Food Allergies: How to Help Your Child Stay Safe

Food allergies can affect children of all ages – from infants to young adults – with mild, severe or even life-threatening reactions. If your child has a food allergy, how can you ensure they’re safe when they’re not at home?

What is a Food Allergy?

A food allergy is different than food intolerance. A food allergy is an immune system response to a food. “Unfortunately, many types of food reactions are mistakenly considered allergic,” explains University Hospitals Rainbow Babies & Children’s pediatric allergy and immunology specialist Kathryn Ruda Wessell, DO.

“But some of these aren’t caused by an immune system response. Lactose intolerance to cow's milk is a good example of a food reaction that is not a food allergy. Symptoms like bloating, nausea and diarrhea aren’t allergic, but rather are due to a lack of enough lactase enzyme in the digestive tract to effectively break down the lactose sugar in milk.”

Two Types of Food Allergies

Food allergies are broken down into two main types based on the immune system’s response: Immunoglobulin E (IgE) and non-IgE food allergies.

• IgE food allergies. The immune system sends antibodies into the bloodstream, which causes the release of histamine and other substances. Histamine causes symptoms such as coughing, wheezing and hives. Reactions occur quickly – from minutes to a few hours after ingesting the food. IgE food allergies can trigger anaphylaxis, a life-threatening emergency that causes difficulty breathing.
• Non-IgE food allergies. The immune system responds with other reactions, not antibodies. Symptoms are delayed and can take hours to appear. They may include eczema and other rashes, and intestinal distress such as vomiting and diarrhea.

Common Food Allergies

Nine foods account for 90 percent of food allergy reactions:

• Milk
• Egg
• Peanut
• Tree nuts
• Wheat
• Soy
• Fish
• Shellfish
• Sesame

The two most common IgE food allergies in children are cow's milk and eggs. Most patients who have an IgE allergy to cow's milk can’t tolerate milk from goats or other mammals either. Fortunately, milk and egg allergies also the most common food allergies that children can outgrow.

The most common foods that trigger non-IgE food allergies are cow’s milk and soy proteins in infants. Wheat is a common cause of non-IgE food allergyies in older children.

Diagnosing and Testing for Food Allergies

• Clinical history and exam. Diagnosing food allergies begins with the child’s and family’s health history and physical exam. The best indicator of an IgE food allergy is a description of symptoms or reactions to the food.
• Skin prick testing is performed in the office to see if scratching the skin with an allergen causes a hive reaction on the skin where the skin is scratched.
• Blood testing measures the IgE antibody level that a patient makes to an allergen.
• Food challenge test. “Typically both skin prick and blood tests are performed to diagnose food allergies,” says Dr. Ruda Wessell. “But the gold standard to diagnose an IgE food allergy is an in-office, provider-guided food challenge. The patient consumes a small amount of the food in age-appropriate amounts under close observation to assess symptoms, with access to medications to treat an allergic reaction if it occurs.”

Treating Food Allergies

Antihistamines are safe and effective for mild food allergy reactions and can be purchased over the counter, without a prescription.

If an allergic reaction occurs quickly and worsens after using an antihistamine or causes a variety of symptoms, epinephrine is the most effective medication to prevent it from progressing. Also known as an EpiPen, it’s the best treatment for anaphylaxis, a serious and life-threatening condition. For any severe allergic reaction, use epinephrine, then call 9-1-1 and/or go to the emergency department immediately.

Non-IgE food allergies do not occur quickly and are not usually life-threatening. The best treatment is to simply avoid the food.

Keeping Kids Safe

Parents can help kids with food allergies stay safe when they’re not at home by teaching them to follow these recommendations:

• Avoid the foods you are allergic to as much as possible.
• Read every label every time for the ingredients. Ask a parent or teacher if you need help or if you aren’t sure about what you’re being served.
• Watch for menu information or signage about allergens at restaurants.
• If you’re unsure of what is in the food product, don’t eat it.
• Have your epinephrine device with you everywhere, at all times: at school, at work, going to a friend’s house, playing sports, on vacation, etc.

Two Rules for the Road

“There are no tests that can predict the severity of a food allergy reaction,” says Dr. Ruda Wessell. “Testing simply provides information on the probability of an IgE food reaction. And a previous reaction to a food does not predict a future reaction to the food. Based on this fact, we encourage every food allergic patient to carry an epinephrine device to be prepared no matter what the future reaction may be.”

“You can live a happy and normal life with food allergies, especially if you follow the two most important recommendations: read every ingredient list and have access to your epinephrine device at all times. Children with food allergies don’t have to feel isolated or embarrassed by their food allergy. They can safely participate in normal daily activities. I view my patients and myself as a team, and together we can determine the best practices to keep them comfortable and safe with their food avoidance strategies.”

Related Links

The experts at University Hospitals Rainbow Babies & Children’s Pediatric Allergy and Immunology Division provide exceptional care for the full spectrum of food allergies. Learn more.