Food allergies in children appear to be on the rise – especially allergies to peanuts. Experts say that the number of visits to pediatric emergency rooms for allergic reactions to foods has risen steadily for about 15 years.
Brad Becker, M.D., an allergy specialist at SSM Cardinal Glennon Children’s Medical Center and Saint Louis University School of Medicine, says that the reason for the increase is not clear. He notes that the incidence of all kinds of allergies has been rising since the 1970s.
One link in food allergies – at least to peanuts – is the food industry’s widespread use of dry roasting. Dr. Becker says that in China, kids eat just as many peanut products, but there the nuts are processed by boiling, which may change or remove the peanut allergen because the allergy incidence has remained steady.
Another factor may simply be increased awareness, both by parents and by doctors. Dr. Becker notes that new allergic syndromes continue to be identified. One called eosinophilic esophagitis or “EoE” is a newly recognized chronic disease with symptoms of acid reflux, nausea and abdominal pain triggered by food allergies.
Pre-school age children with EoE have symptoms similar to acid reflux, and have trouble spitting up and vomiting and abdominal pain. Older, school-age kids, Dr. Becker continues, have more heartburn while post-adolescent kids and adults have trouble swallowing, with food sometimes getting stuck.
With food allergies on the rise, Dr. Becker suggests that parents of newborns and young children familiarize themselves with basic information, particularly if the family has a history of allergies of any kind, including asthma, nasal allergies and eczema. He notes that allergies have a strong genetic component.
Allergic reaction can be frightening, Dr. Becker says, and parents need solid information to react appropriately “Part of any allergic reaction can be swelling around the eyes, the tongue, hands and feet and other parts of the body. Swelling is frightening, but is not actually life-threatening,” he says.
While any allergic reaction should be evaluated by a physician, Dr. Becker cautions that if a child is having any difficulty breathing, this would warrant emergency treatment. Signs that an allergic reaction is leading to breathing problems may include wheezing when trying to breathe, hoarseness, difficulty with throat or mouth breathing, getting light headed or passing out.
While emergencies are frightening – and food allergies continue to make headlines – Dr. Becker suggests that parents who have concerns act upon them and have a child evaluated, and to adopt a treatment plan based on a thorough evaluation.
He notes that this year the National Institute for Allergy and Infectious Diseases recommended new guidelines aimed at preventing misdiagnosis. The guidelines state that doctors should use a combination of a detailed medical history, physical examination and medical tests when diagnosing someone with a food allergy.
Dr. Becker continues that allergy testing may only provide a piece of information needed to reach a diagnosis. For example, he notes that blood allergy tests provide rankings of positive responses to specific food allergens, but the “predictive value” of the rankings may vary between individual children.
Further, having a positive response – meaning the child carries antibodies to the allergens – does not mean the child will have an allergic reaction to the particular food, he says.
“Many of us walk around with allergy antibodies to peanuts or shellfish or eggs or milk, but we’re a-symptomatic – and that is not a food allergy.”
Dr. Becker continues: “I recommend that the parent of a child, or the child’s doctor, send the child to an allergist for more investigation, if they are not sure how to interpret the tests.”
Food allergies also sometimes get confused with “food intolerance,” Dr. Becker adds. He adds that foods can contain natural chemicals that can react with other things, like pollen in the air, and cause allergic symptoms. Foods also contain natural chemicals that act like the chemical histamine, causing symptoms of an allergic reaction.
“An allergist or primary doctor who is familiar with allergies can help parents sort this out – what foods their child needs to strictly avoid and those they can enjoy under certain situations.”
He continues that if a child is diagnosed with severe allergies to certain foods, his or her allergist will prescribe having emergency epinephrine auto-injectors – commonly called EpiPens -- on hands at all times.
Fortunately, about 80 percent of kids with mild food allergies will outgrow them. These include allergies to milk, eggs, soy and wheat. However, most children, Dr. Becker says, do not outgrow allergies to peanuts, tree nuts, fish and shell fish.
As the holidays approach, concerns about food allergies can become heightened, especially if a family is preparing for a large gathering and everyone’s medical histories are not known.
Dr. Becker suggests simply asking guests if they have allergies to particular foods.
“So ask your guests, and if it’s a really big gathering, consider putting a note card next to the food. People sometimes just eat and don’t pay enough attention to the food they are eating,” Dr. Becker says.