Food allergies among children, as worrisome as they may be to parents, are very commonplace. Nearly 1 in every 13 children under the age of 18 in the United States are affected by food allergies, with nearly 15 million people affected nationwide (kidshealth.org). We at AIRE Medical Group understand the parental concern of properly identifying a food allergy and taking care of a child with a diagnosed food allergy. We have compiled this guide to help you identify symptoms, monitor progress, and provide the best tools to maintain your child's diet and health.
What to look for:
Though the term food allergy can be used loosely, it is important to consult a doctor, specifically an allergist, for proper diagnosis. A food allergy is a medical condition where the exposure to a certain food or group of foods triggers a harmful immune response. This immune response can manifest in a wide range of Type I Hypersensitivity reactions which could be mild (e.g. tingling or itching in the mouth), moderate (hives, swelling of the lips, face, abdominal pain, diarrhea), or severe (anaphylaxis that causes lightheadedness, wheezing, trouble breathing, throat closure). Allergies can also manifest in an IgE and non-IgE mediated response of eczema.
Individuals can be allergic to any food; however, nearly 90% of all allergies are attributed to the following foods:
1. milk
2. eggs
3. peanuts
4. soy
5. wheat
6. tree nuts
7. fish
8. shellfish
The most common of these allergens are milk and peanuts. However, the most severe reactions are typically associated with peanuts, tree nuts, fish and shellfish which can last a lifetime (https://acaai.org/allergies/who-has-allergies/children-allergies).
If your child has experienced any symptoms of itching or redness around their mouth; swelling of their face, mouth, or lips; eczema or irritated skin; or coughing, wheezing or shortness of breath after eating specific foods, it is in the parent’s best interest to take their child to an allergist.
The Center for Disease Control & Prevention reports that there has been nearly a 50% increase in food allergies between 1997 and 2011, while the prevalence of peanut and tree nut allergies have more than tripled in children (https://www.foodallergy.org/life-food-allergies/food-allergy-101/facts-and-statistics). Doctors and scientists believe this may be due to the Hygiene Hypothesis. The Hygiene Hypothesis suggests that our extremely clean environments do not provide the exposure to germs required to teach our immune systems how to respond to infectious organisms. Scientists speculate that the increased sanitation measures in developed countries have dramatically decreased our exposure to different bacteria, making it so our immune system launches it’s defense to pollens and foods rather than infectious microorganisms. (https://www.fda.gov/BiologicsBloodVaccines/ResourcesforYou/Consumers/ucm167471.htm). As described by Dr. Susan Rudders, our immune system has become “skewed away from fighting infections, and towards fighting things that it's not supposed to be fighting, like things in the environment or foods” as described by Dr. Susan Rudders (http://www.cnn.com/2010/HEALTH/08/03/food.allergies.er.gut/index.html). In most developed countries including the United States, most of the population’s diet consists of more sugar, animal-fat and calorie dense foods than other countries, which may be contributing to less diversity in the gut bacteria among American children, making their bodies more susceptible to food allergens. A combination of these hypotheses contribute to the increase in food allergy diagnoses in the last decade.
Continuing Care with an Allergist:
When identifying allergy-related symptoms, it is extremely important you follow up with an allergist. At AIRE Medical Group, both Dr. Manoukian and Dr. Tachdjian have experience with pediatric food allergies to properly diagnose your child and provide the proper care and attention they need. In order to first diagnose your child, a proper consultation is conducted. This consists of detailed questions about symptoms, previous experiences with other common food allergens, how often reactions take place, and whether other family members experience similar allergies. It is helpful for parents to keep a record of allergy events, symptoms, and which new foods they have recently tried, and when the onset of symptoms started.
After analyzing the scenario, our doctors determine testing that will best pinpoint the cause of symptoms. Blood tests are conducted to evaluate elevated IgE levels for common food allergens along with component testing (a blood test to check IgE levels to different components of certain food allergens such as different proteins of peanuts). Component testing is helpful in determining the level of allergenicity to a particular food. The percutaneous skin prick test can be conducted in the office and allows us to get results within 15 minutes. At AIRE Medical Group, our food allergen panel tests for nearly 73 different types of foods ranging from tree nuts, eggs, dairy, meat, fish, shellfish, fruits, and vegetables. After thorough care and review of results, our doctors determine the best course of action and care plan for your child.
Our doctors request that patients continue to follow-up with us in order to properly monitor you child’s symptoms. Typically, patients are expected to follow-up every 6 months to a year at which point blood tests & component testing is conducted. Thereafter potential follow-up skin tests to specific food allergens they had previously tested positive to could be administered to monitor any progress. Parents may also have the option of proceeding with a food challenge. During a food challenge, the patient would be given gradually increasing amounts of the potential food allergen while being closely monitored in the office by our medical staff.
With consistent appointments, conducting proper testing, staying on track with treatment plans, and monitoring your child’s symptoms, even the worst food allergy can be controlled to improve your child’s quality of life and progress.
Advances in Food Allergy Therapy:
In most cases, children are encouraged to stay away from specific food allergens, and are prescribed and taught how to use an epipen in case of emergencies. Additionally, depending on your child’s symptoms, inhalers, antihistamines, or creams may be prescribed to properly treat symptoms. However, new forms of therapy are currently on the horizon!
Most recently, extensive research was conducted to determine different forms of immunotherapy to peanuts which have developed methods of epicutaneous immunotherapy and sublingual immunotherapy. Long-Term Epicutaneous Immunotherapy Treatment of Peanuts (EPIT) uses a patch containing a peanut protein that is worn on the skin and replaced daily. In a 12-month trial, EPIT was shown to be most effective in children 6-11 years old. The second method, Peanut Sublingual Immunotherapy (SLIT) involves the peanut allergen being dissolved in a solution and administered on the patient’s tongue, resulting in most patients becoming desensitized to peanut protein. There is a possibility that similar methods will be employed for techniques used to desensitize patients to other foods as more research is conducted. There is progress being made on the possibility of Nano-Emulsion Vaccines as a form of food immunotherapy. The vaccine would be administered in the form of a nasal spray to get the immune response to shift away from the production of allergy-associated IgE antibodies. (https://www.foodallergy.org/about-fare/blog/report-from-aaaai-recent-findings-in-peanut-immunotherapy)
These exciting advancements hold a promising future for more extensive and long-term treatments for food allergies!
“Will my child outgrow the allergy?”
A common question parents often ask is whether their child will outgrow their food allergy. Unfortunately, there is no black and white answer to this question. There are several factors that contribute to this determination including: the age at the onset of symptoms, the amount of foods they are allergic to, and the severity of their symptoms. Typically, children allergic to milk, eggs and soy have shown to outgrow their allergies, compared to those allergic to peanuts, tree nuts, fish and shellfish who are not as likely to outgrow those allergies. Nearly 50% of infants diagnosed with a milk allergy will outgrow it by the age of 5, 50% of children with an egg allergy will outgrow it by the age of 6, and nearly 80% of children with a wheat allergy will outgrow it by the age of 5, whereas only 20% of children with peanut allergies are seen to outgrow them (https://www.allergypartners.com/allergy-myth-busters-kids-will-outgrow-food-allergies/).
Eosinophilic Esophagitis
Eosinophilic esophagitis is a condition that has been increasingly diagnosed since 2000. It is primarily characterized by a large number of eosinophils that cause inflammation in the esophagus, preventing it from functioning normally. Individuals with this condition may have trouble swallowing, have a problem with food getting stuck in their esophagus, nausea and vomiting, difficulty sleeping, abdominal or chest pain, or a refusal to eat or poor appetite. Individuals with EE often respond poorly to usual therapies and medications used for similar symptoms, which may encourage your doctor to conduct an endoscopy and biopsy. Allergy testing is recommended if EE is identified, because many patients with EE have underlying food or environmental food allergies that are contributing to the abnormal esophageal inflammation.
Typically, the route of treatment for EE is dietary therapies, such as eliminating foods you or your child test positive for, and medications such as steroids that help minimize the inflammation. Our doctors at AIRE Medical Group have employed therapies such as 6 or 4 food elimination diets along with a viscous budesonide regimen. In the elimination diet, the 6 most common food allergens (milk, egg, wheat, soy, peanuts, fish/shellfish) are taken out of your diet. Patient’s symptoms are evaluated for improvement and a esophagogastroduodenoscopy (biopsy to retest the esophagus) is conducted to check for inflammation or esophageal narrowing. The 6 foods are then slowly brought back into the diet individually as we assess symptoms along the way. In addition to the diet, patient’s are also prescribed a viscous budesonide treatment. The budesonide coats the affected regions of the inflamed esophagus which has shown to provide significant improvement in inflammation, throat tightness, and difficulty swallowing (https://www.foodallergy.org/about-fare/blog/report-from-aaaai-recent-findings-in-peanut-immunotherapy)
How We Can Help:
We know that food allergies can be an often confusing, worrisome and stressful process. We at AIRE Medical Group are here to dedicate our efforts to resolving the issue and monitoring your child’s progress. We hope to be an integral part in your family’s journey to better health. Our doctors, Dr. Manoukian and Dr. Tachdjian are both experienced with pediatric allergies and will provide the utmost care with the range of allergy treatments and diagnoses. Be sure to give us a call today to schedule an appointment for your child!
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References
https://www.foodallergy.org/life-food-allergies/food-allergy-101/facts-and-statistics
https://www.mayoclinic.org/diseases-conditions/food-allergy/symptoms-causes/syc-20355095
https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg24-25.html
https://www.foodallergy.org/about-fare/blog/who-is-likely-to-outgrow-a-food-allergy
