
  • Percentage of children under the age of six with food allergies: 6 – 8

View the full feature on Kids and Living with Food Allergies

Dr. Mark Ellis
Dr. Mark Ellis
CHOC Allergy and Immunology Specialist

PHYSICIAN FOCUS: DR. MARK ELLIS

Dr. Ellis completed his residency at the University of Arizona Health Sciences Center in Tucson and a fellowship in Allergy-Immunology at the University of California, Irvine, Medical Center. Dr. Ellis is chief of the CHOC Children’s Specialists Allergy & Immunology Division and is the Director of the Allergy, Asthma & Immunology program at CHOC. Dr. Ellis specializes in the treatment and management of allergies and asthma. He is a principal investigator for many clinical research studies for adults and children concerning new treatments for asthma and allergies.

Dr. Ellis’ philosophy of care: “I like to identify the problem and educate the family on ways to prevent disease.”

EDUCATION:
Tulane University School of Medicine in New Orleans

BOARD CERTIFICATIONS:
Pediatrics
Allergy and Immunology

More about Dr. Mark Ellis

This article was featured in the Orange County Register on April 7, 2014, and was written by Amy Bentley.

Tips for Keeping the Home Safe for Kids with Food Allergies

Raising a child with a food allergy can be challenging enough, but what should families do when they have children with and without food issues? That’s a question CHOC Radio host Bryan Mundia recently asked Shonda Brown, a CHOC Children’s clinical dietitian who works in the hospital’s Eosinophilic Esophagitis Clinic.

There are many things a family should consider before deciding to rid the house of one child’s food allergens, thereby restricting the diet of the entire family. The ease of removing particular items from the home and the severity of the allergy are just two things to keep in mind, says Shonda.

In this podcast, Shonda offers tips for keeping the home safe for kids with allergies, without preventing other members of the family from enjoying foods they enjoy.

Food Allergy Resources for Families

Having a child with a food allergy can be challenging at times, but with care and menu planning, these kids can lead happy and healthy lives free of allergic reactions.food_allergy_families

“These kids can live a normal life and with proper education, this problem is very manageable,” says Dr. Mark. Ellis, director of the allergy, asthma and immunology program at CHOC Children’s.

Dr. Ellis says that food allergies are becoming more common, but while many hypotheses about the increase exist, none are supported by the medical research.

CHOC offers families many educational resources to help handle food allergies, including nutritional support and dietary advice.  A CHOC dietitian can ensure the child’s diet is nutritionally sound, Dr. Ellis says. Patients can also visit Food Allergy Research & Education (FARE), a nonprofit organization that offers food allergy information.

Even parents of children without known food allergies should know the symptoms of an allergic attack. The American Academy of Pediatrics offers this list of the most common symptoms:

  • Skin problems
  • Hives (red spots that look like mosquito bites)
  • Itchy skin rashes (eczema, also called atopic dermatitis)
  • Swelling
  • Breathing problems
  • Sneezing or wheezing
  • Throat tightness
  • Stomach symptoms
  • Nausea
  • Vomiting
  • Diarrhea
  • Circulation symptoms
  • Pale skin
  • Light-headedness
  • Loss of consciousness

Related articles:

  • 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, ...
  • Dealing with Food Allergies Around the Holidays
    The holiday season is a festive time, but can present unique challenges for children with food allergies and their parents. We spoke to Vanessa Chrisman, a clinical pediatric dietitian at ...
  • Kids and Living with Food Allergies
    A food allergy usually occurs in the first two years of life, says Dr. Ellis, a CHOC Allergy and Immunology Specialist. “It’s important to know that allergic reactions to food ...