Tips to Identify and Manage Your Child's Food Allergies

The severe and often life-threatening reaction some children have to certain foods is no secret. In one prominent case, a Canadian teenager with a severe peanut allergy died after kissing her boyfriend who ate a peanut butter sandwich a few hours earlier.

A recent episode of the television show "Boston Legal" featured a peanut-allergic child who died after accepting candy at school from a fellow classmate.

Not only are food allergies prevalent among children, the problem is growing. Food allergies affect between 6 to 8 percent of US children, according to the Consortium of Food Allergy Research (CoFAR), a research group established by the National Institute of Health. Peanut allergies are particularly troubling, with rates doubling between 1997 and 2002.

"We're seeing an increase in food allergies in children and more importantly, we're discovering that they are becoming harder to outgrow," says Scott H. Sicherer, a pediatric allergist at Mt. Sinai Hospital in New York City, and the author of the book "Understanding and Managing Your Child's Food Allergies" (Johns Hopkins Press, 2006).

According to the American Academy of Allergy Asthma & Immunology, less than 21 percent of people with peanut allergy will outgrow it.

Dr. Sicherer, who is part of the CoFAR clinical group, is troubled by babies who have an egg or milk allergy and are increasingly developing peanut allergies. "We're finding that one in five babies are going on to develop peanut allergies," he says.

The good news is that with food allergens on the rise, clinical research is increasing. CoFAR was funded by the NIH last July to study the development of a peanut allergy in infants between 3 to 15 months in age with a known milk or egg allergy.

While food allergies are expanding in children, not all adverse reactions to foods qualify as ‘allergic.’ There is a difference between 'food allergy' and 'food intolerance.'

A ‘food intolerance’ is an adverse food-induced reaction not involving the immune system. Lactose intolerance is a common example of a food intolerance.

A ‘food allergy’ occurs when the immune system reacts to a specific food. The most common form of this reaction is when the body creates immunoglobulin E (IgE) antibodies to react with the food.

When these IgE antibodies are released, histamine and other chemicals (known as "mediators") cause hives, asthma, or other symptoms of an allergic reaction. The most severe reaction is anaphylaxis, a sudden and potentially fatal response that can involve different areas of the body, such as the gastrointestinal tract, respiratory and cardiovascular systems.

Eight foods account for 90 percent of all reactions: milk, eggs, peanuts, tree nuts (walnuts, almonds, cashews, pistachios, pecans, etc.) wheat, soy, fish and shellfish. For some people, even trace amounts can cause severe reactions.

Defining a food allergy in your child can be difficult. Food allergy symptoms in babies can manifest themselves different ways.

-- Chronic but temporary reactions such as daily skin rash or eczema are common responses to natural acids in foods like tomatoes and oranges. The rash may be accompanied by diarrhea due to the excess sugar in fruit juice.

-- An egg or milk allergy will produce a more sudden reaction, such as hives or vomiting.

-- Reactions can also include asthma-like symptoms like coughing, wheezing, difficulty breathing or gastrointestinal problems such as abdominal pain, swelling of the stomach or gas.

Dr. Sicherer believes there are three major steps to dealing with a food allergy in children.

1) A formal diagnosis with an allergist

2) Knowledge of treating the allergy

3) Monitoring the child as he or she develops for outgrowth of the allergy or development of other food allergies

"The most important thing is that you have to really make the diagnosis by finding, if you can, a pediatric allergist who has extra training," says Sicherer.

Parents usually have a good instinct as to what the food allergen is, says Steve McGeady, Chief of the Division of Allergy, Asthma and Immunology at the Alfred I. DuPont Hospital for Children in Wilmington, Delaware. "We may give the child a food challenge, starting off with different quantities of food for a reaction, and if they pass that test, we do skin testing for a small wheal (raised skin rash) or a blood test if the rash is 10 millimeters," says McGeady.

Although there is no cure for food allergies and no true prophylactic drugs, Dr. Sheldon Spector, an allergist and medical professor at UCLA, says that Xolair, a drug approved to treat allergic asthma is sometimes used on an off-label basis for food allergies in children over twelve.

Dr. Sicherer says that having a food allergy can be like "living in a minefield." The best treatment of all is to strictly avoid the problem food. This involves inquiring about food ingredients and scrupulous reading of food labels.

After abstinence, the next step is for parents, children and their caregivers is preparing for emergencies. The parent and child may need to carry and be able to use injectable epinephrine (EpiPen or Twinject) and antihistamines to treat a reaction. Talking to those around your child is essential. School administrators and staff, such as school nurses, must be able to act quickly, and know how to use epinephrine, in case of an emergency. Depending upon the severity of the reaction, a trip to a hospital emergency room may be still be necessary - even after an injection.

For more information on food allergies, please visit these resources:

-- The Food Allergy & Anaphylaxis Network

-- The American Academy of Allergy Asthma & Immunology

-- Consortium of Food Allergy Research health writer Angela Macropoulos contributed to this report.

For more great information on living healthy through every decade of life, click here to check out Dr. Manny's book The Check List (Harper Collins, 2007).

Dr. Manny Alvarez is the managing editor of health news at, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.