Food allergies in children Food allergy in children is an abnormal immune reaction to specific proteins in food that can range from mild symptoms to life-threatening reactions. It is estimated that about 6-8% of children under 3 years of age have food allergy and its prevalence is increasing. Recognizing the symptoms, correct diagnosis and accurate management of this condition are vital to maintain the health and quality of life of children and their families. What is a food allergy? Before getting into the details, it's important to understand the difference between food sensitivity and food intolerance: ### Food allergy It is an immune response. The immune system mistakenly identifies a harmless food protein as an invader and releases antibodies (usually of the IgE type) and chemicals such as histamine to fight it. This reaction can occur even with a very small amount of food, and symptoms can appear immediately (within minutes to hours). ### Food intolerance It is an immune reaction. Food intolerance is usually caused by the body's inability to digest or metabolize a particular food (for example, lack of the enzyme lactase in lactose intolerance). Symptoms are usually gastrointestinal (bloating, gas, diarrhea) and usually not life-threatening. A larger amount of the food is required for symptoms to occur, and reactions may take longer to appear. The most common food allergens in children About 90% of food allergies in children are caused by eight main foods: Cow's milk: one of the most common allergies in babies and young children. Eggs: the second most common food allergy. Peanut: one of the severe and persistent allergies. Tree nuts: such as almonds, walnuts, pistachios, hazelnuts, cashews. These allergies are also often severe and persistent. Soy: especially in babies. Wheat: allergy to wheat protein. Fish: Allergy to different types of fish. Shellfish: such as shrimp, crab, lobster. Of course, children can be allergic to any other type of food. Food allergy symptoms in children Food allergy symptoms can be very diverse and range from mild to severe. Reactions usually appear within minutes to two hours after consuming the food. ### Mild to moderate symptoms Skin: urticaria (red and raised bumps with itching), eczema (dry, red and itchy skin), redness and swelling of the skin. Gastrointestinal: nausea, vomiting, heartache, diarrhea. Respiratory: sneezing, runny nose, nasal congestion. Oral: itching or burning in the mouth, swelling of the lips, tongue or throat. ### severe symptoms (anaphylaxis) Anaphylaxis is a severe and life-threatening allergic reaction that requires immediate medical attention. Symptoms of anaphylaxis can include: Severe respiratory: shortness of breath, wheezing, persistent cough, feeling of suffocation, blue lips or skin. Cardiovascular: hypotension, dizziness, weakness, fainting, weak or irregular pulse. Severe gastrointestinal: frequent vomiting, severe diarrhea. Severe skin: widespread hives, severe swelling of the face or throat. Mental: Confusion, sudden lethargy. If you experience any of the symptoms of anaphylaxis, call 911 immediately and use an epinephrine auto-injector if prescribed by your doctor. Diagnosing food allergies in children The diagnosis of food allergy should be made by a specialist in allergy and clinical immunology. Diagnostic steps usually include the following: History check: The doctor asks about the child's symptoms, the time of their occurrence in relation to food consumption, the history of allergies in the family and other details. This step is very important. Physical examination: general assessment of the child's health status. Skin Prick Test (SPT): Small amounts of extracts of suspected food allergens are placed on the skin (usually the forearm) and then the skin is gently scratched. In case of sensitivity, after 15-20 minutes, a red and itchy bump (similar to a mosquito bite) will develop in the place. Blood test: A blood test to measure the level of specific IgE antibodies against specific food proteins in the blood. These tests help with diagnosis but are not always 100% accurate. Oral Food Challenge Test (OFC): This test is the gold standard method to definitively diagnose food allergy and should be performed under strict medical supervision and in an environment with emergency facilities (such as a hospital or well-equipped clinic). In this test, the child consumes controlled and incremental amounts of the suspect food to check the body's reaction. Management and treatment of food allergies Currently, there is no definitive treatment for food allergies, and the best strategies include: ### Total avoidance of allergens This is the most important step. Parents should carefully read food labels and avoid all foods containing allergens. In Iran, many food products mention the presence of common allergens on the packaging. At restaurants, parties and school, the child's food sensitivity should be clearly communicated. Teaching older children to avoid questionable foods. ### Management of allergic reactions Epinephrine: For severe reactions (anaphylaxis), an epinephrine auto-injector (such as an EpiPen) is the only life-saving drug. The doctor teaches the parents how to use it, and you should always have two of it with the child. Antihistamines: For milder symptoms such as hives and itching, antihistamines (such as cetirizine or diphenhydramine) can provide relief, but are never a substitute for epinephrine in anaphylaxis. ### Nutritional immunotherapy This is a relatively new and developing treatment method that is performed under the supervision of an allergy specialist. In OIT, very small amounts of food allergen are added daily and gradually until the child's immune system can tolerate it. This method can help reduce the severity of reactions or even create tolerance, but it also has risks and not all children are candidates for it. ### Education and awareness Parents, caregivers, teachers and even the child himself (at an older age) should be educated about food allergy, its symptoms, how to avoid and how to react in emergency situations. Having a written allergy action plan prepared by your doctor is essential. Living with food allergies in children Living with a food allergy can be challenging, but with proper management and awareness, children can lead normal and happy lives: Meal planning: preparing safe and homemade meals, planning meals for parties and trips. Social relationships: Teaching the child and others how to talk to friends, classmates, and teachers about food allergies. Psychological support: Sometimes children and parents need psychological support to cope with the stress and anxiety caused by food allergies. The future of food allergies in children Fortunately, many children outgrow milk, egg, wheat, and soy allergies as they get older. However, allergies to peanuts, tree nuts, fish, and shellfish are usually more persistent. Research into new treatments and prevention of food allergies is progressing rapidly. #### Summary Food allergy in children is a serious condition that requires accurate diagnosis by a specialist in allergy and immunology and ongoing management. By avoiding allergens, being prepared for emergency responses, and continuing to educate yourself and those around you, parents can help their children lead healthy, safe, and happy lives, even with the challenges of food allergies. Working closely with the best pediatrician is the key to success on this path. Call 02166602506 for advice on your child's diet.