Managing food allergies in children

Published on Tue Nov 23 2021 in Family

Most food allergies begin in early childhood¹, so it is no surprise that when a child starts eating solids, allergy awareness is top of mind for parents. In fact, it is not unheard of for some parents to give the first taste of peanut butter to their child in the hospital carpark, for fear of an allergic reaction. It is a growing concern amongst parents because the actual rate of food allergies is growing worldwide (3% of the population in 1960 compared to around 7% in 2018²).

Because food allergies were rare when today’s parents were children, getting a diagnosis was much more difficult. The diagnostic tests of today didn’t exist, so diagnosis usually followed a strict elimination diet, which could take months to identify the specific cause of the allergic reaction. In this pre-internet era parents were also often in the dark about what was causing the health issue in their children as it was rare to find another parent experiencing the same issues and literature was mostly limited to journals written for medical professionals.

What is a food intolerance?

While some symptoms of food intolerance and food allergies can be similar, it’s important to note the difference.

A food intolerance is when the body has a chemical reaction to a particular food or drink and the body cannot properly digest it or the food might irritate the digestive system. This reaction does not involve the body’s immune system. Typical symptoms of food intolerance include nausea, gas, cramps, belly pain, diarrhea, irritability or headaches.

Common food intolerances include lactose intolerance or coeliac disease.

What is a food allergy?

A food allergy occurs when the body’s immune system over-reacts to an allergen in food, creating a histamine reaction. An allergen is anything which triggers this immune response for a particular person. Therefore, what can be a harmful allergen in some people, is completely harmless in most other people.

Allergic reactions can present in different ways and with a different level of severity for everyone. Some people may have a mild reaction to an allergen, giving them mild symptoms, such as nausea or itching. Whereas the same allergen may cause a severe anaphylactic reaction in others causing, swelling of the airways, breathing difficulty and even death.

Not only can the severity of reaction vary, so can the degree of sensitivity. Some people may need to ingest the allergen to have a reaction, where others may only require skin contact, or to be in the same room as the allergen for it to have an effect.

What are the most common food allergies?

In addition to the rate of food allergies, the number of foods people are reacting to is also increasing.

The most common food allergies are to:

cow’s milk
eggs
peanuts
tree nuts like almonds and cashews
soy
fish
shellfish
wheat
sesame seeds

In New Zealand, these ingredients must be listed on food labels, even if the product only contains very small amounts of them³.

Introducing first foods

Whilst it may be tempting to avoid the above as first foods, the current advice for parents when introducing solids is to not put off potential allergen foods and in fact try to feed these earlier rather than later. Research shows that early exposure (before 12 months) can in fact help prevent a food allergy from occurring. New foods however should be introduced one at a time with a few days between each one to make identifying any allergy easier⁴.

What is the cause of food allergies?

Researchers do not know why there is a growing occurrence of food allergies, nor what causes them, however there is some evidence to suggest that there is a macrobiotic link between gut bacteria diversity and the prevalence of allergies. Also, whilst not hereditary, food allergy is more likely to develop if either of the parents have any food allergies⁵.

What are the typical signs and symptoms of an allergic reaction?

It is important for parents to look out for signs that their child is having an allergic reaction when trying new foods for both the first and second time as some reactions occur on the second exposure, rather than the first. Symptoms may appear a few seconds or minutes after exposure to the food.

Below are signs for parents to look for⁶:

tingling or itching in the mouth
itchy red rash
swelling of the face, mouth, throat or other areas of body
difficulty swallowing
wheezing or shortness of breath
feeling sick or vomiting
abdominal pain or diarrhoea
hay fever-like symptoms, such as sneezing or itchy eyes

Severe reactions are known as anaphylaxis and can be life threatening. Urgent medical treatment should be sought if either of the following are present⁷:

any severe symptoms, such as trouble breathing, repeated vomiting, passing out, or throat tightness
two or more mild symptoms, such as hives and vomiting or coughing and belly pain

How are food allergies diagnosed in children?

Should your child develop mild symptoms, your family GP is the first step in getting a food allergy diagnosis. They can usually diagnose based on examination and the parents’ description of symptoms; however, it the child may also need to complete an allergy test to identify any other foods of concern. These tests usually consist of a blood test and/or a skin prick test where allergens are applied to the skin and monitored for a reaction. Referral to a specialist is sometimes required for this.

How to manage a food allergy in children

Unfortunately, there is no cure for food allergies and management of the condition is largely based around the avoidance of the allergen. The good news for some parents is that most children who are allergic to cow's milk, soy, wheat or egg will ‘outgrow’ their food allergy⁸. Unfortunately, there is no evidence that allergies to other foods will desist over time.

If your child has had a serious reaction in the past, they may need to always carry an Epinephrine Auto-Injector (Epipen) with them to be used in the event of another serious reaction. For young children, all carers should be trained in how to use the device, when needed.

Look for hidden allergens

As a parent of a child with food allergies it is important to practise careful examination of all food labels and be aware that some allergens go by different names in ingredient lists, such as ‘natural flavouring’. Allergens can also be hiding in some non-food-items⁹ such as:

medications
vaccines
dental supplements
anaesthetics
beauty products such as lip balm and gloss
hair care products
craft materials
compost or fertilisers used on food
pet food
health supplements
cosmetics and soaps

Managing allergies at pre-school and school

Most pre-schools and schools are well versed in managing allergies, and you’ll likely find policies already in place for the most common allergens such as nuts. You should advise your school of any allergies upon enrolment and find out what policies they have or can put in place to protect your child from exposure. The level of intervention will depend on the type and severity of allergy and your child’s age. More protection would likely be put in place for younger children, who may struggle to manage their own exposure to allergens.

Teaching your child to only eat food bought from home is essential for allergen avoidance. However, there may be times where children have exposure to food not bought from home such as sports day canteens, co-curricular activities, and class parties. Parents will need to check with suppliers and potentially provide safe alternatives for their child.

Resources for parents

There is a wealth of information about food allergies on the internet, however for the most up to date information that is relevant for your child it is suggested that you speak with your family doctor, Plunket nurse, or call the Plunket parenting helpline on 0800 933 922.

About Author: Momentum Life is a leading provider of Life insurance and Funeral insurance in New Zealand.

1. Food allergies | Health Navigator NZ
2. Why food allergies are on the rise - BBC Future
3. Food allergies » Plunket
4. Food allergies » Plunket
5. Food allergies | Health Navigator NZ
6. Difference in food allergy and intolerance | Health Navigator NZ
7. Serious Allergic Reactions (Anaphylaxis) (for Parents) - Nemours Kidshealth
8. Food allergies | Health Navigator NZ
9. Top Allergens: Places Where They Hide - Allergic Living

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