How to identify and treat food allergies in children

Original article here.

Co-Founders of the Allergy Centre of Excellence (ACE), Professors Adam Fox, Gideon Lack and George du Toit, share advice on diagnosing allergies and the best ways for parents to manage them.

What’s the difference between food intolerances and allergies?

It’s important to distinguish between food allergies and intolerances – which your GP can help with – because management and treatment are very different.

An intolerance, while unpleasant, isn’t dangerous. A common example is lactose, where the body lacks the enzyme to break down the sugar found in milk, which can lead to symptoms like bloating, abdominal discomfort, wind and diarrhoea.

An allergy involves the immune system reacting inappropriately to something harmless, such as peanut protein or grass pollen. It typically results in an immediate response that results in hives and swelling, or in more uncommon but severe cases, wheezing or breathing difficulties. In the most severe form, it can be life-threatening – this type of reaction is called anaphylaxis.

How do I know if my child has a food allergy and what are the most common types?

One of the first symptoms in young babies and children is aversion – often this means that when they’re fed, they turn their head away, arch their back or spit out the food. However, this can often happen with those who don’t have an allergy, so it’s good to look out for other signs.

The most common visible sign is on the skin – hives or flushing around the face which can extend to the body. These rashes can be itchy and lead to the lips and/or eyes swelling.

The most common food allergies are egg, milk, peanut, tree nuts and sesame. However, others include peas, lentils and kiwi, and for older children, it can also include fish and shellfish.

If I think my child has a food allergy, what should I do?

It’s important to stay calm because more often than not it will be a mild rection.

Firstly, you should stop giving your child the food and wipe it off their mouth and skin. Also avoid the suspected food until a diagnosis has been confirmed, especially if the initial reaction was severe.

For moderate symptoms, book an appointment with your GP as soon as possible. Describe the symptoms, including the reaction’s timing, duration, and nature, and explain that you suspect an allergy. They will be able to advise on next steps and treatment options.

However, if your child has a severe reaction or symptoms of anaphylaxis (restricted breathing or blood circulation), it’s best to call 999.

It’s also worth considering joining a support group, like Allergy UK or The Anaphylaxis Campaign. They offer helpful advice, resources, and support for families, and have useful helplines to call.

How should I manage food allergies?

There are a variety of ways to do this. Avoiding the food as much as possible will help minimise risk. This can be done through clear communication with caterers and checking food labels on products. Likewise, understanding how the ‘may contain’ warnings will affect your child.

You should also let the school/pre-school/nursery/restaurants know and make sure your family and friends are fully aware of the diagnosis, including symptoms and how to manage these reactions. To help with this, your doctor should give you an ‘Allergy Action Plan’, which you can give out to people – it’s a really effective way to keep your child safe in different scenarios.

It’s also important to know how to respond to a reaction, especially if it’s severe. The consultant who diagnosed the allergy will be able to tell you what’s best, which may include carrying an adrenaline injector (Epipen or Jext). You’ll need to make sure you/your child/your child’s care setting has access to this all the time and knows when to use it.

It’s also good to have regular check-ups with your GP/consultant because allergies can change over time and some children outgrow them.

What treatment options are available?

After many years of avoidance being the only option, new and innovative ways to prevent and manage allergies are available.

For example, our clinic offers oral immunotherapy (often referred to as OIT) for foods such as peanuts, sesame, tree nuts, wheat, milk, egg and legumes. Under the guidance of the team, a child eats small but increasing amounts of the food to make them less sensitive while protecting them from accidental exposures.

Babies and children who are suitable for this type of support and have successfully gone through the process, have seen their risk of reactions significantly reduced. And as a result, made a big difference in the family’s life and management of the allergy, for example in restaurants, birthday parties, on aeroplanes etc.

New medicines are also becoming available such as omalizumab. Taken either on its own or alongside OIT, it can significantly reduce sensitivity and the severity of reactions.

And a new nasal device to treat anaphylaxis will become available later this year. At the moment, children have to be injected so this will be a great alternative that should mean individuals are less nervous about using these life-saving treatments.

How do parents access these treatments?

If you suspect your child has an allergy or they’ve already been diagnosed, it’s best to speak to your GP. They can advise on next steps, including potentially referring you to an NHS paediatric allergy clinic and speaking to a specialist. Waiting times can be lengthy so it’s good to consider taking action promptly.

However, there are private specialists who can offer faster access – these can be accessed through health insurance or direct payment.

The British Society for Allergy and Clinical Immunology website has a list of NHS allergy clinics.