Food allergies can be difficult to navigate and manage, particularly in children. Food allergies are very prevalent with an estimated 1-10% of people suffering from food hypersensitivities (allergies). A large number of these people are children.

Food allergies are a reaction from the immune system that occurs after eating certain foods. This can range from hives to swollen airways and can cause medical emergencies. It is vital to be aware of common allergies and the symptoms of food allergies to prevent children from life-threatening situations. Once allergies are identified there are steps to prevent reactions and plan of actions if reactions do occur. 

Identifying food allergies in children 

Common Allergens

It can be difficult to identify an allergy in a child as they may not be able to communicate that something is wrong. When eating a range of foods, it can also be difficult to pinpoint which food has caused the reaction. There are a few common food allergens which a high number of people have reactions to:

• Milk
• Eggs
• Peanuts
• Soybeans
• Peas and Chickpeas
• Tree nuts, such as walnuts, cashews, hazelnuts, pecans, almonds, brazil nuts and pistachios
• Shellfish, such as lobster, prawns, and crab
• Wheat

The most common allergens in young infants are milk and eggs so these are foods to be aware of.¹ When introducing children to new foods it is important to pay attention to how they react to them in the time following consumption.  

Signs and symptoms of food allergies in children

A reaction to food usually happens within a few minutes of eating it, so it is key to look for symptoms straight after consumption. Symptoms include:

• Runny or blocked nose
• Sneezing
• Wheezing or coughing
• Watery, itchy, red eyes
• A red, itchy rash
• Worsening of asthma or eczema
• Vomiting or diarrhoea

Symptoms can vary from mild to severe. It is crucial to treat moderate symptoms especially if they are worsening. When there is a severe reaction a child can enter anaphylaxis.  If it reaches anaphylaxis, it is considered a medical emergency. If there is suspicion that a child is going into anaphylaxis 999 should be called immediately. 

Symptoms of anaphylaxis:

• Swelling of the tongue and throat
• Feeling tired or confused
• Skin that is cold to the touch
• Feeling faint, dizzy or fainting
• Difficulty breathing or rapid breathing
• Wheezing, coughing, noisy breathing
• Difficulty swallowing, hoarse voice, tightness in the throat
• Blue, grey or pale skin or lips and tongue- if the child has a darker skin tone this may be easier to observe on the palms of their hands and soles of their feet

Diagnosis of food allergies in children

There are no definitive tests used to diagnose food allergies, so doctors will take several steps to aid diagnosis.

Firstly, they will take a detailed history of all the child’s symptoms. Then, they will take a family history of allergies. This is because there is evidence that suggests that genetics play a role in allergies.² A physical examination will also be performed to rule out other medical conditions, following this, they will likely perform a skin test.

Skin test

A skin test is where several allergens are tested on the skin to see if they cause a reaction. This is done by placing a small drop of the allergen on the skin, usually the forearm, and pricking it with a small needle so it goes under the skin’s surface. This test looks at reactions from individual allergens. A reaction usually appears approximately 15 minutes after the allergen is placed on the skin. The medical professional will look at the different allergen areas and assess whether there is any reaction, such as redness or being raised. A reaction may indicate that there is an allergy to that food.

Blood test

One way of assessing whether a child has allergies is to have an allergy blood test which looks at IgE levels. Antibodies are produced by the body when harmful substances enter the body. When you have an allergy, your body produces IgE antibodies in response to an allergen. There are two types of IgE allergy blood test, one which measures the total amount of IgE in the blood and another that measures IgE in response to specific allergens. There are also blood tests that look at IgG4.³ This is a type of antibody which plays a protective role in response to repeated allergens.⁴ 

Oral food challenge

Oral food challenges are carried out by allergy specialists to confirm food allergies and monitor food allergies.⁵ They are carried out in hospitals or allergy clinics with doctors and nurses present who know how to recognise and respond to an allergic response. 

When attending appointments, the child’s blood pressure, heart rate and temperature will be taken. Then a small amount of the suspected food allergen will be given to the child and they will be observed. Children and infants will be given the food in an age-appropriate manner. This procedure can take a few hours. It is a safe way to assess a child’s reaction to certain foods. 

Managing food allergies in children

Strict avoidance of allergenic foods

To avoid a reaction, it is best to avoid giving children foods that they are allergic to.⁶ Food labels provide allergen information and make this process easier. Pre-packaged food has to have a full ingredient list with allergens emphasised, usually in bold. These are the 14 most common allergens. Additionally, if there is a risk of cross- contamination it must state that it may contain the allergen. This labelling aids people shopping for people with food allergies and reduces the risk of a reaction. Before giving a child with food allergies any item of food, the food labels should be checked every time as ingredients in food items can change over time. 

Educating adults who supervise the child

It’s difficult to manage children’s allergies day to day, particularly when they’re not under the supervision of their caregivers. Adults of whom the child is under the supervision of, such as teachers, club leaders, parents of friends, should be fully aware of the child’s allergies. Educating these individuals on the child’s allergens and how to manage them, such as checking labels and not giving them food they don’t know the ingredients of (e.g. food made by others), will help to prevent a reaction. 

Plan of action for reactions

Even with lots of care and attention to allergies accidents can happen, so it is important to have a plan of action in place to try and respond quickly and effectively to a reaction. This plan should be shared with all adults who supervise the child. One key part of this plan should be that the child always has access to emergency medicines, in particular adrenaline (EpiPen^®). At the child’s school/ nursery, this should be stocked by the establishment in addition to the child supplying it.⁷ A doctor can provide an emergency plan which will detail the symptoms of mild/ moderate reactions and anaphylaxis. There are additionally a lot of templates online. 

Summary

Food allergies are prevalent in children but can be hard to navigate. It is key to be aware of the common allergens when introducing infants to new foods and being aware of the signs and symptoms of allergic reactions. Allergies can develop at any time so it's important to always be aware of the symptoms and pay attention if a child shows any of these symptoms after eating. If there is a suspected food allergy the child should undergo tests to aid diagnosis. These are typically skin tests, blood tests and the oral food challenge. Once it has been established that the child has a food allergy, therefore it needs to be managed. Avoiding the child ingesting the allergen and educating adults that supervise the child will aid prevention of a reaction. It is crucial to have a plan in action in case of a reaction and to share this plan with all supervisory adults. If a child is suspected to be entering anaphylaxis always call 999 immediately.