Food Allergies in Kids
Food allergies have become much more common in the past several years. So much so that many daycare centers and schools have banned common allergenic foods. That’s because 1 in 13 school children are allergic to at least one food. Kids with food allergies are at risk of exposure to these foods in the school setting whether foods have been banned or not, worrying parents. In fact, 71% of preschoolers have had an accidental ingestion of foods they are allergic to.
There is often confusion as to what symptoms actually signify a food allergy. Therefore, let’s start with what is and is not a symptom of food allergies. Food allergies, like seasonal allergies, are caused by the immunoglobulin IgE. When IgE is triggered, it stimulates mast cells to release histamine. The resulting symptoms include hives (an itchy rash), nausea with or without vomiting, congestion, cough, wheeze, and possibly low blood pressure causing a loss of consciousness. According to our resident allergist, Dr. David Stukus of Nationwide Children’s Hospital, “a food allergy will cause rapid onset symptoms within minutes or rarely 1-2 hours after eating a food. If someone has a food allergy, then they will have symptoms every time they eat that food, regardless of form. For instance, someone with cow’s milk allergy will not be able to eat ice cream, cheese, or yogurt.”
Dr. Stukus points out that vague or chronic symptoms are not caused by food allergies. Parents frequently want allergy testing done for vague symptoms like chronic stomach aches but that is unlikely to identify an offending agent. As discussed in my post here, diaper rash is also not a symptom of food allergy. Furthermore, lactose intolerance (missing the lactase enzyme to breakdown the sugar lactose in milk) is not a food allergy.
What foods commonly cause food allergies?
“Cow’s milk, egg, wheat and soy are the most common food allergies among very young children and these tend to resolve as children get older,” says Dr. Stukus. The list of the top 8 most common food allergies is capped off by peanuts, tree nuts, fish, and shellfish which have potential to be lifelong in 80% of children. According to Dr. Stukus, “these 8 foods account for over 90% of all food allergies. Because sesame allergy is also on the rise, the FDA is investigating whether labeling for sesame allergy on packaged products should be included in the federal legislation.”
It is possible to prevent peanut allergy with early introduction. Take a look at my post on starting solids for more information.
What is anaphylaxis?
Anaphylaxis is a rapidly progressing reaction that occurs after exposure to an allergen. It is a clinical diagnosis defined as symptoms affecting more than one organ system. Patients may have symptoms of the skin, nose or respiratory tract, gastrointestinal tract or reduced blood pressure. These symptoms may include hives, coughing, wheezing, vomiting or loss of consciousness. Dr. Stukus reminds us that “a person does NOT need to have difficulty breathing or vomiting to have anaphylaxis. In addition, anaphylaxis is unlikely without recent exposure to the offending allergen – this is important as many highly allergic children can still have many of these symptoms at other times, making it challenging for parents” during illnesses like colds or gastroenteritis.
For peanut allergies specifically, there is unlikely to be a reaction if it is inhaled or on the skin, BUT peanut is detected in saliva and on surfaces several hours after exposure. Therefore, it is important for parents, teachers and caregivers to teach kids not to share any utensils or water bottles, along with not sharing food. Washing all surfaces with wipes and cleaning hands with soap and water is also important for removing peanut protein.
Anaphylaxis is life threatening!
Dr. Stukus makes if very clear, “anaphylaxis could become life threatening unless treated properly.” It’s imperative that all parents, caregivers and teachers who care for children with food allergies “be counseled on proper avoidance strategies, the signs/symptoms of anaphylaxis, and be prepared with immediate access to epinephrine at all times.” Epinephrine is the quickest way to reverse the symptoms of anaphylaxis. It is easily administered through a pre-dosed auto-injector. Because epinephrine “will not cause significant side effects or problems if used and epinephrine is the only effective treatment for anaphylaxis,” says Dr. Stukus, “many families are counseled to administer epinephrine for any symptoms more than hives.”
One last note, children with food allergies are frequently bullied at school. Bullies will wave foods in their face or pressure them into eating these foods. Sometimes, teens feel embarrassed about being different and therefore do not work to avoid allergenic foods. It is so important to talk to all kids about the potential life-threatening nature of food allergies. Patients and their peers need to understand the risks and be respectful of these, and all, differences.