New Developments in Pediatric Food Allergies

Image 8The human immune system is exquisitely designed to protect the body from foreign invaders.

Like a walled medieval castle bristling with armed guards, we have both physical and adaptive defenses. Skin works as an excellent moat, and our sentries are scattered at points of entry. You’ll never think of your tonsils the same again.

Even with overlapping layers of defenses, sometimes false alarms occur — we call them allergies.  In this setting, an ordinarily harmless substance (usually dust, pollen, or proteins in offending foods) creates a reaction that can range from bothersome to dangerous.

The prevalence of food allergies, particularly to peanuts, has been on the rise since the early 1990s. No one knows for sure why this is occurring. Possible explanations include improved hygiene (children living on farms have fewer allergies), lower omega 3 and antioxidant intake, lower vitamin D levels, new food processing techniques, or mode of initial exposure.

Thankfully, true food allergies are rare, occurring in 5-6% percent of children under the age of five and 3-4% of adults. Better still, many children outgrow their allergies as they get older.

Some of the most serious allergic reactions are to peanut. But exciting new research may provide a treatment option for peanut allergy in the coming years. A few small clinical trials have been successful at desensitizing children using miniscule doses of peanut flour. Larger studies are needed to confirm efficacy and safety of this method.

Lowering your child’s risk of allergies has historically meant following a highly restrictive diet during pregnancy.  But a recent study published in the Journal of the American Medical Association found expectant mothers who consumed higher amount of peanuts (more than five servings per month) had lower rates of peanut allergic children.

Thanks to this research, the dietary restrictions have radically changed for pregnant women who want to minimize allergies in their children. Consumption of allergenic foods like peanut, shellfish, and eggs while pregnant is now encouraged. Pass the Pad Thai with shrimp, please!

Extending this theme, last year the American Academy of Allergy, Asthma and Immunology loosened their recommendations for introducing highly allergenic foods like peanut butter, dairy, eggs, or fish to children.

But don’t set a place for Mr. Peanut just yet.

Solids are started typically between four to six months of age, with a new food added in every three to five days. Begin nice and easy with mashed up vegetables, fruit or whole grains. Feel free to add in fish, eggs or peanut butter (really, it’s OK). Avoid milk until after age one.

You can introduce more than one food at a time, but it may require a little more detective work if a reaction does occur. And don’t be discouraged if your child doesn’t like a “healthy food” at first.  It can take up to a dozen tries before your child acquires a taste for a new food! My son Emil tasted kale cooked in eight different ways before he liked it.

If your child develops a reaction after trying a new food, talk to your doctor to determine if it is a food allergy. And if you or your child has a food allergy, be sure to work with your physician to devise an emergency plan if an exposure does occur.

One final note — food allergies are different from food intolerances. A food intolerance or sensitivity (like lactose intolerance) does not involve the immune system. Symptoms are often vague and may include constipation, diarrhea, bloating, abdominal pain, rashes, and headaches.

A food diary that allows you to record both intake — and reaction — is often helpful to connect symptoms to foods.  An elimination diet where common food triggers are removed from the diet for three to four weeks, then reintroduced one at time, is another way to sleuth your own food sensitivities.

If you are experiencing vague symptoms that haven’t responded to traditional treatments, start paying close attention to what you are eating and see how certain foods make you feel. Changing your diet can be a remarkable tool to improve your mood and energy level. As the ancient Greek physician Hippocrates said,  “Let food be thy medicine, and medicine be thy food.”

 

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