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Could my child have a food allergy?
Food allergies are quite common in children, although a suspected food allergy often turns out to be something else. A child who has a tummy ache or diarrhea after eating something, for example, probably is not allergic to it but is just having trouble digesting the food.
By understanding how allergies work, you may be able to recognize the early signs, just in case. It's also important to know what to do if your child ever has a true allergic reaction.
What happens during an allergic reaction to food?
When kids are allergic to a food, their body treats the food like an invader and launches an immune-system attack.
Sometimes the body makes an antibody called IgE, a protein that can detect the food. If your child eats the food again, the antibody tells your child's immune system to release substances such as histamine to fight the "invader." These substances cause allergy symptoms, which can be mild or severe.
What are the symptoms of a food allergy?
Symptoms usually show up within minutes to two hours after eating a specific food. If your child is having a milder reaction, she may have:
- Itchy, watery eyes
- Itchy mouth, nose, and/or ears
- Itchy skin, red spots, or hives
- Flaring of eczema
- Redness around the mouth or eyes
- Runny or stuffy nose
- Stomach cramps
- Nausea and vomiting
- Odd taste in mouth
If your child has a severe allergic reaction (anaphylaxis), it can be life threatening. Call 911 or your local emergency number right away. Severe symptoms that need immediate medical attention include:
- Trouble breathing
- Turning blue
- Swelling of the lips or tongue
- Throat tightness or hoarseness in the throat
- Lightheadedness or fainting
- Chest tightness or pain
- A weak pulse
- Panicky feeling
- Tingling in the hands, feet, mouth, or scalp
- Trouble swallowing, drooling, or suddenly slurred speech
What else should I know about food allergy symptoms?
Milder food allergy symptoms can develop into more severe symptoms.
Symptoms involving more than one part of the body are more concerning. Your child having stomach problems as well as skin problems, for example, indicates that she's having a more severe reaction than one that's isolated to just her stomach or just her skin.
Chronic or ongoing symptoms can make diagnosis harder. If your child has chronic symptoms – for example, gastrointestinal problems like vomiting or diarrhea – they could be caused by something else and a food allergy. Another example is eczema, which is dry, scaly patches of skin that show up on a child's face, arms, trunk, or legs.
Children can react to a food even if they've eaten it before without any problem. A child with an egg allergy, for instance, might not have a reaction the first few times she eats eggs – but eventually symptoms will appear.
Your child may be exposed to an ingredient when it's combined with something else. For instance, your child may eat eggs, milk, or ground nuts in a cookie. Also, some children can tolerate an ingredient, such as milk or egg, when it's baked or cooked into other foods but not when it's eaten on its own.
What foods might my child be allergic to?
It's possible to be allergic to any food, but these eight foods are responsible for 90 percent of food allergies:
- Fish (such as tuna, salmon, and cod)
- Shellfish (like lobster, shrimp, and crab)
- Tree nuts (like walnuts, Brazil nuts, and cashews)
Among these, allergies to milk, eggs, peanuts, tree nuts, soy, and wheat are most common in children. An allergy to sesame is also a growing concern.
More than 160 foods have been found to cause allergic reactions.
What should I do if I think my child's having an allergic reaction to food?
If your child is having trouble breathing, has swelling of the lips or tongue, or develops any of the severe symptoms described above, call 911 or your local emergency number right away.
Severe allergic reactions are urgent. Your child's airway can close up within minutes, so don't call the doctor to get advice or drive your child to the emergency room. You need paramedics on the scene as soon as possible.
For a milder reaction
- Keep an eye on your child, and call the doctor if he seems to be getting worse, or if hives last longer than 24 hours.
- Call 911 if your child develops any severe reactions (see "What are the symptoms of a food allergy?").
- If your child is at least 12 months old, diphenhydramine (Benadryl) or cetirizine (Zyrtec) can help with milder reactions, such as hives.
- A cool bath may help with itching, but limit it to 10 minutes so your child doesn't become chilled.
- If your child consistently has symptoms within two hours of eating a certain food, ask his doctor about an evaluation. You may be referred to a pediatric allergist for testing.
- Be prepared in case it happens again. Even if the first reaction was mild, the next one might be severe. Your child's doctor can provide you with an action plan, including instructions on how to manage an allergic reaction.
What's a food intolerance and how is it different from a food allergy?
A food intolerance is the most common type of adverse food reaction and does not involve the immune system. If your child has a food intolerance, it may mean that she has trouble digesting a particular food. Food intolerances aren't fun, but they're rarely dangerous.
If your child has a food intolerance, you may notice that every time she eats or drinks that food she's plagued with digestive symptoms such as:
- Loose stools
- Feeling flushed
Lactose intolerance is the most common type of food intolerance. People who are lactose intolerant lack the enzyme necessary to digest the sugar in cow's milk and other dairy products.
An allergist may be able to tell you which food or foods are triggering your child's symptoms and whether they're caused by a food allergy or intolerance.
Are food allergies becoming more common?
Yes. Five and a half million kids in the United States – nearly 8 percent of all children – have food allergies. About 40 percent of those with food allergies are allergic to more than one food.
The U.S. Centers for Disease Control and Prevention (CDC) estimate that between 1997 to 1999 and 2009 to 2011, food allergies increased 50 percent among children. The prevalence of peanut or tree nut allergy more than tripled between 1997 and 2008.
Experts are trying to figure out why. It's a complicated topic to study, in part because people have different definitions of allergies, and studies have focused on different foods and different populations. There do seem to be genetic, lifestyle, and environmental factors at play, though.
Many experts think that the timing of exposure is a factor. That's why they now suggest introducing allergenic foods at an earlier age rather than delaying their introduction.
Are allergies inherited?
Your child may inherit the tendency to have allergies but not necessarily a specific allergy.
For example, if you have hay fever, pet allergies, or a food allergy, your child has a 50 percent chance of having some sort of allergy too, although maybe not the same one you have. That probability jumps to 75 percent when both parents have allergies.
A food allergy can start at any age. A child with a food allergy is two to four times more likely to have other allergies and related conditions, such as eczema and asthma, than kids who don't have allergies.
Do kids outgrow food allergies?
It depends on the food, but many children do outgrow allergies. For other kids, the allergy will be lifelong.
Here are some statistics:
- Milk allergy: More than 50 percent will outgrow it by age 5 to 10, and 80 percent by age 16.
- Egg allergy: About 50 percent will outgrow it by age 2 to 9, and 70 percent by age 16.
- Soy allergy: About 45 percent will outgrow it by age 6, and 80 percent by age 16.
As for peanut allergy, up to 25 percent of children will eventually outgrow it. A smaller percentage of children will outgrow allergies to tree nuts or seafood.
What should I do if I think my child might have a food allergy?
Talk with his doctor. She might suggest a food diary to help identify the cause or, if your child is still an infant and bottle-fed, a change in infant formula.
If you're referred to a pediatric allergist, she'll ask detailed questions about your child's symptoms. She might do an allergy skin test or blood test to determine whether the symptoms are caused by an immune reaction.
If the skin test produces a hive or the blood test shows that your child has elevated IgE antibodies to the food, there's a chance he's allergic to that specific food. If the tests are negative, your child's symptoms are less likely to be due to a food allergy, although they may be caused by a food intolerance.
At that point, you may be referred to a pediatric gastroenterologist to pinpoint the cause of the intolerance or to investigate other explanations for your child's symptoms.
If my child has a food allergy, will I need to carry an epinephrine auto-injector (EpiPen)?
The doctor may recommend that you carry an epinephrine auto-injector (EpiPen), which delivers an emergency shot of epinephrine to stop an allergic reaction.
These devices automatically administer the right dose of epinephrine. The doctor can prescribe an auto-injector and show you how to use it. (She may also provide instructional materials or direct you to a how-to video.)
Anyone who takes care of your child should also have access to an auto-injector in case your child needs it.
In some cases – if he's very responsible – an older child can carry the epinephrine injector himself. Talk with your child's doctor about whether this is recommended for your child.
Is there anything I can do to prevent food allergies?
Possibly. In the past, the American Academy of Pediatrics (AAP) suggested delaying the introduction of allergenic foods in children with a higher risk of allergies. But the AAP now says there's no evidence that waiting to introduce allergenic foods protects children from developing an allergy. In fact, delaying the introduction of allergenic foods may actually raise the risk of food allergies.
Recent research – such as the LEAP (Learning Early About Peanut) trial – found that children are less likely to develop allergies to foods when they're exposed to them starting at 4 to 6 months and throughout early childhood.
Experts now suggest introducing commonly allergenic foods as soon as your baby is developmentally ready for solids and has eaten and tolerated a few other typical first foods such as meats, fruits, and vegetables.
Food manufacturers have products on the market designed to help you incorporate commonly allergenic foods into your child’s diet. These stir-in powders and finger foods may contain one commonly allergenic protein or a blend of several.
Breastfeeding may offer protection against some allergic symptoms, though scientists don't yet know if it's protective against specific food allergies. Consider breastfeeding your baby as long as you can, especially if you have a family history of allergies.
Note: Don't give your baby cow's milk before his first birthday. But products that contain processed milk protein – such as cheese and yogurt – are usually fine to include in your baby's solid food diet.
Is it possible to prevent a peanut allergy?
It might be. According to the AAP, introducing peanut products early (soon after starting solids) to infants who are at high risk for peanut allergy may actually reduce their risk of developing the allergy. The exact timing for when to introduce an infant-safe peanut product to your baby depends on factors such as:
- If your baby does not have eczema or any food allergies: Peanuts should be freely introduced when age appropriate and in accordance with family preferences and cultural practices (6 months and later for infants who are exclusively breastfed).
- If your baby has mild to moderate eczema: Give your baby his first taste of an infant-safe peanut product once he's developmentally ready around 4 to 6 months of age – after he has tried and tolerated a few non-allergenic infant foods without issue.
- If your baby has severe eczema or egg allergy: Consult with the doctor before giving him his first taste of a peanut product. He'll need to get allergy tested first, at around 4 to 6 months. Read more about how and when to introduce peanut products to your baby.
My child was diagnosed with a food allergy. How do we prevent future allergic reactions?
The key is strict avoidance of the food.
Avoiding a particular food is trickier than it sounds. Foods show up in unlikely places, and even a little bit may be enough to trigger a severe reaction. Most people who have a severe reaction have eaten a food they thought was safe.
Tell caregivers about the allergy. Make sure anyone who takes care of your child – babysitters, relatives, daycare workers, teachers – knows about the allergy and which foods are off-limits. Point out the kinds of foods that could hide the substance, and ask caregivers to double-check ingredients. Tell caregivers exactly what to do if your child has an allergic reaction.
Read food labels. Be vigilant about reading food labels, knowing which ingredients to avoid, and asking about ingredients in restaurant dishes or in food at friends' homes.
Talk to a dietitian. If your child is avoiding many foods, talk with his doctor about seeing a dietitian, to make sure the nutrients in his diet are adequate.
Modify your diet if you're breastfeeding. The proteins that cause the allergy can be passed on in your breast milk. So you may need to give up the offending food yourself if you're nursing a baby with a food allergy.
Explore changing your baby's formula. And if you're formula-feeding a baby who seems to be allergic to cow's milk, you may need to change formulas. Some babies who are allergic to cow's milk are also allergic to soy, though, so it's important to discuss the situation with your child's doctor before making any kind of change.
Get medical ID jewelry that lists the allergy. Consider having your child, depending on her age, wear medical identification jewelry, such as a bracelet.
What allergens are food manufacturers required to list on product labels?
Food manufacturers are required by law to list these top food allergens on product labels:
- Tree nuts
- Crustacean shellfish (crab, shrimp, and lobster but not mollusks like clams, oysters, or squid)
Nuts, fish, and shellfish must be named specifically. All the allergens must be listed in plain language. For example, the label has to say "egg" instead of "albumin" or "egg" in parentheses after "albumin." If you're unsure about a product's ingredients, call the manufacturer.