By Dr Dave Ong
Common childhood atopic/allergy-related conditions include:
Asthma, atopic eczema and allergic rhinitis/rhino-conjunctivitis have all been covered in previous articles under Parenting Tips and Health Topics A-Z. This article will focus on the diagnosis and management of food allergies, as well as the prevention of common childhood allergies.
Food allergies are immune system-driven undesired bodily reactions to specific food. Certain food allergies are more likely to be outgrown (such as cow’s milk and eggs), in contrast to certain food allergies (such as nuts or seafood) which are less likely to be outgrown.
A strong family history of food allergies increases the chance of food allergies in a child, suggesting that there is a genetic component. Certain environmental factors may also play a role, including delayed introduction of foods into the child’s diet. Thus, the introduction of solid foods should not be delayed beyond 4 to 6 months of age, including so-called “allergenic” foods like eggs and peanuts.
When there is a true food allergy, your child may experience the following symptoms very quickly (within 30 minutes) after consuming the culprit food:
The diagnosis of food allergies can be confirmed based on a good history from the patient/parents and the assistance of skin prick tests or blood tests. These tests can also be used later on to predict the chances of the child outgrowing the food allergy.
The standard treatment advice is careful avoidance of the food allergen. Immunotherapy is available for certain food allergies such as peanuts and eggs. The child should preferably be 5 years old and above. This can only be done by a paediatrician sub-specialising in allergy, with the appropriate facilities in place.
If the exposure to specific foods clearly resulted in a reaction, your child should avoid the suspected food and consult a paediatrician as soon as possible.
When there are uncertainties or doubts about the specific food causing the reaction, it would be helpful to keep a food diary, which may help to indicate a hidden ingredient in the food that is causing the reaction. Bring the food diary along for the consultation with the doctor, as it serves as a very important piece of information in the diagnostic process.
Avoid labelling your child with multiple food allergies without a proper diagnosis by a paediatrician, because of the risk of malnutrition from excessive food avoidance.
Any baby can develop an allergy. It has long been known that allergies tend to run in families. If one or both parents or other siblings have an allergic disease, an infant is more likely to develop an allergic condition, such as food allergy or atopic dermatitis (eczema). Your feeding choices can also make a difference in your baby’s likelihood of developing allergies, and your child’s nutrition can play a critical role in prevention.
Note: The following recommendations for your baby’s nutrition and prevention of allergies are not intended for infants who have already developed an allergic condition.
In the past it was suggested that avoiding certain foods during pregnancy or breastfeeding could reduce your infant’s chance of developing allergies. More recent information indicates there is no significant allergy prevention benefit to your baby if you avoid highly allergenic foods during this time. Foods considered highly allergenic include cow’s milk protein, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish. Avoiding nutritious, highly allergenic foods such as milk and eggs is not recommended during pregnancy. Avoiding highly allergenic foods when breastfeeding is also not recommended. A healthy balanced diet is strongly recommended, because of the numerous benefits to the mother and baby during pregnancy and breastfeeding.
Research has shown that up to 3 servings of oily fish per week during pregnancy and breastfeeding may be beneficial, because it provides omega-3 fatty acids which may help prevent early-onset atopic dermatitis
There is moderate evidence that probiotic intake during pregnancy and breastfeeding may help prevent early-onset atopic dermatitis. However, the optimal type and dosage of probiotics are still not clear, thus specific recommendations cannot be given yet.
Note: This recommendation does not apply if you or your infant has developed a food allergy. Although not recommended, if you choose to avoid foods during pregnancy or lactation, dietary counseling with a nutritionist is recommended.
Breastfeeding is the best way to feed your infant, and there is no benefit of formula over breast-feeding to prevent allergic disease. If breastfeeding is not possible, a standard cow’s milk based formula can be given. There is no evidence that soy or goat’s milk formula reduce the risk of allergic disease when used in preference to standard cow’s milk based formula. Based on recently published systemic reviews of research studies, there is no consistent convincing evidence to support a protective role for partially hydrolysed formulas (usually labelled ‘HA’ or Hypoallergenic) or extensively hydrolysed formulas for the prevention of eczema, food allergy, asthma or allergic rhinitis in infants or children.
Breastfeeding is the ideal way to nourish your infant. Breast milk is least likely to trigger an allergic reaction, is easy to digest and strengthens an infant’s immune system. Exclusive breastfeeding is recommended for at least 4 months and up to 6 months of age because it may reduce the incidence of atopic dermatitis, early onset of wheezing, and the incidence of cow’s milk protein allergy.
Experts recommend exclusive breastfeeding until 4 to 6 months of age. The introduction of solid foods for your baby depends on their developmental readiness.
Your baby may be ready for solid foods when he or she:
Timing of certain foods should also be considered when introducing solid foods to your baby. Try introducing these single ingredient infant foods to your baby one at a time, every 3 to 5 days:
This slow process can give you the chance to identify and eliminate any food that may cause an allergic reaction. You do not need to avoid acidic foods for your baby (e.g. berries, tomatoes, citrus fruits and vegetables) that may cause a rash around the mouth. This is due to irritation from the acid in the food, not from an allergic reaction to the food.
Learn more on Weaning Your Baby onto Solids.
Highly allergenic foods can be introduced to your baby between 4 and 6 months of age, just as you would introduce any other solid foods. Highly allergenic foods that you can feed your baby include:
You may want to be cautious when introducing your baby to highly allergenic solid foods. One safe way to do this is to introduce the first tastes at home rather than at day care or a restaurant. You should introduce highly allergenic foods to your baby after other solid foods have been fed and tolerated, and with the first taste being at home. If no reaction occurs, then you can gradually increase the amount at a rate of one new food every 3 to 5 days.
You should to talk to your baby’s paediatrician before introducing a highly allergenic food for the following situations:
Some infants will develop food allergies regardless. Thus if there is any allergic reaction to any food, that food should be stopped and you should seek advice from your child’s paediatrician. Your child’s paediatrician may refer him/her a paediatric allergist/immunologist for further evaluation, depending on the clinical situation.
While the cause of food allergies are unknown, it has been suggested that family history and the environment contribute to a child developing food allergies.
After consuming the food allergen, children with food allergies may wheeze, experience shortness of breath, hives, swelling of the mouth area, vomiting or other symptoms.
Food allergies can be diagnosed through skin prick tests and blood tests, which can be done by a paediatrician sub-specialising in allergies.
Avoid suspected food allergens and help your child keep a food diary to track your observations. If you are unsure, consult your child’s doctor for a diagnosis.
Exclusive breastfeeding for babies up to 6 months of age strengthens the immune system and may reduce incidence of eczema, wheezing and cow’s milk protein allergy.
When introducing solids foods which are highly allergenic to your baby, first try this at home and gradually increase this at 1 new food every 3 to 5 days.
Want to find out more? You may be interested in these articles:
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