Food Allergies in Kids

Did you know that eight food categories account for over 90% of food allergies in kids?

Did you know that children will outgrow many of these while others can be lifelong?

Do you know what signs and symptoms to watch for in your child as you introduce new foods to their diet?

Do you know the difference between a food allergy and food intolerance?

In this article, I will review the most common food allergies and symptoms and give proven tips for minimizing food allergies in your child. This article should give you the answers to the above questions.

The most common food sources of allergies include the Big 8:

• Peanut

• Tree nuts

• Fish

• Shellfish

• Milk

• Egg

• Wheat

• Soy

*A ninth food, sesame, will be added to the list of food allergens on labels in 2023.

Symptoms can range from mild to severe. The most severe reaction is termed anaphylaxis and can be life-threatening. An allergic reaction is an immune response that can occur quickly after exposure or be delayed until two to three hours later. About 8-9% of children suffer from food allergies.

Mild symptoms include:

• Acute rash

• Hives or urticaria (welts or a raised itchy rash)

• Eczema

• Sudden nasal congestion or runny nose

• Itching or tingling in the mouth

• Abdominal pain

• Vomiting or diarrhea

• Blood in the stool

• Dry cough

• Swelling of the lips, face, or eyes

Severe symptoms include:

• Trouble swallowing

• Difficulty breathing or wheezing

• Swelling of the tongue or throat

• Hoarseness with trouble talking

• Chest pain

• A sudden drop in blood pressure

• Fainting

• Anaphylaxis

If you suspect an allergic reaction in your child, do not give that food again. For mild symptoms, a call to your child’s doctor is in order. A more severe reaction warrants an emergency room visit where medication can be given to counteract the reaction.

Any infant who is introduced to food for the first time and reacts should be evaluated by their doctor and an allergist. Subsequent encounters with the same food can potentially cause a worse reaction. If a child has a true food allergy, it is imperative to read food labels to look for cross-contamination.

At least half of the children with a food allergy as an infant will outgrow it by 2-3 years, although some allergies tend to be lifelong.

Range of dairy products

Cow's Milk Allergy (CMA)

CMA is one of the most common allergies that usually develops in infancy. Symptoms can range from mild to severe. An infant who develops eczema early in infancy (before three months) or has a family history of allergies and eczema has a higher risk for cow's milk allergy. About half of the children will outgrow this by age 8 and the majority by age 16. Until then, avoid ALL milk and dairy products. You may need to supplement with calcium and vitamin D.

If an infant is on a milk-based formula, your doctor will choose a different one. Babies under six months with cow's milk allergy may also react to soy formula.

CMA should not be confused with lactose intolerance. Intolerance to food does not involve the immune system and is not life-threatening. A milk allergy involves a reaction to the protein in milk; lactose intolerance is a reaction to the sugar in milk, lactose, and causes discomfort but is not harmful to health.

Egg Allergy

About 1-2% of children have an egg allergy. Typically this is an allergy to the protein in the egg white. Most children (about 80%) will outgrow this by age five; many will tolerate well-cooked eggs sooner. However, there are MANY hidden sources of egg in foods, so reading labels is necessary.

Vaccines, such as influenza and measles, mumps, rubella (MMR), are usually safe to receive with an egg allergy but check with your doctor.

Assortment of peanuts and tree nuts

Peanut Allergy

Peanut allergies have become very common and can be very severe. Peanuts are the most common cause of food allergy deaths and are often lifelong. Children with peanut allergies can react even if inhaling particles from foods containing peanut allergens. Again, reading labels is of utmost importance to check for possible cross-contamination. It is also best to avoid foods with peanut oil.

The recommendations for peanut avoidance have changed dramatically over the years based on research. Mothers do not need to avoid peanuts or peanut products during pregnancy (unless they are allergic). Peanut butter can be introduced in a tiny amount before a year, as early as six months. If tolerated, a small amount, about 1/4 to 1/2 teaspoon, should be given daily for several days in a row, then every few days following. Research has shown that introducing this before a year can decrease the likelihood of a peanut allergy, compared to delaying it until after three. Should an allergic reaction occur, then stop all peanuts and peanut products. An allergist should manage further.

Peanuts and other nuts are a choking hazard under the age of 4.

Tree Nut Allergy

There are many tree nuts; a child can develop an allergy to only one or to multiple. Tree nuts include almonds, brazil nuts, cashews, chestnuts, hazelnuts, macadamias, pecans, pistachios, pine nuts, and more. Having a peanut allergy does not mean a child will also have a tree nut allergy. Allergy testing will determine that.

There are many hidden sources of tree nuts and their oils in numerous processed foods, so check labels carefully. Tree nut allergies are less likely to be outgrown (less than 10%).

Variety of shellfish

Shellfish Allergy

Shellfish include crustaceans (crab, shrimp, lobster, krill) and Mollusca (clams, octopi, oysters, squid, mussels, scallops). These reactions can be severe so all shellfish should be avoided. This allergy tends to be lifelong.

Fish Allergy

Fish allergies are not as common as some of the other foods but are usually lifelong. Children with fish allergies may also be allergic to other seafood. Cooking fish in a home that has someone with a fish allergy can be dangerous and trigger an allergic reaction. You cannot test for every type of fish, so it is best to avoid all fish if your child is allergic to any.

Soybeans and oil

Soy Allergy

Soy allergies are less common than dairy, egg, or peanut. Despite soy and peanuts both being legumes, it is unusual to be allergic to both. It is important to know all the products that contain soy and the various names of these products such as tofu, tempeh, soy sauce, miso, edamame, and tamari to name a few. This allergy may resolve with age.

Wheat stalk, wheat flour and bread

Wheat Allergy

Wheat allergy is more common in children than adults. Wheat grain is in many food items - bread, crackers, cereal, pasta - and in many less common items such as cold cuts, hot dogs, soups, canned gravies, and even Play-Doh! Wheat allergy is not to be confused with wheat intolerance or celiac disease. Celiac disease is autoimmune; wheat intolerance is not immune-mediated like allergies. When dealing with wheat allergy, one must avoid products containing wheat but not all gluten. Gluten is a protein found in wheat, barley, and rye; a person with celiac disease must avoid all these. With a wheat allergy, only avoid wheat products. Many children with a wheat allergy will outgrow it by twelve.

When and How to Introduce these Common Allergic Foods?

The latest research promotes introducing very small amounts of these Big 8 allergic foods between 6-12 months as a way to reduce food allergies. The idea is to give only one at a time in a tiny amount (1/8-1/4 teaspoon) for several days in a row, as long as there is no reaction. If tolerated, continue this food regularly, three times a week. Each of these foods should be first introduced during separate weeks while continuing the foods already tolerated. Do not introduce more than one of these foods in the same week. If your baby reacts, do not give that food again until an allergist can evaluate your child. If a food is tolerated, this food can become incorporated into their regular diet. When introducing dairy, plain, full fat yogurt should be used. Do not introduce cow’s milk or shellfish before a year of age. Any nut should be introduced as nut butter, not the nut itself since nuts are a choking hazard.

If your child has been prescribed an Epi-pen (epinephrine pen) for a food allergy, this should always be with you. Having this and knowing how to use it can be life-saving.