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Children and Food Allergies

Food allergies tend to be overdiagnosed, but about 5% of children have true allergic reactions to food. Suspect that your child may have a food allergy if any of the following allergic symptoms occur after your child eats certain foods:

The most common reactions:

Lips, tongue, or mouth swelling

Diarrhea or vomiting

Hives

Itchy red skin (especially if a child already has eczema).

Some less common symptoms:

Sore throat or throat clearing

Nasal congestion, runny nose, sneezing, or sniffing (especially if a child has hay fever).

Rarely a child has a severe allergic reaction, called "anaphylactic reaction," that may be life-threatening. Symptoms of such a reaction are a sudden difficulty breathing, sudden difficulty swallowing, or a sudden fall in blood pressure (shock).

Children who have other allergic conditions, such as eczema, asthma, or hay fever are more likely to have associated food allergies than children who do not have allergies. A few children who have asthma, migraine headaches, colic, or recurrent abdominal pain may have attacks of these problems triggered by food allergies. If an attack is triggered by a food allergy, the child will also have some of the typical symptoms of food allergies listed above. Attention deficit disorder and behavioral disorders, as isolated symptoms, have not been scientifically linked to food allergies.

If other family members (parents or brothers or sisters) have food allergies, a child has a greater chance of also having a food allergy. Food allergies are often inherited.

The Cause of Food Allergies

Allergic children produce antibodies against certain foods. When these antibodies come in contact with the food that causes the allergy, there is a reaction between the antibodies and the food. This reaction releases chemicals that cause the allergy symptoms.

The tendency to be allergic is inherited. If one parent has allergies, each child has about a 40% chance of developing allergies. If both parents have allergies, the chance of food allergy rises to about 75% for each child. Sometimes a child is allergic to the same food(s) as the parent.
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Outgrowing Food Allergies

At least half of the children who develop a food allergy during the first year of life outgrow it by the time they are 2 or 3 years old. Some reactions to food (for example, milk) are more often outgrown than others. Although 3% - 4% of all infants have a cow's milk allergy, less than 1% of these infants are allergic to milk the rest of their lives. Allergies to tree nuts, peanuts, fish, and shellfish (shrimp, crab, and lobster) often do last a lifetime.
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Foods that Often Cause Allergies

Overall, the food that most often causes allergies is the peanut. In infants, allergies to eggs and milk products are more common. Peanuts (and peanut butter), eggs, cow's milk products, soybeans (and soy formula), and wheat cause over 80% of food reactions. These foods plus fish, shellfish, and tree nuts cause over 95% of all food reactions. Chocolate, strawberries, corn, and tomatoes are often blamed for allergic reactions, but actually these foods rarely cause allergic reactions.
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Diagnosing a Food Allergy

Take the following steps to determine whether your child has a food allergy and what foods cause the allergy.

Keep a diary of symptoms and recently eaten foods: If you already know what food is causing an allergic reaction, go directly to step 2. Otherwise, be a good detective and keep a diary of foods and symptoms for 2 weeks. Any time your child has symptoms, write down the foods that he ate during the last meal.

After 2 weeks, look at the diary to see if your child ate any of the same foods on the days he or she had symptoms. There may be some inconsistency because the symptoms may depend on how much of the food your child ate. Anaphylactic reactions can be triggered by even small amounts of foods, but other allergic symptoms (for example, diarrhea) and their degree of severity usually depend on how much of the food your child eats.

Reactions to food may be worse when a child is also reacting to other substances in the environment, such as pollens (hay fever). Therefore, food allergies may flare up during pollen season.

Have your child stop eating the suspected food for 2 weeks. Record in the diary any symptoms that your child has during this time. If you have eliminated the correct food from the diet, your child should stop having allergic symptoms. Most children improve within 2 days. Almost all of them improve after 1 week of not eating the food causing the allergy.

Have your child start eating the suspected food again. (CAUTION: Never do this if your child has had a severe or anaphylactic reaction to a food). This is called "rechallenging" and the purpose is to prove that the suspected food is definitely the cause of your child's symptoms. Give your child a small amount of the food you think is causing the allergy. The same allergic symptoms should appear within 10 minutes to 2 hours after the food is consumed. Call your child's physician before you rechallenge.

Treatment of Food Allergies

Your child should avoid eating the food that causes the allergy. This should keep your child free of symptoms. If your child is breast-feeding and is allergic to a food that you are eating, do not eat this food until your child stops breast-feeding. Food allergens can be absorbed from your diet and enter the breast milk. Talk to a nutritionist if you have questions.

Consider avoiding other foods in the same food group. Some children are allergic to two or more foods. Occasionally the foods belong to the same food group. This happens most often to children who are allergic to ragweed pollen. These children often react to watermelon, cantaloupe, muskmelon, honeydew melon, and other foods in the gourd family. Children allergic to peanuts may react to soybeans, peas, or other beans. Most nuts from trees are not related to each other. For example, a child who is allergic to walnuts will probably not be allergic to other tree nuts.

Provide a substitute for any missing vitamins or minerals. Eliminating single foods from the diet usually does not cause any dietary problems. However, if you eliminate a major food group, you will need to make sure your child gets all the nutrients he or she needs from other sources. For example, if you eliminate dairy products, your child will need to get calcium and vitamin D from other foods or supplements. Talk to your physician or a nutritionist about dietary supplements (such as vitamins).

Your child should try eating the food again in about 3 to 6 months. (CAUTION: Never do this if a child has had a severe or anaphylactic reaction to a food. Such a child should avoid that food for the rest of his life. You should also keep emergency kits with epinephrine-loaded syringes at home, at school, and in the car). Many food allergies are temporary. If a child is less than 3 years old, he or she should try eating the food every 6 months until the age of 3. If the child continues to react to the food each time, get an evaluation by a board-certified allergist before you permanently eliminate the food from the diet.

Preventing Food Allergies in High-Risk Children

Children are more likely to have allergies if they have parents, brothers, of sisters with asthma, eczema, severe hay fever, or food allergies. The risk is highest if both parents are allergic to foods.

The onset of allergies in these children may be delayed if you are careful about their diet. If possible, they should breast-feed until they are at least 1 year old. The mother should avoid eating or drinking milk products, peanuts, and eggs during this time. If the mother cannot breast-feed during the first year, she should use either a formula made from protein hydrolysate (called an "elemental formula"), or a soy protein formula.

The allergy-prone child should not have any solid foods until the age of 6 months. Try to avoid milk products, eggs, peanut butter, soy protein, fish, wheat, and citrus fruits in the child's diet during the entire first year of life. Try to avoid peanuts and fish until age 2 years.

RECOMMENDED READING: FOOD ALLERGY: A Primer for People; by S. Allan Bock; Vantage Press, 1988.

Adapted from “Your Child's Health,” by B.D. Schmitt, M.D., Bantam Books.
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Foods with Highest to Lowest Allergy Potential

In each of the following food group lists, foods with the highest allergy potential are closer to the top of the list while foods with the lowest allergy potential are closer to the bottom of the list:

Grains & Flours

Wheat, Triticale, Semolina, Bulgur, Spelt, Kamut

Corn

Oats

Rye, Barley

Brown rice, White rice, Wild rice

Quinoa

Buckwheat (kasha)

Amaranth

Tapioca, Cassava

Saga, Arrowroot, Millet

Vegetables

Tomato, Spinach, Celery (raw)

Carrot (raw), Green pea, Lima bean, Broad bean (fava bean), Cabbage

Cauliflower, Brussel sprouts, Green bean

Avocado, Cabbage (outer leaves)

Onion, Green onion, Garlic

Celery (cooked), Green/red peppers

Potato, Cucumber, Lettuce

Asparagus, Broccoli, Beets

Squashes (all types)

Carrot (cooked), Parsnip

Turnip, Sweet potato, Yam

Fruits

Strawberry, Raspberry, Orange, Fig, Mango, Watermelon

Apple (raw), Apricot (raw), Peach (raw), Date, Cantaloupe

Pineapple, Raisin, Apple (cooked)

Kiwi, Cherry, Plum/prune, Apricot (cooked)

Loganberry, Boysenberry

Plantain, Banana, Grape

Grapefruit, Lemon, Lime

Currants (red and black)

Peach (cooked/canned)

Cranberry, Blackberry, Blueberry

Pear

Rhubarb

Nuts & Seeds

Peanuts, Hazelnuts (filbert)

Walnut, Pecan, Brazil nut, Almond, Sesame seed

Cocoa bean, Chocolate, Coconut, Flax seed

Cashew, Pistachio, Macadamia

Legumes: Soy bean, Dried pea, Lentils, Dried bean, Navy, Pinto, Garbanzo, Carob, Sunflower seed

Pumpkin seed

Bean sprouts

Poppy seed

Proteins

Egg white, Egg yolk

Shellfish: Crab, Lobster, Prawn/Shrimp
Mollusks: Clam, Oyster, Scallop

Fin fish: Cod, Sole

Other White fish: Tuna, Salmon

Processed meats: Pepperoni, Salami, Bologna, Hot dog, Ham, Bacon

Pork

Chicken, Beef, Veal

Wild meats: Deer, Elk, Moose, Bear, Buffalo

Turkey, Lamb, Rabbit

Dairy

Ice Cream

Cow's milk: Homogenized, Raw, 1%, 2%, Skim

Fermented cheese: Cheddar, Camembert, Blue, Swiss, Edam, Mozzarella, Goat

Cottage cheese, Cream cheese

Cream, Sour cream

Canned milk (evaporated)

Goat milk, Sheep milk

Processed cheese

Cream cheese

Yogurt, Buttermilk

Butter

Clarified butter

Sequence of Adding Solid Foods for the Allergic Infant

Time of Introduction	Grains / Cereals	Vegetables	Fruits	Proteins	Dairy	Nuts, Seeds & Other
Six to nine months	Rice Millet	Cooked: Yam Sweet Potato Squash (all types) Carrot Beet Broccoli Potato Green bean Cabbage	Cooked: Pear Peach Banana Apricot Nectarine Blueberry	Lamb Turkey	Breast milk If absolutely necessary, casein hydrolysate formula	None
Nine to twelve months	Barley Rye Oats	Asparagus Avocado Cauliflower Brussel sprout	Plum Prune Pineapple Grape Apple (cooked) Cranberry Raisin	Chicken Veal Beef	Breast milk or casein hydrolysate formula	None except vegetable oils in formula
Twelve to 24 months	Corn Wheat Other grains	Green pea Spinach Tomato Celery Cucumber Lettuce Onion Garlic Lima Bean Broad Bean Other legumes including soy Any raw vegetable	Citrus fruits: Orange Grapefruit Lemon Lime Berries: Strawberry Raspberry Other: Melons Mango Fig Date Cherry Any raw fruits	Ham Pork Fish Egg	Yogurt (plain) Homogenized milk White cheese Cottage cheese	Seed oils: Canola Safflower Sunflower
After two years	All	All	All	Shellfish	All others including ice cream	Peanut Nuts Chocolate Seeds