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Food Allergies – Symptoms and Treatment

What are Food Allergies

Allergies are the body’s over-reaction to any outside material. Our immune system helps to protect us from dangerous outside materials like germs and chemicals, but sometimes it overdoes it. Food allergies are the result of that over-reaction to things in the food we eat. The most common part of a food that causes an allergy is one of the proteins – most foods have at least some proteins in them. Some children develop allergies to some of the dyes, sweeteners, or preservatives that are in prepared or processed foods. Children can show signs of allergies in many different ways, from mild to quite severe. Signs of mild allergies include skin rashes and itching, sometimes with watery eyes. More serious allergic symptoms can include wheezing or difficulty breathing, swelling of the throat, and even shock (anaphylaxis). Certain foods like nuts and seafood are more likely to provoke serious allergic reactions, but children can have a serious reaction to any kind of food.

Children rarely develop food allergies before the age of one year old, with the exception of mild protein allergies. Most infants with diarrhea and/or vomiting related to formula are not truly allergic to the milk. They usually have a problem digesting the sugars. This problem is called lactose intolerance. Older children with this problem may have bloating, gas pains, diarrhea or cramps after eating milk products. It’s important to understand that this condition is not an allergy, because we treat it very differently.

Dangerous Food Allergy Symptoms

The first concern in any allergic reaction is the “ABC’s.” That means we want to be sure the child’s Airway is not swollen or blocked, that s/he is Breathing, and that his or her Circulation (heart and blood vessels) is working. In most cases, we do this just by looking at the child and talking with him or her. Please see the list below for danger signs that would require an ambulance. Once the ABC’s are OK, the next concern is comfort. Unlike environmental allergies, like hay fever or pet allergies, once a child has eaten a food, s/he can’t just get away from it. the food or its parts will stay in the digestive system for up to 48hours. This means we need to treat the itching, swelling, and other symptoms for longer amounts of time. It can also mean that the symptoms of the allergy can keep getting worse for a few hours after the child eats the food, so we have to watch more closely.

Food Allergy Treatment

Severe allergic reactions require emergency room care and sometimes hospitalization. Children who have any problems with breathing or with circulation need injections of epinephrine and often intravenous fluids. Doctors usually want to observe children with these problems for many hours, or even overnight, in a hospital.

Milder allergic reactions, such as skin rash and itching, don’t require such advanced care. We can treat those with antihistamines. You can give your child diphenhydramine (dye-fen-hi-drah-meen; Benadryl® and many others) for itching. The main side effect of diphenhydramine is drowsiness, which is actually often helpful to a child whose itching is making him or her frantic. Diphenhydramine in topical lotions does not help itching more than the lotion itself. Some children complain of pain as well as itching. You can give your child acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) as directed for the next 24 hours to help relieve any pain.

The EpiPen®

If your doctor was concerned that your child may have a serious allergy to foods, s/he may have given you a prescription for an “EpiPen®,” a device to inject epinephrine (adrenalin). Epinephrine is life-saving if you give it in the first few minutes of a reaction, in a child who is known to have a moderate or severe allergy. The EpiPen Jr. is for children who weigh less than 60 pounds, and the adult EpiPen is for larger children and teens. Please be sure to fill the prescription right away. Keep the EpiPen someplace where you can get at it right away. Older children should keep their EpiPen with them all the time. The side effects of using the Epi-Pen are a rapid heart rate, dry mouth, and mild trembling.

The EpiPen can be life-saving, but your child must use it within the first few minutes of a reaction starting. Many people keep several different EpiPens in places the child often visits (one at home, one at school, one at camp, etc). Check the expiration date when you fill the prescription, and mark your calendar for the date it needs to be replaced. Your doctor can provide a practice EpiPen that does not contain a needle or medicine. You and your child should practice using it regularly. Then, if your child needs to use it for real, s/he will know what s/he needs to do, how much pressure it takes to trigger the injection, and so forth. When an EpiPen expires, don’t throw it away immediately! Use it to practice giving the injection into an orange. This will provide more regular practice for your child, and will prevent the EpiPen from accidentally injuring someone else.

Allergy testing

Sometimes it is immediately obvious what food a child has reacted to. This is often the case when a child eats an unusual food for the first time, or has a serious reaction within minutes of eating just one food. In other cases it can be more difficult to know exactly what the child is allergic to. Any child who has had a serious reaction to food should see an allergist who will decide what kind of testing the child should have. This is because some foods “cross-react” with each other. For example, a child who is allergic to peanuts may also be allergic to cashews, and this is vital information to have. Children with milder allergies usually do not need allergy testing. Your doctor will advise you of the best course to take.

When should I be worried?

Your doctor sent your child home because s/he is not having a serious allergic reaction. Still, it is good to watch your child for the first 48 hours after an allergic reaction to be sure that more serious signs do not develop. Please remember that the food allergy reaction can be unpredictable. Your child could have a more severe reaction the next time s/he eats whatever s/he is allergic to, and/or s/he could have a delayed reaction and only show signs of a severe reaction after a few hours. Here are some signs of a serious reaction to watch for over the next 12 – 24 hours:

  • Difficulty breathing or speaking
  • A feeling of swelling or tightness in the throat or chest
  • A hoarse voice
  • Wheezing (whistling breath sounds)
  • Increasing puffiness or swelling of the face or arms and legs
  • Increasing numbers of red wheals or hives
  • Extreme irritability in a toddler or infant
  • Lethargy (inappropriate sleepiness)

If any of these occur, please be sure to call your doctor’s office right away. If your child or infant is difficult to awaken or seems unconscious, go directly to the emergency room.

Other points of concern

If your child has had a moderate or severe reaction to food, it will be important for you to become a label reader. When your child is old enough, s/he will need to do the same. Many companies use ingredients that can cause serious allergies, even when these are not the main ingredient in a package of food. Foods may contain peanut oil, for example, or be processed on equipment that was used earlier to process peanuts. A new U.S. food labeling law requires plain, commonsense language about foods that contain any of the “big 8″ foods that cause allergies. These are milk, egg, peanut, tree nut, fish, shellfish, wheat and soy. Some companies use “icons,” little pictures that are color-coded to indicate what kinds of allergy-causing foods are present.

Eating in a restaurant poses another challenge for people with serious food allergies. You and your child should always ask if a specific dish contains or was prepared with any of the foods that cause a problem. Please remember that restaurants don’t list ingredients, and that servers often don’t know exactly what goes into a dish, so it will be important to learn to be firm about having them find out. If in doubt, skip the dish.

Some people believe that subtle allergies to certain foods can cause a variety of complaints, such as headache, mood changes, and even more serious conditions. The scientific support for these ideas is fairly slim at the moment, but that may change. If your child seems to behave differently or complains of headache consistently after eating a certain food, it is common sense to avoid it.

Other Conditions that Might Be Present

Often an itchy rash, watery or pink eyes, coughing, and so forth can be signs of other allergies besides food. Since most people have eaten something within a few hours of a reaction, it can be easy to mistake a pollen reaction, for example, for a food allergy. Since food allergies can be more severe, it’s a good idea to avoid a food if you think it caused an allergy. You may want to read our article on Environmental Allergies.