Could this be food allergy?
This post was inspired by a recent assignment from my FARE Certificate of Training in Pediatric Food Allergy course. This 9-month program will finish in May 2023 and provides training on up-to-date and evidence-based nutrition care for children with food allergies.
Picture a six-month old sitting in his highchair at the dinner table with the rest of his family.
He recently started complementary foods and is about to try diluted peanut butter for the first time. His primary source of nutrition is breast milk, with his last feeding about an hour ago.
The infant’s parents feed him three small bites, then pause to wait before offering more. He enjoys the initial taste, but after a few minutes becomes fussy. His parents notice raised, red bumps on his face, which are more pronounced around his mouth and chin.
Starting to get concerned, his parents remove his shirt and find more raised, red bumps on his neck, stomach, and upper back. The infant because more upset, with loud, agitated cries.
It has only been ten minutes since the first bite of the diluted peanut butter. Could this be food allergy?
What is food allergy?
Food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food, according to the 2010 NIAID/NIH-supported Guidelines. Let’s break this definition down:
A food allergy is a medical condition.
It occurs when the immune system attacks a protein in food.
A reaction will be reproducible when exposed to that food. Even the smallest amount of food can cause a serious reaction.
A food allergen is essentially the protein in the given food that interacts with the immune system and is responsible for initiating the allergic reaction.
There are two types of food allergy:
Immunoglobulin E (IgE)-mediated food allergy
Non-IgE-mediated food allergy.
IgE-mediated food allergy is more common; an IgE-mediated allergic reaction happens as the result of interaction between the allergen and a type of antibody known as IgE.
What are symptoms of food allergy?
The symptoms of an IgE-mediated food allergy reaction can affect many different parts of the body:
Skin: redness, itching, hives
Eyes: itching, tearing, redness, swelling
Upper respiratory system: itchy or runny nose, sneezing, throat swelling, dry cough
Lower respiratory system: chest tightness, shortness of breath, wheezing
Gastrointestinal system: swelling of lips or tongue, nausea, vomiting, diarrhea
Cardiovascular system: paleness, dizziness, fainting, loss of consciousness
Uterine contractions
Sense of “impending doom.”
In a classic IgE-mediated food allergy reaction, symptoms almost always occur immediately or within two hours after eating the food. Additionally, symptoms will occur reproducibly, which means a symptom or combination of symptoms or variation of combination of symptoms will appear whenever the individual is exposed to that food.
Unfortunately, food allergy reactions are unpredictable. This means that the severity of future reactions cannot be predicted based on previous symptoms.
Is food intolerance or sensitivity the same as food allergy?
But what about food intolerance or sensitivity? Are these the same thing as food allergy?
No. Food allergies are a medical condition involving the immune system that will be reproducible when exposed to a protein from the food. Symptoms of a food allergy reaction can range from mild (itchy mouth, hives, nausea) to severe (trouble breathing, swelling of the tongue or lips, vomiting, anaphylaxis).
A food intolerance occurs when the digestive system is unable to break down or digest a certain food. A common example is lactose intolerance.
There is no consensus definition from the allergy community for food sensitivity, which makes it so confusing to differentiate.
But only food allergy involves the immune system. The only way to prevent a food allergy reaction is careful and complete avoidance of that food. This is different from managing a food intolerance or sensitivity, where small amounts of the food can often be eaten safely.
So, could this be food allergy?
Spoiler alert: the story at the beginning of this blog is based on my family’s first experience with an allergic reaction. The image is an illustration from my children’s book, Be a Food Allergy Helper! which describes our experience learning about and managing food allergy in our home.
But just to wrap this post up neatly: is a food allergy evaluation warranted in the case of our six-month old baby?
His symptoms of widespread hives are consistent with an IgE-mediated food allergy.
This was his first known ingestion of a peanut-containing food, with symptoms occurring just minutes after eating a few small bites.
Additionally, breast milk was his primary source of nutrition that day with no other complementary foods.
Yes. For the above reasons, most allergists would agree that this infant should be evaluated by a qualified healthcare professional for possible food allergy diagnosis and management.
Has your child had a similar experience? Has he or she been diagnosed with food allergy? If so, are they established with a qualified allergist?
An allergist that works in food allergy and is willing to do food challenges can make a huge difference in long-term management of a food allergy diagnosis. A oral food challenge is a medical procedure in which gradually increasing amounts of a suspected allergen are fed to an individual, under medical supervision, to accurately diagnose or rule out a clinical food allergy. Food challenges can be used during the initial diagnosis process as well as to determine if an individual has outgrown a specific allergy.
You can use this search tool to find an allergist in your community. It is available from Food Allergy Research & Education (FARE), in partnership with the American Academy of Allergy, Asthma & Immunology (AAAAI) - the professional society for allergies or asthma.
The American College of Allergy, Asthma, & Immunology (ACAAI) also offers a search tool to find Certified Allergists. Please note that not all allergists specialize in food allergy, so contact the provider office in advance to determine if they can help meet your needs.
