Food Foe or Friend? Child's Allergies Explained by Paediatric Skin Specialist

While all parents worry about their children getting a balanced diet, for some, mealtimes become a much bigger concern. This is especially true for parents of children with food allergies, which can range from mild rashes and swelling to life-threatening reactions.

“A food allergy is when the body has an abnormal immunological response towards certain foods,” shares Dr Sanjay Woodhull, Consultant Paediatrician at Subang Jaya Medical Centre (SJMC).

It can be present in many forms but the commonest form that most parents are aware of is rashes or hives. The child may also have swelling in the eyes, ears or face, throat itchiness, coughing, vomiting, and wheezing.

“The most severe spectrum is something called anaphylaxis, which is very dangerous, rapid in onset, life-threatening and requires immediate treatment.”

Some children experience symptoms immediately after consuming the offending food, for example, anywhere between minutes to two hours while others may experience a late onset of symptoms, after a few hours or even a few days.

In some cases, there may be a mix of both immediate and delayed reactions.

Common Foods Allergies in Children

 Dr Sanjay says in most cases (meaning 60-70% of children), food allergies tend to show up within the first year of life. The most common foods which cause allergies are cow’s milk, eggs, fish, and peanuts.

“Generally, in children with food allergies, their immune system becomes over-responsive towards a particular food, and this results in an inflammatory cascade of events going through the body,” he says.

He adds that if parents suspect a food allergy in their child, they must see a doctor and provide a detailed history. If possible, they should also take pictures of the rashes or facial swelling which appears when the child consumes that particular food and show it to their doctor, so they are able to get a clear picture of the situation.

While it's tempting to restrict your child's diet if you suspect a food allergy, avoid eliminating foods blindly. This can lead to nutritional deficiencies.

Consult with the Paediatric Dermatologist

Instead, consult a doctor for proper diagnosis and guidance. Recent research suggests that unnecessarily avoiding potential allergens might increase the risk of developing a true allergy later. Early diagnosis and a balanced diet are key to managing food allergies effectively.

“So, we don’t recommend avoiding foods purely on suspicion. The longer they don’t take it, the higher the chance that upon reintroduction one or two years later, they will develop an allergy to it,” he says.

Dr Sanjay adds that based on parental concern, the incidence of allergy in some populations may get pushed up by as high as 20-30% but when these children are tested, less than 2% actually have an allergy.

There’s a huge gap between perception and the actual number of allergic kids in a population.

Early Diagnosis of Children food allergy

 Just because your child develops a rash after eating doesn't automatically mean it's a food allergy. Rashes can have many causes. Additionally, if it is a food allergy, pinpointing the culprit can be tricky. Meals often contain multiple ingredients, making it difficult to isolate the trigger.

To diagnose a food allergy, doctors typically use skin prick tests or blood tests. These tests identify specific foods a child might be sensitive to. They will also gather a detailed dietary and medical history from you, the parent, to help narrow down the possibilities.

Dr Sanjay says the blood test or skin prick test only indicates sensitivity towards a particular food — it doesn’t confirm an allergy. Having sensitivity towards something doesn’t mean a child will break out in rashes or experience other food allergy symptoms each time he consumes a certain food.

For example, a significant number of children with a positive result on the skin prick test for egg and fish can still easily consume both types of food. Their bodies are sensitised to it, but they don’t exhibit symptoms.

Even in children with a confirmed allergy such as an egg allergy, for example, they sometimes don’t exhibit symptoms if they eat a muffin which contains egg as opposed to scrambled eggs because the protein in the egg gets broken down during the baking process.

As a result, diagnosing a food allergy critically lies in getting the patient’s history.

“Taking a good history would be the most important thing when diagnosing a food allergy,” he stressed.

What doctors usually do after the skin prick test or blood test and after obtaining a detailed history is something called an “oral challenge”, where the child is fed the offending food and his reaction monitored.

Children with food allergies need to be educated on their condition and parents must help them manage the problem.

Dr Sanjay explains that by the time children are two to three years old, some tend to outgrow food allergies. By age three, for example, most children outgrow their cow’s milk allergy.

Egg allergies often improve by the time a child reaches ages 3-7. However, peanut allergies tend to be more persistent, sometimes lasting into adolescence, teenage years, or even adulthood.

While a family history of allergies increases a child's risk, research suggests some promising ways to potentially reduce the risk. Studies show that exclusive breastfeeding and delaying weaning may help delay or prevent the onset of food allergies altogether.

Dr Sanjay says children who are started on solids earlier – at around four to five months of age (instead of six months) – are less likely to develop allergies as they are exposed to foods such as eggs, fish and peanuts at an earlier age.

Source: New Straits Times