Ask Dr. Bell
Food Allergies
Watching What Children Eat By Louis Bell, M.D. We hear a lot in the news about the rise in food allergies among kids. And it’s real: The incidence of peanut allergy doubled between 1995 and 2005, and allergies in general seem to be increasing over time. No one knows exactly why, which naturally concerns parents. But studies show something else, too: Around 25 percent of parents suspect that their child has a food allergy, even when only 4 percent to 6 percent of children truly do. With the thinking on food allergies often shifting and changing, I checked in with two expert CHOP colleagues, Terri Brown-Whitehorn, M.D., and Jonathan Spergel, M.D., Ph.D., who study, diagnose and treat all types of food allergies. At its most basic, a food allergy happens when the body’s immune system has an adverse reaction to something we eat. The most common type of reactions include immediate hives or lip swelling that may progress quickly to vomiting, coughing, wheezing and, at times, low blood pressure. These reactions can even be life-threatening, so allergies are not something to take lightly. Until very recently, doctors recommended that parents delay introducing certain foods known to cause allergy, such as eggs, milk and peanuts, to their children, and many parents are still getting that advice. Unfortunately, withholding those foods didn’t stop the rise of allergies. As of 2010, guidelines from the American Academy of Pediatrics (AAP) say that when a certain food is introduced does not determine whether an allergy will develop to it. The newer recommendation, say my colleagues, is to feed your baby in much the same way your grandparents fed their kids. The AAP advises giving only one new food at a time, then watching for allergic reactions and waiting a few days before starting another. Solid foods can typically be introduced at 4 months of age with one new food every three to five days. There are other, more severe types of food allergies as well. One of these, food protein-induced enterocolitis (FPIES), occurs when a baby or young toddler eats a food and becomes very sick two hours later with vomiting, diarrhea and even shock. Another food protein allergy is eosinophilic esophagitis (EoE). It can appear in young toddlers as severe acid reflux or food refusal, in school-age children as abdominal pain and/or acid reflux, or in adolescents as difficulty swallowing food. CHOP’s Center for Pediatric Eosinophilic Disorders is the largest EoE center in the country, bringing allergists, gastroenterologists and
Louis Bell, M.D., chief of the Division of General Pediatrics at CHOP, explains the latest in medical thinking on an important topic: food allergies.
nutritionists together to treat more than 1,200 children from all over the United States. Parents play an important role in detecting food allergies. If there are any concerns, consult your pediatrician right away. If symptoms are severe, bring your child to the emergency department and follow up with an allergist, who may recommend testing. Once an allergy has been diagnosed, the safest treatment is to carefully read labels and avoid the allergen, but there is hope for the future. Researchers at CHOP are studying new treatments, including a method to add the food slowly back into the diet under careful supervision. Some studies of this kind have been able to eliminate the allergy in about 80 percent of children. It is promising research and may revolutionize the way that we treat children with food allergies. n
To read more of Dr. Bell’s columns, please visit giftofchildhood.org/childrensview. Children’s View
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