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Health & Nutrition

Food Allergies

True food allergies are not as common as most people believe and only affect about 2% of children, although they are more common in younger children (affecting about 5-8% of younger children). And fortunately, most young children will outgrow them by the time they are three years old.

Symptoms of a food allergy can include wheezing and difficulty breathing, itchy skin rashes, including hives, vomiting, diarrhoea, nausea, abdominal pain and swelling around his mouth and in his throat. These symptoms usually develop fairly quickly after your child ingests the food he is allergic to, often within minutes to hours. Nasal symptoms by themselves, such as congestion or a runny nose, are usually not caused by food allergies.

Symptoms may be mild or very severe, depending on how much of the food your child ingested and how allergic he is to the food. A severe reaction can include anaphylaxis, with difficulty breathing, swelling in the mouth and throat, decreased blood pressure, shock and even death.

More common than food allergies are intolerances to certain foods, which can cause vomiting, diarrhoea, spitting up, and skin rashes. An example of such a reaction occurs in children with lactose intolerance, which occurs because of a deficiency of the enzyme lactase, which normally breaks down the sugar lactose. Children without this enzyme or who have a decreased amount of the enzyme, develop symptoms after drinking lactose containing food products, such as cow's milk. However, because this reaction does not involve the immune system, it is not a real food allergy.
If you notice that your child develops symptoms after being exposed to certain foods, then you should avoid those foods. The most common foods that can cause allergies include: peanuts, tree nuts (walnuts, pecans, etc.), fish, shellfish, eggs (especially egg whites), milk, soy, and wheat. Keeping a diary for a few weeks and recording what foods your child has been eating, especially new foods, and when he develops symptoms may help figure out what he is allergic

Once you determine what your child is allergic to, it is important to learn to read food labels because the food your child is allergic to may be an ingredient of many other foods. You should also avoid eating foods that may have been prepared using equipment that was also used to prepare the types of food that your child is allergic to.
When trying to determine what your child is allergic to, parents often incorrectly assume that if their child has eaten a food before and has not had problems, he probably is not allergic to that food. They usually only suspect that new foods will cause a food allergy.

However, it is important to keep in mind that it takes time for the immune system to build up a reaction against something that the body is allergic to. It may take days, weeks, months or even years to build up enough of a response to cause noticeable symptoms. So your child may be allergic to a food even if he has eaten it many times before without problems.

In addition to avoiding what you think your child may be allergic to, children with more severe reactions should be evaluated by their Pediatrician or an allergist. Testing may be done, either skin testing or RAST (radioallergosorbent test, a blood test to check for antibodies against certain things your child may be allergic to) to see if specific food allergies can be found. In addition, your child will be prescribed an epinephrine autoinjection device (such as the EpiPen or EpiPen JR) and should wear a medical alert bracelet to notify others
of his allergy.

Preventing food allergies may be possible, especially if your child is at high risk of having a food allergy, including already having an allergy to food or formula, eczema, hayfever, or asthma, or having other family members with these conditions or a food allergy.

Most importantly, breastfeed and avoid supplementing with infant formula or offering solids for the first six months. If you are not breastfeeding or need to supplement, then consider using a hypoallergenic infant formula (soy formulas and goat's milk may not be good alternatives, because many infants that are allergic to cow's milk may also be allergic to soy). If you are breastfeeding, then you should avoid milk, eggs, fish, peanuts, and tree nuts in your own diet.

If your child is at high risk of having food allergies, you should delay offering solids until he is at least six months old (and continue breastfeeding), and begin with an iron fortified infant cereal. It is best to start with rice and oat cereals and introduce wheat cereals later. Next you can introduce vegetables, but avoid legumes (foods in the bean and pea family) at first, and then non-citrus fruits and fruit juices. Meat and protein foods can be added once your child is 8-9 months old.

Foods to avoid until your infant is at least a year old include cow's milk and other dairy products, citrus fruits and juices, and wheat. Also, avoid giving eggs until age two, and peanuts (as smooth peanut butter) and shellfish until your child is at least three years old. Whole peanuts and tree nuts should be avoided until your child is four because of the choke hazard.

When you do introduce new foods, do so slowly and only give one new food every four to five days. This way, if your child does have a reaction or allergy, then you will know which food caused it and you will be able to avoid giving it again.

Cow's milk is the most common cause of food allergies (in addition to being a common cause of food intolerances). Unlike cow's milk intolerance which is usually a reaction to the sugar lactose, allergies to cow's milk are usually from the proteins that are in the milk. Infants who have an allergy to cow's milk based formulas should usually be changed to an elemental or hydrolyzed formula, such as Nutramigen or Alimentum. Soy formulas and goat's milk may not be good alternatives in this case, because many infants with allergies to cow's milk proteins are also allergic to the proteins in soy and goat's milk although they usually are for older children.

Other foods to avoid if your child is allergic to cow's milk include, but are not limited to: buttermilk, cheese, evaporated and condensed milk, ice cream, yoghurt, instant mashed potatoes, margarine, casein, cream, hydrolysates, lactalbumin, nougat, sour cream, whey, and other foods made with milk. Older children who are unable to drink milk or eat milk based foods should be sure to have additional sources of calcium in their diet, including calcium fortified juices.

Eggs, especially the proteins in egg whites are also a common cause of food allergies. To help prevent allergies to eggs, it is a good idea to avoid giving egg whites to infants under a year old. Other foods to avoid include, but are not limited to foods that are derived from eggs, including egg substitutes, and foods that contain albumin, globulin, ovalbumin and vitellin. Also avoid foods that are prepared with eggs, which may include French toast, cake, biscuits, pancakes, eggnog, bread, ice cream, pasta, puddings, creamy salad dressings and foods with custard or cream fillings. Wheat allergy can develop in infants given a wheat cereal, and is probably best to offer a rice or oat cereal first and delay giving wheat until after your child is 6-8 months old. Other foods that may cause problems in children allergic to wheat include, but are not limited to many breads and cereals (unless they are made from oats, rye, corn or rice) made with wheat flour or enriched flour. Also avoid foods with cornstarch, gluten, semolina, all purpose or white flour.

Peanuts are not true nuts, but rather are actually legumes from the pea and bean family. Children with allergies to peanuts can be very sensitive to foods with even very small amounts of peanuts in them. Avoid all foods with peanuts, including candy, baked goods, chili, many ethnic foods (including Thai, Asian, and Indonesian foods), peanut butter, and mixed nuts. Children who are allergic to peanuts can often eat tree nuts, such as walnuts or pecans, since they are from separate plant families.
Tree nut allergies are also possible, and can include allergies to walnuts, pecans, cashews, almonds and hazel nuts and other nuts in hard shells. You should avoid foods prepared with tree nuts, including many kinds of candy, baked goods and different oils. Corn is rarely a cause of food allergies. If your child does seem to be allergic to corn, you should avoid corn based cereals and breads, corn syrup, and caramel.

Certain food dyes and preservatives, especially sulphites, may also cause food allergy symptoms.

1. While children often outgrow their food allergies, if your child had a severe reaction to a food, then you should talk with your Paediatrician or allergist before reintroducing the food.

2. Talk with and educate other family members and caregivers about your child's food allergies. Most people do not understand how serious food allergies can be, and may think it is all right to give just a small amount of a food that your child is allergic to.

3. Educate your child about his allergy, so that he can learn to avoid foods that he is allergic to.

4. If your child does not improve with these interventions or if he has had a severe allergic reaction, then you should consider having him see an allergy specialist for testing to figure out what foods he is allergic to and to possibly start allergy injections.

5. Children with severe allergic reactions or anaphylaxis should wear a medical alert bracelet to notify others of his condition and should carry an epinephrine autoinjector (such as the EpiPen JR) to ensure rapid treatment during an allergic reaction.

6. Most importantly, learn to read food labels and look for ingredients that your child may be allergic to and practice strict avoidance of those foods. If you don't know what an ingredient is, then call the manufacturer before giving it to your child to be safe.

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