Ask anyone who raised children 30 years ago if they ever heard of food allergies back then, and the likely answer will be no. Yet today, who doesn’t know a child -if not several kids- who have severe food allergies? Pediatricians and allergists are observing first-hand that food allergies in infants and children have increased to epidemic proportions over the last few decades. Approximately 4% of Americans are estimated to have food allergies. That’s more than 12 million individuals. The prevalence of food allergies is even higher-6% to 8%-in infants and young children under three years old.
Any type of food can trigger an outbreak, yet the “Big 8” account for more than 90% of all cases: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. Sesame is quickly becoming another common cause of allergies, especially in those with Mediterranean diets. The good news is that the incidence of documented food allergies decreases with age, probably due to the development of tolerance in children allergic to milk, wheat, soy, and eggs. Of the 2.5% of children allergic to milk, approximately 80% will “outgrow” their allergy by age five. Kids with peanut or tree nut allergies aren’t as lucky: Recent studies have shown that only about 10% to 20% of children will lose their allergy as they age.
Delayed Allergic Reactions
While less dangerous in terms of one’s immediate health, the “delayed allergic reaction” can be much more difficult to diagnose and treat. As the name implies, it can take hours or even days after ingestion for the symptoms to show up, making it harder to establish a cause-and- effect relationship. The typical symptoms can involve several organ systems and may be quite subtle in their presentation. In addition to the classic allergy symptoms (think nasal congestion, a runny nose, and a rash), delayed reactions may also present with very vague and nonspecific symptoms, such as frequent headaches, recurrent or chronic abdominal pain, fatigue and lethargy, irritability, dark circles under the eyes, leg pains, and recurrent ear or sinus infections.
Part of the difficulty in diagnosing these food reactions is that there’s no reliable allergy test that can accurately identify or predict a delayed outbreak. So how can you figure out if your child’s symptoms are the result of something he or she is eating? The best method is to eliminate the suspected food (or drink) from your kid’s diet for four weeks. If you notice a significant improvement in symptoms, you’re ready for the challenge phase: Serve the food in question for several days straight. If the symptoms start recurring, you can be relatively sure that a cause-and-effect relationship has been established. Even after avoiding the food culprit, it can still take a few weeks for symptoms to completely disappear, so be patient.
By far, milk and other dairy products are the most common cause of this type of reaction. Over the years, many teenagers have walked into my office with their parents complaining about stomach discomfort and profound tiredness. By the time they’ve come to see me, they’ve usually been through various tests and have seen multiple physicians, including gastroenterologists, and have often been diagnosed with irritable bowel syndrome. After hearing about their saga and symptoms-and seeing the dark circles under their eyes and their pale, sallow complexion-I can usually tell that it’s a dairy allergy. Fortunately, many responded dramatically to a few weeks off of milk. They couldn’t believe that the innocent act of drinking milk and eating dairy products could make them feel so ill-and that avoiding these products could restore their good health and vitality in such a short time.
Allergies In Infants
Because of their age, newborns and infants can be especially sensitive to food allergies. Symptoms may include colic, irritability, excessive spitting and vomiting, rashes (including eczema or hives), nasal symptoms (such as congestion and runny nose), coughing or wheezing, and other gastrointestinal symptoms (diarrhea, bloody stools, or constipation). There can also be poor weight gain. Allergies in infants up to age one are almost always caused by food-most commonly cow’s milk. Yet a baby doesn’t have to drink milk straight for symptoms to break out: The proteins in cow’s milk can enter the baby’s system through some commercial formulas, as well as by passing through the mother’s milk during nursing. A small percentage of milk-allergic babies are also allergic to soy.
In recent years, researchers have devoted themselves to understanding the disturbing rise of food allergies, especially in infants and kids. What they have discovered is leading allergists and physicians to dramatically revise recommendations on how and when we introduce foods to infants. For many decades, the time-honored and well-established approach was to delay the introduction of highly allergenic foods into the infant’s diet to prevent the emergence of food allergies. For example, solid foods are generally not recommended until six months of age, cow’s milk until one year, eggs until two years, and peanuts, tree nuts, and fish until three years. There is also a widely accepted notion that breast feeding alone for the first six months of life will minimize or delay the onset of food allergies and other allergic diseases (including asthma), as well as atopic dermatitis or eczema.
Managing Severe Allergies
Historically, the treatment of serious food allergies has consisted of avoiding exposure and ingestion of the allergenic food, and making antihistamines and epinephrine immediately available. Total abstinence is indeed difficult and often impossible, as evidenced by the large number of accidental ingestions and allergic reactions that have resulted in emergency room visits. Even with strict avoidance measures, the potential for sudden and life-threatening outbreaks can lead to extreme anxiety in both the child-and the parent.
Fortunately, medical research has now proven that orally-administered immunotherapy can result in a significant degree of desensitization, or tolerance, to a given food in most allergic patients. This form of therapy, however, is associated with a significant amount of risk and should only be performed under the watchful eye of a board-certified allergist experienced in oral tolerance induction. Presently in the United States, this form of desensitization is being performed at a few highly-acclaimed medical centers.
An Allergy-Free Future
With all the time and money being put into food allergy research, there is excitement in the medical field about the possibility of new breakthroughs in the near future-both in prevention and treatment.