Food Allergies In Infants and Childrenby Catherine Clinton, ND
Food allergies in infants and children are a growing problem in the US. Nearly 6 million or 8% of children have food allergies with young children being most affected. 1 The prevalence of food allergies and associated anaphylaxis appears to be on the rise as well. Research reported by the CDC in 2008 shows an 18 percent increase in allergies among children from 1997-2007. 2 More recent research is even more alarming with a study released by the Centers for Disease Control and Prevention in 2013 that reported food allergies among children increased approximately 50% between 1997 and 2011. 3 As a parent, food allergies and sensitivities can make life challenging for you and your child but being informed about the topic is one of the best tools in your toolbox.
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What are Food Allergies?
With a food allergy, the body’s immune system creates IgE antibodies to certain food proteins. These antibodies attach to mast cells and basophils which release the histamine, leukotrienes, prostaglandins, tryptase and other inflammatory cytokines that increase allergic inflammation. This inflammation impairs the intestinal barrier function and increases intestinal mucosal permeability which contributes to an ongoing inflammation. 4 This intestinal permeability allows even more potential allergens into the bloodstream and the vicious cycle repeats itself. 5 The allergic inflammation can also travel through the bloodstream and affect places that haven’t even come in contact with the food. For example, inflammation from a food allergen can cause diarrhea and swollen lips from direct contact with the allergen but the allergic inflammation can travel in the bloodstream causing nasal congestion as well.
IgE isn’t the only immune response in food allergies or sensitivities. An IgE allergic reaction is more immediate while the non-IgE allergic reactions have more delayed reactions. The severe allergy to wheat seen in celiac disease is an IgA response. Other disorders like eosinophilic gastrointestinal disorders are marked by high eosinophils, and T lymphocytes are responsible for the allergic reaction in food protein induced enterocolitis syndrome. IgG food sensitivity testing is becoming more popular with alternative health practitioners and patients report symptom relief after elimination of the IgG food trigger. Though still controversial the research behind IgG food sensitivity looks promising and it should be considered when looking for the cause of your child’s allergic symptoms.
Food intolerances like lactose or mild gluten intolerance as well as the intolerance to yeast, sulfites, certain food colorings/preservatives, fructose or histamine in foods are not considered true allergic responses. Food intolerances do not directly activate the immune system but rather create allergic symptoms because the body cannot digest or tolerate the food. While not necessarily a food allergy, food intolerances offer another avenue for pinpointing the source of your child’s symptoms.
Food allergies may be a trigger for or associated with other allergic conditions, such as autoimmune disorders, atopic dermatitis and eosinophilic gastrointestinal diseases. Children with a food allergy are 2-4 times more likely to have other related conditions such as asthma and other allergies, compared with children without food allergies.
What are the most common food allergens?
The eight most common food allergens, which are responsible for 90% of problems, are the proteins found in milk, eggs, fish, shellfish, tree nuts (e.g. almonds, walnuts), peanuts, wheat and soy. However, it is not uncommon for children to be allergic to other foods or have multiple food allergies. Infants and young children are more sensitive to these proteins and are more prone to food allergies/sensitivities in general. The intestinal tract of infants and many children, especially those with food allergies or sensitivities, is more vulnerable to permeability.
How can I tell if my infant or child has food allergies or sensitivities?
Some allergic reactions are immediate and severe, while others are less severe and may take days to appear. We still don’t fully understand why there is such a range from severe to mild symptoms in food allergies but it is believed to be genetic. Severe reactions could appear instantly after eating just half a nut or the reaction could take days to appear.
Common food allergy/sensitivity symptoms:
- Tingling or itching in the mouth
- Rash, hives, itching or eczema
- Swelling of the lips, face, tongue and throat or other parts of the body
- Wheezing, nasal congestion, cough or trouble breathing
- Abdominal pain, diarrhea, constipation, gas/bloating, nausea or vomiting
- Dizziness, lightheadedness or fainting
- Infant with runny mucusy poop, severe spitting up
- Recurrent respiratory infections
- Behavioral changes
- Developmental delays
How can I be sure my baby or child has food allergies/sensitivities?
If you suspect your child has a food allergy or sensitivity, your healthcare provider can best guide you to the appropriate test. There is the skin prick test which involves placing liquid extracts of food allergens on your child’s forearm or back, pricking the skin, and waiting to see if red raised spots appear within a few minutes. A positive skin test to a certain food only shows that your child could be allergic to that food and usually additional tests for confirmation are needed. Your provider might also perform blood tests, called RASTs (radioallergosorbent tests), which check the blood for IgE antibodies to specific foods or the ELISA test for IgG or IgA mediated reactions. An oral challenge to the suspected allergen can be done in your doctor’s office as well.
The best test for food allergies is an elimination diet. Although it can be challenging to change eating habits, this is the best way to test for reactions to food in infants and children. Dairy and gluten are usually the most problematic foods, followed by soy and eggs, and should be eliminated first to see if your child’s symptoms resolve. Many skin, digestive, and behavioral symptoms in infants and children can be partially or fully resolved by avoiding these top allergens. Allergy testing in infants under 1 year is not accurate and should be reserved for infants with a suspected severe allergy such as a parent or sibling with a severe allergy. Approaching infant colic as a food allergy or sensitivity by removing the top two or three allergens from the infant’s diet or from the breastfeeding mother’s diet is the best first step to determining the source of your baby’s discomfort. You can reserve the more expensive and invasive skin and blood tests for when your child’s symptoms do not resolve after removing the suspect allergen or if a severe food allergy is suspected.
Another promising test is component food allergy blood testing. This test can help predict the severity of future food allergy/reactions, whether the allergy will be outgrown and to which forms of foods (cooked or unprocessed) your child will have reactions to. This test offers a promising avenue to help parents navigate their child’s food allergies.
Are food allergies preventable?
There is a lot we do not understand about the cause of food allergies and sensitivities. While studies have been mixed surrounding the prevention of food allergies, research has also turned up some promising approaches. We do know that exclusive breastfeeding is associated with reduced risk of food allergy. 6 Breastmilk is rich in many different immunological components including mucosal IgA that helps create tolerance, rather than allergy, to foods. Exclusive breastfeeding for 4-6 months has been associated with a protective effect of reducing the incidence of asthma, atopic dermatitis, and eczema by 27% in a low-risk population and up to 42% in infants with positive family history. 7 8 Research also shows us that introducing gluten while breastfeeding reduces the risk of celiac disease by 52%. 9 It seems that introducing a food during a time when the infant is otherwise solely breastfeeding offers some protection from allergic reactions. Recent research also highlights the protective advantage of supplementing with fish oil and probiotics during pregnancy can have in decreasing overall allergic inflammation. 10 11
Food introduction can be confusing and frustrating for the parent of a child who has a suspected food allergy/sensitivity. Old advice used to warn against early food allergen introduction, urging parents to wait until a year of age to introduce top food allergens. Three recent large studies provided compelling evidence that early introduction of peanut, milk, and egg into an infant’s diet may decrease the risk of IgE-mediated allergy to those foods. 12 13 14 Research released in February of this year reported an 81% decrease in peanut allergies in children who continuously consumed peanuts in their diet from an early age compared to children who avoided eating peanuts. 15 Recent research also shows that mothers with mild to moderate food allergies/sensitivities who had avoided cow’s milk while breastfeeding produced less mucosal IgA which actually increased the rate of cow’s milk allergy in their children. 16 When it comes to food introduction unless you suspect a severe life threatening reaction you should start to introduce food after 4-6 months of exclusive breastfeeding. Allergenic foods should be introduced slowly and in the presence of breastmilk. Cereals and packaged baby foods are not the best choice, infants should be introduced to one whole food at a time.
Are food allergies/sensitivities treatable?
Although there is no cure for food allergies several interventions can help the symptoms of food allergies/sensitivities. The first line of defense in the treatment of food allergies is an elimination diet. There are several ingredients to be wary of and avoid when on an elimination diet.
Depending on the severity of the reaction, prescription epinephrine pens are used to resolve severe anaphylactic allergic responses. Studies with humanized recombinant anti-IgE antibodies have shown a decrease in sensitivity to peanut allergens in some patients. 17 Exciting new research demonstrates how allergen-specific immunotherapy may help the body tolerate food allergens. Recent reports have demonstrated partial success with oral, sublingual, subcutaneous and epidermal immunotherapy in the treatment of food allergy. 18 19 20 21 Probiotics, fish oil and digestive enzymes also have promising research in the treatment of food allergies. 22 23 Preliminary research on the antioxidant quercitin shows that it is a powerful mast cell stabilizer, inhibiting the release of histamine that creates the allergic reaction in food allergy. 24 While research is not conclusive, alternative treatments for food allergies provide encouraging results. Parents also report success with homeopathy for treating the discomfort of food allergies and colic. Talk with your healthcare provider today if you suspect food allergies or sensitivities in your child or infant.
- Gupta RS, Springston, MR, Warrier BS, Rajesh K, Pongracic J, Holl JL. The prevalence, severity, and
distribution of childhood food allergy in the United States. J Pediatr.2011; 128.doi: 10.1542/peds.2011-0204
- Branum A, Lukacs S. Food allergy among U.S. children: Trends in prevalence and hospitalizations. National
Center for Health Statistics Data Brief. 2008. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db10.htm
- Jackson K et al. Trends in Allergic Conditions among Children: United States, 1997-2011. National Center for
Health Statistics Data Brief. 2013. Retrieved from www.cdc.gov/nchs/data/databriefs/db10.htm
- Ventura MT, Polimeno L, Amoruso AC, Gatti F, Annoscia E, Marinaro M, et al. Intestinal permeability in patients with adverse reactions to food. Dig Liver Dis. 2006;38:732–6
- Chen T1, Liu X, Ma L, He W, Li W, Cao Y, Liu Z. Food allergens affect the intestinal tight junction permeability in inducing intestinal food allergy in rats. Asian Pac J Allergy Immunol. 2014 Dec;32(4):345-53. doi: 10.12932/AP04184.108.40.2064.
- Kull I et al (2002). Breast feeding and allergic diseases in infants–a prospective birth cohort study. Arch Dis Child 87: 478-481.
- Ip S, Chung M, Raman G, et al., Tufts-New England Medical Center Evidence-based Practice Center. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007;153(153):1–186
- Greer FR, Sicherer SH, Burks AW, American Academy of Pediatrics Committee on Nutrition, American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183–191
- Akobeng AK, Ramanan AV, Buchan I, Heller RF. Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Arch Dis Child. 2006;91(1):39–43
- Elazab N1, Mendy A, Gasana J, Vieira ER, Quizon A, Forno E. Probiotic administration in early life, atopy, and asthma: a meta-analysis of clinical trials. Pediatrics. 2013 Sep;132(3):e666-76
- Furuhjelm C1, Warstedt K, Fagerås M, Fälth-Magnusson K, Larsson J, Fredriksson M, Duchén K. Allergic disease in infants up to 2 years of age in relation to plasma omega-3 fatty acids and maternal fish oil supplementation in pregnancy and lactation.
- Du TG, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008;122(5):984–991
- Katz Y, Rajuan N, Goldberg MR, et al. Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy. J Allergy Clin Immunol. 2010;126(1):77–82.
- Koplin JJ, Osborne NJ, Wake M, et al. Can early introduction of egg prevent egg allergy in infants? A population-based study. J Allergy Clin Immunol. 2010;126(4):807–813
- Du Toit G et al. Randomized trial of peanut consumption in infants at risk of peanut allergy. New England Journal of Medicine DOI: 10.1056/NEJMoa1414850 (2015).
- Järvinen KM1, Westfall JE, Seppo MS, James AK, Tsuang AJ, Feustel PJ, Sampson HA, Berin C. Role of maternal elimination diets and human milk IgA in the development of cow’s milk allergy in the infants. Clin Exp Allergy. 2014 Jan;44(1):69-78. doi: 10.1111/cea.12228.
- D.Y. Leung, H.A. Sampson, J.W. Yunginger, A.W. Burks Jr., L.C. Schneider, C.H. Wortel, F.M. Davis, J.D. Hyun, W.R. Shanahan Jr. Effect of anti-IgE therapy in patients with peanut allergy N. Engl. J. Med., 348 (2003), pp. 986–993
- A.D. Buchanan, T.D. Green, S.M. Jones, A.M. Scurlock, L. Christie, K.A. Althage, P.H. Steele, L. Pons, R.M. Helm, L.A. Lee, A.W. Burks Egg oral immunotherapy in nonanaphylactic children with egg allergy J. Allergy Clin. Immunol., 119 (2007), pp. 199–205
- P. Meglio, E. Bartone, M. Plantamura, E. Arabito, P.G. Giampietro A protocol for oral desensitization in children with IgE-mediated cow’s milk allergy Allergy, 59 (2004), pp. 980–987
- Fernandez-Rivas M, Garrido FS, Nadal JA, et al. Randomized double-blind, placebo-controlled trial of sublingual immunotherapy with a Pru p 3 quantified peach extract. Allergy. 2009;64(6):876–883
- Dupont C, Kalach N, Soulaines P, Legoue-Morillon S, Piloquet H, Benhamou PH. Cow’s milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol. 2010;125(5):1165–1167
- Oral administration of an IL-10-secreting Lactococcus lactis strain prevents food-induced IgE sensitization.
J Allergy Clin Immunol. 2007
- Untersmayr E1, Jensen-Jarolim E. The effect of gastric digestion on food allergy. Curr Opin Allergy Clin Immunol. 2006 Jun;6(3):214-9.
- Zuyi Weng,#1,2 Bodi Zhang,#1,2,3 Shahrzad Asadi,1,4 Nikolaos Sismanopoulos,1 Alan Butcher,5 Xueyan Fu,6 Alexandra Katsarou-Katsari,7 Christina Antoniou,7 and Theoharis C. Theoharides Quercetin Is More Effective than Cromolyn in Blocking Human Mast Cell Cytokine Release and Inhibits Contact Dermatitis and Photosensitivity in Humans PLoS One. 2012; 7(3): e33805.