How to navigate when a family member has a food allergy.
A food allergy refers to an immune system reaction to a particular food, ranging from an upset stomach to life-threatening anaphylactic shock. It is triggered each time that food is eaten and is not related to the amount of the food that is consumed. Identifying and avoiding any food that triggers an allergic reaction is the only cure for food allergies. As you can imagine, this is especially difficult when the allergy occurs in young children.
With 1 in 13 children having a food allergy, food allergies are everywhere these days. Your best friend is breastfeeding and cannot eat dairy because her baby is allergic. You cannot pack peanut butter and jelly sandwiches for your child’s lunch because her classmates may be allergic. Deviled eggs are off limits at family gatherings because of your nephew’s allergy. With all the buzz about food allergies, you may be wondering how you can keep your child allergy-free.
Can food allergies be prevented?
The Asthma and Allergy Foundation of America (AAFA) states that the top food allergies in the U.S. are related to:
- Milk
- Eggs
- Peanuts
- Tree Nuts
- Soy
- Wheat
- Fish
- Shellfish (crustaceans)
If you or someone you know has a food allergy, you know how difficult it is to completely avoid the offending food. Parents would do anything to prevent their child from having such an allergy, but is there anything that can be done? A lot of research is being done to try to answer that question.
Pregnancy
Not long ago, the American Academy of Pediatrics (AAP) recommended that pregnant women avoid eating peanuts. It was thought that this might eliminate peanut allergy in young children. Recent studies have not found a connection, though, between eating peanuts during pregnancy and peanut allergies in children. The AAP now states that there is no evidence to suggest that restricting certain foods during pregnancy will prevent allergies in infants. That being said, if your newborn will be at high risk for developing food allergies, it is a good idea to discuss your options with your doctor. All pregnant women should eat a balanced, healthy diet to provide the best start for their babies.
Breastfeeding
Some mothers of children with food allergies need to avoid eating certain foods while breastfeeding. While some studies show a benefit and others do not, the AAP has not found enough evidence to recommend that breastfeeding mothers avoid common allergic foods like milk, eggs, and peanuts. Once again, if your new child is at high risk for developing food allergies, it is a good idea to discuss your options with your doctor.
Some studies do suggest that infants who are at risk of developing allergies due to family history, exclusively breastfeed rather than formula feed for the first 4 months to reduce the risk of allergy to cow’s milk. While not all studies show that breastfeeding reduces the risk of food allergies, many organizations like the National Institute of Allergy and Infectious Diseases (NIAID) recommend that all infants be breastfed exclusively until 4-6 months of age unless there is a medical reason not to do so.
Introducing Solid Foods
When it is time for your baby to eat solid foods, you may wonder when to introduce foods that commonly cause food allergies. The AAP recommends waiting to introduce solid foods until your baby is 4-6 months of age and whole cow's milk until 12 months of age. This is mainly to ensure that your baby gets all the nutrition s/he needs from breast milk or formula.
It used to be recommended that common allergic foods like eggs, nuts, and fish not be introduced into your child’s diet for up to several years. More recent evidence suggests that there is no reason to delay introducing these foods. Delaying introduction to these foods may not prevent an allergic reaction and, in some cases, it may even increase the chance that your child will develop an allergy. Current guidelines now state that high-risk infants with severe eczema and/or egg allergy should be introduced to age-appropriate peanut-containing food at age 4-6 months to reduce the risk of peanut allergy. There are no current guidelines for other potentially allergic foods.
Symptoms
Symptoms differ from child to child, and may range from a mild rash or dizziness to anaphylaxis, a life-threatening allergic reaction. Symptoms of an allergic reaction may include:
- Skin rashes, itching and hives.
- Swelling of the lips, tongue, or throat.
- Shortness of breath, trouble breathing, or wheezing (whistling sound during breathing).
- Dizziness and/or fainting.
- Stomach pain, vomiting, and diarrhea.
- Feeling like something awful is about to happen.
How are food allergies diagnosed?
Diagnostic tests must be done to determine if a true food allergy is present. Some people suffer from food intolerances, such as lactose intolerance, gluten intolerance, or sensitivity to sulfites. People with food intolerances may have a reaction from eating certain foods, but it does not involve the immune system. Testing to determine if a true food allergy exists may include:
- Skin prick test—Extracts of suspected food antigens are dropped on the skin and the area is pricked or scratched through the drop. If the skin develops a raised bump, then that substance is causing an allergic reaction.
- Blood tests—These test indicate the presence of IgE, the antibody most active in food hypersensitivity reactions. The test can help identify which foods to avoid by matching up specific food antigens and IgE antibodies.
- Challenge test—The patient is fed suspected foods under carefully controlled conditions, and any reactions are noted. This is can be dangerous, however, if there is a risk of anaphylactic shock. The challenge test is only performed in certain situations.
- Food diary—If the diagnosis remains in question, the patient or their parent may be asked to keep a food diary for 1-2 weeks, writing down all foods eaten and noting any reactions. Any suspected foods are then eliminated to see if the symptoms clear up.
- Patch testing—While this type of test is not commonly recommended, it may be used in some cases. The food is placed under a dressing on the skin for 48 hours and the area is watched for any signs of reaction.
What can parents do?
All of this information may seem overwhelming to the parent of a child with a food allergy. With new studies coming out all the time and recommendations from groups like AAP changing, you may feel confused about how to protect your child from food allergies. The most important thing is to make sure your child eats a healthy diet. It also helps to know that many children outgrow milk and egg allergies by the time they enter school. Unfortunately, not as many children outgrow peanut, tree nut, or seafood allergies. Follow these guidelines to help increase the odds that your child will not suffer from food allergies:
- Feed your baby only breast-milk preferably or formula until age 4-6 months.
- If you have any family history of food allergy or reason to be concerned, talk to your doctor.
- When your child is old enough for solid foods, provide a variety of healthy foods for them.
- When you are introducing new foods to your child, be familiar with the signs of food allergy. Call the doctor if you notice your child is having a reaction.
If your child is diagnosed with a food allergy, take steps to avoid an allergic reaction. These include:
- Learn how to read food labels for ingredients your child is allergic to. Read the label every time you buy a product, even if you have used that product before, because manufacturers may change ingredients.
- Ask about ingredients in foods that other people make for your child.
- Avoid passing allergens to foods that are safe for your child to eat by washing your hands and your child's hands with soap and water before handling food. Prepare and serve foods with clean utensils and other kitchen items and on clean surfaces.
- Educate family, friends, and others who will be with your child about your child's allergies. Be sure to tell your child's school and anyone responsible for your child about his or her food allergies.
- Teach your child how to manage his or her food allergies. You can start educating your child about their allergy, even at a young age. When old enough, teach your child to read food labels, how and when to use an epinephrine autoinjector (sometimes called an EpiPen), and to tell an adult if he or she is having an allergic reaction.
- After the diagnosis, focus on what safe foods your child can have, rather than what he or she cannot have. Start with plain foods with simple ingredients. From there you can look for new recipes that use safe ingredients.
You may not be able to prevent all food allergies in your child, but you can still give them a good start by eating a healthy diet during pregnancy and breastfeeding, and providing a healthy, balanced diet full of fresh fruits and vegetables when they are older.
Sources:
Asthma and Allergy Foundation of America (AAFA) :www.aafa.org
Healthychildren.org (sponsored by American Academy of Pediatrics):www.healthychildren.org
Kids with Food Allergies (a division of AAFA): www.kidswithfoodallergies.org
National Institute of Allergy and Infectious Diseases (NIAID):niaid.nih.gov
If you suspect your child has food allergies, please see your healthcare provider. Dr. Elliot Freed is available for consultant, diagnosis, and treatment. To schedule an appointment, call the office at (540) 626-4343 or click to book an appointment online below.