I was interviewed this week on TV about food allergies. I’ve pushed all my inner-Cindy Brady moments aside. Watch the video below…
When F was about 13 months old his face turned bright red after he ate breakfast one morning. I eliminated all the foods he had eaten that morning– milk, oatmeal, banana and berries. He’d had all those foods many times but I was concerned he’d developed an allergy. Gradually, I introduced them back, one food at a time. Mild reactions returned (his face looked like a work of art, his ears turned red), but inconsistently, so I was confused. After strict re-introductions, I finally figured out cinnamon was causing his facial flushing. Turns out, regular oatmeal did nothing, but eating apple and cinnamon oatmeal he got all red goofy faced. To this day, F doesn’t complain when eating cinnamon, I just know he has ingested it when his face is covered in artful red spottiness.
We were lucky; F’s reaction was mild and limited to cinnamon. It’ still unclear to me if it is a true allergy. I consider him sensitive to it so I avoid serving him cinnamon whenever I can.
But I had a dagger of fear in my heart while trying to determine what was causing his facial rash for a few weeks. Like most parents who have children with allergies, I found the not knowing what was going to happen absolutely unnerving.
Allergies can be scary. Strict avoidance of a food is the only way to assure you avoid a reaction. Learn the F-A-S-T formula to stay safe.
Fact is, some children have only one food allergy, while others are very sensitive and allergic to multiple foods. Some children may outgrow allergies, others can have them for a lifetime.
Even pediatricians have a hard time diagnosing allergies. One study this year surveyed over 400 pediatricians & family doctors regarding typical knowledge about allergies. The doctors answered only 61% of the questions right. When I looked at the questions in the study, I certainly don’t think I would have scored 100% either. So, if you’re confused about food allergies, know you’re not alone—diagnosing food allergies may not be as straightforward as you think.
Some Data:
- There is no real cure for food allergies. Some allergies fade away with time, but once a child is past the age of 2 or 3 years, they may continue to have a particular allergy throughout life.
- Allergies can present at any age, although allergies are most common in infants and children up to 3 years of age.
- About 4% of children in the US have food allergy symptoms. This is up over the last decade. A study in Pediatrics found that between 1997 and 2007, food allergies have risen 18%.
- Blood test results and allergy symptoms are not the same! In the same year that we say 4% of children have food allergies, 9% have positive blood tests to peanuts.
- There is no perfect consensus on why allergies are on the rise. Some physicians and statisticians think that due to increased awareness there are simply more children diagnosed now, while others feel environmental exposures (nut oils in baby lotions, for example) have increased rates of sensitivities & allergies in children.
- Milk allergy is the most common allergy in children, followed by peanut, egg, and shellfish.
- Milk allergy may manifest in early infancy as a baby is exposed to cow’s milk proteins. Changing formula or reducing dairy intake for a breast-feeding mom can often eliminate symptoms.
- Lactose intolerance is not a food allergy to milk. Lactose intolerance is uncommon in children under age 5 years of age.
- Gastrointestinal symptoms however can be a sign of food allergies: diarrhea, blood in the stools, mucus-like stools or vomiting.
- Runny nose is not thought to be a sign of food allergies.
- Severe and life threatening allergic reactions are rare, but do happen. Adolescents are more likely to have a severe reaction than young children.
Mama Doc Tips For Decreasing Risks For Allergies:
- The AAP (and me!) recommend waiting to introduce any solid food until your infant is 6 months of age. One study published this year refutes this recommendation but it has not changed my opinion and recommendation.
- Learn the F-A-S-T formula. (Facts-Avoidance-SIgns/Symptoms-Treat Immediately). Find an educator to help you. This stuff is tough!
- If your baby starts to develop eczema or significant/severe skin rash under 6 months of age, talk to you pediatrician about the possibility of food allergies.
- If you baby or child develops swelling of the lips, flushing of the face, a cough, excessive drooling, or vomits immediately upon ingestion of a particular food, stop providing it to your child. If your baby is having a hard time breathing, call 911 immediately.
- If your baby vomits every time after eating a particular food, stop providing it until you determine if it’s an allergy.
- If you have a family history of food allergies (especially severe allergies or anaphylaxis) consider waiting until age 2 years of age to introduce nuts and shellfish.
- Talk with your pediatrician if you have concerns. If you’re still confused or alarmed, inquire about seeing a pediatric allergist.
- If your child’s mouth gets itchy or swollen after eating a new fruit or food and also suffers from hay fever or a diagnosis of allergic rhinitis, consider talking with your pediatrician about oral allergy syndrome. Sometimes, those children with hay fever may develop sensitivities to fruits that cause cross-reactions to similar proteins. A common oral allergy syndrome comes from a sensitivity to Urushiol (poison-ivy) also found in mango. Peeling the fruit or cooking the fruit will eliminate the symptoms. Avoiding it of course, does the same.
Bottom line: If your child reacts to a particular food every time they ingest it, they are likely allergic or sensitive to the food. Your child’s clinical response is far better than any lab test, blood test, or skin prick. Trust your instincts and avoid foods that cause alarm. If they continue, talk with your pediatrician or an allergist or an allergy educator who may assist in helping you determine how best to care for and protect your child.
Jana says
Your readers and patients might be interested in local food allergy education and support found at https://wafeast.org Thank you for educating others about life-threatening food allergies.
Katie says
Thank you for letting me know about your blog, Dr. Swanson. I look forward to following it. Also, thank you for all of your time at today’s appointment. Will and I really appreciate all that you do for us! One website that I have found to be very useful in providing family-healthy recipes (and keeps allergies/sensitivities in mind) is https://weelicious.com/. They even have a chicken in a crock pot recipe front and center to help you on your new crock pot kick (https://weelicious.com/2010/03/16/chicken-in-a-crock-pot-2/).
Daniel says
Thanks for the useful info. and sharing your personal story. I note that you question whether F’s reaction to cinnamon is a “true allergy,” though you consider him “sensitive” to it. I (believe I) understand that the term allergy refers to a specific type of immune response, but I get confused when people differentiate this term from symptomatic responses to substances that they label “sensitivities,” rather than allergies. If they aren’t true allergies, what are these sensitivities; or, perhaps more concretely, are there any common childhood “sensitivities” that are not true allergies, and what causes them? Thanks.
Wendy Sue Swanson, MD says
You pose a great, although complicated question. Here’s my take. Anyone feel free to add or correct me here…Dear Allergist, please respond. Here’s how I think of it: sensitivities are children showing just that, a reaction to things they touch, eat or come in contact which leaves them “sensitive.” That can be redness, irritation, swelling or discomfort of some kind. I think of sensitivities more like suspected allergies. You can’t tell a sensitivity from an allergy, until you have a child tested. Many patients, like F, report sensitivities to things. For example, a study in Pediatrics from 2003 notes that suspected food allergy is extraordinarily common. They found that ¼ of all parents reported 1 or more adverse food reaction while true food allergy was confirmed in far less–anywhere from 5-10% of young children with a peak prevalence at about 1 year of age. https://pediatrics.aappublications.org/cgi/content/full/111/6/S2/1631 True allergy is thought to be more scientifically confirmed, where a patient has a response that is mediated by the IgE immunoglobulins where a skin prick test or blood RAST(radioallergosorbent test) tests is positive and confirms an immunoglobulin based reaction or allergy to suspected proteins. Those Ig-E mediated processes are often thought of as true allergic reactions to proteins that children come in contact with. With this contact, those proteins elicit a response from the immune system that turns on the “allergic” cascade. Sensitivities may not turn on this cascade (hence those reactions may not be treated by anti-histamines) but may be otherwise explained from other parts of the immune system responding. Note that there are other processes that are called “allergies” as well that are non-IgE mediated reactions. Poison Ivy, for example, is one of those…it’s a cell mediated process (T cells) rather than an antibody(immunoglobulin) response. But, your question about common sensitivities? I don’t know from any data. However, in practice, I see many children respond to sunscreen at times with red eyes, slight rash, and irritation. They are not often confirmed by allergy tests to be allergic, but clearly those responses to the sunscreen prove they’re sensitive and should avoid the product in the future…
Laura says
Thank you Seattle Mama Doc! My oldest has struggled with several severe reactions since he was 3. The first time he reacted – it was a swollen throat, face, lips, drooling and thrashing that sent us in to a panic. He has passed out before I was even able to dial 911. We were lucky, very very lucky. But we continue to struggle with managing the things he has been found to be allergic to. You are correct – it’s been tough to diagnose. When they first ran blood tests we recieved nearly 30 pages of documentation about things he was ranked (on a scale of 1-5) ‘allergic to’. We were told to avoid all 4’s & 5’s. That left us steering clear of Milk, TreeNuts & Shellfish. Skin tests revealed mold, grass and a few others. We’ve filled countless prescriptions for epi pens, filled out school forms, field trip forms, doctor forms, etc. (you get the picture). We go years without a reaction – and then we have another ‘run to the ED’ episode. As he’s grown the reactions seem to change – leaving me scrambling when it happens not knowing exactly what do do – and it’s SCARY. It scares me most when I send him off to a sleepover at a friends home or on a vacation with his dad (we are divorced). The last reaction we had was a year ago – and he had what the ED doc indicated were ‘several of his systems’ struggling with whatever went in that he was unable to have his body cope with. He was on benadryl every 6 hours for 2 days and several other things to stop the reaction from continuing in his system. I really appreciate the information you’ve provided…continued awareness of the masses is important for those little guys who struggle with this. Thank you for all you do!
Terri says
I am searching for a local doctor that specializes in wheat sensitivity. I need direction regarding ingredients in shampoos and soaps. My daughter is very sensitive to wheat, touching playdough causes hives. I think her shampoo might be an issue, because after showering she is flushed. I am finding it difficult to cook for her, because she is tired of the gluten free options, it has been one year of staying away from wheat containing foods. Is there any help out there for us moms struggling to feed our kiddos! I work fulltime, hubby is a fulltime student, and it is crazy here around mealtimes. Her options are always so costly, twice as much to feed her and lucky if she finishes a special muffin or pancake. : ( Of course, her big brother and sister love wheat and eggs (another no no or her), which makes it particularly difficult to keep everyone happy and eating! Thanks for any advice you might have. (BTW, her pediatrician told be from day 1 that her dermatographia was not caused by a food, guess what, it is! WHEAT! And her horrible skin as a baby…I am sure that was wheat as well, and those stools once per week that were green. So disappointing that I wasn’t given better advice early on.)
Viki says
Terri, I think most allergists would be able to help you. If your daughter is that sensative, she should see and allergist to evaluate whether she needs and epi pen, medication, therapies. My kids see both an allergist and a gastroenterologist. For allergy we go to Northwest Asthma and Allergy. It’s hard to go wrong- most do research, teach, and serve on boards of med associations. We see Dr Jonathan Becker who I can’t say enough good things about. I don’t know if he intended to have a strong pediatric practice, but he does now! I think it’s because he’s very well read in current research and nothing seems to surprise him.
There is a Bermuda triangle of unknowns between general pediatrics, gastroenterlogy, and allergy/immunology. In the last 4 yrs since I’ve been reading about allergy, more and more information is emerging. My kids test negative across the board for IgE-mediated allergies (“true” allergy) and fall into that “sensitivity” bucket. Except the sensitivity bucket could hold anything from metabolic disorders to immune responses mediated by other cells in the immune system. Sometimes (as is the case for my daughter) it’s as simple as “if that makes her sick, avoid it.” And other times (as is the case for my son), it isn’t simple. I don’t expect my ped to know what the GI or allergist know. But I see the long letters of correspondence and call logs in my child’s chart. She’s still the “hub” for his care.
Shampoo: wheat is a common ingredient in shampoo; as are oats, soy, barley, and corn. This is why wearing fragrance and stinky products is prohibited at the allergists’ office. You can give someone a reaction. Common ingredients that are derived from wheat:
https://www.suite101.com/content/how-to-choose-true-gluten-free-shampoo-products-a253425
My son is sensative to corn, soy, and dairy. We are evaluating wheat. This means, generally, NO to: preservatives, additives, food color & dye, natural flavor, and fragrance.
I do NOT cook separate meals. It’s hard enough to travel with a special cupcake to holiday and birthday parties. I don’t want him feeling left out at home. It also introduces cross contamination issues in addition to creating more work. I don’t bake so I’ve come to rely on Sun Valley Bakery for all my “special” baked goods. It sounds like you’ve had a tough year: go get a sheet of cinnamon rolls and never look back 🙂 https://www.sunnyvalleywheatfree.com/
Kelly Morgan says
Just wanted to say how grateful I am to see this info on your blog and wanted to add that eosinophilic conditions are increasingly being diagnosed in kids with food allergies and intolerances. The Kids with Food Allergies website has some very useful information about eosinophilic conditions in addition to a vast amount of information for families and individuals with IgE food allergies.
https://www.kidswithfoodallergies.org/resourcetopic.php?topic=gastrointestinal-disorders
Also, Dr. Scott Sicherer discusses several non-IgE food reactions in his book Understanding and Managing Your Child’s Food Allergies. He discusses proctocolitis,protein enteropathy, food protein-induced enterocolitis syndrome (FPIES), eosinophilic esophagitis and gastroenteritis, colic, oral allergy syndrome, and celiac disease. More recently, work at the University of Maryland has identified biomarkers for non-celiac gluten intolerance as well,
https://somvweb.som.umaryland.edu/absolutenm/templates/?a=1474&z=5.
It seems likely that there is still more to learn about the true relationship between food and the immune system. Thanks for taking time to educate others about food allergies on your blog!
Kelly Morgan, President
Washington FEAST
http://www.wafeast.org