Paediatric Food Allergies: What Parents Must Know

Food allergies are common in children, and it is increasing. Children with food allergies can manifest very mild symptoms like rash and itching, although sometimes it can be severe, like breathing problems and anaphylaxis. Vomiting, recurrent abdominal pain, and growth faltering can also be features of food allergies.

How common are pediatric food allergy?

As per western data, almost 1 in 10 children have food allergies.  Indian data is lacking, but some studies suggest that nearly 19% of children and adolescents are sensitive to 1 food item.

What are common food allergies in children?

The following eight food items account for more than 90% of pediatric food allergies.

• Cow’s milk
• Egg
• Fish
• Shellfish
• Wheat
• Soya
• Peanuts
• Tree nut

Peanut allergy is less common in India, but we see many cases of lentil or dal allergy.

Why are food allergies increasing?

Although the exact cause is not established, various theories are there.

• Increase in urbanization and industrialization
• Change in food habits
• More awareness about hygiene
• More use of antacids
• Vit D insufficiency
• Genetic predisposition etc

Whether food allergies are permanent?

No, some food allergies we gradually outgrow with age. But some food allergies persist lifelong

Types of food allergies

Food allergies are typically two types.

IgE mediated: here, children develop symptoms within minutes of ingesting food, easy to diagnose.

Non-IgE mediated: here symptoms can be delayed by hours to days, difficult to identify and diagnose.

What are the symptoms of food allergies?

Symptoms are different for IgE and non-IgE mediated food allergies.

IgE mediated: itching, urticaria or wheals on the skin, swelling of lips, breathing problems, severe cases can have hypotension and shock. Even death can occur if not treated aggressively.

Non-IgE mediated: vomiting, recurrent pain abdomen, diarrhea, blood mixed stool, growth faltering, abdominal distention.

Are food allergies and food intolerance the same?

No. Food intolerance is the physical manifestation due to indigestion of a particular food item if consumed in large amounts.  That sometimes means your child will get symptoms but sometimes not after ingesting a specific food.  Usual manifestations of food intolerance are bloating sensations, vomiting, loose stool. In contrast, food allergies are immune-mediated manifestations against a particular food.  Even a small amount of food can be dangerous, and it develops every time food is taken.

Are food allergies genetic?

Food allergies can be transmitted in families. Still, you should visit your doctor before avoiding the food for your child.

How do we diagnose food allergies?

Various methods are available to diagnose a food allergy.

For IgE mediated food allergy:

Skin Prick Test (SPT): here, the skin is pricked to know the sensitivity of your child to a particular food. It is less expensive but invasive.

Specific IgE testing: here blood test is done to know the presence of antibodies in your child against a particular food. More expensive but non-invasive

For non-IgE mediated food allergy:

Endoscopy of various parts of the gastro-intestinal tract depending on your child’s symptoms.

Elimination diet and oral challenge: here, the suspected food is stopped from your child’s diet for 2-4 weeks. And then, it is gradually reintroduced to check the reappearance of symptoms.

If an allergy test shows a positive result, does it mean my child is allergic?

No, not necessarily. A positive result in an allergy test means only that your child is sensitized to those allergens/food items. Allergy is there only if your child shows signs and symptoms of allergy after ingesting a particular food each time. Only an expert will be able to help you in this regard.

Does the mother have to stop the allergenic food if breastfeeding?

There are chances of a child getting the components of offending food through breast milk. So a mother should avoid the allergic food. But parents should consult a pediatrician before making a decision.

How do we treat food allergies?

To date, the best is to avoid the allergic food. But as explained earlier, some food allergies kids will outgrow with time, and some will persist lifelong. So, parents should not decide about when to stop and when to start the allergic food. They should consult a pediatrician or an allergist.

Drugs: certain drugs like antihistaminics, oral steroids, and adrenaline are used to treat symptoms of allergy (never self-medicate as these drugs can be dangerous if wrongly taken)

Immunotherapy: it should always be done by an allergist or an expert in a setup with all the resuscitation facilities.

Hidden allergens:

There are hidden allergens in various food items we are not aware of. Always try to read the label of the food item before giving it to your child. Suppose your child is allergic to cows’ milk, and you have given him/her a biscuit that contains milk. So he/ she might develop a severe allergic reaction after taking the biscuit. If you don’t read the food label carefully, you will miss it. Also, various cosmetics and beauty products sometimes contain milk or nut oil.

TAKE HOME MESSAGE

• Food allergies are common in children and increasing.
• Manifestations of food allergies can be different.
• Never self-diagnose and stop food to your child suspecting food allergy.
• Allergy test positive does not always mean a food allergy.
• There are some food allergies that kids outgrow, but some don’t
• Always consult a pediatrician or an allergist before avoiding a food.
• There are hidden allergens in various food and cosmetics; always read the label carefully.