More Bad News Food Allergies Are Increasingly Problematic for Children

The news about food allergies just got worse.

A new study in the July issue of the journal Pediatrics noted that approximately 8{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of U.S. children have some kind of food allergy — that’s 1 in every 13 children, with 2 in 5 having a severe food allergy.

I believe we are seeing more nut allergies in particular. As physicians, we are more aware of them, and parents are learning more about them due to the increasing exposure the media has given to food allergies. Nuts are also becoming a bigger part of our diets.

While some mothers are breastfeeding as long as they can today to protect their children from developing food allergies, research has shown that peanut allergens can be passed through a mother’s milk to her baby, increasing their risk of an allergic reaction later in childhood. Also, smooth and creamy peanut butter is one of the first foods often given to children when they start on solids.

But it isn’t just about peanuts. Milk and shellfish are common allergens, as well as eggs, tree nuts, soy, wheat, and fish.

What’s Happening?

In medical terms, a food allergy occurs when the body’s immune system triggers an abnormal response to a food by producing a specific type of antibody called immunoglobulin E (lgE).

According to the Food Allergy and Anaphylaxis Network, each year there are more than 300,000 food allergy-related ambulatory-care visits in the U.S. among children. Allergic reactions to foods vary and usually occur soon after eating in the form of a skin rash or more serious swelling of the mouth or throat called anaphylaxis, when the patient finds it hard to breathe and has an abrupt drop in blood pressure. Reactions in the gastro-intestinal tract are rare, but could include nausea, vomiting, diarrhea, or constipation.

Those who are extremely sensitive can develop symptoms from just touching a food or from airborne allergens carried in steam when boiling a food.

While blood or skin tests are often used to identify specific allergies, a number of tests for food allergies can come back as false positives. The ultimate test is what happens when a child eats a specific food, leading parents to seek care for their child after identifying a pattern that could signal an allergy to that food.

Most allergies to food begin in the first or second year of life. But the good news is that most infants who develop food allergies, with the exception of fish and nuts, will outgrow them.

Most children, even those who previously experienced a severe reaction, will outgrow cow’s milk, egg, soy,, and wheat allergies. About 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of children with peanut allergies will outgrow them, while only 9{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} will outgrow their tree-nut allergy.

At this time there is no cure for food allergies. Food-allergic children must avoid certain foods and constantly guard against accidental exposures to hidden food allergens. Medications are available to treat symptoms, which range from itching to a life-threatening drop in blood pressure, but only after the allergic reaction to food occurs. Antihistamines can treat mild symptoms such as itching or hives. Also, injectable epinephrine may be prescribed to keep close at hand for a parent — or child, when old enough — to administer after accidentally ingesting a food that has caused a severe allergic reaction in the past.

Food for Thought

The best thing I can tell parents is to tell their kids, “if mom or dad doesn’t make it, don’t eat it. It doesn’t matter what you are allergic to, don’t eat it.” A careful parent will drive this rule into their child’s head. I also advise parents to always, always, always carry an epinephrine auto-injector with them, and not wait to use it when an accident happens.

Anaphylaxis can be a frightening experience, but it usually isn’t life-threatening. The vast majority resolve themselves without severe consequences, but there is no way of identifying ahead of time what is going to happen after a child mistakenly eats a food he or she is allergic to. So it’s important to not wait for any symptoms to appear, and to administer the epinephrine immediately. If epinephrine is administered, the child should receive immediate emergency follow-up care. There is a distinct possibility that a child may have a second reaction later on.

It’s also a good idea to always carry multiple epinephrine auto-injectors with you at all times, especially when traveling or camping, and to check them periodically to be sure they haven’t expired. And be sure not just parents, but other caregivers like babysitters, relatives, and teachers, know how to use the injectors properly.

Additional tips in managing food allergies include:

• Asking about ingredients when eating at a restaurant or eating foods prepared by other family members or friends;
• Reading food labels carefully, even a product you always purchase in case the ingredients have changed;
• Safeguarding against cross-contamination in the kitchen with knives, cutting boards, and other utensils and appliances; this can also be a concern in restaurants, school kitchens, and elsewhere; and
• Wearing an identification bracelet that describes the allergy.

If you haven’t already, meet with school staff to create a safe environment and complete a Food Allergy Action Plan (available at www.foodallergy.org/actionplan.pdf).

For more information, Baystate’s Pediatric Allergy Clinic is held the first and third Fridays of each month at Baystate High Street Health Center – Pediatrics, located at 140 High St., Springfield. v

Dr. Robert Walker, who practices at Allergy and Asthma Care, Main Street, Springfield, is a member of the Baystate Children’s Hospital medical staff.