My granddaughter’s doctor has diagnosed her with food allergies, and I am very worried. What does this mean? She is not a good eater as it is, and I am concerned she will become malnourished.
A true food allergy, as opposed to food intolerance, is an allergic response to certain foods (not all). It involves an activation of the body’s immune system in such a way that an inflammatory reaction takes place. We call this an immunoglobulin E-mediated immune response.
Though up to 25 percent of adults may report symptoms related to certain foods, only about 3 percent are truly allergic to food. Children are more likely to manifest food allergies, and 6 to 8 percent of children in the United Kingdom and the United States are thought to have food allergies. Cows’ milk, hens’ eggs, peanuts, tree nuts, and sesame seeds account for the majority of children’s allergies, with kiwi fruit being a newcomer to the group. Egg and peanut allergies are the most likely childhood allergies; and in the case of egg allergy, some 66 percent will resolve and disappear by age 5, and 75 percent by age 7 or 8.
Symptoms of a food allergy range from hives (an itchy, red, raised rash) to life-threatening anaphylaxis (throat constriction, breathing difficulty, and collapse). Persons with food allergies often have eczema, a chronic skin disease characterized by inflamed and, at times, blistered skin, which often affects elbows and knees over their flexor surfaces.
Asthma and allergic rhinitis are more common in children with food allergies.
It should be obvious that avoidance of relevant foods will reduce symptoms. The problem comes when there are multiple food allergies. Consultation with a trained dietitian is invaluable in getting help, and we urge you to encourage such a consultation. Dietitians are trained to give advice that will ensure adequate nutrition and prevent secondary deficiencies. When dealing with multiple food allergies, children thrive and grow optimally when managed by a team approach of dietitians, nurses, and physicians. Potential problems of rickets, anemia, impaired growth, and osteoporosis in adulthood can thus be avoided.
Occasionally, acute symptoms will be encountered. If there is an anaphylactic reaction, prompt and appropriate management is required, which will include rapidly acting antihistamines and intramuscular epinephrine, inhaled bronchodilators, and corticosteroids. Anaphylaxis should not be underestimated—it can be very serious. Intramuscular epinephrine should be given in the lateral thigh. Delay in the use of epinephrine can prove fatal. A child with a history of anaphylaxis should have instant access to epinephrine, which is available in special one-dose injection kits produced especially for such eventualities.
While it is appealing to think exclusive breast-feeding might reduce immunoglobulin E-mediated food allergy, this has not been shown in studies. A reduction in eczema has been noted, but not in food allergy. In contrast, in the mouse model, early exposure to food antigens has reduced food intolerance.
Fortunately, the majority of children with food allergies find the allergies disappear or are reduced as they reach adulthood.
Skin-prick testing and a detailed history delineate the problem; acute reactions are controlled by a kit for emergencies, and team management will improve outcomes.
Resources are available online for those dealing with food allergies. These are the American Academy of Allergy, Asthma, and Immunology (www.aaaai.org), the Food Allergy and Anaphylaxis Network (www.foodallergy.org), and the Anaphylaxis Campaign (www.anaphylaxis.org.uk).