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Food Allergies
However, food allergies are often misunderstood, with some parents restricting their children's diets because they think that they are allergic to everything and others not believing in allergies at all and putting allergic kids at risk by offering them foods that they are allergic to. And even once you understand that your children have a food allergy, it can be hard to avoid the things that they are allergic to as many foods that cause allergies, like milk, eggs, and peanuts, are hidden ingredients in other foods. REMEMBER: Most food allergies are caused by milk, eggs, peanuts, tree nuts, wheat, soy, fish and shellfish. Determining what foods are the cause of an allergic reaction is key to treatment. Symptoms Symptoms of a food allergy can include wheezing and difficulty breathing, itchy skin rashes, including hives, vomiting, diarrhea, nausea, abdominal pain and swelling around his mouth and in his throat. These symptoms usually develop fairly quickly after your child ingests the food he is allergic to, often within minutes to hours. Nasal symptoms by themselves, such as congestion or a runny nose, are usually not caused by food allergies. Symptoms may be mild or very severe, depending on how much of the food your child ingested and how allergic he is to the food. A severe reaction can include anaphylaxis, with difficulty breathing, swelling in the mouth and throat, decreased blood pressure, shock and even death. More common than food allergies are intolerances to certain foods, which can cause vomiting, diarrhea, spitting up, and skin rashes. An example of such a reaction occurs in children with lactose intolerance, which occurs because of a deficiency of the enzyme lactase, which normally breaks down the sugar lactose. Children without this enzyme or who have a decreased amount of the enzyme, develop symptoms after drinking lactose containing food products, such as cow's milk. Keeping a diary for a few weeks and recording what foods your child has been eating, especially new foods, and when he develops symptoms may help figure out what he is allergic to. If you notice that your child develops symptoms after being exposed to certain foods, then you should avoid those foods. Common Food Allergies Cow's milk is the most common cause of food allergies (in addition to being a common cause of food intolerances). Unlike cow's milk intolerance which is usually a reaction to the sugar lactose, allergies to cow's milk are usually from the proteins that are in the milk. Infants who have an allergy to cow's milk based formulas should usually be changed to an elemental or hydrolyzed formula, such as Nutramigen or Alimentum. Soy formulas and goat's milk may not be good alternatives in this case, although they usually are for older children, because many infants with allergies to cow's milk proteins are also allergic to the proteins in soy and goat's milk. Other foods to avoid if your child is allergic to cow's milk include, but are not limited to, buttermilk, cheese, evaporated and condensed milk, ice cream, yogurt, instant mashed potatoes, margarine, casein, cream, hydrolysates, lactalbumin, nougat, sour cream, whey, and other foods made with milk. Older children who are unable to drink milk or eat milk based foods should be sure to have additional sources of calcium in their diet, including calcium fortified juices. Eggs, especially the proteins in egg whites are also a common cause of food allergies. To help prevent allergies to eggs, it is a good idea to avoid giving egg whites to infants under a year old. Other foods to avoid include, but are not limited to foods that are derived from eggs, including egg substitutes, and foods that contain albumin, globulin, ovalbumin and vitellin. Also avoid foods that are prepared with eggs, which may include French toast, cake, cookies, pancakes, eggnog, bread, ice cream, pasta, puddings, creamy salad dressings and foods with custard or cream fillings. Soybean allergies are usually found in infants given a soy formula, but can also be found in older children who drink soy milk. Other foods that contain soy proteins and may cause allergic symptoms in children allergic to soy include, but are not limited to tofu, miso soup, soy sauce, foods prepared in soybean oil, veggie burgers and hot-dogs, and ingredients on a food labile including emulsifiers, hydrolyzed or textured vegetable protein. Wheat allergy can develop in infants given a wheat cereal, and is probably best to offer a rice or oat cereal first and delay giving wheat until after your child is 6-8 months old. Other foods that may cause problems in children allergic to wheat include, but are not limited to many breads and cereals (unless they are made from oats, rye, corn or rice) made with wheat flour or enriched flour. Also avoid foods with cornstarch, gluten, semolina, all purpose or white flour. Peanuts are not true nuts, but rather are actually legumes from the pea and bean family. Children with allergies to peanuts can be very sensitive to foods with even very small amounts of peanuts in them. Avoid all foods with peanuts, including candy, baked goods, chili, many ethnic foods (including Thai, Asian, and Indonesian foods), peanut butter, and mixed nuts. Children who are allergic to peanuts can often eat tree nuts, such as walnuts or pecans, since they are from separate plant families. Tree nut allergies are also possible, and can include allergies to walnuts, pecans, cashews, almonds and hazel nuts and other nuts in hard shells. You should avoid foods prepared with tree nuts, including many kinds of candy, baked goods and different oils. Corn is rarely a cause of food allergies. If your child does seem to be allergic to corn, you should avoid corn based cereals and breads, corn syrup, and caramel. Certain food dyes and preservatives, especially sulfites, may also cause food allergy symptoms.
Determining Once you determine what your child is allergic to, it is important to learn to read food labels because the food your child is allergic to may be an ingredient of many other foods. You should also avoid eating foods that may have been prepared using equipment that was also used to prepare the types of food that your child is allergic to. When trying to determine what your child is allergic to, parents often incorrectly assume that if he has eaten a food before and not had problems, then he probably is not allergic to that food. They usually only suspect new foods as being able to cause a food allergy. However, it is important to keep in mind that it takes time for the immune system to build up a reaction against something that the body is allergic to. It may take days, weeks, months or even years to build up enough of a response to cause noticeable symptoms. So your child may be allergic to a food even if he has eaten it many times before without problems. Cchildren with more severe reactions should be evaluated by their Pediatrician or an allergist. Testing may be done, either skin testing or RAST (radioallergosorbent test, a blood test to check for antibodies against certain things your child may be allergic to) to see if specific food allergies can be found. In addition, your child will be prescribed an epinephrine autoinjection device (such as the EpiPen or EpiPen JR) and should wear a medical alert bracelet to notify others of his allergy. Consider that there are two types of food allergies. They are classified as: • Fixed food allergies: A fixed food allergy may be very apparent, such as the child whose lips swell and throat itches immediately in response to eating peanuts. The cause for this type of food allergy is similar to that of inhalant allergies, so the diagnosis is more easily reached. Blood testing (i.e., RAST test) is typically used to verify fixed food allergies. Approximately five to 15 percent of food allergies are of the fixed variety. • Cyclic food allergies: These allergies are far more common but less understood. Delayed food allergy symptoms can take up to three days to appear. This type of reaction is associated with the body's immunoglobin G (IgG) or antibodies. Unlike fixed food allergies, this allergic response is cyclical in nature. As an example, a child may be IgG sensitive to milk. Consequently, symptoms might appear if the child increases the intake and/or frequency of milk consumption. Outgrowing the allergy As more parents learn about food allergies, they often ask their doctors to do allergy testing. Unfortunately, although easy to do, these food allergy tests are often difficult to interpret. Even with skin testing, a positive result only suggests that the person is allergic to the food. For example, if you test positive for allergies to milk and peanut butter, but have never had an allergic reaction or any typical allergy symptoms, then you likely aren't really allergic to those foods. Will your child outgrow the allergy he has? It depends. Many people believe that allergies to cow's milk and eggs are easily outgrown. One recent study showed that half of infants with an egg allergy outgrew their allergy after 35 months and 66% after 5 years. For other foods, like fish and peanuts, your child is less likely to outgrow the allergy. The type of reaction may also determine if your child outgrows the allergy or not, with more serious reactions being less likely to be outgrown. Can food allergies be prevented? By avoiding high risk foods, it may be possible to prevent food allergies from ever developing. To prevent high risk children from developing food allergies, such as those who already have food allergies, eczema, hay fever or asthma, or family members with these problems, you should: • Breastfeed exclusively for the first six months of your baby's life (that means no formula supplements or solid foods) and then continue to breastfeed until your child is at least 12 months old. • Avoid peanuts and tree nuts while breastfeeding. You may also want to consider avoiding eggs, cow's milk and fish while nursing. • If you do want to supplement your breastfeeding with formula, use a hypoallergenic formula, such as Nutramigen or Alimentum. • Do not introduce solid foods to your infant until he is at least six months old, and then start with an iron fortified rice cereal. • Avoid feeding milk and dairy products until your child is 12 months old. • Avoid introducing eggs (especially egg whites) until he is 2 years old. • Avoid peanuts, tree nuts, and fish until he is 3 years old. Preventing food allergies may be possible, especially if your child is at high risk of having a food allergy, including already having an allergy to food or formula, eczema, hayfever, or asthma, or having other family members with these conditions or a food allergy. Most importantly, breastfeed and avoid supplementing with infant formula or offering solids for at least the first six months. If you are not breastfeeding or need to supplement, then consider using a hypoallergenic infant formula (soy formulas and goat's milk may not be good alternatives, because many infants that are allergic to cow's milk may also be allergic to soy). If you are breastfeeding, then you should avoid milk, eggs, fish, peanuts, and tree nuts in your own diet. If your child is at high risk of having food allergies, you should delay offering solids until he is at least six months old (and continue breastfeeding), and begin with an iron fortified infant cereal. It is best to start with rice and oat cereals and introduce wheat cereals later. Next you can introduce vegetables, but avoid legumes (foods in the bean and pea family) at first, and then non-citrus fruits and fruit juices. Meat and protein foods can be added once your child is 8-9 months old. Foods to avoid until your infant is at least a year old include cow's milk and other dairy products, citrus fruits and juices, and wheat. Also, avoid giving eggs until age two, and peanuts (as smooth peanut butter) and shellfish until your child is at least three years old. Whole peanuts and tree nuts should be avoided until your child is four because of the choke hazard. When you do introduce new foods, do so slowly and only give one new food every four to five days. This way, if your child does have a reaction or allergy, then you will know which food caused it and you will be able to avoid giving it again.
Important Reminders • While children often outgrow their food allergies, if your child had a severe reaction to a food, then you should talk with your Pediatrician or allergist before reintroducing the food. • Talk with and educate other family members and caregivers about your child's food allergies. Most people do not understand how serious food allergies can be, and may think it is all right to give just a small amount of a food that your child is allergic to. • Educate your child about his allergy, so that he can learn to avoid foods that he is allergic to. • If your child does not improve with these interventions or if he has had a severe allergic reaction, then you should consider having him see an allergy specialist for testing to figure out what foods he is allergic to and to possibly start allergy injections. • Children with severe allergic reactions or anaphylaxis should wear a medical alert bracelet to notify others of his condition and should carry an epinephrine autoinjector (such as the EpiPen JR) to ensure rapid treatment during an allergic reaction. • Most importantly, learn to read food labels and look for ingredients that your child may be allergic to and practice strict avoidance of those foods. If you don't know what an ingredient is, then call the manufacturer before giving it to your child to be safe.
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