Understanding Kids Food Allergies

Food allergies affect 6 percent of children under the age of 5 and 4 percent of teens and adults in the United States. Food allergy is a form of adverse reaction that is mediated by the immune system. Ingestion of the offending food leads to a cascade of allergic symptoms such as hives, flushing, vomiting, stomach pain, and/or coughing and wheezing. Not all reactions to food are allergies, though. Some adverse reactions may be non-immune-mediated, such as lactose intolerance, which presents with gas, bloating and diarrhea after the ingestion of dairy.

Children are at higher risk of developing food allergies than adults, although they can begin at any age. Allergic reactions can range from mild to severe, and can even lead to death, although this is rare. A careful evaluation, identification of food triggers, parent and child education, and emergency-management plans are the cornerstones of treatment. A medical cure is not yet available, although research in this area has been promising.

Eggs, cow’s milk, peanuts, tree nuts, soy, wheat, shellfish and fish are the most common triggers, constituting more than 90 percent of all pediatric food allergies. Discovering the specific trigger can be complicated. A detailed history, physical exam, and skin or blood tests and food challenges can help establish or refute this diagnosis. Food challenges are the most conclusive test for diagnosis. This is when increasing amounts of the suspected food are given to the patient under medical supervision. However, these can be dangerous, because anaphylaxis is always a possibility, and should only be performed under the supervision of a physician specialized in allergic disorders.

Sixty to 80 percent of food allergies to eggs, milk, wheat and soybeans tend to resolve by adolescence. However, peanut, tree nut, fish and shellfish allergies tend to persist into adulthood.

Avoidance of the allergen and preparedness are the mainstays of treatment. This can be a daunting task because most food allergens are everywhere. Careful reading of ingredient lists and educating all of the child’s caregivers as well as the child helps to prevent accidents. Parents should seek additional advice from their child’s pediatrician or a pediatric allergist for proper identification of the food trigger and avoidance techniques. The patient and family are then provided with a written plan of action and epinephrine in case of accidental ingestion and subsequent anaphylaxis.

For anaphylaxis, the short-term management includes epinephrine and a rapid-acting antihistamine such as diphenhydramine (Benadryl). After immediate intervention, the patient usually requires transport to the nearest hospital for evaluation and treatment with other supportive measures.

For more information, check out the Food Allergy Research and Education website.

Dr. Joel Gallagher is a resident pediatrician at Carolinas Medical Center and Dr. Erin Stubbs is a board-certified pediatrician at CMC Myers Park Pediatrics.