Food Allergies in Babies and Toddlers

If you are concerned your baby or toddler may have a food allergy, you’re not alone. Food allergies are quite common today. According to research, nearly 5 percent of children under the age of five years have food allergies. It’s important to get the facts, consult with your physician and take the right steps to keep your little one safe. If you believe your child is having an anaphylactic (severe) reaction, emergency treatment is critical. If left untreated, anaphylaxis can cause a coma or even death. Read on to learn more about food allergies and what you can do as a parent to protect your child.

What is a food allergy?

Food Allergy Research and Education (FARE) classifies a food allergy as a medical condition. It can occur at any age, including babies and toddlers. According to John Hopkins Medicine, a food allergy is “an abnormal response of the body to a certain food.” More specifically, the immune system attacks protein(s) in the food. It is not the same as a food intolerance, which does not affect an individual’s immune system, but there may be similar symptoms. Food allergies cause an immune system response, which in turn causes symptoms involving various bodily organs that range from uncomfortable to life-threatening. Although many children “outgrow” their allergies, allergies to peanuts, tree nuts, fish and shellfish are often lifelong.

What causes a food allergy?

Before having an allergic reaction to a certain food, a baby or toddler (or child) would typically have been exposed to the food in question at least once before, or may have been exposed through breast milk consumption. Usually, the second time a baby, toddler or child consumes the food, there is an immune system response and allergic reaction symptoms occur. The body has mistaken food as something harmful. At that time, Immunoglobulin E or “IgE” antibodies (antibodies produced by the immune system) react with the food. Histamines (chemicals made by your immune system that help your body get rid of foreign threats) are released, which can cause your child to experience a wide range of symptoms.

Which foods cause food allergies?

According to FARE, more than 170 foods have been reported to cause allergic reactions. John Hopkins Medicine says approximately 90 percent of food allergies are caused by the following eight foods (also known as the “big eight”): milk, eggs, wheat, soy, tree nuts, peanuts, fish and shellfish. Eggs, milk, and peanuts, wheat, soy, and tree nuts are the most common food allergies in children. FARE says allergy to sesame is an emerging concern. Allergies to milk and soy are typically seen in infants and very young children.

The symptoms for these allergies often include the following: colic, blood in the stool and poor growth. Doctors will often advise parents to change their baby’s formula to a soy formula, hypoallergenic formula or breast milk if it is believed there is a milk allergy. Peanuts, tree nuts, fish and shellfish typically cause the most severe allergic reactions. Keep in mind that food allergens can get transmitted through breast milk.

What are the symptoms of a food allergy in babies and toddlers?

As previously mentioned, babies, toddlers and children will typically experience an allergic reaction to food fairly quickly after the second exposure to it. There are a wide range of symptoms that your child may experience, such as (but not limited to) hives, asthma, itchiness and digestive symptoms such as cramps, vomiting and diarrhea. Food allergies can also cause skin conditions like eczema. Any of these symptoms should be investigated by your child’s doctor as soon as possible. The Mayo Clinic says more serious symptoms can include rapid pulse; drop in blood pressure; trouble breathing due to constriction or tightening of the airways; and/or swelling of the throat, lips, face, tongue or other parts of the body. Seek emergency treatment if your child develops any of these signs or symptoms of anaphylaxis.

Risk factors for food allergies

Risk factors for food allergies include family history, other allergies (if your child has one allergy, it can put them at risk for others) and asthma — asthma and food allergies often occur together. Dr. Thomas Casale, MD, says allergic reactions to food can affect different systems of the body. Dr. Casale serves as FARE’s Chief Medical Advisor for Operations and is also a Professor of Medicine (including in the Department of Pediatrics) at the University of South Florida (USF Health). He says, “An allergic reaction to food can affect the skin, the gastrointestinal tract, the respiratory tract and, in the most serious cases, the cardiovascular system. Symptoms typically appear within minutes to several hours after eating a food to which the baby is allergic. A more comprehensive list of symptoms indicating an allergic reaction to food can be found on the FARE website.” Dr. Casale advises, “in very young children, signs of an allergic reaction can include putting their hands in their mouths, pulling or scratching at their tongues, and becoming hoarse or squeaky. The FARE website also lists some of the language that children might use to describe their allergic reactions.”

One family’s experience

Living in Boston, Melanie Gold’s three year old, Ruth, was diagnosed with an anaphylactic allergy to peanuts and tree nuts. When Ruth was exposed to peanuts she experienced an itchy throat and difficulty breathing. Her pediatrician said these symptoms are common in anaphylaxis. Melanie sought emergency medical attention and Ruth was administered an EpiPen, which treated her immune response. “It was a scary experience to have such a young child diagnosed with an anaphylactic allergy. Over the last few years we have learned how to protect Ruth from any cross contact with nuts and tree nuts through awareness and education. As a family, we are always reading food labels and ‘may contain’ labels. We check and double check with wait staff and chefs at restaurants and we call food producers when in doubt. We inform family, friends, Ruth’s teachers and anyone who has direct contact with her about her allergies and the seriousness of them. Ruth always has an EpiPen in a fanny pack around her waist for any emergency situation. We have social support from other families with children who have anaphylactic allergies like Ruth. My best advice to parents is be brave but always be prepared. We experienced one incident where restaurant staff promised Ruth’s meal was nut free and then she experienced an anaphylactic reaction where we needed to administer her EpiPen. We later found out the meat was cooked in peanut oil and that ingredient was overlooked. Be diligent and always ask questions. Check and double check. Remember you are not alone.”

Although parents of babies need to be aware and diligent, they should not catastrophize about the unknown. A recent study suggests allergic reactions to foods are milder in infants. “We found that infants, unlike older children, have a low-severity food-induced anaphylaxis, which should come as reassuring news to parents who are about to introduce their baby to potentially allergenic foods like peanuts,” says Waheeda Samady, MD, and lead author from Lurie Children’s, who also is an Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “Since early introduction of peanuts is now encouraged by national guidelines, it is understandable that parents might be fearful of triggering a serious reaction.”

What about celiac disease?

Celiac disease (CD) and non-celiac gluten sensitivity (NCGS) are not caused by food allergies. Neither is lactose intolerance. However, some of the symptoms can be similar. While CD is sometimes mistakenly referred to as a gluten allergy, it is actually an autoimmune disease and digestive disorder that does not result in anaphylaxis. It can get confusing because CD can involves an immune system response when gluten (proteins found in wheat, barley, rye and their hybrids) is consumed, but the reaction is more complex than a typical food allergy.

If your child is diagnosed with CD and consumes foods containing gluten, an immune reaction occurs that damages the surface of the small intestine, which causes an inability to absorb certain nutrients. A strict gluten-free diet is the only treatment recommended by medical doctors for celiac disease.

Are there treatments for food allergies?

Regardless of age, there are no medications for food allergies (at the time this article was written). Aimmune Therapeutics, a California-based company, has been working on submitting an orally administered immunotherapy capsule (also referred to as the peanut capsule) for peanut allergies for approval in North America and Europe. In the meantime, the best treatment is prevention of exposure to food allergens. Although it is not considered a cure, the company expects the drug to become available in 2020. Desensitization, the underlying principle behind immunotherapy like the peanut capsule, is being studied to help treat other allergies. “It’s the same mechanism behind allergy shots for dust mites and pollen,” says Dr. Susan Waserman, a professor in the Division of Clinical Immunology & Allergy at McMaster University in Hamilton, Ontario. “The reason it was slow to start for food is in part because of uneasiness around making patients eat something potentially dangerous.” There was an immunotherapy study conducted in Colorado in 1997, where a child died of anaphylactic shock. “That kind of tragedy derails research for a long time.”

What can parents do?

Detection and prevention is key. Seek medical attention if your child displays any food allergy symptoms. Help your child avoid foods they are allergic to. Be aware of ingredients in foods that well-hidden, especially in restaurants and social settings. Here are some helpful tips in random order.

· This is important and could be lifesaving. Speak with your doctor about emergency epinephrine. Your child may need to carry an epinephrine auto-injector (EpiPen, Adrenaclick, Auvi-Q) at home and at school or daycare if he/she is at risk of a severe allergic reaction. Be aware of the expiration dates on auto-injectors. If your child does not have an allergist, you can ask their primary-care provider for a referral.

· There is medical consensus (at the time this article has been written) that cow’s milk, wheat, eggs, peanuts and fish should be avoided during a child’s first year of life. Additionally, babies should not be fed solid food until they are at least 6 months of age.

· Read all food labels very carefully (pay attention to “may contain” statements) and inquire about questionable ingredients and cross contamination from food manufacturers and those who prepare your child’s food (relatives, restaurant chefs, etc.).

· If you breastfeed your child, avoid foods that your child is allergic to. Small amounts of food allergens can be transmitted to your child through your breast milk and cause an allergic reaction.

· Purchase a medical alert bracelet for your child that lists and informs others about his/her food allergy should your child have a reaction and be unable to communicate. Indicate required treatment, such as auto-injector.

· Be extremely clear and careful at restaurants. Inform your server and chef that your child can’t eat the food they’re allergic to (mention the serious consequences), and you need to be 100% certain their food doesn’t contain it. Ensure their food isn’t prepared on surfaces or in pots/pans that contained any of the food they’re allergic to. Request to have their protein (like meat or fish) cooked in foil to avoid cross contamination.

· Prepare healthy snacks before leaving home (especially when flying). Take a cooler packed with allergen-free foods when you travel or attend an event. Include a (safe) special treat so your child doesn’t miss out on dessert. Take a small sandwich maker and allergy-friendly bread with you when you travel. It can come in handy!

· Be mindful of cross contamination at home and outside the home. Ensure your kitchen surfaces are clean and sterile. Use separate kitchen tools including cutting boards, toasters, pots, pans and utensils when preparing your child’s meal.

· Teach your child about their allergies as early as possible and how to request help if needed. Educate others and indicate that allergic reactions (explain what they are) can be life-threatening and require immediate action. You can also show them how to administer an auto-injector. Speak with relatives, friends, child care providers, school staff and other adults who interact with your child. Your child’s school (and anywhere your child is supervised) should have an information form and action plan that includes all steps that should be taken in the event of an emergency. See the link below regarding laws that protect children with food allergies.

· Ask your child’s doctor if he/she should take any specific vitamins and/or minerals due to deficiencies that can arise from avoiding certain foods.

Additional resources

For more information, visit:

Asthma and Allergy Foundation of America: https://www.aafa.org

Food Allergy and Anaphylaxis Network (FAAN): http://www.foodallergy.org/anaphylaxis

Food Allergy Research and Education (FARE): http://fare.foodallergy.org

Learn about U.S. laws and regulations regarding food allergies: https://www.foodallergy.org/life-with-food-allergies/newly-diagnosed/laws-and-regulations

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