When children have food allergies, simple things like peanuts and milk take on a whole new meaning.
Nikolaus Franco’s first birthday was truly memorable. His parents, Aime and Luciano, celebrated the occasion with a party for family and friends, complete with cake and candles. The cake’s icing ended up smeared all over the birthday boy’s face, much to his delight.
“Nikolaus had eaten cake before and hadn’t had any problems,” says his mother, Aime. “He was having a grand old time. Then he started getting fussy.”
The party soon ended, and friends departed the family’s Bellevue home. That’s when the nightmare began. “His eyes started to swell shut. We got him in the tub, but soon his face, lips and cheeks started getting swollen, too,” Aime recalls. “I said, “OK, we’re not calling the pediatrician. We’re calling 911.”
Paramedics arrived and assessed Nikolaus’ condition. Because his breathing was normal, paramedics recommended that they call their pediatrician, which resulted in a late night visit to see him. In the days that followed, there were tests to determine the extent of Nikolaus’ allergies. The party culprit? Eggs. But Nikolaus was also severly allergic to nuts, joining the more than 3 million Americans living with nut allergies.
The experience was an eye-opener for Nikolaus’ parents, neither of whom is allergic to eggs or nuts. Like other parents of children with food allergies, they are now learning to manage Nikolaus’ diet and daily activities to prevent future allergic reactions.
At the beginning, it’s a daily maze of ingredient detective work and educating everyone your child comes into contact with about food allergies. It takes diligence and patience. But it must be do-able.
What is a Food Allergy?
According to the Food Allergy Network, a food allergy is defined as a response by the body’s immune system to a particular food that it believes is harmful. More than 90 percent of food allergies – especially in young children – are caused by dairy products, eggs, peanuts, tree nuts, fish, shellfish, soybeans and wheat.
Many people confuse food intolerance with food allergies, but there is a difference, according to Joseph Gigante, M.D., a pediatrician at the Monroe Carell Jr. Children’s Hospital at Vanderbilt (VCH). Food intolerance is generally associated with stomach discomfort, he says. “Some kids just don’t tolerate certain foods very well,” he says. “For example, they might get diarrhea from lactose intolerance when they drink milk. We call these ‘gut symptoms.'” Symptoms like this make parents feel like they need to reach for the Pepto Bismol.
But, food allergies produce a wider range of symptoms. “Typical food allergies have mild symptoms such as skin rashes, hives and red, raised lesions,” he says. “Then there are more significant symptoms like wheezing, or the most severe which is anaphylactic swelling of the larynx or voice box. Thankfully, we don’t see that very often,” he adds.
Reports vary about the exact number of people – let alone children – who have food allergies. The Food and Drug Administration (FDA) estimates that approximately two percent of adults and five percent of infants and young children suffer from food allergies. That may seem like a small percentage, but when it’s your child wheezing or swelling, it’s somewhat monumental.
What is clear is that children of parents with food allergies have a higher potential for that allergy. Gigante says that parents should be aware of this when introducing new foods into their child’s diet. “Proceed with caution, and keep an eye on when your child has that food to see what the response is,” he says.
A Visit to the Doctor
Sudden, severe reactions to food that result in breathing difficulties, although rare, are cause for concern and require immediate attention by a healthcare professional. But, if you suspect your child may have a milder food allergy, what should you do?
Gigante suggests starting at your pediatrician. “Go to your pediatrician’s office and take a history, ask questions about foods and do a physical exam,” he says. This can help determine if a food allergy is present and if additional testing is warranted.
In addition to your child’s pediatrician, you may want to consult an allergist if a food allergy is diagnosed or if testing is recommended.
Donna Hummell, M.D., is an allergist and immunologist at VCH with an interest in pediatric food allergies. She sees patients as young as 6 months old, the age when solid foods are usually introduced, often because a child’s mother has noticed some classic allergy symptoms like swelling. “In that case, seeing an allergist can be helpful in deciphering what the problem is, plus it also provides family guidance about food and how to feed their baby,” she says.
Allergy testing can help confirm or eliminate food allergies as the cause of a child’s symptoms. Your child’s doctor may recommend either skin or blood testing, depending on the child’s age and severity of symptoms.
Managing a Food Allergy
Because there is no known cure for food allergies, avoiding problematic foods is the only way to prevent reaction. The good news is that doing so is getting easier for parents and their children.
Earlier this year, the FDA began requiring all consumer food labels to include easy-to-read ingredient information clearly stating if the product contains protein derived from the eight most common allergenic foods. In addition, many schools and day -care centers are becoming more sensitive to children with food allergies. Menus are offered that provide options for children with different allergies, and some schools and day care centers have peanut-free policies requesting parents to skip nuts when sending snacks for the class.
Providing a child’s meals for school or day care is an option chosen by many parents, including Aime Franco. Although her son’s day-care center is peanut-free, his allergy to eggs means that many foods are still off limits. “Eggs are very difficult because it seems like everything has eggs in it,” she says. Eating out can also be problematic. “We have to bring his own food,” Franco says. “It makes you stop and think a lot more than you thought you did before,” she says.
Children with severe food allergies can also be prepared. One way is by equipping the child with a medical device like an EpiPen”, an adrenaline-filled syringe that doctors prescribe for use in emergency situations. “An EpiPen” allows a child to inject himself, providing rapid treatment for an allergic reaction,” says Gigante. “Another thing is having a medical alert bracelet to alert people to certain conditions.”
Outgrowing Food Allergies
By the age of 3, many children outgrow their food allergies. According to Hummell, this positive development is the result of a child’s maturing digestive system. “It’s known that an infant’s intestinal tract at its immature stage is not capable of excluding complex molecules,” she says. “When the child gets older, the intestinal tract provides a better barrier against these molecules, and the digestive system is much more efficient.”
Food allergies to dairy and soy products are among those most commonly outgrown. Allergies to nuts and shellfish, however, often linger. Consulting a doctor before reintroducing a food to a child who previously experienced allergic symptoms is advisable. In some cases, a doctor may want to be present when the food is offered again to gauge the child’s reaction and provide treatment if needed.
A Proactive Approach
The Franco’s will continue to have Nikolaus tested annually for his allergies until he’s at least 5 years old. After her experiences with Nikolaus, Aime advises other parents to stay informed and keep a watchful eye. “When it comes to an allergy, you can’t overreact,” she says. “You want to be proactive. I’d rather be safe than sorry.”
Liz C. Taylor is a freelance writer and mother living in Nashville.
Learn more about food allergies with the following resources:
American Academy of Allergy, Asthma & Immunology
American Academy of Pediatrics