Food Allergies in Children

Food allergies are a growing concern among parents, and for good reason with allergy and related conditions estimated to cost the UK NHS about £1 billion a year. Food allergies affect around 5% of the population with 1 in 50 children having a peanut allergy. These allergies can cause a range of reactions, from mild discomfort to severe, life-threatening emergencies. While we can't completely eliminate the risk of food allergies, there are steps we can take to help prevent them in our children. At Spital Clinic, we're committed to providing parents with the information they need to keep their children safe and healthy.  

As a parent of a child with a nut allergy myself, I am aware of the stress to mealtimes, birthday parties, and eating out. It's felt like a constant game of "allergen detective," checking every label, asking a million questions, and always having that little voice in the back of my head worrying about a reaction. Plus, lugging around two sets of EpiPens everywhere is a constant reminder of the seriousness of the situation. It's heartbreaking to think that it took the tragic loss of 15-year-old Natasha Ednan-Laperouse in 2016 for Natasha's Law to be implemented, requiring full labelling of ingredients on all prepacked food. While it's a step in the right direction, it's a bittersweet reminder of the risks and challenges we face every day.  

Understanding Food Allergies.

A food allergy occurs when the body's immune system mistakenly identifies a particular food as harmful. This triggers an allergic reaction, which can involve symptoms such as hives, swelling, vomiting, and difficulty breathing. Some of the most common food allergens include:

• Peanuts
• Tree nuts (e.g., almonds, walnuts, cashews)
• Eggs
• Milk
• Wheat
• Soy
• Fish
• Shellfish

Prevention Strategies.

While research is ongoing, several strategies may help reduce the risk of food allergies in children:

1. Early Introduction of Allergenic Foods: The groundbreaking LEAP (Learning Early About Peanut Allergy) study has revolutionised our understanding of food allergy prevention. It found that introducing peanuts to high-risk infants early on (between 4 and 11 months) significantly reduced their chances of developing a peanut allergy by age 5. This challenges the traditional advice of delaying the introduction of allergenic foods. Consult your GP about the best timing and approach for introducing allergenic foods to your child.

2. Breastfeeding: Breastfeeding for at least the first 4-6 months of life may offer some protection against allergies. Breast milk contains antibodies that can help strengthen your baby's immune system.

3. Healthy Diet: Encourage a varied and balanced diet rich in fruits, vegetables, and whole grains. This helps support a healthy immune system and may reduce the risk of allergies.

4. Probiotics: Some research suggests that probiotics, beneficial bacteria that live in the gut, may play a role in preventing allergies. Talk to your doctor about whether probiotics are right for your child.

5. Skin: The atopic march refers to the progression of allergic diseases that often begins in early childhood. It typically starts with dry skin that can progress to eczema (atopic dermatitis), followed by food allergies, and then progresses to allergic rhinitis (hayfever) and asthma later in childhood or adolescence. The earlier and more severe the eczema, the higher the risk of developing other allergic conditions. The atopic march highlights the interconnectedness of these allergic diseases and the importance of early intervention and management. Key tip from our doctor’s at Spital Clinic – do not take eczema lightly! Especially if your child is under the age of 6 months. If the first exposure to an allergen is through broken skin such as in eczema, the immune system over-reacts and can cause the development of food allergies.  

When to Seek Help.

If you suspect your child has a food allergy, seek medical attention promptly. Symptoms of an allergic reaction can range from mild to severe, and early diagnosis and treatment are essential.

Food Allergies in Children FAQs.

Can probiotics during pregnancy prevent food allergies in children?

There is no evidence to suggest that taking probiotics during pregnancy can prevent food allergies in children.  

How can I prevent food allergies in pregnancy?

Please continue to have a healthy diet in pregnancy which includes the common allergens. There's no evidence that avoiding specific foods or allergens during pregnancy or breastfeeding prevents food allergies in babies. Unless the mother has a food allergy or dietary restrictions (like veganism), it's recommended to include all allergens, such as dairy, eggs, wheat, peanuts, and tree nuts, in the diet throughout pregnancy.

Are there probiotics that can help my child to prevent food allergy?

There is evidence that Lactobacillus rhamnosus has anti-allergic properties and can be used to help improve the gut microbiota of children.  

Can children outgrow their food allergies?

Many children outgrow allergies to milk and eggs, but allergies to peanuts, tree nuts, fish, and shellfish are often lifelong. Regular follow-ups with a healthcare provider can help determine if an allergy has been outgrown.

How do I explain to my child about food allergies?

Sadly about 66% of children/people with food allergies feel that there mental health is affected by it. Children are often smarter than we realize and with this comes anxiety around food allergies. It is easy for them to pick up on our own apprehensions around food especially considering the diligent way of life parents of children with food allergies must live. My son has been aware he has a food allergy since he was 2 after being diagnosed at 13 months. We would often play food detectives when reading packaging together and try our best to not make it a stressful process but more a normal way of life. He knows he doesn’t leave the house without epipens and now often reminds us as well about remembering them! I think the key tip is ensuring that they don’t take on our understandable worries around it.  

I am worried about using steroid creams on my child?

Steroid creams in short courses for the management of eczema are perfectly safe. The worries around steroids tend to come with prolonged use when people haven’t been supported by their doctor for it.  

How do I manage eating out?

Current UK regulations require restaurants to provide allergen information in writing, but it may not always be readily visible to all customers. This puts the onus on customers to request information, which can be risky if staff are not fully trained on allergens. Owen Carey's tragic death, caused by a server's mistake regarding allergens, highlights the need for change.

Owen's Law aims to make it mandatory for all restaurants to clearly state allergens on their menus. It also calls for increased training for staff to understand their responsibilities in handling food allergies. While Owen's family continues to advocate for this law, I hope you can find the below tips helpful.  

Dr Sinthu's Top Health Tips:

1. Have a look at the allergens menu yourself  

2. Explain to them that this is a food allergy (and not food intolerance). Explain that it can result in anaphylaxis and you carry epipens for this.

3. Make sure that you feel confident in the way the server has interacted with you. If they do not sound like they have a full grasp of the severity of allergies then feel free to leave the restaurant. Unfortunately people do not often understand the implications of food allergies and if you do not feel reassured then there is no point taking the risk

4. Please do not live a life of fear cause of this. The risks overall are low and with simple measures, harm can easily be prevented.    

Labels often say “may contain”. Is it safe for my child to eat this?

The label simply means that while the labelled product isn’t supposed to contain allergen(s) the manufacturer is saying they can’t be sure it doesn’t. They can’t be sure there hasn’t been cross-contact with allergens during its preparation. Foods with 'may contain' labels might not contain any allergens at all, but there is also a chance they might. Although it is very frustrating to have to worry about this, there is increasing pressure on food production companies to have more clear labels.  

How do I know the difference between a food allergy or food intolerance?

While both food allergies and food intolerances can cause discomfort after eating, they differ significantly in their underlying causes and potential severity. A food allergy triggers an immune system response, mistakenly identifying a food protein as harmful and leading to the release of histamine and other chemicals. This can result in symptoms ranging from mild (hives, itching) to severe and life-threatening (anaphylaxis). Even a tiny amount of the allergen can be dangerous. Food intolerances, on the other hand, stem from the digestive system's inability to properly process certain foods, often due to enzyme deficiencies or sensitivities. Symptoms are generally less severe, mainly gastrointestinal issues like bloating, gas, and diarrhea, and the amount consumed often influences the reaction. Food intolerances are not life threatening.  

Is there anything that can be done once my child has a food allergy?

Some specialist NHS allergy clinics now offer oral immunotherapy for more serious or persistent milk, nut and egg allergies. OIT is not a cure but can help reduce the seriousness of reactions. Many private providers also offer this service.  

Can you give me some advice on travelling abroad?

Traveling abroad with a food allergy requires careful preparation, but it's absolutely manageable. Research your destination's common ingredients and learn key phrases to communicate your needs in the local language. Consult your doctor before departure, as you may need a doctor’s letter to carry an epipen on board. While traveling, clearly communicate your allergy when ordering food and opt for self-catering accommodations if possible. Always carry snacks and medication, be cautious with street food, and familiarise yourself with local emergency procedures. Remember, thorough preparation and proactive communication are vital for a safe and enjoyable experience. Despite the extra precautions, traveling with a food allergy can still be a rewarding and enriching adventure. Allergy UK has very useful translation cards that you can use to help communicate about your allergy.  

References.

1. BSACI
2. Allergy UK
3. The Natasha Allergy Research Foundation  
4. Nitert MD, Barrett HL, Foxcroft K, Tremellen A, Wilkinson S, Lingwood B, Tobin JM, McSweeney C, O'Rourke P, McIntyre HD, Callaway LK SPRING: An RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women.BMC Pregnancy Childbirth.(2013-Feb-25)
5. The role of probiotics in prevention and treatment of food allergy Shimin Gu, Dong Yang, Chenglong Liu, Wentong Xue