Friday, August 23, 2013

Food Allergy

Food Allergy

I am reading a lot about food allergies lately in the news. How do I know if my child is allergic to a food?

Food allergies are fairly common in children and with the potential of being severe (i.e. causing anaphylaxis and death), they are a big concern for parents and pediatricians.
It is estimated that up to 8% of children have an allergy to at least one food. The incidence of food allergy in children is most common in the first few years of life.

If my child is allergic to a food when they are a baby, will they be allergic forever?
That depends, while a majority of children will eventually outgrow their allergy as they age, there are some food allergies (i.e. peanuts, tree nuts, seafood) which are not commonly outgrown.
·         Children with a history of anaphylaxis (a severe, life threatening allergy) to a food should avoid that food for life or until cleared by a physician who is a board-certified allergist. 

What are common foods that I should watch for signs of allergy?
Children can have a reaction to any food or drink and every child is different. Some of the most commonly found food allergies in children:
·         Cow’s milk, eggs, peanuts, tree nuts, soy, wheat 

What are the symptoms of a food allergy?
This is one of the frustrating areas for parents. Specific food allergies can be difficult to diagnosis by history alone as children are commonly are exposed to multiple foods in one meal, especially after infancy.
Some of the common symptoms are: red face or skin (flushing), rash, hives, swelling, itching, sneezing, runny nose, cough, chest tightness, wheezing, difficulty breathing, nausea, vomiting, diarrhea, or abdominal pain.
·       Tip: if you suspect that your child may have a food allergy, keep a detailed food diary of all the foods they eat and the times they are eaten. Also mark down the times when symptoms appear or get worse.
·       Food allergies can also worsen eczema in children who have the dry skin condition. 

Should I have my child tested for common food allergies before I give them a food for the first time?
It is not currently recommended to routinely test for food allergies prior to giving a child foods for the first time.
·         If a sibling of a child has a history of anaphylaxis or severe allergy to a certain food, discuss with your pediatrician or allergist when or how to introduce that food to the other children.
·         Certain foods are recommended to avoid in the first year of life (i.e. regular cow’s milk). Discuss with your pediatrician a proper schedule of introducing foods to an infant.
o   Solid foods should be introduced starting around 4-6 months of age. 

Should I use soy formula instead of cow’s milk based formula to prevent an allergy?
No. It is not recommended to use soy milk for the purpose of preventing an allergy in an otherwise healthy infant.
Studies have shown that giving soy formula to newborns and infants does not prevent allergies later on.

How are food allergies diagnosed?
Along with a history and examination of the child, pediatricians and allergists can use blood tests and/or skin-prick testing to determine what foods a child is allergic to.
·         Note: skin prick testing is typically performed only by board-certified physicians in allergy/immunology. 

Is being lactose intolerant the same as a food allergy?
Food intolerance (i.e. lactose intolerance) is very different than food allergies. A food allergy is an immune response from the body where as a food intolerance is the inability for the digestive system to breakdown a food properly or a reaction to a food additive. Lactose intolerance results from the body's lack of or reduced amount of the enzyme lactase. While the symptoms of food intolerance, such as diarrhea, can also be seen in food allergies, they are not the result of an immune response and will not show up as positive on allergy testing blood work.
·         Children with food intolerance will sometimes outgrow their intolerance or will be able to tolerate the food in small quantities.
·         Food intolerance is not a cause of anaphylaxis.

Are there any treatments for food allergies?
There are currently no specific treatments for food allergies. The standard treatment for food allergies is to avoid the foods which cause reactions. While difficult for children and families to have to adjust diets and eliminate certain foods from the home, it is imperative for the child’s health. Discuss with your pediatrician or a nutritionist for other food options to ensure daily requirements of vitamins and minerals are being met.
·         Any time a child is suspected of having an allergy to a food, that food should no longer be given until the child is seen by a physician. 

Food-induced anaphylaxis:
Anaphylaxis is a severe and life-threatening allergic reaction where a child or adult who was exposed to a known or suspected food and will have two or more of the following symptoms:
-Skin symptoms (i.e. rash, hives, flushing) or swollen lips.
-Difficulty breathing or feeling of throat closing.
-Vomiting, diarrhea, or abdominal cramps.
-Decreased blood pressure.
Symptoms of anaphylaxis are always life-threatening and should be managed by administering an epinephrine auto-injector, i.e. Epi-pen (if available) and calling 9-1-1.
·         Epinephrine auto-injectors contain a medication called epinephrine (adrenaline) which can reverse a severe allergic reaction until the child or adult can seek further medical care.
o   Any person who is suspected of having anaphylaxis and/or injected with an epinephrine auto-injector must immediately seek medical attention.
§  There is a risk for a second wave of anaphylaxis symptoms which occurs later on, known as a biphasic reaction, in anyone who is suspected of having anaphylaxis. 

Who should have an epinephrine auto-injector?
All children and adults with a history of anaphylaxis, or a history of food allergy and asthma, or a history of allergy to peanuts, tree nuts, fish, or shellfish should have an epinephrine auto-injector.
·         Any child who has been prescribed an epinephrine auto-injector should always have it readily available where ever they are. This includes having one at their school and with them on play dates at another parent's home.
Children with a history of anaphylaxis should be injected with their epinephrine auto-injector immediately if they are having any symptoms of an allergy, even if the symptoms are mild. Epinephrine auto-injectors should be injected into the outer thigh only and can be given directly through clothing.
·         Do not give children with a history of anaphylaxis other medications first and wait to see if symptoms worsen.
o   Always be sure that anyone who is caring for or watching your child knows how to use the child's epinephrine auto-injectors should they require it.
o   More information about Epi-pens and their administration can be found @

Prior to starting any new medication or obtaining any medical test, always consult with your pediatrician. 

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