Managing Food Allergies in Children

One of the most enjoyable parts of life is eating. Much of our culture centers around mealtimes and food rituals – families gathering to enjoy a meal, friends hosting parties with an array of different foods. There are countless videos online showing infants and children trying new foods for the first time, capturing priceless expressions and reactions. Allergic reactions to food, however, is a growing public health concern as the number of children allergic to one or more foods has been steadily increasing. 

What are the most common food allergies?

While any food can be a potential trigger of an allergic reaction in a child, there are some foods that much more commonly cause reactions. These are: 

• Peanut
• Tree nuts
• Cow’s milk
• Egg
• Soy
• Wheat
• Fish
• Shellfish

What are the symptoms of food allergies? 

Unfortunately, for some individuals certain foods can cause an allergic reaction when they are eaten. These allergies can cause symptoms in different parts of the body, ranging from mild to severe and even life-threatening. 

Skin – rashes, hives (welts), eczema, and swelling

Respiratory – sneezing, wheezing (noisy breathing), tightness of the throat

Digestive – nausea, vomiting, diarrhea

Circulation – paleness of skin, light-headedness or dizziness, fainting 

If not treated quickly and appropriately, severe reactions, called anaphylaxis, can lead to death.  We will discuss treatment in a later section. 

Allergy vs Intolerance

An intolerance to a food is different than an allergy because it does not involve the immune system. Intolerance to a food occurs when the body is sensitive to a food or has trouble digesting a food due to issues within the gastrointestinal system. One of the most common is lactose intolerance, which occurs when a person has difficulty with milk products. This is due to a missing enzyme in the gut that allows milk sugar, or lactose, to be broken down. Ingestion of lactose in an intolerant person leads to bloating, stomach pain, loose stools, and gas, but does not actually cause an allergic reaction.  Other food intolerances include gluten (wheat protein), food additives or dyes, soy, and eggs. 

Can you prevent food allergies?

It used to be thought that restricting the common causes of food allergies from a pregnant mother’s diet would help prevent food allergies in the child. However, we now know that early exposures to food proteins is more beneficial. The AAAAI (American Academy of Allergy, Asthma, and Immunology) now recommends that infants be introduced to high-allergenic foods such as eggs, dairy, peanuts, and fish, starting between 4-6 months. This should be done after infants have first tolerated low-allergenic foods, such as singe-ingredient fruits, vegetables, and grains.  *Please note – peanut should be given to infants as a paste or a powder, NEVER as whole or broken pieces of the nut due to choking risk.

It is important to talk to your child’s Pediatrician if there is a severe, or life-threatening reaction to a food in your immediate family. If a parent or sibling has a severe peanut allergy, for instance, it will likely be advised to consult with an Allergist prior to introducing peanut to your infant. 

Care of children with food allergies

The primary treatment of children with food allergies is avoidance. If your child has anaphylaxis to a certain food, it is best to remove it from the house completely, so no accidental exposure occurs. As your child grows older, teach him or her to read labels and not to share food with friends. 

If your child has been exposed to an allergen and develops significant or severe allergy symptoms – difficulty breathing, swelling around the mouth or of the face, trouble swallowing, – call 911 or go to the nearest emergency room immediately. Children who have an anaphylactic reaction to a food are prescribed an epinephrine auto-injectors (one common brand is called an EpiPen). This is a syringe with a prescribed dose of epinephrine, a drug that is used to reverse the symptoms of anaphylaxis through injection into a muscle (usually the thigh). 

Any person who is given an injection of epinephrine outside of a medical setting should be seen in the emergency room as soon as possible for further evaluation and monitoring. 

Daycares and schools should be made aware of food allergies as well, since children spend many hours of the day in these settings and it can be difficult at times to strictly avoid food allergens. There is an “Allergy Action Plan” that can be filled out and provided to caregivers and school nurses. If your child has had an anaphylactic reaction to a food, an epinephrine auto-injector should be kept at the daycare or school as well as at home. 

Resources

FARE (Food Allergy Research & Education): www.foodallergy.org

Allergy Action Plan:  https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/food-allergy-anaphylaxis-emergency-care-plan

Introduction of common allergens in infants, recommendations from AAAAI: https://www.aaaai.org/conditions-and-treatments/library/allergy-library/prevention-of-allergies-and-asthma-in-children

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