Nut-free. Wheat-free. Dairy-free.
The prevalence of food allergies in children has been on the rise for the last few decades. While eating nutritious food is key to ensuring that kids grow healthy and strong, allergies to particular foods make this goal more challenging for parents and, if left unchecked, can pose some real dangers for children.
Our Children turned to Dr. Jacob Kattan, a pediatric allergist at the Jaffe Food Allergy Institute at Mount Sinai Hospital and at the Valley Medical Group in Paramus, to shed light on this topic.
OUR CHILDREN: What are the most common food allergies among children?
DR. JACOB KATTAN: There are 9 foods that cause most allergic reactions in children. These foods include milk/dairy, egg, peanut, tree nuts, sesame, fish, shellfish, wheat, and soy.
OUR CHILDREN: When do food allergies manifest?
DR. JACOB KATTAN: Most food allergies manifest in the first one to two years of life. If a child has a food allergy, he or she usually reacts to that food one of the first times they eat it, if not the first time. It is rare for a child to eat a food regularly and then develop a food allergy as they get older. The exception to this is that some people will develop sensitivities to certain foods, often raw fruits or vegetables, as they get older and develop seasonal allergies. This is known as “pollen food syndrome.”
OUR CHILDREN: What are the symptoms of food allergies from mild to severe?
DR. JACOB KATTAN: Mild symptoms of a food allergic reaction may include itchy mouth, a few hives, or mild nausea or abdominal pain. Symptoms of a severe reaction may include trouble breathing, wheezing, repetitive coughing, trouble swallowing, feeling dizzy or confused, diffuse hives, severe abdominal pain, repetitive vomiting, or a swollen tongue. With a typical food allergy, symptoms will begin shortly after eating a food, almost always within two hours of ingestion.
OUR CHILDREN: Can you explain the prevalence of certain food allergies today that years ago were uncommon, for example allergy to peanuts. Kids would bring along and eat their peanut butter and jelly sandwiches, a lunch staple, in school with nary an issue. Today, we live in nut-free environments. What has changed?
DR. JACOB KATTAN: Food allergies have been increasing in prevalence over the last 20 to 30 years, and this is likely due to a combination of genetic, epigenetic, and environmental risk factors. We have learned in recent years that our fear of allergy, and subsequent recommendations to delay introduction of common food allergens such as peanut and tree nuts, likely led to higher rates of food allergy. There is also evidence that self-reported food allergy rates are higher than physician-confirmed food allergy rates, demonstrating the importance of having children with food allergies seen by specialists comfortable evaluating food allergy.
OUR CHILDREN: Do childhood food allergies disappear with age?
DR. JACOB KATTAN: Certain food allergies are likely to resolve as a child gets older, including allergies to milk, egg, soy, and wheat. It is hard to predict at what age resolution may occur, as some will outgrow a food allergy in the first few years of life, while others will not outgrow an allergy until the teenage years. Some food allergies, including peanut, tree nuts, and sesame, are more likely to persist into adulthood.
OUR CHILDREN: Besides avoidance are there any other ways parents can safeguard their children with food allergies?
DR. JACOB KATTAN: Right now, avoidance is the best way to prevent allergic reactions for children with food allergies, but there is a lot of hope in current and emerging therapies for food allergy. This past year, for the first time, a treatment for food allergy got approval from the FDA, a product used for oral immunotherapy for peanut. Potential therapies for food allergy include oral immunotherapy (eating small amounts of the allergen on a daily basis), epicutaneous immunotherapy (wearing a patch that delivers small amounts of an allergen through the skin), Chinese herbal medicines, and biologic medications such as omalizumab and dupilumab, which are already being used to treat allergic asthma and eczema. Some of these therapies are closer to being used in clinic than others, but it is exciting that there are so many potential treatments on the way!
OUR CHILDREN: Is there anything else you would like to add?
DR. JACOB KATTAN: Food allergic reactions can be difficult to predict, and severity of reactions can vary for an individual. Because of this, and because prompt use of epinephrine is key in treating a severe allergic reaction, children who are diagnosed with a food allergy should have an auto-injector of epinephrine close by at all times. While we don’t plan on a child accidentally eating something that they are allergic to, we can make a plan to treat an allergic reaction if an accidental ingestion is to happen.