Diagnosis and management of food allergies in children
One in thirteen kids has a food allergy. A food allergy is when the immune system recognizes food as an allergen and results in an allergic reaction after your child eats that food. Allergic reaction symptoms include hives, swelling, itching, runny nose, congestion, cough, difficulty breathing, vomiting, stomachache, dizziness and fainting.
History is key in the diagnosis of food allergy — What did they eat? What symptoms occurred? How soon? Have they eaten this food before or afterwards? If so, what happened? Skin prick tests and blood (food-specific IgE) tests are adjuncts to help determine food allergy and an oral food challenge is the gold standard test.
We avoid food panel testing because these tests can result in false positives and induce anxiety in parents and/or lead to inappropriate food restriction diets. For example, your child was tested to multiple foods and wheat came back positive, but they eat wheat-based pasta without any reactions — hence, they do not have a wheat allergy and they do not need to avoid it!
There are other food allergies such as food protein-induced enterocolitis syndrome (FPIES) that are diagnosed based on a history of delayed repetitive vomiting and eosinophilic esophagitis (EoE) that requires an endoscopy and biopsy by a GI physician for a diagnosis. Food sensitivity tests (IgG) are not scientifically-proven and not indicated for diagnosis.
The mainstay of treatment for food allergy is avoidance and carrying epinephrine autoinjectors at all times. Avoidance includes reading labels and avoiding warning labels due to the risk of cross-contamination.
Recently, a peanut oral immunotherapy (OIT) drug was FDA-approved for children and teens 4-17 years old. This drug is not curative but indicated to reduce the risk of a severe allergic reaction in the case of accidental exposure. Families should discuss side effects, risks and benefits, and their goals for this treatment to see if your child would be a good candidate for this drug.
Written by: Ammara Ahmed, DO, MHS, completed Pediatric Allergy and Immunology Fellowship training at Johns Hopkins University and Suzanne Kochis, MD, completed pediatric allergy immunology fellowship training at Johns Hopkins University.