Is there anything to prevent or delay a food allergy?
This is the million-dollar question. In the past, the American Academy of Pediatrics (AAP) suggested delaying the introduction
of certain foods in children who seemed likely to have allergies because their parents had allergies. But practices in other
cultures—and recent research—suggest that might not be the
best course of action.
The AAP now says there’s no solid evidence that waiting to introduce allergenic foods protects children from developing an allergy. In fact, delaying the introduction of allergenic foods may actually raise the risk of food allergies. If you think your child is likely to have a food allergy, talk with his doctor about the best strategy.
Experts are now suggesting you introduce new foods, including potential allergens, starting at 4 to 6 months of age, after some other typical foods have been started (such as fruits and vegetables and cereals). Introduce the new foods, including the potential allergens, one at a time, so if your child has a reaction you’ll know what he’s reacting to.
Don’t give your child cow’s milk until he’s 12 months old, but other dairy products are fine. Breastfeeding may offer some protection against allergies. Consider breastfeeding your baby as long as you can, especially if you have a family history of allergies.
Take steps to avoid allergic reactions
The only way to avoid an allergic reaction is for your child to stay away from foods that have caused symptoms. Even traces of an allergen can cause an allergic reaction. For example, people and pets who have eaten an allergen recently can pass it on to your child through their saliva. Here are some steps you can take:
Learn how to read food labels for ingredients your child is allergic to. Read the label every time you buy a product, even if you’ve used that product before. Food ingredients in any given product may change.
Ask about ingredients in foods that other people make for your child.
Avoid passing allergens to foods that are safe for your child to eat by washing your hands and your child’s hands with soap and water before handling food. Prepare and serve foods with clean utensils and other kitchen items and on clean surfaces.
Educate family, friends, and others who will be with your child about your child’s allergies. Be sure to tell your child’s school and anyone responsible for your child about his or her food allergies.
Teach your child how to manage his or her food allergies. You can start teaching your child even at a young age. When old enough, teach your child to read labels. Also teach your child how and when to use an epinephrine autoinjector, and to tell an adult if he or she is having an allergic reaction.
After the diagnosis, focus on what safe foods your child can have, rather than what he or she can’t have. Start with plain foods with simple ingredients. From there you can look for new recipes that use safe ingredients.
Do kids outgrow food allergies?
This is an important point to emphasize. Children generally, but not always, outgrow allergies to milk, egg, soy and wheat. New research indicates that up to 25 percent of children may outgrow their peanut allergy, with slightly fewer expected to outgrow a tree nut allergy. There is no need to assume your child’s food allergy will be lifelong, though for many, this may be the case. If a food allergy develops as an adult, chances are much lower you will outgrow it. Food allergies in adults tend to be lifelong, though there has not been a lot of research in this area.
National survey of U.S. children
Few large studies have explored which factors could help predict whether or not a child will achieve tolerance—that is, outgrow an allergy. Between June 2009 and February 2010, Dr. Ruchi Gupta and colleagues (Ann & Robert H. Lurie Children’s Hospital, Chicago) surveyed the families of 40,104 children nationwide—the largest study of this kind to date. The researchers analyzed data for nine common food allergies: milk, peanut, shellfish, tree nuts, egg, fin fish, wheat, soy, and sesame.
The study, published online in the Annals of Allergy, Asthma and Clinical Immunology in July 2013, found that 3,188 children surveyed currently had a food allergy, while 1,245 had outgrown one. Key findings of this study include:
A little more than a quarter of the children—26.6 percent—outgrew their allergies, at an average age of 5.4 years old.
Children who were allergic to milk, egg, or soy were most likely to outgrow their allergies. The likelihood of outgrowing shellfish, tree nut, and peanut allergies was significantly lower.
The earlier a child’s first reaction, the more likely that child was to outgrow the allergy.
Other factors that contributed to outgrowing an allergy included having a history of only mild to moderate reactions, being allergic to only one food, and having eczema as the only symptom. Conversely, children with severe symptoms (trouble breathing, swelling, and anaphylaxis) and multiple food allergies were less likely to achieve tolerance.
Black children were less likely to outgrow their allergy than white children.
Boys were more likely to outgrow their allergy than girls.
Dr. Gupta and her team conclude that, while more studies over longer periods of time are needed to confirm these findings, this data can improve the management of food allergies and aid in counseling food allergy families.
Outgrowing peanut allergy
Peanut allergy is one of the most common food allergies among children. In the United States, the number of children with peanut allergy more than tripled between 1997 and 2008.
This allergy tends to be lifelong only about 20 percent of children are fortunate enough to outgrow it.
A Canadian research team reports that children are most likely to outgrow their peanut allergy by age 6. After age 10, the chance of spontaneous resolution (i.e., of outgrowing the allergy) is much lower, according to this study, which was published online in the Journal of Allergy and Clinical Immunology: In Practice on June 27.
Between 1998 and 2011, the researchers, led by Dr. Anne Des Roches (Centre Hospitalier Universitaire Sainte-Justine, Montreal), followed 202 children with peanut allergy from early childhood (18 months or younger) to adolescence. To confirm their diagnosis and monitor their allergies, the children periodically received skin prick tests, along with blood tests, which measured the amount of peanut IgE in their blood. (IgE is the antibody that triggers the symptoms of a food allergy.)
Starting at age 5, children whose blood tests showed a comparatively low level of peanut IgE also had the opportunity to undergo food challenges, the most accurate test available.
At the end of the study, 51 of the original 202 participants—just over 25 percent—had outgrown their allergy. Further, 80 percent of the children in this group were allergy-free before age 8. Tests also showed that these children had low levels of peanut IgE in their blood. In children who remained allergic, the amount of peanut IgE in the blood increased over the years.
The Canadian team concluded that their findings are consistent with a previous study by researchers in Australia, which followed 267 children over 5 years. They recommend additional studies to examine “whether spontaneous resolution may still occur in this population in late adolescence or early adulthood.”
9 tips for avoiding cross-contact of food allergens
Foods that cause allergic reactions are called allergens. Even a tiny amount of an allergen can cause a reaction. Allergic reactions usually occur after your child eats a food that she or he is allergic to.
Precautions you should take to avoid allergic reactions
Some parents choose to completely eliminate all food allergens from their homes. Others, especially those whose children have many food allergies, do not make this choice. If you choose to allow allergens in your house, you run the risk that those foods will “contaminate” your home and your safe foods. This is known as cross contact.
Cross-contact occurs when a food allergen comes in contact with food or an item not intended to contain that allergen. Small traces of allergens can cause allergic reactions.
There are several precautions you should take to avoid food mix-ups and accidental cross-contact.
Label foods in your home as “safe” or “not safe”
To ensure everyone (including your children, visitors, babysitters, etc.) can determine which foods in your home are “safe”, it can be helpful to label the food in your pantry, refrigerator, and freezer. A convenient way to do this is to use red and green circle-shaped stickers. You can buy these types of stickers or make your own. The red stickers are for unsafe foods and the green are for the safe foods (i.e., “red” means “stop” and “green” means “go”). Apply these stickers to every food item in your house.
Avoid pantry mix-ups
If you have both “safe” and “unsafe” versions of similar items (like soy milk and cow’s milk) in your home, do not store these products next to each other. Designate particular shelves or cabinets for storing the “safe” foods. Avoid purchasing items that look similar to each other.
Avoid sippy cup mix-ups
If your toddler is allergic to milk, buy a “special” sippy cup to use both at home and away from home. This cup is never used for anyone else. Put your child’s name on it. Once you put the lid on the average sippy cup you cannot see the contents. Having a special cup that is always used ensures that your child doesn’t grab the wrong cup by mistake.
Avoid contaminating your food supply
If you keep both “safe” and “unsafe” foods in your household, you need to take steps prevent cross-contact:
Washing hands – Teach everyone to wash their hands with soap and water before touching safe foods. Their hands could have allergens on them and they could make a safe food become unsafe.
Utensils – Do not allow allergen-covered utensils to touch your “safe” foods. For example, if a knife used on butter gets inserted into a jar of jam, the jam is no longer safe for a dairy-allergic individual to eat. If you spread butter on wheat bread toast and then dip your knife into the butter again, the butter will now contain traces of wheat.
Countertops and other surfaces – Teach everyone to clean all surfaces after preparing food and to clean countertops before preparing food. Countertops could have traces of allergens on them. Food prepared on an unclean countertop can result in cross-contact with allergens.
Avoid getting allergenic residue All over the house
If you allow food allergens in your home, you need to prevent allergen residue from getting all over the house. Teach all members of your household to always wash their hands with soap and water immediately after touching or eating allergens. Consider confining all food consumption to your kitchen and dining areas. Otherwise, crumbs and traces will get onto your carpets, furniture, toys and other surfaces.
Take care to wash dishes
Wash pans, utensils, and dishes in hot, sudsy water before using them to prepare food for someone with food allergies. It is best to rinse off dirty dishes and utensils before loading them into your dishwasher. This prevents stray bits of dried allergens from sticking to your clean dishes.
Don’t forget your guests
When friends arrive, politely ask them (and their children) to wash their hands with soap and water. If your friends have infants, you may need to take precautions to avoid spit up on your carpets or furniture. The food, formula, or breast milk that is spit up is likely to be allergenic, and it will get on surfaces your child may touch. Set down a clean blanket for babies to protect carpet or furniture.
Take precautions when cooking
Take steps to avoid cross-contact with allergens during the cooking or serving process:
If you are preparing both “safe” and “unsafe” food for the same meal, prepare the safe meal first.
Do not use the same utensils to prepare allergenic and non-allergenic dishes.
Place utensils, plates, and cutting boards directly into the sink or the dishwasher immediately after use. Teach your family that soiled items in the sink or dishwasher are not safe to use until they have been properly washed.
If you use a barbecue, be sure to fully clean the grill before cooking for your child. Consider using foil or a clean grill pan to prepare foods for your child.