Food Allergies (2)

Not all reactions to food are allergic reactions and parents need to be sure that their child has a true food allergy if they suspect it (See the previous article: ”Food Allergy”).  If the initial symptoms occur more than 3 hours after the exposure to the food or if the symptoms last for days or weeks, allergy is probably not involved. True food allergy involves a response from the immune system. An immune antibody called IgE is commonly involved in the allergic reaction, but there are other true allergic reactions which do not involve IgE. Because there was many ways of testing for food allergy and the test results can be very confusing, parents need to speak with their caregiver before eliminating a food from a child’s diet. Symptoms of true food allergy usually involve the gastrointestinal tract, the respiratory tract or the skin. Headaches, muscle pain or weakness or behavioral problems are not caused by allergy. Symptoms of a more severe allergic reaction include vomiting, wheezing, difficulty breathing, hives and fainting. Immediate treatment is needed.

     The treatment for an allergic reaction to food is an injection with epinephrine. People are often frightened by the thought of an injection but they must not be. The medication itself is safe. Before nebulizer treatment was available in the clinic, we used to give one, two or even three injections of epinephrine in a row to young children to stop an asthma attack. The injection needs to be given in the outside part of the thigh and it needs to be given immediately. A common cause of death is waiting “to see if the reaction is going to get worse”. Even if the child’s symptoms improve, the child needs to go to the ER and be observed. Sometimes a second severe allergic reaction can occur hours after the first. It is impossible to predict which children will have a severe allergic reaction. In one study of children who died from allergic reaction, 1/3 of the children had an initial reaction to food that was so mild that the doctor didn’t think it was necessary to give the parents an epinephrine pen.

     Parents of a child with true food allergy need lots of support and education. They need to be comfortable giving the epinephrine injection. They have to balance their fear of severe reaction against their child’s nutritional needs. They might have friends or family who question whether the allergy is real. They might have guilt that somehow they caused the allergy. They have to worry about eating anywhere other than home because ingredients are unknown or food could be cross contaminated. An excellent source for information is the Food Allergy and Anaphylaxis Network (www.foodallergy,org).

     If there is a strong family history of allergies, eczema or asthma, parents should consider steps to try to prevent allergy. Exclusive breast-feeding for the first 4 months of life and possibly holding off on solids until 6 months of age is recommended. If formula is used, the milk protein should be broken down – called hydrolyzed.  “Extensively hydrolyzed” formula lowers the risk of allergy but is very expensive. “Partially hydrolyzed” formula is cheaper but less effective and it still has some milk protein in it, so a severely allergic child shouldn't drink it. Other recommendations are to not give the child dairy until one year of age, eggs until 2 years of age and nuts until 3 years of age. It is not known whether following these withholding recommendations is worthwhile. Allergy are rarely helpful with food allergy.