It’s one of the most anticipated milestones of baby’s first year: the introduction of solid food. How fun it is to watch a child delight in the first sweet taste of bananas or perhaps snarl in disgust when presented with a taste or texture they’re not fond of. However, when your child exhibits an allergic reaction to a new food, meal times can quickly become stressful and even frightening.
By Mandy Hughes Jackson
Food allergies are typically identified in childhood. The most common food allergies are peanuts, tree nuts (pistachios, almonds, cashews, pecans, walnuts, pine nuts, Brazil nuts, hazelnuts and chestnuts), milk, eggs, wheat, soy, shellfish and finned fish.
A food that causes an allergy is called a food allergen. Usually it is the protein in a food that causes the problem. Eggs, milk, wheat, soy and peanuts cause most problems in children. Peanuts, tree nuts, fish and shellfish cause most problems in adults.
Food Allergy Symptoms
Food allergies can cause many different symptoms, ranging from mild to serious. Typical symptoms may include:
• A tingling feeling in the mouth and swollen lips.
• Cramps, an upset stomach or diarrhea.
• Itchy skin with hives.
• A stuffy nose, wheezing or shortness of breath.
• Dizziness or lightheadedness.
Children usually have the same symptoms as adults. Typically, an allergic reaction will cause a child to cry a lot, vomit or have diarrhea. If your child displays these symptoms, call your doctor right away.
The most severe allergic reaction is called anaphylaxis, which affects the entire body. Anaphylaxis usually starts within an hour after eating the problem food, and the symptoms can come back one to two hours later. Anaphylaxis can cause the following reactions:
• The throat and tongue may swell quickly.
• Wheezing or breathing problems.
• Vomiting or stomach ache.
• Feelings of faintness or passing out.
Anaphylaxis can be deadly. If you or anyone else exhibits any of these symptoms, call 911 immediately.
Identifying Food Allergies
Dr. Susan Raschal of Covenant Allergy & Asthma Care says, “If your child, especially a young baby, is behaving differently or being particularly irritable, you may want to modify their diet to see if there’s a change.” Even breastfed babies who have not tried solid food can present food allergy symptoms if they’re allergic to something the mother has eaten.
Once a food allergy is suspected, it is important to make an appointment with an allergy specialist to confirm. The first step is a skin test. A positive skin test to a specific food concludes about a 50 percent chance that there is a food allergy present. The next step is a blood test called a CAP RAST, which confirms or denies the allergy and also rates the severity if it is present.
Preparation is Critical
There are no medications to prevent allergic reactions, so once a food allergy diagnosis is made, Raschal says it is critical to be prepared, informed and educated.
Every year in the U.S., 150 to 200 people die from anaphylaxis after eating foods they are allergic to. Immediate treatment with injected epinephrine can keep these allergic reactions from becoming life threatening. Therefore, it is recommended that children and adults with a history of severe food allergy reactions carry injectable epinephrine at all times. The most widely prescribed self-administered epinephrine is the EpiPen® auto injector.
Anyone involved in the care of a child with severe allergies should be trained in how to use injectable epinephrine.
It is important to be aware of all foods that contain specific food allergens. Additionally, everyone who cares for a child with severe food allergies should be educated about the seriousness of those allergies. Raschal recommends that a food warning letter be sent to school or day care and the child wear a medical ID bracelet after an allergy is determined.
“It’s important to realize that food allergies can be deadly,” Raschal says. “When taking a child with a food allergy out to eat, I tell my patients to tell restaurant employees, ‘My child could die if they ingest this certain food,’ rather than simply saying, ‘My child is allergic to this food.’”
Many children outgrow their food allergies, depending on the type of food they are allergic to. “In six to 12 months, we bring the child back to repeat the blood test,” says Raschal. “If the CAP RAST severity is lower, we can challenge the allergic reaction in a moderate, controlled environment.” After monitoring the child’s vitals, Raschal will give the child a minute amount of the offending food, gradually increasing the portion if no reaction or change in vitals occurs, to see if the allergy still exists.
The link between food allergies, asthma and skin conditions like eczema and atopic dermatitis has caught the interest of researchers in the past few years. “It’s called the ‘allergic march,’” Raschal says. “Forty percent of children with eczema or atopic dermatitis by age six weeks have a food allergy and may develop asthma. We are starting to recognize the importance of controlling the allergic march at an early age.”
Dr. Marc Cromie, an allergist with Chattanooga Allergy Clinic, says adults often mistake a food sensitivity or food intolerance for a food allergy. A food sensitivity or intolerance, which frequently presents symptoms such as diarrhea or bloating, does not involve the antibodies present in an allergy.
Cromie says it is uncommon to discover a new food allergy as an adult. “The only time this happens is if they’ve never been exposed to a food before,” he says. “For example, if they add pine nuts to their salad and they’ve never eaten them before.”
The good news is that food intolerance is easier to deal with. “Patients can add lactate powder to foods like milkshakes so they can tolerate them,” Cromie says.
An intolerance to gluten is sometimes misidentified as a wheat allergy, but it is actually a separate disorder. Rather than an antibody that attacks food proteins, it is actually an autoimmune disorder called celiac disease. Some of the symptoms are the same as a food allergy, including abdominal bloating and pain, chronic diarrhea, vomiting and constipation; however, celiac disease does not typically cause hives, shortness of breath or anaphylaxis.
Kelly Brexler, co-founder of Gluten Free Chattanooga, has a 4-year-old son with celiac disease. “His stomach hurt all the time, he would vomit and complained of his joints hurting all the time,” Brexler says. “We went through several tests – blood, stool, etc. – and were told that he could have cancer, juvenile arthritis, Crohn’s disease, etc. Finally, after a lot of Internet research, it appeared to me that celiac was the issue.”
One of the hardest issues facing children with celiac disease is that gluten is in a great deal of the foods American children eat, such as chicken fingers, cupcakes, sandwiches and pizza.
Brexler stresses yearly blood testing and “110 percent adherence” to a glutenfree diet as the best ways to combat the disease. Visit www.glutenfreechatt.org for more information.
For the 11 million Americans living with food allergies, grabbing a quick meal is not so simple. However, there are many foods and substitutes on the market today that provide easy and enjoyable alternatives for those who suffer from allergies and digestive disorders. While there are no easy answers to these issues, with a little planning and a lot of communication, daily dining doesn’t have to be a struggle.
Mandy Hughes Jackson is a native of Chattanooga. She has a degree in communication from the University of Tennessee at Chattanooga. Mandy and her husband, Chris, have two children and live in Falling Water, Tenn.