Do you suspect that your child has a food allergy or intolerance?
In Australia, food allergy affects 10% of children up to 1 year of age, 4-8% of children up to 5 years of age and 2% of adults.
(Reference: Australian Society of Clinical Immunology and Allergy website, 19 Sept 2018. https://www.allergy.org.au/patients/food-allergy/food-allergy)
With those statistics, even if you don’t have a child with food allergy, you probably know someone who does.
Fact: Most children outgrow food allergy
Most children allergic to cow's milk, soy, wheat or egg will 'outgrow' their food allergy. By contrast, allergic reactions to peanut, tree nuts, sesame and seafood persist in the majority (~ 75%) of children affected.
(Reference: Australian Society of Clinical Immunology and Allergy website, 19 Sept 2018. https://www.allergy.org.au/patients/food-allergy/food-allergy)
Food intolerances are often confused with food allergy, but they are very different. Food intolerance does not involve the immune system, doesn’t result in severe allergic reactions and won’t show up on allergy testing.
Here’s some things you may not know…
It can be tempting to simply cut out foods that we suspect our kids may be sensitive to, but this may not be the best thing for our kids. Working out if your child has a food allergy or a food intolerance is often tricky:
When children have a reaction, the culprit food may not necessarily be the last food that was eaten.
In fact, the culprit may not be food at all. Reactions may be caused by other irritants or a non-food allergy.
Reactions can be as varied as skin rashes, eczema, tummy upset, vomiting, bloating, diarrhoea, constipation, swelling and difficulty breathing (anaphylaxis).
Reactions can occur immediately, hours after, or days after eating the culprit food. Food allergy reactions appear more quickly (immediate – within a few hours). Food intolerance reactions can be delayed up to a few days.
Some children have an allergy or intolerance to one food or multiple foods.
A positive skin prick test or allergy blood test is not the same as being food allergic. These tests can produce false positives. Food challenges may be required to properly diagnose an allergy.
Food intolerances cannot be diagnosed by any quick test and usually require an elimination diet to solve. We need to do food detective work for these!
There are MANY, MANY types of elimination diets, and they all have different purposes and rules. It can be difficult to work out what to eliminate, for how long, and when to challenge.
To make sure you get the right answers and the right diagnosis, it is important to seek help from a health professional with experience in food allergy and intolerance.
Food Allergy - What are the most common culprits?
These nine foods cause 90% of food allergic reactions and are most common in children:
Egg
Cow’s milk
Soy
Wheat
Peanuts
Tree nuts
Sesame
Fish
Shellfish
Although almost any food can cause an allergic reaction, allergies to other foods besides these above are rare.
Food Allergy - What are the symptoms of food allergy?
Mild to moderate symptoms of food allergy:
Swelling of face, lips and/or eyes
Hives or welts on the skin
Abdominal pain, vomiting
Signs of a severe allergic reaction (anaphylaxis) to foods include:
Difficult/noisy breathing
Swelling of tongue
Swelling/tightness in throat
Difficulty talking and/or hoarse voice
Wheeze or persistent cough
Persistent dizziness and/or collapse
Pale and floppy (in young children)
Food Intolerance - What are the most common culprits?
Food intolerances have many different causes, but what unites them is that they are usually caused by a component in food (such as a food chemical or fermentable sugar) and they do not activate the body’s immune system. Food intolerances are not life threatening, but they do cause the unpleasant symptoms mentioned above.
Natural and artificial food chemicals that cause food intolerance symptoms:
Artificial colours
Natural colour annatto (160b)
Preservatives
Flavour enhancers
Natural food chemicals called salicylates, amines and glutamates which are found in many different and seemingly unrelated foods
Because food intolerances are usually caused by food chemicals that can be present in many different foods, it is unlikely that a child or adult will have a food intolerance to a specific food e.g. strawberries or kiwifruit. Diet investigation with the help of a suitably qualified Accredited Practising Dietitian with food intolerance experience is necessary.
Food intolerance - What are the symptoms?
Some of the symptoms of food intolerance like skin rashes are similar to symptoms of food allergy. Other food intolerance symptoms are variable and can come and go and change throughout life.
Skin (rashes, swelling)
Airways (asthma, stuffy or runny nose, frequent colds and infections)
Gastrointestinal tract (irritable bowel symptoms, colic, bloating, diarrhea, vomiting, frequent mouth ulcers, reflux, bedwetting, 'sneaky poos', 'sticky poos')
Central nervous system (migraines, headaches, anxiety, depression, lethargy, impairment of memory and concentration, panic attacks, irritability, restlessness, inattention, sleep disturbance, restless legs, mood swings)
(Reference: Fed Up website, 19 Sept 2018. https://fedup.com.au/factsheets/support-factsheets/allergy-or-intolerance#foods)
Food intolerance symptoms may be delayed up to 48 hours or more and are often dose-related. For example, a person may not experience symptoms if they eat a small amount of foods containing the suspect food chemical but will if they eat too much. The “dose” may build up over days, causing symptoms that fluctuate. Get professional help to work it out!
Other reactions to food that are not food allergy or food intolerance:
To make matters even more confusing, other reactions and symptoms can be caused by toxic reactions, food poisoning, enzyme deficiencies, food aversion or irritation from skin contact with certain foods. This is even more reason to seek professional medical help to work out the cause.
What’s wrong with cutting out foods from our kids’ diet?
Children (and adults) should never be on a nutritionally restrictive diet without good reason. If you have cut out most or all foods from a food group or are avoiding certain food, then your child may be at risk of nutrient deficiency in the long-term. For example, insufficient calcium in childhood can result in poor bone density in later life, exposing children to a much higher risk of fractures and osteoporosis as they age. Seek professional help to work out which (if any) foods need to be avoided, which don’t, and whether nutritional supplements are needed.
What to do if you suspect that your child has a food allergy or intolerance?
1. Book an appointment with an allergy specialist/health professional
Some clinical immunology and allergy specialists will allow you to make an appointment directly without a referral from your child’s General Practitioner, however you may wish to speak with your GP first about who they recommend. They will be able to advise you on allergy specialist services that are located close to you.
2. Record the history of signs or symptoms
Your Allergy Specialist will help you do the food detective work by asking you many questions about your child, their symptoms and reactions, medical history, and foods and other environmental factors that they may be exposed to.
You can be prepared for your appointment by recording as much as you can about the detail of your child’s reactions or symptoms. The following may be a helpful start:
Time, place and frequency of symptoms
Take photographs of any visible symptoms - rashes, hives or eczema
Bowel toileting records
Parents and carers’ thoughts, observations and even “gut feelings” can be extremely helpful to your child’s healthcare team
Sensitivities to other non-food substances, for example: washing powders, soaps, sprays, dust, pollens, plants and animal hair
Information about the food and drink that your child eats.
Your Allergy Specialist or Dietitian may ask you to record a details food and symptom diary for your child for one or more weeks. This will help with the food detective work. You will be given clear instructions on the exact information you need to record in a comprehensive food diary. If your child is at a Yummies centre, we can provide daily ingredient lists to help with this process.
3. Seek professional help
Even if you feel certain that a particular food has caused a negative reaction or symptom for your child, it is always best to get this properly confirmed by a health professional. A health professional who is experienced in allergy and intolerance will be able to help you do the food detective work to get clear answers about whether your child has a food allergy or intolerance, or not, and what to do about it. Most importantly, they can help you discover what you don’t need to worry about. Your child’s GP is a good place to start, and will be able to refer you onto a specialist in food allergy or intolerance if needed.
These are some of the things that an allergy specialist, immunologist and/or Accredited Practising Dietitian who is experienced in food allergy and intolerance can do to help:
Help you make sense of symptoms and reactions
Recommend if blood tests or skin-prick tests are needed
Help work out if an elimination diet would be helpful, and what kind
Help you make sense of an elimination diet and work out how you can make it work for your child and your family
Consider if your child is at risk of nutrient deficiencies and advise on other food sources or supplements if needed
How do I know if my child needs an allergy test and what test to get? How do I know if my child needs an allergy test and what test to get?
You should always seek advice from your General Practitioner or an Allergy Specialist about whether allergy testing is needed, and what kind. It is important to understand that a positive skin prick test or allergy blood test is NOT the same as being food allergic. A positive test means that the body’s immune system has produced a response to the food, but sometimes these responses may be “false positives”. This means that although a person has had a positive result on an allergy test, they may still be able to safely eat that food. Your doctor will be able to help you interpret your child’s allergy test results properly and advise if further food challenges are needed to confirm an allergy. Medicare rebates are available for skin prick tests or blood tests for allergen specific IgE (formerly known as RAST) in Australia.
For more information on the different types of helpful, evidence-based allergy testing that your doctor might recommend, refer to the Australian Society of Clinical Immunology and Allergy page on allergy testing: https://www.allergy.org.au/patients/allergy-testing/allergy-testing
How should elimination diets be used?
Elimination diets should only be used for as long as it takes to confirm or exclude a suspect food as a source of intolerance through food challenges. This usually takes anywhere from a few weeks to a few months. The result should be that your child’s diet is as wide as it can be within the limitations of their food allergy or intolerance and include as much variety as possible. Elimination diets should be followed under the supervision of a clinical immunology or allergy specialist, specialist paediatrician or an Accredited Practising Dietitian with experience in food allergy and intolerance. They will be able to help make sure that you are eliminating all necessary foods, monitor symptoms, and guide you with food challenges and re-introduction of foods.
“May contain traces of…” - A note on precautionary allergen statements
“May contain traces of…” is a precautionary allergen statement that some manufacturers use to declare possible cross-contamination risk. For example, a peanut-free product may include the statement “May contain traces of peanuts” on its label if it’s processed on machinery that also processes a product that contains peanuts. These statements are not compulsory for food manufacturers. Unlabelled food or food prepared by others outside the home at a restaurant or by family and friends is generally a much higher risk than those labelled “May contain traces of …”
(Reference: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_general_info_2014.pdf)
If your child has a food allergy, it is best to discuss what to do about these foods with your allergy specialist. If your child has a food intolerance, it is not necessary to exclude foods that have these precautionary statements.
Cow’s Milk Protein Allergy - Often mis-diagnosed as lactose intolerance
When parents notice that their baby or toddler seems to be having problems with milk, lactose is often blamed. However, true lactose intolerance is extremely rare. The more likely cause is Cow’s Milk Protein Allergy which is quite common in babies and small children and can cause gut symptoms such as vomiting, diarrhoea, and mucous/blood in poos.
Sometimes temporary lactose intolerance can occur when the gut has been under stress such as immediately after a gastro bug. Get help from your doctor or an Accredited Practising Dietitian to help you work it out.
Beware of unorthodox testing for food allergy and intolerance
There are many unorthodox tests available for food allergy and intolerance that have no scientific rationale or proven role in the diagnosis of food allergy and intolerance. Not only are these tests unhelpful in diagnosis, they can come at a very high cost to the consumer. For a comprehensive list of unorthodox tests to avoid, refer to the Australian Society of Clinical Immunology and Allergy page on unorthodox testing and treatment: https://www.allergy.org.au/patients/allergy-testing/unorthodox-testing-and-treatment
Allergy and Intolerance specialists in and around Brisbane
Health professionals who have experience in supporting families who suspect food allergy and or food intolerances can help you to work out what is going on and how to manage it.
Here are just a few to get you started:
Queensland Allergy Services http://www.qldallergy.com/
Compass Immunology Clinic http://www.immclin.com/
Allergy Medical Group http://allergymedicalgroup.com.au/
Allergy First https://www.allergyfirst.com.au/
The Accredited Practising Dietitians at Kids Dig Food are also able to assist your family to understand and manage food allergies and intolerances.
You can contact us here: https://www.kidsdigfood.com.au/