Starting Solid Foods: Food Allergies

If you are new to the parenting scene, you might be wondering why so many children have food allergies today. If you take a child to any group function, allergy alert signs are posted everywhere, and entire schools are nut-free zones. When I was a child, peanut butter sandwiches were lunchbox staples. Today they are strictly banned, and the topic of food allergies is not one to be discussed lightly, especially if you are a parent with an allergic child.

Some allergic children respond to certain foods with itchy skin or a scratchy throat. Others are deathly allergic, meaning they can develop anaphylaxis (pronounced an-uh-fil-LAX-is), a medical emergency that requires treatment with an epinephrine (pronounced ep-in-EF-rin) injector, or EpiPen, and a trip to the emergency room for constriction of the throat, severe drop in blood pressure, and loss of consciousness.

Symptoms of food allergies

A child can have an allergic reaction to a food within seconds, or a reaction may develop hours later. For example, an itchy mouth and throat might signal Oral Allergy Syndrome (OAS), which can occur as a child with hay fever eats fruits and vegetables that cross-react with pollen. However, an allergic reaction to foods like milk or soy may occur hours later. If you are uncertain about your child’s reaction to a food, talk to your doctor. An allergist will be able to distinguish between symptoms of an immune reaction (food allergy) and an inability to digest a certain food (food intolerance).¹⁰⁸

Look for these signs and symptoms as you introduce allergenic foods to your baby:

• Swelling in the tongue and throat
• Tingling in the mouth
• Hives
• Eczema or an itchy rash
• Coughing or wheezing
• GI symptoms, such as abdominal pain, vomiting, or diarrhea
• Dizziness
• Loss of consciousness
• Anaphylaxis. This is a severe allergic reaction that can be fatal, due to its rapid onset.

These eight types of foods account for 90% of all allergic reactions in children:

• Eggs
• Cow’s milk
• Peanuts
• Tree nuts (like walnuts, pecans, hazelnuts, almonds, cashews, and pistachios)
• Soy or soybeans (primarily in infants)
• Fish (like tuna, salmon, cod)
• Shellfish (shrimp, crab, lobster)
• Wheat

Note: The FDA estimates that 80 to 90% of children with allergies to milk, eggs, wheat, and soy should outgrow them by age five, while only 20% will outgrow a peanut allergy and 10% will outgrow tree nut allergies.

In March 2019, the AAP updated its recommendations to focus specifically on children who are at risk for a food allergy.

” Those recommendations focus on a high-risk population—infants with severe atopic dermatitis and/or egg allergy—who are advised to introduce infant-safe forms of peanut as early as 4-6 months, in specified amounts, with consideration of pre-testing to rule out allergy. The guidelines recommend that infants with mild to moderate eczema be introduced to infant-safe peanut-containing foods as early as 6 months of age, and those without food allergy or risk factors do so when age appropriate and depending on family preferences, i.e., after 6 months of age if exclusively breastfeeding.”

Practical tips from real parents: What if You Suspect Food Allergies?

Mild reactions (newborn to infant)

• Keep a careful food diary if you suspect that your baby may be having mild reactions, such as pink areas around the mouth, tummy discomfort, patches of hives or a rash, to certain foods,
• If your child has eczema or asthma as an infant, be on the lookout for food allergies later.
• If your child has eczema as a newborn, or if an older sibling has allergies, have the younger sibling’s blood tested for allergies as a baby around 6-9 months. My third child tested negative to an allergy blood test as a baby and our allergist told me to introduce peanuts and eggs immediately. I did, and he has no allergies, unlike his older two siblings. I don’t know if the early introduction is the reason he doesn’t have food allergies or not, but the fact remains that he doesn’t.   

 Food allergy concern or diagnosis

• Talk to your doctor about vaccinations. Certain vaccines have lactose, egg protein, or yeast protein added that is enough to cause an allergic reaction.
• Our child’s food allergy diagnosis changed our life. If this happens to you, educate yourself as much as possible.
• Teach your family, nannies, babysitters, and anyone else caring for your child about his or her food allergy. Also, teach everyone how to use an epinephrine injector.
• Fill out an emergency plan with your allergist and share it with others.
• Visit your child’s day care and talk about your allergy. Have a step-by-step plan in writing for any allergic reactions.
• Put reminders on your calendar for refilling your epi-pen prescription because they have an expiration date. Also, get extras. You will leave pens everywhere.
• Buy an ID bracelet for your child with your name, phone number, and their allergies.
• Expect to become a professional label reader. Check both the “Ingredients” labels and “Contains” labels.
• If your child is diagnosed with a food allergy, try shopping online at a food allergy-friendly website to save time painfully reading labels in the store.
• Don’t think that lesser past reactions are an indicator of the future. Our son had several bad reactions to a certain food at age five that began with a mild reaction at age one.
• Children with food allergies are more likely to have environmental allergies. As babies and toddlers get older, food allergies typically improve but environmental allergies can get worse. Allergy shots have helped my son significantly.
• Be matter of fact when talking about your child’s allergies. They are already scary for a child, especially when the throat constricts. A child needs to know they can trust you and that you have the tools (Benadryl and epi-pen) to keep them safe. They will follow your lead in how to respond.