Pediatrician on allergies: “Parents need to watch their children closely”
Children's Food Allergies
Dr. Allen J. Dozor is the associate physician-in-chief and chief of pediatric pulmonology at the Maria Fareri Children’s Hospital at Westchester Medical Center in Valhalla, which provides advanced care for children throughout the Hudson Valley.
Dozor says there are many clues indicating that food allergies in children are on the rise, and there are many studies trying to sort through all the clues.
Among them is the Centers for Disease Control and Prevention, which released last fall the results of the largest study on food allergies to date. The CDC study looked at data from 1997-2007 and concluded that an estimated 3 million children, or 4 out of every 100, suffer from food allergies.
“It clearly showed a significant increase, about 18 percent,” he says. “It could not have been a statistical blip.”
Yes, people are more aware, but awareness is not the explanation. Food allergies themselves are on the rise.
Q. Why?
A. That’s the $64,000 question, and there are many theories.
The fact that food allergies are increasing in developed countries worldwide, rather than in developing nations, has given rise to the hygiene hypothesis. Allergies are rare among children who live in countries with less-sanitary conditions, giving rise to the theory that because their immune systems are exposed to various microbes early on, they are strengthened. When developing immune systems are not challenged in this way, they then overreact to certain harmless substances, such as foods or pollen.
This is the leading theory, but as a scientist, I know the cause of food allergies is far more complicated than just antibacterial cleaning products.
Q. So with a food allergy, the immune system isn’t responding properly?
A. The immune system protects the body. Ideally, we want an aggressive defense against the bad guys without clobbering too many of the good guys.
The immune system begins developing in utero and then continues developing throughout early childhood based on how it is stimulated.
In the case of allergies, including food allergies, the regulation is just a little off, prompting the immune system to overreact to what it perceives as a foreign threat.
There are also 30 different genes related to allergies; without the genetic component, there won’t be allergies.
Q. What are the most common types of food allergies?
A. Eggs, milk, soybeans, wheat, peanuts and shellfish are involved in about 90 percent of food allergies, although the body can react in the same way to any food.
The really bad guys are peanuts and shellfish, although in rare cases, there can be a severe reaction to milk.
There are also cross-reactions. For example, people who react to birch tree pollen can also experience an itchy throat upon eating the skin of an apple.
Q. What are the most common symptoms?
A. Symptoms can range from itching and hives to a bellyache and wheezing. An infant who’s allergic to cow’s milk, for example, might develop eczema, diarrhea, fussiness or wheezing.
However, although not common, peanut and shellfish allergies can be fatal.
And a first reaction might be mild, followed by a severe reaction upon subsequent exposure.
Q. That’s a pretty wide range of symptoms. How can a parent tell if the stomachache, for example, is a food allergy?
A. If a parent is suspicious of a food allergy, the child should be taken to a board-certified allergist to find out for certain. Parents should not try to make that determination on their own, especially if the suspected culprit is peanuts or shellfish.
That said, I first ask parents to recall what symptoms appeared in the first hour after food was consumed. If a child wakes up with a bellyache and hasn’t eaten anything since the night before, that is not a food allergy.
Food allergies are a memory reaction, so a child cannot react the first time he or she is exposed. However, a first exposure could have happened in utero, so this aspect is a little tricky.
Age, too, can play a role, although you can become allergic at any time in your life. Allergies to cow’s milk, for example, are seen in infants, and peanut allergies often manifest between the ages of 2 and 5, when, depending on the family diet, peanut butter might become a mainstay.
Q. Is food intolerance the same as an allergy?
A. No, and there is a lot of food intolerance; take milk, for example. Some people cannot tolerate the lactose or the fat or the carbohydrates in the milk. They will have a reaction that makes them uncomfortable, but it’s not potentially dangerous. That’s the distinction.
Q. Can you outgrow food allergies?
A. Many children outgrow milk or egg allergies, but never a peanut allergy.
A peanut allergy is a lifelong challenge. Some children are so sensitive that they wheeze if another child is eating a peanut butter sandwich three seats away. Eating out can be difficult – if not hazardous – because only trace amounts on a knife or pan could prompt a reaction. Many times the offending food is an unsuspected ingredient in a cake or casserole. Teens sometimes become lax about carrying their EpiPens (syringes that contain epinephrine used to counter anaphylactic shock).
There are a number of exciting reports, particularly one from Duke University in February, indicating that consumption of tiny amounts in a controlled setting could eventually desensitize the person. This is NOT something that anyone with allergies should attempt on their own.
Q. But until then, it’s up to the parents and child to manage the allergy?
A. Yes. First, they must find out one way or another whether there is an allergy, and then have a good plan. Every allergy is different and every reaction is different.
Parents need to watch their children closely. Because 70 percent of the kids with lifelong asthma also have allergies, an allergic reaction can also trigger an asthmatic attack. Bronchodilators need to be on hand.
Keep in mind that Benadryl or other antihistamines might stop the itch but not the progression to a severe reaction.
If an EpiPen is part of the plan, get a few two-packs. I recommend that two EpiPens be carried at all times in case one doesn’t work or one dosage isn’t enough.
Check the expiration date. Make sure the school nurse has fresh packs each year. And consider logistics – the size of the school campus, for example. I had to write a letter for a middle-school student requesting that his classes be in the building where the nurse was located.
And even if an EpiPen has been administered, 911 should be called because a reaction can go longer.
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Source: Record Online
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