Q&A: Pediatric Food Allergies and GI Issues

Friday, August 01, 2014 3:19 PM comments (0)

tummy acheAre stomachaches and messy potty breaks frequent occurrences for little ones in your home? “Stomach problems” happen to everyone, and children are no exception. Sometimes an upset tummy is just an upset tummy, but children, just like adults, can suffer from food allergies and sensitivities, and just like adults these allergies and sensitivities can and should be addressed.

Vincent Biank, MD, Pediatric Gastroenterology at NorthShore, answers some common questions about GI food allergies and sensitivities in children: 

 Is there an easy, relatively non-invasive test to see which foods a child is allergic or sensitive to?
There are several simple blood tests for allergies but unfortunately we do not have simple tests for sensitivities that are accurate in children; therefore, we will commonly have to do an elimination diet.  We will remove one food item at a time for two weeks and then replace that food item after those two weeks, carefully documenting any changes in the symptoms. The two most common sensitivities are lactose and gluten. I would not recommend removing gluten from a child’s diet until they have been properly tested for Celiac disease otherwise you will just need to add it back in for one to two months before it can be accurately checked in the blood.

What foods are typically off-limits for child with soy and dairy allergies? Is it possible to eliminate these foods entirely from a child’s diet?
Soy and diary are in almost everything, so eliminating them is difficult. For this reason, we will have our pediatric dieticians work with families to make sure no soy or dairy in getting into a patient’s diet. Until then, check labels! Anything that has soy, soy protein, milk, milk protein, casein or whey in its label should be avoided.

Are children with GI food allergies more likely to develop other GI-related issues as young adults and adults? 
Unfortunately we don't have enough data to answer this question at this time. Although food allergy with typical symptoms of anaphylaxis, hives, trouble breathing etc. has been diagnosed and treated for many years, the majority of the GI manifestations of food allergy are recent in their discovery. For example it wasn't until 1995 that Eosinophilic Esophagitis was even considered a diagnosis and now we are diagnosing it one to two times per week. The result is we still don't have a clear idea of the natural history of GI food allergies over time.

Should children with stomach “issues” be given probiotics, as well as brought in for testing? 
The short answer is to go ahead and try probiotics prior to the visit. The long answer is that unfortunately we are only at the beginning of our understanding of what probiotics do, such as which varieties are best, how much to give and how long they should be taken.

What are some of the warning signs of GI issues in toddlers/children? Should a parent be concerned about frequent loose stools?
The biggest sign of GI issues is poor weight gain. Diarrhea can be a symptom of an underlying GI disorder but not always. We frequently see toddlers with loose stools with no additional systemic signs of disease, like poor weight gain; therefore, we will typically rule out some common GI-related problems. If tests are negative, we will then discuss how to thicken the stool.

Are the foods known to cause GI allergic reactions in kids the same as those that cause skin or more severe allergic reactions? What are the common foods for GI allergies?
Yes, for some individuals the foods that cause GI allergic symptoms could also cause skin and the typically more severe allergic reaction; however, this is not the case for everyone. Some individuals will only have GI symptoms and others will only have skin or respiratory symptoms. The most common foods for GI allergies are the “Big Six:” milk, soy, wheat, eggs, nuts and fish.

Does your child have a food allergy or sensitive that results in GI issues?

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Am I Allergic? Common Food Allergies

Friday, August 09, 2013 10:00 AM comments (0)

food allergies

Food allergy is a reaction by the immune system that occurs quickly after eating a food. Symptoms occur with ingestion of even a tiny amount of a food and can range from rash or mild itching of the mouth and tongue to life-threatening and life-ending reactions. Many people who think they have a food allergy actually have food intolerance. Food allergy is estimated to affect six to eight percent of children under five, and three to four percent of adults. 

Intolerances to food will affect most people at some point in their lives. For example, lactose intolerance occurs when your body can’t break down milk sugar leading to bloating, cramping and diarrhea. While food intolerances can be uncomfortable they are less serious than food allergy and are not life-threatening. 

Common food allergies for adults:

  • Shellfish--shrimp, crab, lobster
  • Peanuts and tree nuts--walnuts, pecans, cashews, pistachios, almonds

Common food allergies in children:

  • Eggs
  • Milk
  • Peanuts and tree nuts
  • Wheat
  • Soy
  • Fish and shellfish

How do you determine if you have a food allergy to a specific food? Understanding the symptoms of an allergic reaction is important. In allergic reactions, symptoms develop within seconds to a few hours of ingesting the food. Symptoms occur each time you ingest the food allergen. In fact, 85% of food allergic reactions occur have ingesting the same eight foods: milk, egg, wheat, soy, peanut/tree nuts, fish and shellfish. Symptoms can range from mild to severe—itching in the mouth; hives or eczema; swelling lips, face or tongue; trouble breathing; diarrhea, vomiting and abdominal pain; dizziness and fainting are all symptoms of allergic reactions. Anaphylaxis is a severe, life-threatening allergic reaction to foods. 

Rachel Story, MD, Allergist at NorthShore, highlights some approaches your physician might take to determine if you suffer from a more mild food allergy and what might be triggering your reactions:

  • History. A thorough history of reactions and the foods ingested in 2-3 hours prior to the reaction is important in diagnosis of food allergy.
  • Food diary. Your physician might ask you to start keeping a food diary for a period of time. Your diary will track what you eat, when you eat it and how you feel after eating certain foods.
  • Skin test. In a skin test, purified extracts of the suspected food will be placed on your back or arm and then the skin will be pricked with a skin-testing device to allow a small amount of the food to penetrate your skin. If you react with a raised bump you may have an allergy to that food. 
  • Blood tests. Blood tests can be performed to see if you have allergic antibodies to specific foods in your blood. These are often used with a skin test to identify food allergies.  

Food allergy can cause a severe reaction called anaphylaxis.  Symptoms of anaphylaxis include swelling of the airways with throat closing or difficulty breathing, a drop in blood pressure, rapid pulse and fainting. This type of reaction must be treated immediately as it could result in death. All people with suspected food allergy should be evaluated by a physician as they may need to carry medications to treat accidental ingestions of food allergens. Over-the-counter antihistamines such as diphenhydramine (Benadryl) and cetrizine (Zyrtec) are used to treat mild reactions. Severe reactions are treated with an injection of epinephrine that can be administered using an epinephrine autoinjector (EpiPen, AuviQ).

There are currently no FDA-approved treatments for food allergy. However, much promising research is ongoing and there is hope for a treatment for food allergy in the next 5 to 10 years. 

Are you allergic to a food? How did you discover your food allergy?

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