Childwise: Dealing with Food Allergies in Children

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Childwise is a medical advice column for parents of children ages birth to 21. 

By Kathleen Ganster

It sounds cliché, but what happened with Andy Winzen is something no parent wants to see happen to her child.

At only 18-months old, soon after Andy ate some peanut butter, his lips and eyes began to swell and his face covered in hives. When he began to vomit, his mother, Addie, called 911 and he was rushed to Children’s Hospital.

Fortunately, Andy survived his first allergic reaction to peanuts (he is also allergic to all tree nuts), but according to Winzen she and her husband, Uwe, must be ever-vigilant about exposure for Andy.

“There is no cure for food allergies, so the dangers that exist for our son is that he may be accidentally exposed to one his allergens,” she said.

So how do you know if your child has allergies?

According to Todd Green, Assistant Professor of Pediatrics, Children’s Hospital of Pittsburgh, and allergist/immunologist and director of UPMC fellowship in allergy/immunology, there are numerous types of adverse reactions to foods, but it also important to know that there can different adverse reactions to food.

“Allergic reactions are just one group. For instance, lactose intolerance is different from milk allergy; the former results from trouble digesting the sugar in milk — and is not diagnosed by allergy testing — while the latter represents an immune reaction to a protein in milk,” he explained.

Dr. Todd Green

Dr. Green said that when most allergists use the term allergy, they are referring to a specific immune response to a food that typically is not subtle – a reaction like Andy’s.

“Reactions tend to occur very quickly, often as an individual is eating a food, and are reproducible, so that every ingestion of a food that a child is allergic to should lead to a reaction.”

The reactions can involve skin symptoms (redness, flushing, hives, itching), but can involve other signs and symptoms as well, including vomiting, repetitive, coughing, wheezing, and others, said Dr. Green.

“They can also lead to anaphylaxis, which is a severe allergic reaction that also tends to occur rapidly and in the most severe cases can be fatal,” he said.

Parents shouldn’t panic, however. Dr. Green said that death from food allergies is extremely rare.

According to Dr. Green, milk, egg, wheat, soy, and peanut explain at  least 90% of food allergies in young children and in older children and adults, peanuts, tree nuts, fish, and shellfish are most the most common allergens.

Food allergies occur more often in children with a parent or sibling with allergies, as well as in children with a history of eczema, asthma, and environmental allergies, so if you have a family member with an allergy, that may be a warning signal.

“Epinephrine is a very effective medicine for treating allergic reactions, and many individuals with food allergies should carry this in a self-injectable form — for example, EpiPen,” he said.

The Winzen family always carries Andy’s epinephrine auto-injector, said Addie, and read every label every time. They also never eat out without careful research.

“We also spend time making sure friends, family members, neighbors and school personnel are aware of his allergies and the measures that are necessary to keep him safe,” she said.

There are numerous resources for families such as the Winzens including local conferences and groups. Dr. Green serves on the medical advisory team for Kids with Food Allergies Foundation, a national nonprofit group dedicated  to educating and improving the quality of life for children with food  allergies and their families, just one source for more information.

If a parent suspects her child might have a food allergy, Dr. Green said to reach out to their pediatrician or primary care physician.

“The history is extremely important. Allergy testing with blood work or skin testing should generally be avoided unless the history is suggestive, since it is possible to test positive on one of these tests and not be clinically allergic to a food,” he cautioned.

“Parents should have a thorough discussion with their physician, and then the appropriate testing can be ordered,” said Dr. Green.

Parents can find a board certified allergist immunologist through the American Board of Allergy and Immunology website: www.abai.org.

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