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Food Allergies (for Parents) - Nemours KidsHealth
What Are Food Allergies?
A food allergy happens when the body's immune system, which normally fights infections, sees the food as an invader. This leads to an allergic reaction.
Even if previous reactions have been mild, someone with a food allergy is always at risk for the next reaction being life-threatening. So anyone with a food allergy must avoid the problem food(s) entirely and always carry emergency injectable epinephrine.
What Are the Most Common Food Allergens?
A child could be allergic to any food, but these common allergens cause 90% of all reactions in kids:
- milk
- eggs
- peanuts
- soy
- wheat
- tree nuts (such as walnuts and cashews)
- fish
- shellfish (such as shrimp)
- sesame
What Are the Signs & Symptoms of a Food Allergy?
An allergic reaction is an immune system response in which chemicals like histamine are released in the body. An allergic reaction can be mild or severe. A person can have a severe reaction to a food even if their previous reactions were mild. Symptoms of an allergic reaction can include:
- wheezing
- trouble breathing
- coughing
- hoarseness
- throat tightness
- belly pain
- vomiting
- diarrhea
- itchy, watery, or swollen eyes
- hives
- red spots
- swelling
- a drop in blood pressure, causing lightheadedness or loss of consciousness (passing out)
Sometimes, an allergy can cause a severe reaction called anaphylaxis. Anaphylaxis might start with some of the same symptoms as a less severe reaction, but can quickly get worse. The person may have trouble breathing or pass out. More than one part of the body might be involved. If it isn't treated with injectable epinephrine, anaphylaxis can be life-threatening.
What Is a Food Intolerance?
People often confuse food allergies with food intolerance.
The symptoms of food intolerance can include burping, indigestion, gas, loose stools, headaches, nervousness, or a feeling of being "flushed." But food intolerance:
- doesn't involve the immune system
- can happen because a person can't digest a substance, such as lactose
- can be unpleasant but is rarely dangerous
How Is a Food Allergy Diagnosed?
If your child might have a food allergy, the doctor will ask about:
- your child's symptoms
- the time it takes between eating a particular food and the start of symptoms
- whether any family members have allergies or conditions like eczema and asthma
The doctor might refer you to an
allergist(allergy specialist doctor), who will ask more questions and do a physical exam. The allergist probably will order tests to help make a diagnosis, such as:
- a skin test. This test involves placing liquid extracts of food allergens on your child's forearm or back, pricking the skin, and waiting to see if reddish raised spots (called wheals) form.
A positive test to a food shows that your child might be sensitive to that food. - blood tests to check the blood for IgE antibodies to specific foods
Your child may need to stop taking some medicines (such as over-the-counter antihistamines) 5 to 7 days before the skin test because they can affect the results. Check with the allergist's office if you are unsure about what medicines need to be stopped and for how long.
If the test results are unclear, the allergist may do a food challenge:
- During this test, a person slowly gets increasing amounts of the potential food allergen to eat while being watched for symptoms by the doctor. The test must be done in an allergist's office or hospital with access to immediate medical care and medicines because a life-threatening reaction could happen.
Food challenge tests are also done to see if people have outgrown an allergy.
How Are Food Allergies Treated?
A child who has a food allergy should always have two epinephrine auto-injectors nearby in case of a severe reaction.
An epinephrine auto-injector is a prescription medicine that comes in a small, easy-to-carry container. It's easy to use. Your doctor will show you how. Always have two auto injectors nearby in case one doesn't work or your child needs a second dose.
The doctor can also give you an allergy action plan, which helps you prepare for, recognize, and treat an allergic reaction. Share the plan with anyone else who needs to know, such as relatives, school officials, and coaches. Wherever your child is, caregivers should always know where the epinephrine is, have easy access to it, and know how to give the shot. Also consider having your child wearing a medical alert bracelet.
Time matters in an allergic reaction. If your child starts having serious allergic symptoms, like trouble breathing or throat tightness, use the epinephrine auto-injector right away. Also use it right away if symptoms involve two different parts of the body, like hives with vomiting. Then call 911 and have them take your child to the emergency room.
Medical supervision is important because even if the worst seems to have passed, a second wave of serious symptoms can happen.
If your child has a food allergy, carefully read food labels so you can avoid the allergen. Ingredients and manufacturing processes can change, so it's important to read labels every time, even for foods your child has had safely in the past. The most common allergens should be clearly labeled. But less common allergens can be hidden in ingredients like natural flavors or spices.
One thing that might not show up on a label is cross-contamination risk. Cross-contamination happens when a food you are not allergic to comes in contact with a food you are allergic to. This can happen if a manufacturer uses the same equipment to grind lots of different foods, for example. Some companies state this on their labels to alert customers to the risk of cross-contamination with messages like: "May contain peanuts," "Processed in a facility that also processes milk," or "Manufactured on equipment also used for eggs.
" You'll want to avoid products that have these kinds of alerts.
But companies are not required to put cross-contamination alerts on a food label. So it's best to contact them to see if a product might been in contact with your child’s allergens. You may be able to get this information from a company website. If not, contact the company and ask.
When your child eats away from home, make sure anyone preparing food knows about the allergy and which foods to avoid. You may want to provide food that you know is safe for your child.
You can learn more about managing food allergies online at:
- Food Allergy Research and Education Network (FARE)
Reviewed by: Larissa Hirsch, MD
Date reviewed: January 2022
Symptoms, Risk Factors, and More
What is FPIES?
Food protein-induced enterocolitis syndrome (FPIES) is a rare food allergy. It affects mostly young children and infants. This allergy occurs in the gastrointestinal (GI) tract.
It causes recurring or sometimes chronic — but often severe — vomiting and diarrhea.
The reaction typically begins after the infant or child consumes dairy or soy foods. The allergy may also appear when the infant begins eating solid foods for the first time.
Some children with FPIES will struggle to gain or even maintain a healthy weight. As a result, they may begin failing to meet growth milestones, including weight and height goals. Ultimately, children with FPIES may be diagnosed with “failure to thrive.”
Unlike other food allergies, an FPIES reaction is contained to the GI tract. The signs of a reaction may take several hours to appear. This delay may make it harder to diagnose the allergy.
Symptoms of FPIES may also be confused with gas, acid reflux, or a stomach bug. The symptoms return after each exposure to the food allergen, so it’s the chronic and repetitive nature of FPIES and the association with one particular food that ultimately distinguishes it from a brief episode of tummy trouble.
The signs and symptoms of FPIES include:
- chronic or recurrent vomiting
- diarrhea
- dehydration
- lethargy
- changes in blood pressure
- body temperature fluctuations
- weight loss
- stunted growth
- failure to thrive
A child with a diagnosis of failure to thrive may have delays in many milestones, including:
- height, weight, and head circumference
- physical skills, including rolling over, sitting, standing, and walking
- social skills
- mental skills
There are several risk factors for FPIES:
- FPIES appears to affect boys slightly more than girls.
- According to the American College of Allergy, Asthma, and Immunology (ACAAI), 40 to 80 percent of children with FPIES have a family history of allergic conditions, including food allergies, eczema, or hay fever.
- If your child received a diagnosis with one type of food allergy, it’s possible they may have an additional allergy.
FPIES is unlike most food allergies, which cause reactions within several seconds or minutes of contact with the allergen. Your child might have both types of food allergies.
Triggers
All foods can cause an FPIES reaction, but certain foods are also more likely to trigger one. Milk and soy products are the leading causes of a reaction. Usually the food must be ingested directly by the infant, so breastfed babies develop symptoms later than formula-fed babies — if they get symptoms at all. Other food allergens that might trigger it include:
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Most children with FPIES only have one or, occasionally, two food triggers. It’s possible, however, for a child to have reactions to multiple foods.
Experts don’t know how many children have FPIES. It’s considered a rare disease. In recent years, the number of FPIES cases has been increasing. It’s unclear if this increase is the result of wider awareness for FPIES or an actual increase in cases of the condition.
If your child is exposed to the allergen that causes their reaction, you have several options for treating the symptoms. The treatment options depend on the severity of your child’s reaction and what foods trigger their reactions.
Steroid injections
A steroid shot may help reduce the severity of your child’s immune response. This may lessen the severity of symptoms, too.
IV fluids
If your child is experiencing severe vomiting, diarrhea, or dramatic changes in body temperature, see their pediatrician immediately. Your child may need IV fluids for rehydration and to prevent shock.
Lifestyle treatments
These treatments help reduce or ease the symptoms of an FPIES reaction. They don’t treat the condition itself, though. Treatments are individualized to your child and their triggers.
Once an infant or young child receives an FPIES diagnosis and their trigger food is eliminated from their diet, symptoms resolve. Most children outgrow FPIES by the time they’re 3 years old.
However, cases in older children and adults have been reported.
If your child has a reaction to a milk product, including cow’s milk, soy, or another type, your pediatrician may recommend a hypoallergenic formula.
It’s rare for a child to react to their mother’s breast milk. But if they do, their doctor may recommend you switch to a formula temporarily. Then, while pumping to maintain your supply, you can work with your child’s doctor to determine the exact allergy so that you can remove it from your diet and begin breastfeeding again.
If your child only reacts to one or two foods, they can simply avoid eating them. Ultimately, the best course of management and treatment for FPIES is to avoid the allergen altogether.
It may take several weeks or months to get a diagnosis of FPIES. Then, you’ll have to change your child’s lifestyle to meet the new restrictions that come with the diagnosis.
Fortunately, FPIES isn’t a lifelong condition. In fact, according to the ACAAI, most children will outgrow FPIES by age 3 or 4.
Once the doctor — usually an allergist or gastroenterologist — believes your child has outgrown their allergy, they’ll work with you to begin slowly introducing the trigger foods back into your child’s diet. They may also recommend you work with a dietitian experienced in working with those who have allergies.
Your child’s allergist may want you to do food exposure tests in their office, where your child can be monitored. Once the doctor is satisfied that the trigger no longer causes an allergic reaction, you may begin feeding your child these foods again.
Unfortunately, some children may live with the condition beyond their earliest years. Some children with FPIES will live with it into their adolescence and beyond. Thankfully, proper diet and FPIES control can help your child grow and thrive, despite the condition.
If your child shows signs of FPIES, make an appointment to speak with their doctor. Identify the signs and symptoms your child experiences and when they occur.
Testing for FPIES is limited and not very certain, so your child’s doctor may conduct several tests to eliminate other conditions.
After those conditions are ruled out, their doctor may consider an FPIES diagnosis more likely. If, under the care of their doctor, eliminating the suspected trigger food from your child’s diet causes the symptoms to go away, this helps make the diagnosis. Together, you can begin developing ways to help your child live and cope with the new diagnosis.
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