Allergic Reaction

ALLERGIC REACTION
WHAT YOU NEED TO KNOW NOW ABOUT FOOD ALLERGIES AND YOUR CHILDREN

Kids and food allergies is a hot-button issue nowadays—with a lot of misinformation bandied about. Here, THE FAMILY GROOVE gets the inside scoop from the distinguished medical advisory team at Kids With Food Allergies Inc. (www.kidswithfoodallergies.org) , a nonprofit support group that fosters the optimal health, nutrition and well-being of children by providing education and a caring community for their families.

THE FAMILY GROOVE: What are the signs/symptoms of a food allergy in an infant?
Kids With Food Allergies Inc.: An allergy occurs when the body becomes sensitized and overreacts to a foreign substance that would usually be considered harmless. Eight foods cause 90 percent of all allergic reactions: milk, eggs, soy, wheat, peanuts, tree nuts, fish and shellfish. It is estimated that 8 percent of children under 6 may have a food allergy, while 2 percent of adults do.

An infant may present an allergy in several different ways. One of the more common ways for a young infant to present is with bloody/mucousy stools. This is called proctocolitis. This event scares most parents, prompting them to make a panicked call to their pediatrician. If the infant is otherwise well, breast-feeding moms may be instructed to eliminate all dairy products from their diets (don’t forget to read ingredient labels) and formula-fed babies may be switched to a hypoallergenic kind. This is usually enough to resolve the situation. Most babies will outgrow this reaction by 1 year of age. Persistent bloody stools require more of an evaluation. If you note bloody stools in your infant, please call your pediatrician.

An infant may also show signs of an allergy with eczema (also called atopic dermatitis), which is an itchy, scaly or bumpy red rash. This may be mild—for example, only the cheeks are involved—or more severe, like a head-to-toe rash on an itchy, miserable baby. The infant or child with mild eczema is not likely to have a food allergy, but an infant that has moderate to severe eczema will have a food allergy about one-third of the time. Please see your pediatrician for the treatment of eczema.

More difficult to figure out is the crying or colicky infant. Do these babies have allergies? Crying or colic is considered to be a milestone by some, and occurs generally in the evening in a three-week to three-month-old infant. This is a very difficult situation for parent and doctor alike, because all want a happy child. A trial milk elimination for the breast-fed infant or a hypoallergenic formula for the formula-fed infant may help in the evaluation of the crying baby. A crying baby may be diagnosed with gastroesophageal reflux disease, also known as GERD or reflux, but these infants are usually crying all day long and may arch their backs and fuss when lying down flat. Reflux may occur alone or as a symptom of a food allergy. Without other signs of an atopic (allergic) disorder, a trial on an acid blocker is the usual course of action. A crying child that is not growing brings about more concern and deserves a deeper evaluation.

TFG: What are the signs/symptoms of a food allergy in a toddler?
KWFA: As the immune system matures, the toddler may present differently than the young infant. Toddlers are not likely to present with bloody stools—if this is happening in your 15-month-old, then it is more likely to be from other causes. Eczema can still mean a food allergy, but again, moderate to severe eczema is more likely to be due to a food allergy than mild eczema is and definitely warrants allergy testing.

Some new events may occur at this stage as well. Hives or urticaria (a very itchy rash that looks a bit like bug bites with redness surrounding them) may be seen in an older infant or toddler. Again, nature chooses not to be very clear, so it can be due to a reaction to a food allergen in the environment or a virus. If your child has developed hives, please call your doctor.

The reaction that all parents fear is anaphylaxis. This can be a life-threatening reaction that may include shortness of breath or wheezing; runny nose; nausea, vomiting and diarrhea; swelling of the face and tongue; hives, swelling or redness of the skin; and dizziness or fainting.

Anaphylaxis is an emergency situation. If a child has known food allergies, typically they are prescribed and need to be given an epinephrine autoinjector known as an EpiPen or Twinject, and then call 911. If this is the first occurrence, call 911 immediately. After the emergency is over, the child should have a thorough evaluation and referral to a board-certified allergist.

TFG: What are the signs and symptoms of allergies in a child?
KWFA: The signs and symptoms are largely the same in a child as in a toddler; however, a child is more verbal and better able to describe what is happening to him or her. For instance, a child who is anaphylactic and has ingested his allergen may describe a taste, tingling sensation or feeling of impending doom.

Remember that this is a continuum and a more atopic infant may have symptoms that are more typical of a toddler. Again, if you have concerns about your child, please contact your physician.

TFG: What are some common misdiagnosed ailments that are actually signs of food allergies?
KWFA: Eczema (also known as atopic dermatitis), gastroesophageal reflux disease (GERD), colic and wheezing can all be signs of a food allergy.

TFG: Can disorders like ADHD by caused or worsened by a food allergy?
KWFA: This is a question about which many parents wonder. There are a lot of possible adverse reactions to foods, including such things as lactose intolerance and food poisoning, which are different from allergic reactions. When allergists use the term food allergy, they are generally referring to a specific immune reaction to a food that most frequently involves skin (hives, rashes), gastrointestinal (repetitive vomiting) or respiratory (repetitive coughing, wheezing) symptoms.

Some parents are concerned that behavior issues in their children are related to food allergies. Some studies have suggested a link between certain additives and behaviors like hyperactivity. Allergic reactions, however, typically begin very quickly following ingestion, so longer-term behavior changes seen in a disorder, such as ADHD, in the absence of classic allergy symptoms as mentioned, are either not related to foods or are working through a nonallergic mechanism. In order to prove that a food is leading to a behavior change, studies should ideally be performed in which children alternate separate periods of including the suspected food and excluding it, and neither parent, child nor other observers (such as teachers) are aware of when the food has been eaten and when it has not.

If you believe that a food allergy is causing some of your child’s symptoms, it is best to talk with your pediatrician or visit an allergist. Unnecessary elimination of food from the diet can lead to nutrition problems, especially if multiple foods are eliminated. Additionally, eliminating certain foods for a child with a real food allergy can increase the risk of a reaction if not done properly and supervised by a professional.

TFG: What should you do if you suspect your child has a food allergy?
KWFA: If your child is having a reaction, please either call your pediatrician or 911, depending on the severity. Once your child has been treated, you should call your doctor for an evaluation and treatment plan. If your child suffers from colic, eczema or GERD and you suspect it may be related to allergies, you should call your doctor.

TFG: Can children outgrow allergies?
KWFA: Thankfully, most children outgrow their allergies to many of the common foods that once led to allergies. Milk, eggs, wheat and soy are frequently outgrown in childhood, often by school age, though sometimes later. Peanut, tree nut, fish and shellfish allergies are more commonly persistent, although a minority (for example, about 20 percent of peanut-allergic individuals) will outgrow these as well.

TFG: Is there anything parents can do to help their children outgrow food allergies?
KWFA: Unfortunately, at this point there does not seem to be anything that parents can do to help their children outgrow their food allergies faster. Complete avoidance of the problem food is the safest option, since the quantity needed to cause an allergic reaction can vary over time. Studies are ongoing into different treatment options for food-allergic individuals, but at this point, parents can help their children the most by teaching them how to avoid the food(s) in question and to be prepared to manage any reactions to accidental ingestions.

TFG: What it the latest thinking on when a child should have peanuts, strawberries and other potentially allergy-causing foods?
KWFA: The American Academy of Pediatrics (AAP) has recently updated its policy statement on introducing solids to infants and children. Babies should be breast-fed for the first six months and formula-fed for the first four to six months before introducing solids. The recommendations formerly made regarding when to introduce foods considered more allergenic have been retracted due to insufficient data and the fact that these recommendations seemed to have no effect on the rise in food allergies. If you have allergies in your family or your child already has an atopic (allergic) disorder, such as asthma or eczema, then your child is at increased risk for food allergies. Please discuss introducing foods for your child with your doctor.

TFG: What do parents need to know about food allergies?
KWFA: Food allergies are unfortunately on the rise, as are other allergic disorders. If your child has been diagnosed with a food allergy, information is your best ally. For information and the ability to connect with other parents who find themselves in the same situation, Kids With Food Allergies Inc. is a wonderful resource and can be found at www.kidswithfoodallergies.org. Another good source of information may be found at www.foodallergy.org. For a downloadable brochure on what to expect after your child has been diagnosed, please go to www.foodallergy.org/downloads/DYHFA.pdf.

The above answers were written by members of the Kids With Food Allergies Medical Advisory Team:

Kimberly Khosla, M.D., F.A.A.P., Chair
Pediatrician
Springboro, OH

Todd Green, M.D.
Assistant Professor of Pediatrics, Section of Allergy/Immunology
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, PA

David W. Hauswirth, M.D.
Clinical Assistant Professor of Pediatrics and Allergy
The Ohio State University and Children’s Hospital
Columbus, OH