When Marcy prepared a peanut butter and jelly sandwich for her son Ben's lunch that morning, she did it because they were running late for day care and it was the quickest thing she could put together. But shortly after Ben began eating his lunch, his child-care provider noticed he seemed to be trying to scratch an itch in his mouth. After he vomited and began wheezing, the care provider sought medical treatment for Ben, who was later diagnosed with a food allergy, in this case to peanuts.
Along with milk, eggs, wheat, soy, and shellfish, peanuts are among the most common foods that cause allergies. For some kids, food allergies can cause only minor discomfort, like a little tingling in the mouth. But for others they can be severe, causing difficulty breathing, for example.
Learning how to recognize an allergic reaction will help you get your child the medical care needed if a reaction occurs. If your child has already been diagnosed with a food allergy, it's important to know:
what emergency preparations to make in case your child has an allergic reactionWhat Is a Food Allergy?
With a food allergy, the body reacts as though that particular food product is harmful. As a result, the body's immune system (which fights infection and disease) creates antibodies to fight the food allergen, the substance in the food that triggers the allergy. The next time a person comes in contact with that food by touching or eating it or inhaling its particles, the body releases chemicals, including one called histamine, to "protect" itself. These chemicals trigger allergic symptoms that can affect the respiratory system, gastrointestinal tract, skin, or cardiovascular system. These symptoms might include a runny nose, an itchy skin rash, a tingling in the tongue, lips, or throat, swelling, abdominal pain, or wheezing.
People often confuse food allergies with food intolerance because of similar symptoms.
Food intolerance:
- doesn't involve the immune system
- can be caused by a person's inability to digest certain substances, such as lactose
- can be unpleasant but is rarely dangerous
The symptoms of food intolerance can include burping, indigestion, flatulence, loose stools, headaches, flushing, or nervousness. A person with food intolerance can usually eat small amounts of the particular food without having any symptoms.
According to the U.S. Food and Drug Administration (FDA), up to 6% of children in the United States under age 3 have food allergies. They are less common in adults but, overall, food allergies affect nearly 4 million people.
Doctors can't predict which kids will have food allergies and which kids won't, but some factors may place a child at higher risk for developing food allergies. The tendency to become allergic in general is inherited. Many kids with food allergies come from families whose members have a history of other allergies.
Certain other health conditions are associated with severe allergic reactions to foods. For example, people with asthma are at greater risk for developing severe reactions from food allergies.
There's nothing you can do to completely eliminate the possibility that your child will develop food allergies. However, breastfeeding (especially exclusive breastfeeding that is not supplemented with infant formula) can help infants who are especially prone to milk or soy allergies avoid allergic reactions. When an infant consumes only breast milk, he or she has a decreased exposure to foods that can cause allergies. Some doctors also recommend that allergy-prone babies not be fed solid foods until 6 months of age or later to avoid exposure to allergenic foods.
Some Common Food Allergens
A child could be allergic to any food, but there are eight common allergens that account for 90% of all reactions in children:
- milk
- eggs
- peanuts
- tree nuts (such as walnuts and cashews)
- fish
- shellfish (such as shrimp)
- soy
- wheat
In general, most common food allergies are outgrown in childhood. Of kids who are allergic to milk, eggs, wheat, and soy, 55% of them outgrow those allergies by the time they are 3 years old. When it comes to nuts and seafood, 25% of kids with those allergies outgrow them by the time they are 3 years old.
Because allergens affect multiple parts of the body, an allergic child may experience a wide variety of symptoms within a few minutes or up to 2 hours after coming into contact with the food. Typically the first symptom is itching; other symptoms involve a rash, gastrointestinal symptoms, nausea, diarrhea, respiratory symptoms, and swelling.
A common skin symptom of a food allergy is hives, or raised red itchy bumps on the skin. Swelling of the face, throat, lips, and tongue also may occur, often within minutes of contact with the food. Respiratory symptoms such as wheezing and trouble breathing or gastrointestinal symptoms such as sudden abdominal pain and vomiting also are common reactions.
When a child has a serious allergic reaction with widespread effects on the body, this condition is known as anaphylaxis. A child with anaphylaxis, which can involve the heart, lungs, blood vessels, and other body systems, may:
- feel dizzy or lightheaded
- lose consciousness
- have a rapid heart rate
- have difficulty breathing because of a swelling in the throat and airways
- have a life-threatening drop in blood pressure (also known as anaphylactic shock)
Without rapid emergency medical treatment, children with anaphylaxis can die if they are unable to breathe or if they collapse due to shock.
Medications that increase the heart rate and blood pressure, such as epinephrine, are often needed to control any kind of severe allergic reaction.
Diagnosing a Food Allergy
you suspect your child may have a food allergy, it's a good idea to contact your child's doctor or an allergy specialist. The doctor will take your child's medical history and ask questions about specific symptoms and your child's diet. To help identify specific allergens, the doctor may ask you to keep a food diary for your child with details on what foods are eaten and when symptoms occur.
Before diagnosing your child with a food allergy, the doctor will look for any other conditions that could be causing symptoms. For example, if your child seems to have diarrhea after drinking milk, the doctor may check to see if lactose intolerance could be causing this instead of a food allergy. In rare cases, a child is sensitive to dyes or food additives such as yellow #5 or monosodium glutamate (or MSG, a flavor enhancer commonly used in Asian and other foods), which can cause symptoms similar to those of a food allergy.
Another condition that may mimic food allergy symptoms is celiac disease, in which the child is not able to tolerate gluten, a protein found in wheat and certain other grains. Occasionally, a reaction can be caused by eating cheese, wine, or fish with high levels of histamine, a chemical occurring naturally in the body that in larger amounts may cause symptoms such as hives and rashes.
may recommend an elimination diet to help diagnose and identify a food allergy. During an elimination diet, a child avoids eating any food that is suspected of causing an allergy and the doctor follows the results to see if allergy symptoms disappear. If they do, the food will then be reintroduced to see if the child's symptoms reappear.
also may be done to diagnose a food allergy. This procedure is usually performed in the doctor's office. The doctor will prick or scratch the child's skin with a plastic or metal prong with a small amount of allergen on it, placing the suspected allergic substance on the skin. If the child develops an itchy bump surrounded by redness (also called a wheal) within 15 minutes of the skin prick, the child is considered allergic to that substance.
For children who have extremely severe allergic reactions or other skin conditions such as eczema, the skin test may cause irritation or other more serious reactions. Your child's doctor may also do blood tests that check for antibodies for specific allergens.
Treating a Food Allergy
After diagnosing your child with a food allergy, the doctor will help you create a treatment plan. No medication can cure food allergies, so treatment usually means avoiding the allergen and all the foods that contain it.
Often, allergists will instruct parents to completely restrict the allergen from the child's diet. But it can be difficult to eliminate the offending food and maintain an otherwise nutritious, balanced diet, so it may be helpful to consult a registered dietitian about your child's diet.
Your child also may be advised to avoid foods containing similar allergens because they could cause a reaction as well. For example, a child who experiences hives and wheezing after eating shrimp probably will be told to avoid other shellfish such as lobster and crab. Your child's doctor should provide you with information about foods to avoid, ingredients to be careful of, and support groups for parents of children with food allergies.
Although there's no cure for food allergies, medications can treat both minor and severe symptoms. Antihistamines may be used to treat symptoms such as hives, runny nose, and abdominal pain associated with an allergic reaction. If your child wheezes or has asthma flares (also called attacks) as the result of a food allergy, the doctor will likely recommend that a bronchodilator such as albuterol (which can be inhaled from a handheld pump device) be taken right away to reduce breathing difficulties. But remember: If your child experiences an allergy-triggered breathing problem, it's important to seek emergency medical treatment immediately, even if your child has been given breathing medications at home or school to treat the reaction.
Epinephrine is often used to treat severe allergic reactions. If your child has severe food allergies, it's a good idea to have epinephrine within easy reach for quick use at all times. This may mean keeping epinephrine in your home, car, briefcase or purse, and also at relatives' homes, and your child's day care or school.
Signs and symptoms of a severe allergic reaction include:
- feeling of warmth, flushing, or tickling in the mouth
- red, itchy rash
- hives
- feeling of lightheadedness
- shortness of breath
- wheezing
- severe sneezing
- anxiety
- cramps in the stomach or uterus
- vomiting or diarrhea
If your child has a food allergy reaction severe enough to cause wheezing, you should seek emergency care immediately instead of using an inhaler to treat the wheezing. As soon as you recognize that your child is having a severe reaction, call 911 and explain your child's condition. Quick treatment can mean the difference between life and death for children with the most severe food allergies.
Feeding Your Child With Food Allergies
Feeding a child with food allergies can be challenging. You'll need to familiarize yourself with food labels and ingredients lists so you can avoid your child's particular allergen. Below are a few suggestions of what to watch out for.
If your child is allergic to:
Shellfish: Avoid crab, lobster, shrimp, snails, clams, and oysters, as well as other types of shellfish. Children who are allergic to shellfish may be able to tolerate fish that swim, such as flounder or cod, but testing may be needed to determine any sensitivity to those foods. Alternatively, children who are allergic to fish that swim may tolerate shellfish. Marinara sauce, Worcestershire sauce, salad dressings, and hot dogs and deli meats may also contain fish or shellfish ingredients.
In general, if your child has severe food allergies, it's a good idea to be cautious about allowing your child to eat processed foods. If you cook with whole-food ingredients and bake from scratch, you'll greatly decrease your child's risk of exposure to an allergen.
And just because your child has a food allergy doesn't mean that favorite kid foods have to be out of reach. Many of your favorite family recipes can be easily modified to fit your child's special needs. For example, in recipes calling for milk, substitute equal amounts of juice or water to preserve consistency. If your child has an egg allergy, you can substitute a mixture of 1 teaspoon (5 milliliters) of baking powder, 1 tablespoon (15 milliliters) of water or milk, and 1 tablespoon (15 milliliters) of vinegar for each egg. For more information about food substitutions and allergen-free recipes, look to food allergy organizations such as the Food Allergy & Anaphylaxis Network (access their website by clicking the Additional Resources tab), which publishes cookbooks and recipes for parents of children with food allergies.
Beginning in 2006, packaged foods that contain some of the most common allergens must be clearly labeled. Food makers are required to clearly state, in or adjacent to the list of ingredients, whether the product contains milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, or soybeans. This new law only applies to foods labeled after the start of 2006, so there may still be products on the grocery store shelves that were packaged before then, which don't have information about allergens.
Even so, eating packaged foods or dining in schools or restaurants could bring your child into contact with hidden sources of the allergen. Even if a food does not initially contain the allergenic food as an ingredient, your child could be exposed to it due to cross-contamination. In cross-contamination, a pan, utensil, dish, or surface used to prepare an allergenic food could contaminate a food that wouldn't normally cause a reaction. For example, cheeses and deli meats might be cut with the same slicer, which could be dangerous for a child with a milk allergy who orders a cheese-free sandwich.
Planning is key to helping your child enjoy meals and snacks and avoid allergic reactions. In general, it's safer to pack your child's food yourself than to rely on restaurants. If you do visit a restaurant with your child, it's important to ask detailed questions about the preparation techniques and ingredients used to make the food. And consider choosing simply prepared menu items such as cuts of meat, steamed vegetables, or baked potatoes instead of complicated dishes that contain many ingredients.
Traveling with a child who has food allergies can be challenging, but many hotels and airlines offer options to make it a little easier. When making reservations with an airline, it's a good idea to tell the representative that your child has food allergies. With prior notice, some airlines will avoid serving peanut snacks during the flight and most will serve your child allergen-free meals. To ensure your child's safety, confirm your child's special meal before boarding the plane and ask the flight attendants how the food is prepared so you're sure there's no chance of cross-contamination. At your destination, consider staying in a hotel or motel offering small refrigerators or hot plates that will allow you to prepare meals in your room.
Although packing your child's lunch will avoid cross-contamination and ensure that your child eats only allergen-free foods, you also may be able to work with your child's school cafeteria to manage your child's allergy. Talk to the school's nutritionist for detailed information about the ingredients in breakfast or lunch menus, and discuss food preparation practices to determine if cross-contamination could take place. Some schools even provide peanut-free tables or rooms for children with severe peanut allergies. It's important to be open with teachers and school administrators about your child's allergy so they can help keep your child safe.
Other Tips for Avoiding Reactions
The key to successful management of your child's food allergy is being prepared. Depending on the severity of the allergy, your child's doctor may recommend that your child carry prescription medication, such as epinephrine, in case of a severe allergic reaction. You may also be instructed to keep antihistamines close at hand to treat your child in case of an emergency.
Unfortunately, mistakes can happen even when you and your child are being careful. Because of the potential severity of allergic reactions to food, your child should wear a medical alert bracelet or necklace with the allergic condition inscribed on it. In an emergency, medical personnel or doctors will know that your child has a food allergy.
Try to work with your child's school or child-care center to find ways your child can be supervised to prevent contact with allergenic foods. Find out who would give your child treatment and discuss your child's allergies with that person, making sure that they have any necessary medications.
Although breastfeeding is one way to delay a child's exposure to allergens, certain allergens from foods in a mother's diet can be passed through breast milk and cause a reaction in an infant. If your family has a history of food allergies and you are breastfeeding your child, discuss your situation with an allergy specialist or your child's doctor. The doctor may recommend that you eliminate major allergenic foods such as dairy products, eggs, peanuts and tree nuts, fish and shellfish, and soy from your own diet.
If you must eliminate a major component of your diet - such as dairy products - consider consulting a registered dietitian to ensure that your diet is balanced and provides enough calories for good health while you're nursing.
A final crucial step in protecting your child is stressing the importance of healthy habits. Teach your child to never share or trade food at school or at a friend's house. If the allergy isn't outgrown, you'll need to teach your child how to read food labels and ingredients lists and to ask how food is prepared when eating away from home.
Article © 2005 from: 
Updated and reviewed by: William J. Geimeier, MD
Date reviewed: July 2005
Reviewed by: Stephen McGeady, MD
For more information and support, visit
Families With Food Allergies: www.FWFA.net
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