Questions About Food Allergies in Children

Today, more and more infants and children are being diagnosed with asthma, eczema, hay fever and food allergies. Food allergies are of particular concern, because reactions may be severe and even fatal. Currently, one in 13 children has a food allergy. Here, Dr. Susan Schuval talks about the rising incidence of food allergies in children. 

What are typical food allergies in children?
The most common food allergens in children are milk, egg, soy and wheat. Up to one-third of children with eczema may have a food allergy. Infants may have reactions to cow’s milk formula, leading to vomiting, rash and wheezing. Symptoms may persist despite multiple formula changes. Older children and adolescents are more likely to have peanut and tree nut allergies. The Pediatric Allergy Clinic at Stony Brook Children’s Hospital offers testing for all types of food allergies.

How do you test for allergies?
There are a few ways. We can do prick skin testing, which is easy and quick. Another option is ImmunoCAP blood testing. Both tests detect allergic antibodies to food or environmental allergens. The best way to tell if a child has outgrown a food allergy is to do an oral challenge test. Patients come into the clinic, and we carefully give them the suspected food allergen in increasing amounts over a three- to-four-hour period under close observation to see if an allergic reaction will occur. This type of oral challenge test is necessary in cases when a patient is suspected to have outgrown his or her food allergy.

When should a child see an allergist?
Anyone who has had a severe allergic reaction, particularly an anaphylactic reaction, should see an allergist. Children who have family members with severe food allergies should also see an allergist. Other indications for allergy testing include eczema, hives or angioedema (swelling). Recent studies have shown that infants with eczema and egg allergy are at higher risk for peanut allergy. Current national pediatric guidelines suggest that these children should be evaluated for peanut allergy prior to introduction of peanut, which is now recommended prior to the first birthday. Prick skin tests or ImmunoCAP testing to peanut should be performed, and supervised oral challenge with peanut may be needed, depending upon the results.

What is the treatment? 
Of course, if you think your child is having an anaphylactic reaction, you should call 911 and go to the nearest hospital emergency department. For less severe reactions like hives, antihistamines such as diphenhydramine are usually given. There is no cure for a food allergy. The treatment is to strictly avoid the food trigger. This may involve reading labels on foods and exercising extreme caution outside the home, especially in restaurants. If a child has had a severe reaction, parents should have an adrenaline autoinjector such as the EpiPen®, which is used to treat life-threatening allergic reactions. Certain children over the age of 12 may be taught to use the EpiPen.
Recently, there have been food immunotherapy trials, which involve giving children increasing amounts of milk, egg or peanut over time in a controlled environment to induce tolerance to the food. These studies have shown to help some children to overcome their food allergies. This is something that we might do in the future, but it’s not our current standard of care. 
Another recent study receiving a lot of attention is the LEAP (Learning Early About Peanut) study, which showed that early administration of peanut to infants may prevent the development of peanut allergy. It also suggested that infants with severe eczema or egg allergy should be tested for peanut prior to peanut administration. 
The good news is that children will often outgrow milk, egg, soy and wheat allergies. Older children and adults, who have allergies to peanuts, tree nuts, fish and shellfish, are less likely to outgrow these allergies. We do see these children yearly, however, as one in five children will outgrow a peanut allergy and one in ten children will outgrow a tree nut allergy.

Why should a parent take their child to the Pediatric Allergy Clinic?
We are an academic medical center on the cutting edge of recent advances in allergy diagnosis and treatment. Our Allergy/Immunology team includes three board-certified pediatric allergists/immunologists and a certified pediatric nurse practitioner/nurse educator, all of whom have many years of experience treating children with allergies. We offer allergy testing and focus on patient education at every visit. We teach our patients to identify their food allergy triggers and how to avoid them in order to prevent reactions.

For more information about Stony Brook Children’s, call (631) 444-KIDS.

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