Food Allergies are on the Rise!
Food allergy is on the increase in the United States. Approximately
11 million Americans suffer from food allergy- 2 million of
these are school aged children. 1 in every 20 children under
the age of 3 has a documented food allergy. All allergic individuals
are at risk for anaphylaxis- a potentially life-threatening
allergic reaction. Eight foods account for 90% of all reactions
in the U.S.: milk, eggs, peanuts, tree nuts (walnuts, almonds,
cashews, pistachios, pecans) wheat, soy, fish and shellfish.
Trace amounts of a food that may be a potential allergen can
cause a reaction. There is no cure for food allergy- only
prevention or avoidance.
I have allergies, what are the chances my child will
too?
Hereditary factors may play a role in determining
whether a child has allergies. If one parent has allergies,
the chance of a child developing them is 30-50%. If both parents
have allergies, the chances increase for the child 60-80%-
hereditary allergies are not always type specific. For example,
a mother is allergic to penicillin and eggs-her child may
not be allergic to these items, but to peanuts instead.
What is a food allergy?
A food allergy is a reaction by the body’s immune system
in which it mistakes a food for something harmful. When a
particular food is labeled harmful by the body- it creates
specific antibodies to this food. The next time this food
is eaten, the immune system releases chemicals into the body-
including histamine- in order to protect the body. These chemicals
may exert a variety of effects on different parts of the body:
- Mouth: itching and swelling of the lips,
tongue or mouth
- Throat: itching and/or a sense of tightness
in the throat, hoarseness or cough
- Skin: hives, itchy rash, and/or swelling
of the face or arms/legs
- GI system: nausea, abdominal cramps,
vomiting and/or diarrhea
- Lung: shortness of breath, repetitive
coughing, and/or wheezing
- Heart: weak pulse or feeling faint-
“passing out”
To restate, in order for an allergy to develop, there must
be a first time exposure after which it is labeled as an allergen
by the body. Subsequent exposure produces the body reaction.
Recent preliminary research has found that the primary exposure
could possibly be in utero or through breastmilk
for some potential allergens. More research needs
to be performed to further delineate this pathway as a possible
risk for primary exposure.
What can I do to prevent a food allergy?
Breastfeed exclusively for the first six months of your baby’s
life (if possible, no formula, or solid foods) and then continue
to breastfeed your baby until at least 12 months old. If your
physician has advised, avoid peanuts and tree nuts while breastfeeding
if possible. Do not introduce solid foods to your infant until
he is at least four to six months old, and then start fortified
rice cereal. New solid foods should be introduced in a 5 day
trial interval before other new foods are introduced- this
time is beneficial to determine if an allergic reaction may
occur. Avoid feeding milk and dairy products until your child
is 12 months old. Some allergists suggest that avoiding the
introduction of eggs (especially egg whites) until your child
is 2 years old may help prevent this allergy. Although, a
6 month old baby who has received a flu shot and has not had
a reaction may possibly safely consume eggs because a single
flu vaccine is made in a whole egg (usually 9 months to start
yolk and egg white later). Avoid peanut products and other
tree nuts until age 5. All of these age guidelines are merely
presented as a guideline- always check with your provider
first.
What are some common food allergens?
95% of children’s food allergies are due to cow’s
milk protein, egg whites (surprisingly not yolks!), wheat
proteins, soybeans, shellfish, fish, peanuts, and tree nuts
(like walnuts). Other common allergens include soy, corn,
citrus fruits, berries, chocolate, and food additives.
What is the difference between food intolerance and
food allergy?
An undesirable reaction to a food can be the result of food
intolerance or food allergy. These terms are not equivalent.
A food allergy occurs when the body’s immune system
mistakenly believes that a food is harmful. For protection,
antibodies to the specific allergen are created which have
the ability to recognize the offending food and signal the
immune system to release large quantities of chemicals including
histamines. These substances trigger allergic symptoms affecting
among other body systems, the respiratory system, gastrointestinal
system, skin, or cardiovascular system. A severe allergic
reaction may be life threatening and is called anaphylaxis.
Food intolerance is related to metabolism and not immunity.
A child may be incapable of digesting a particular food completely
and symptoms may result. For example, a lactose intolerant
individual lacks an enzyme that aids in digesting milk sugar.
When the child eats milk products, symptoms such as gas, bloating
and abdominal pain may occur.
What should I do if I think my child has an allergy
to a food?
Start by calling your child’s pediatrician’s office-
an appointment or a talk with your child’s provider
or nurse may be recommended to ascertain whether an allergy
is present. The symptoms may warrant referral to an allergist
or your provider may just recommend not exposing your child
to the questionable food or allergen for some time. Within
the context of your encounter at your child’s office-a
history of the symptoms after food ingestion, the amount of
ingestion, including timing and resolution of the symptoms
is significant. A referral to an allergist may be necessary
as tests may be ordered to definitively diagnose the allergy.
Other substances may be tested as well, because often if your
child is diagnosed with one allergy-sometimes other allergies
may be lurking. Allergy testing may be performed at any age-
the results become more reliable with age, however especially
if the child is over the age of 3.
What type of tests does an allergist administer?
An allergist may employ one or all of these testing measures
to discover what allergies your child has. Blood tests
are performed to measure the amount of IgE (immunoglobulin
E) antibodies to specific allergens in the blood. The blood
test most commonly used is called RAST (radioallergosorbent
test), although CAP ELISA (enzyme linked immunosorbent assay)
is also utilized. Blood tests may be used when skin tests
cannot be performed. The results are usually received within
a week. Skin testing is very accurate testing
that measures levels of IgE antibodies in response to certain
allergens or triggers. Using small amounts of the offending
food/allergen in solution the allergist will either inject
under the skin or apply the allergens with a small scratch.
Skin testing is usually not performed is the allergic reaction
to the allergen was life threatening. In addition, skin testing
may not be utilized if the patient has been taking antihistamines
for allergies i.e. Benadryl, Claritin, Zyrtec, Allegra, etc.
Rarely a nasal smear is performed- this test
is performed to check the amount of eosinophils in the nose-
eosinophils are a type of white blood cells that increase
in number during an allergic reaction.
What can really happen if my child has an allergy,
won’t repeated exposures help him grow out of the allergy?
What is anaphylactic shock?
No! Some allergic reactions are mild at first, and then further
exposure can induce progressively worse response. A potentially
fatal allergic reaction called anaphylactic shock
may occur which affects the entire body. The eyes, lips, and
face of the child begin to swell in seconds- the throat may
then swell making it difficult to breathe. If your child ever
has any of these symptoms call 911 immediately. A child may
become unconscious in minutes if treatment is not administered
immediately. Peanuts, nuts, eggs, shellfish, bee and wasp
stings, and penicillin are the main allergens that can cause
anaphylactic shock. Medicine in the form of epinephrine is
generally to be administered. If your child has exhibited
a food allergy before, usually medicine in the form of epinephrine
or Epipen should be kept nearby in case of another reaction.
After Epipen (epinephrine) is administered in response to
an allergic reaction, your child must then go to the emergency
room to be monitored for further symptoms and/or resolution
of the allergic reaction.
My child seems to be allergic to everything, what
does this mean? Is it related to eczema and asthma?
Rest assured, there is a multitude of research that is being
conducted in this area- it is a “hot topic” as
more and more children are being diagnosed with allergies.
A constellation of allergy symptoms may be present if a child
“seems to be allergic to everything”- this condition
is called atopy. A skin condition may develop in infancy called
eczema, gastrointestinal diseases such as food intolerances
or allergies or diarrhea may develop as the child approaches
2, and respiratory conditions such as asthma increase as the
child reaches age 3 and beyond. A specific allergen and avoidance
treatment plan may be developed with the help of your child’s
pediatrician and a pediatric allergist.
Eczema is also called atopic dermatitis-
this is a chronic skin disease that may persist throughout
life- the symptoms are intense itching and redness which may
lead to scaling and infection. The skin disease may begin
on the face in infancy and then spread to arms and legs as
the child ages. There are research studies being conducted
to ascertain whether the aggressive treatment of eczema may
prevent further development of allergic disease such as asthma.
The AAP has suggested that food allergies may play a role
in about 25% of cases of eczema in young children. Steroid
creams (like Cortaid) and emollients such as Aquaphor, Cetaphil,
Aveeno or Eucerin, (www.osmotics.com)
may be prescribed. A daily quick warm bath is beneficial with
emollients and lotions applied right after to seal in moisture.
Do not use soaps or detergents with perfumes, dyes (Even Johnson
& Johnson Baby products, Dreft and Ivory Snow have a scent!)-
and double rinse clothing in the washer.
Asthma is a chronic respiratory condition
strongly linked to allergies. In asthma, the airways that
run from the nose down to the lungs are overly sensitive and
may swell and become inflamed in response to a trigger- sometimes
an allergen. Sometimes there is also tightening of the tiny
muscles that surround the airways, this is called bronchospasm.
In severe, untreated cases of asthma, damage to the lungs
can occur resulting in scarring and permanent narrowing of
the airways. This is why it is important to follow your provider’s
recommendations about decreasing symptoms of asthma. Children
with asthma can breathe normally most of the time, but if
the body encounters a trigger, an attack or exacerbation may
occur in which the lung passages are narrowed. Children’s
air passages are smaller than those of an adult, so a relatively
small reaction can produce more amplified and severe symptoms
than may be observed in an adult.
Some common asthmatic triggers are: tobacco smoke, dust,
pollen, exercise, viral infections such as the common cold,
animal hair or dander, foods, molds, changes in weather, strong
emotions, air pollution, or some medications. Medications
for asthma may include bronchodilators such as Albuterol,
or Xopenex which aid in opening narrowed lung passages and
subsequently decrease cough, wheeze or shortness of breath-
these medications are considered rescue medications and may
be administered by inhalation or occasionally are taken orally.
Anti-inflammatory medications help to decrease the inflammation
that occurs chronically in the airways. These medications
may include an inhaled corticosteroid called Flovent or Advair,
a nebulized version called Pulmicort, or may be also administered
orally as in a steroid prednisone like Orapred. A newer class
of medications called anti-leukotrienes like orally administered
Singulair help to decrease narrowing of the lungs and decrease
the chances of fluid in the lungs as well. Sometimes these
diseases and symptoms present in the classic triad of : allergies,
eczema and asthma. Studies are currently being conducted to
further delineate their interwoven symptomatology.
What is the best treatment for food allergy?
Strict avoidance and prevention of reaction is the only treatment.
Read ingredient labels. Check out www.foodallergy.org
for some suggestions on how to read ingredient labels and
also check with your pediatrician or pediatric allergist for
some ingredient lists. If your doctor recommends medication
such as antihistamines or epinephrine, always have it available
for your child at home, in the diaper bag, at daycare or school,
and at grandma’s house. Know how and when to use epinephrine
and accompany your child to the emergency room after administration
for further monitoring.
Is there a cure for food allergies- do children outgrow
them?
There is no cure for food allergies, only avoidance until
they hopefully disappear- your provider will help with determining
when the optimal time for oral challenge will be. Allergies
to peanuts, nuts, fish, and shellfish are often considered
to be incurable and lifelong allergies. Much research is being
performed and much still needs to be done.
Books/Resources/Links:
The Food Allergy and Anaphylaxis Network
http://www.foodallergy.com
Informative website with accurate advice and special instructions
for each type of food allergy and avoidance guidelines
American Academy of Allergy, Asthma,& Immunology
http://www.aaaai.org
American College of Allergy, Asthma, and Immunology
http://www.allergy.mcg.edu
Books
The AAP’s Guide to Your Child’s Allergies
and Asthma
(Children’s Books)
Allie the Allergic Elephant, Aaron’s Awful Allergies,
Cody the Allergic Cow, The Peanut Butter Jam, Taking Food
Allergies to School
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