Food Allergies

Dear Lisa,

Now that my daughter is one year old, my Pediatrician told me that it is time to start introducing table food. The thing that worries me is that I have two nephews with food allergies and I have seen how much it affects their lives. I ’m afraid that my daughter is going to develop food allergies too, so I prefer to be very cautious when giving her new food. Please tell me what types of food are most likely to cause food allergies. What are the signs of food allergy that I should look for? Is there anything that I can do to prevent her from developing a food allergy?


“Worried About Food Allergies”

Dear “Worried About Food Allergies’,

At one year old a child is developmentally ready to eat table food. Different tastes, textures and temperatures of food will help her learn and strengthen the muscles in her mouth which will eventually help her speak. Although this is a necessary step, it is also difficult for many parents because of the fear of food allergies. When choosing table food it is much harder for parents to decipher which foods are appropriate and safe for their children.

If you follow a few simple steps, it can help the transition from jarred food to table food go more smoothly. When introducing new food, make sure that you introduce one new item at a time. This way if there is an allergic reaction you will know which food is the culprit. Secondly, when introducing highly allergic foods, start by giving only small amounts at a time. The severity of an allergic reaction can vary due to quantity of the food ingested. (1) Therefore if you start with a smaller amount, it is more likely if a reaction occurs that it would be mild and easier to handle. Know the signs of a food allergy and observe for them when introducing highly allergic food to your child.

The foods that tend to cause allergies in children include cow’s milk, eggs, peanuts, tree nuts (such as walnuts, hazelnuts, Brazil nuts and Pecans), fish, shellfish, soybean and wheat. (1,2) The important thing to remember when introducing table food is that these allergic items may be hidden ingredients in foods when you may not suspect it. (1) For example milk may be hidden in deli meats when the slicer is used for both meat and cheese. Some meats may have casein (one of the proteins found in milk) as a binder. Powdered milk may be added to products such as pancake mix, spices or tuna fish to prevent the item from clumping.

Peanut oil may be a hidden ingredient in red sauce used to make pasta dishes or Pizza. In certain restaurants, peanut oil may be used to coat the pan when cooking ethnic dishes such as Mexican food, Asian food, Vietnamese foods or Thai food. (1) Therefore, if you give your daughter a dish and she develops a reaction you can not assume that the reaction is due to the obvious item, because it may be due to a hidden ingredient.

Signs of an allergic reaction include; hives, flushing, facial swelling, nasal congestion, itchiness of the ears, itchy mouth, itchy throat, swelling of the tongue, cough, trouble breathing, itchiness of the skin and vomiting. (1,2) It is important to remember that young children may not be able to tell you how they feel. If their mouth and throat is itchy they may react by putting their hands in their mouth or spitting out the food. Sometimes the first sign that a child is allergic is they spit out the food. The interesting thing I found when leading a support group for parents with food allergic children is that many of the parents reported remembering their child repeatedly spitting out the foods that they eventually ended up being allergic too.

If your child develops allergic symptoms when introducing a new food the first thing to do is to remove the offending item. Thoroughly rinse the child’s face, neck, hands and whatever part of the body that the food came into contact with. Contact your child’s doctor and inform him of the allergic reaction and follow the instructions given regarding treatment and follow up. For severe allergic reactions where facial swelling occurs and the child’s breathing is affected, contact the Emergency Medical Services without delay.

Once it has been determined that a child had an allergic reaction it is important to keep a log recording the incident. The log should include the type of food ingested, the time the food was eaten and the time and type of reaction. Keeping a log is important because sometimes it is difficult to identify the offending food. Keeping a log can help you determine the offending item over time.

In other cases, there may be more than one offending food. Some reactions only occur in combination with other foods or activities, such as in the case of Exercise-Induced Allergic Urticaria/ Anaphylaxis. (1) Exercise Induced Anaphylaxis occurs when a child ingests an offending food, such as celery, and then engages in exercise like jogging for example. The allergic reaction only occurs when the two situations occur together. If the child ate celery and did not exercise, there would be no allergic reaction. In the same instance if a child exercised and did not eat celery before engaging in the sport, there also would be no reaction.

Children with food allergies should have an evaluation by a board certified Allergist. (1, 2) Blood or skin testing should be performed in order to verify the food allergy and an emergency treatment plan should be reviewed in case there is an accidental ingestion. Regular follow up visits are recommended because in time, many children do outgrow some food allergies. (3) Allergies to peanuts, tree nuts and seafood are likely to continue throughout a person's life. Although, it is expected that about 20% of children with peanut allergies will loose their sensitivity. (3)

If an Allergist confirms that your child has a food allergy there are measures that you should take to keep your child safe. The best prevention is avoidance of the allergic food. Many times you may not only have to avoid the allergic food, but you may need to avoid all foods in the same class. With some food families, especially tree nuts and seafood, an allergic sensitivity to one food in a group may confer an allergic sensitivity to other foods in the same group.(1) For example if a person is allergic to Almonds there is a greater chance that they are also allergic to Pecans because they are in the same family.

Parents should read the food labels of everything that their child eats to make sure the allergic item is not a hidden ingredient. (3) You will also need to teach your child’s caregivers about the allergy and the need to read all food labels. Since anyone with a food allergy could have a severe reaction or life threatening reaction from such minimal exposure, an Epipen should be carried at all times and all caregivers should be trained how to use it. (2) The new guidelines recommend carrying two Epipens because an anaphylactic reaction may be prolonged and two doses may need to be given. (3) It is also important to make sure your child wears a Medic Alert bracelet listing his food allergy. (1)

In regards to your question about what you can do to prevent food allergies; it is a good idea to wait until your child is between 2 and 3 years old before introducing peanuts and tree nuts. It is believed that the avoidance of nuts early in a child’s life may prevent a child from developing a food allergy. (1) Since 80% of children with Peanut allergy will not outgrow their allergy, this extra effort early in life may prevent a lot of grief in the future.

For more information about Food Allergies contact:

The Food Allergy and Anaphylaxis Network (FAAN)

(1)Bassett CW. What to do when foods become allergens. The Clinical Advisor. 2005. Dec:43-48.
(2)Grassia T. The diagnosis of food allergy is ‘an inaccurate science’. 2006 Jan:52-53.
(3)Lieberman PL. Diagnosis and treatment of anaphylaxis: How can we do better? Presidential plenary session. Presented at: 2006 Annual Meeting of the American Academy of Allergy, Asthma and Immunology; March 3-7, 2006: Miami Beach, Fla.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily