Kids and Allergies

Being a parent is a full-time job and let’s be real we are never “off duty.” Parenthood offers up quite the challenges and so many blessings; ones we never anticipated. When challenges arise with our children, in particular their health, the best thing we can do is empower ourselves with the correct information so that we can overcome the challenge with the least amount of stress and in the simplest way and of course cause the least amount of disruption in our child’s sense of “normalcy.” As a Registered Dietitian Nutritionist, that I what I hope to provide you with today when it comes to the 8 common allergens and your child’s nutrition status.

What is a food allergy?

“A Food allergy is an immune system reaction that occurs soon after eating a certain food. Even a tiny amount of the allergy-causing food can trigger signs and symptoms such as digestive problems, hives or swollen airways. In some people, a food allergy can cause severe symptoms or even a life-threatening reaction known as anaphylaxis” (Mayo Clinic).

What is an intolerance?

“It’s easy to confuse a food allergy with a much more common reaction known as food intolerance. While bothersome, food intolerance is a less serious condition that does not involve the immune system” (Mayo Clinic).

A food intolerance or a reaction to another substance you ate may cause the same signs and symptoms as a food allergy does — such as nausea, vomiting, cramping and diarrhea.

Depending on the type of food intolerance you have, you may be able to eat small amounts of problem foods without a reaction. By contrast, if you have a true food allergy, even a tiny amount of food may trigger an allergic reaction.

Food allergy risk factors include:

• Family history
• Other allergies
• Age. Food allergies are more common in children, especially toddlers and infants. As you grow older, your digestive system matures, and your body is less likely to absorb food or food components that trigger allergies.Fortunately, children typically outgrow allergies to milk, soy, wheat and eggs. Severe allergies and allergies to nuts and shellfish are more likely to be lifelong.
• Asthma

Prevention

Early introduction of peanut products and other common allergens has been associated with a lower risk of the being diagnosed with a food allergy. Once your child is beginning to eat solids, it is recommended to introduce potential allergenic foods; unless, there is a family history and your child is at an increased risk- then please consult your pediatrician and dietitian for further individualized guidance.

But, once a food allergy has already developed, the best way to prevent an allergic reaction is to know and avoid foods that cause signs and symptoms.

If you know you have a food allergy, follow these steps:

• Know what you’re eating and drinking
• If you have already had a severe reaction, wear a medical alert bracelet or necklace.
• Talk with your doctor about prescribing emergency epinephrine
• Be careful at restaurants. 
• Plan meals and snacks before leaving home. If your child has a food allergy, take these precautions to ensure his or her safety:
• Notify key people that your child has a food allergy. 
• Explain food allergy symptoms. 
• Write an action plan. 

What are the 8 common allergens?

• Milk
• Eggs
• Wheat
• Soy
• Peanuts
• Tree nuts
• Fish
• Shellfish

Milk

Cow’s milk is the usual cause of milk allergy, but milk from sheep, goats, buffalo and other mammals also can cause a reaction. It must be noted, if your child is allergic to cow’s milk, don’t assume they will be able to handle milk from other mammals including goat and sheep as the proteins are very similar and are likely to still cause a reaction.

Avoiding milk and milk products is the primary treatment for milk allergy. Fortunately, most children outgrow milk allergy.

Key Nutrients of Concern: Calcium, Vitamin D, Protein, Riboflavin

Obvious sources of allergy-causing milk proteins are found in dairy products, including:

• Whole milk, low-fat milk, skim milk, buttermilk
• Butter
• Yogurt
• Ice cream, gelato
• Cheese and anything that contains cheese
• Half-and-half

Milk can be harder to identify when it’s used as an ingredient in processed foods, including baked goods and processed meats. Hidden sources of milk include:

• Whey
• Casein
• Ingredients spelled with the prefix “lact” — such as lactose and lactate
• Candies, such as chocolate, nougat and caramel
• Protein powders
• Artificial butter flavor
• Artificial cheese flavor
• Hydrolysates

Milk alternatives for infants

In children who are allergic to milk, breast-feeding and the use of hypoallergenic formula can prevent allergic reactions.

• Breast-feeding is the best source of nutrition for your infant. Breast-feeding for as long as possible is recommended, especially if your infant is at high risk of developing milk allergy.
• Hypoallergenic formulas are produced by using enzymes to break down (hydrolyze) milk proteins, such as casein or whey. Further processing can include heat and filtering. Depending on their level of processing, products are classified as either partially or extensively hydrolyzed. Or they may also be called elemental formulas.

Some hypoallergenic formulas aren’t milk based, but instead contain amino acids. Besides extensively hydrolyzed products, amino-acid-based formulas are the least likely to cause an allergic reaction.

• Soy-based formulas are based on soy protein instead of milk. Soy formulas are fortified to be nutritionally complete — but, unfortunately, some children with a milk allergy also develop an allergy to soy.

If you’re breast-feeding and your child is allergic to milk, cow’s milk proteins passed through your breast milk may cause an allergic reaction. You may need to exclude from your diet all products that contain milk.

Milk allergy or milk intolerance?

Common signs and symptoms of milk protein intolerance or lactose intolerance include digestive problems, such as bloating, gas or diarrhea, after consuming milk or products containing milk.

People with lactose intolerance are unable to fully digest the sugar (lactose) in milk. As a result, they have diarrhea, gas and bloating after eating or drinking dairy products. The condition, which is also called lactose malabsorption, is usually harmless, but its symptoms can be uncomfortable.

Too little of an enzyme produced in your small intestine (lactase) is usually responsible for lactose intolerance. You can have low levels of lactase and still be able to digest milk products. But if your levels are too low you become lactose intolerant, leading to symptoms after you eat or drink dairy.

Most people with lactose intolerance can manage the condition without having to give up all dairy foods.

Substitutions to include: dairy free yogurt, diary free cheese, diary free milk {coconut (no protein) almond milk (no protein) cashew milk (no protein) soy milk (protein)} watch added sugars and get unsweetened versions. A calcium and Vitamin D supplement may be necessary.

Eggs

Egg allergy can occur as early as infancy. Most children, but not all, outgrow their egg allergy before adolescence.

Both egg yolks and egg whites contain proteins that can cause allergies, but allergy to egg whites is most common. It’s possible for breast-fed infants to have an allergic reaction to egg proteins in breast milk if the mother consumes eggs.

Hidden sources of egg products-unfortunately, even if a food is labeled egg-free it may still contain some egg proteins. When in doubt, contact the manufacturer.

Foods that contain eggs can include:

• Marshmallows
• Mayonnaise
• Meringue
• Baked goods
• Breaded foods
• Marzipan
• Frostings
• Processed meat, meatloaf and meatballs
• Puddings and custards
• Salad dressing
• Many pastas
• Foam on alcoholic specialty coffees
• Pretzels

Several terms indicate that egg products have been used in manufacturing processed foods, including:

• Albumin
• Globulin
• Lecithin
• Livetin
• Lysozyme
• Vitellin
• Words starting with “ova” or “ovo,” such as ovalbumin or ovoglobulin

Vaccinations and egg allergy

Some shots to prevent illness (vaccines) contain egg proteins. In some people, these vaccines pose a risk of triggering an allergic reaction. Be sure to consult with your doctor.

Wheat

Avoiding wheat is the primary treatment for wheat allergy, but that isn’t always as easy as it sounds. Wheat is found in many foods, including some you might not suspect, such as soy sauce, ice cream and hot dogs.

Some sources of wheat proteins are obvious, such as bread, but all wheat proteins — and gluten in particular — can be found in many prepared foods and even in some cosmetics, bath products and play dough. Foods that may include wheat proteins include:

• Breads and bread crumbs
• Cakes, muffins and cookies
• Breakfast cereals
• Pasta
• Couscous
• Farina
• Semolina
• Spelt
• Crackers
• Hydrolyzed vegetable protein
• Soy sauce
• Meat products, such as hot dogs
• Dairy products, such as ice cream
• Natural flavorings
• Gelatinized starch
• Modified food starch
• Vegetable gum

NOT to be confused with a Gluten Allergy

Celiac disease. Celiac disease is sometimes referred to as a gluten allergy, It’s a unique reaction that’s more complex than a simple food allergy.

This chronic digestive condition is triggered by eating gluten, a protein found in bread, pasta, cookies, and many other foods containing wheat, barley or rye.

If you have celiac disease and eat foods containing gluten, an immune reaction occurs that causes damage to the surface of your small intestine, leading to an inability to absorb certain nutrients.

Following a gluten-free diet requires paying careful attention to food selections, the ingredients found in foods, and their nutritional content.

Allowed fresh foods

Many naturally gluten-free foods can be a part of a healthy diet:

• Fruits and vegetables
• Beans, seeds, legumes and nuts in their natural, unprocessed forms
• Eggs
• Lean, non-processed meats, fish and poultry
• Most low-fat dairy products

Grains, starches or flours that can be part of a gluten-free diet include:

• Amaranth
• Arrowroot
• Buckwheat
• Corn — cornmeal, grits and polenta labeled gluten-free
• Flax
• Gluten-free flours — rice, soy, corn, potato and bean flours
• Hominy (corn)
• Millet
• Quinoa
• Rice, including wild rice
• Sorghum
• Soy
• Tapioca (cassava root)
• Teff

Grains not allowed

Avoid all foods and drinks containing the following:

• Wheat
• Barley
• Rye
• Triticale — a cross between wheat and rye (to be avoided in a wheat free diet as well)
• Oats, in some cases

While oats are naturally gluten-free, they may be contaminated during production with wheat, barley or rye. Oats and oat products labeled gluten-free have not been cross-contaminated. Some people with celiac disease, however, cannot tolerate the gluten-free-labeled oats.

Wheat terms to know (these should be avoided in a wheat free diet as well)

There are different varieties of wheat, all of which contain wheat gluten:

• Durum
• Einkorn
• Emmer
• Kamut
• Spelt

Wheat flours have different names based on how the wheat is milled or the flour is processed. All of the following flours have gluten (these should also be avoided in a wheat free diet as well):

• Enriched flour with added vitamins and minerals
• Farina, milled wheat usually used in hot cereals
• Graham flour, a course whole-wheat flour
• Self-rising flour, also called phosphate flour
• Semolina, the part of milled wheat used in pasta and couscous

Processed foods that often contain gluten

In addition to foods in which wheat, barley and rye are likely ingredients, these grains are standard ingredients in a number of other products. Also, wheat or wheat gluten is added as a thickening or binding agent, flavoring, or coloring. It’s important to read labels of processed foods to determine if they contain wheat, as well as barley and rye.

In general, avoid the following foods unless they’re labeled as gluten-free or made with corn, rice, soy or other gluten-free grain:

• Beer, ale, porter, stout (usually contain barley)
• Breads
• Bulgur wheat
• Cakes and pies
• Candies
• Cereals
• Communion wafers
• Cookies and crackers
• Croutons
• French fries
• Gravies
• Imitation meat or seafood
• Malt, malt flavoring and other malt products (barley)
• Matzo
• Pastas
• Hot dogs and processed lunchmeats
• Salad dressings
• Sauces, including soy sauce (wheat)
• Seasoned rice mixes
• Seasoned snack foods, such as potato and tortilla chips
• Self-basting poultry
• Soups, bouillon or soup mixes
• Vegetables in sauce

Medications and supplements

Prescription and over-the-counter medications may use wheat gluten as a binding agent. Talk to your doctor or pharmacists about the drugs you’re taking. Dietary supplements that contain wheat gluten must have “wheat” stated on the label.

Eating gluten-free at home and in restaurants

For people with celiac disease it’s particularly important to avoid exposure to gluten. The following tips can help you prevent cross-contamination in your own food preparations at home and avoid gluten-containing food when you eat out:

• Store gluten-free and gluten-containing foods in different places.
• Keep cooking surfaces and food storage areas clean.
• Wash dishes and cooking equipment thoroughly.
• Toast bread in the oven — or consider separate toasters — to avoid cross-contamination.
• Read restaurant menus online ahead of time if possible, to be sure there are options for you.
• Eat out early or late when a restaurant is less busy and better able to address your needs.

Nutrients of concern (the same for a wheat allergy as well):

• Iron
• Calcium
• Fiber
• Thiamin
• Riboflavin
• Niacin
• Folate

Therefore, following a gluten-free diet will likely change your nutrient intake. Some gluten-free breads and cereals have significantly varied nutrient levels compared with the products they are replacing.

Some gluten-free foods also have higher fat and sugar contents than the gluten-containing food being replaced. It’s important to read labels, not only for gluten content but also for overall nutrient levels, salt, calories from fats and calories from sugars.

Be sure that you are including other whole grains (mentioned above), dark green leafy vegetables, beans, lentils and meat (if allowed in your personal preference) and dairy in order to help get enough  of the nutrients of concern. If you are unable to consume dairy as well be sure to include the alternatives mentioned above.

Soy

Allergy to soy, a product of soybeans, is a common food allergy. Often, soy allergy starts in infancy with reaction to soy-based infant formula. Although most children outgrow soy allergy, some carry the allergy into adulthood.

Having a soy allergy means avoiding products that contain soy, which can be difficult. Many foods, such as meat products, bakery goods, chocolate and breakfast cereals, may contain soy.

Read food labels carefully. Soy is often present in unexpected foods, including canned tuna and meat, baked goods, crackers, energy bars, low-fat peanut butter, and canned soups. Read labels every time you buy a product, because ingredients can change. Also, check for the statement “contains soy” or “may contain soy” on product labels.

Highly refined soy oil may not cause a reaction because it doesn’t contain soy proteins. Similarly, you might not react to foods that contain soy lecithin. But generally, if a label includes the word “soy,” avoid it. Products to avoid include, but are not limited to:

• Soy milk, soy cheese, soy ice cream and soy yogurt
• Soy flour
• Tofu
• Miso
• Natto
• Shoyu
• Tempeh
• Soy sauce and tamari
• Edamame
• Vegetable oil, vegetable gum, vegetable broth and vegetable starch

Besides “soy,” “soya” and “soybeans,” other words on food labels may indicate that the product contains soy, including:

• Glycine max
• Hydrolyzed vegetable protein (HVP)
• Hydrolyzed plant protein
• Textured vegetable protein (TVP)
• Monodiglyceride
• Monosodium glutamate (MSG)
• Artificial flavoring
• Natural flavoring

There are not too many nutrients of concern if one must avoid soy. The main reason people consume soy is as a protein alternative to meat so just ensuring that you are getting enough protein from other sources such as beans, lentils, whole grains, fish, dairy products if you don’t have those allergies and if they are allowed in your personal preferences.

Peanut

Peanut allergy is one of the most common causes of severe allergy attacks. For some people with peanut allergy, even tiny amounts of peanuts can cause a serious reaction that can even be life-threatening (anaphylaxis).

Peanut allergy has been increasing in children. Even if you or your child has had only a mild allergic reaction to peanuts, it’s important to talk to your doctor. There is still a risk of a more serious future reaction.

Exposure to peanuts can occur in various ways:

• Direct contact. The most common cause of peanut allergy is eating peanuts or peanut-containing foods. Sometimes direct skin contact with peanuts can trigger an allergic reaction.
• Cross-contact. This is the unintended introduction of peanuts into a product. It’s generally the result of a food being exposed to peanuts during processing or handling.
• Inhalation. An allergic reaction may occur if you inhale dust or aerosols containing peanuts, from a source such as peanut flour or peanut oil cooking spray.
• According to recent studies, there is strong evidence that introducing at-risk babies to peanuts as early as 4 to 6 months of age may reduce their risk of developing food allergies by up to 80%. Babies at risk for peanut allergy include those with mild to severe eczema, egg allergy, or both. Before introducing your baby to peanuts, discuss the best approach with your child’s doctor.

Avoid anything with peanuts in the ingredient list as well as if a food was produced in a facility that also handles peanuts. You want to avoid tree nuts if they were produced in the same facility as peanuts as this is typically a common practice.

By simply avoiding peanuts there are no real concerns for nutrient deficiencies just ensure a well-balanced diet with heart healthy fats and protein.

Fish Allergy

A fish allergy is not exactly the same as a seafood allergy. Seafood includes fish (like tuna or cod) and shellfish (like lobster or clams). Even though they both fall into the category of “seafood,” fish and shellfish are biologically different. So shellfish will only cause an allergic reaction in someone with a fish allergy if that person also has a shellfish allergy.

Unlike other food allergies, which are typically first observed in babies and young children, an allergy to fish may not become apparent until adulthood; in one study, as many as 40 percent of people reporting a fish allergy had no problems with fish until they were adults. Those with fish allergies usually have that allergy for the rest of their lives.

Having an allergy to a finned fish (such as tuna, halibut or salmon) does not mean that you are also allergic to shellfish (shrimp, crab and lobster). While some allergists recommend that individuals with a fish allergy avoid eating all fish, it may be possible for someone allergic to one type of fish to safely eat other kinds.

Managing a fish allergy includes strict avoidance of the fish to which you are allergic. Doctors typically advise people who are allergic to one type of finned fish to avoid all types.

Many prepared foods contain fish in some form. Fish is a common ingredient in Worcestershire sauce and Caesar salad and is sometimes found in imitation crab products in the form of surimi, a processed food made mainly from Alaska pollock. Fish is also prevalent in Asian cuisine, which uses fish-based stock for many dishes.

While an allergy to fish protein is most common, it is possible to be allergic to fish gelatin (made from fish skin and bones). People with a fish allergy should consult their allergist before taking fish oil dietary supplements.

Due to the high risk for cross-contact during food preparation, it is best to avoid seafood restaurants in general, even if you plan to order something other than fish. Stay out of areas where fish is being cooked, as proteins may be released into the air during cooking.

There are more than 20,000 species of fish. Although this is not a complete list, allergic reactions have been commonly reported to:

• Anchovies
• Bass
• Catfish
• Cod
• Flounder
• Grouper
• Haddock
• Hake
• Halibut
• Herring
• Mahi mahi
• Perch
• Pike
• Pollock
• Salmon
• Scrod
• Sole
• Snapper
• Swordfish
• Tilapia
• Trout
• Tuna

Also avoid these fish products:

• Fish gelatin, made from the skin and bones of fish
• Fish oil
• Fish sticks (some people make the mistake of thinking these don’t contain real fish)

Some Unexpected Sources of Fish

• Barbecue sauce
• Bouillabaisse
• Caesar salad and Caesar dressing
• Caponata, a Sicilian eggplant relish
• Imitation or artificial fish or shellfish (e.g., surimi, also known as “sea legs” or “sea sticks”)
• Worcestershire sauce
• Certain cuisines (especially African, Chinese, Indonesian, Thai and Vietnamese)—even if you order a fish-free dish, there is high risk of cross-contact

Allergens are not always present in these food and products, but fish can appear in surprising places. Again, read food labels and ask questions if you are ever unsure about an item’s ingredients.

Carrageenan, or “Irish moss,” is not fish. It is a red marine algae used as an emulsifier, stabilizer and thickener in many foods like dairy foods. It is safe for most people with food allergies.

By simply avoiding fish there are no real concerns for nutrient deficiencies just ensure a well-balanced diet with heart healthy fats and protein.

Shellfish allergy

Shellfish allergy is an abnormal response by the body’s immune system to proteins in certain marine animals. Marine animals in the shellfish category include crustaceans and mollusks, such as shrimp, crab, lobster, squid, oysters, scallops and others.

Some people with shellfish allergy react to all shellfish; others react to only certain kinds.

There are several types of shellfish, each containing different proteins:

• Crustaceans include crabs, lobster, crayfish, shrimp and prawn.
• Mollusks include squid, snails, clams, oysters and scallops.

Some people are allergic to only one type of shellfish but can eat others. Other people with shellfish allergy must avoid all shellfish.

Though people of any age can develop a shellfish allergy, it’s more common in adults. Among adults, shellfish allergy is more common in women. Among children, shellfish allergy is more common in boys.

By completely avoiding shellfish there are no real concerns for nutrient deficiencies just ensure a well-balanced diet with heart healthy fats and protein as well as enough zinc. Sources of zinc include: beans, nuts, whole grains, fortified breakfast cereals and dairy products.

Follow the advice in each section for each food allergy and don’t forget to AVOID CROSS CONTAMINATION

You can do everything right to ensure your child isn’t eating the allergen, however it is very easy to cross contaminate their allergen free food with the allergen food, especially if not everyone in the house is following the same restrictions. So here are some very important tips to keep in mind:

Food to Food- if there are nuts on top of a salad don’t simply pick them off. The other foods in the salad have already been contaminated with the allergen

Food to Object-cookware, dishes, utensils and cooking surfaces must be properly cleaned before preparing food for someone with an allergen. In some cases, if the allergy is severe separate cookware dishes and utensil may be needed.

Food to Saliva- this can happen when you share utensils and bites of food. The allergen can be passed through saliva. For example, if you ate peanuts and your child is allergic and you gave your child a bite from your fork after you ate something with peanuts, your child could have a reaction.

Other simple tips:

• Wash hand before and after eating or before touching eyes, nose and mouth – soap and water is preferred over sanitizers (sanitizers can still leave allergen residues)
• Don’t share food utensils or drinks
• Don’t pick an allergen out of the food and then eat the rest of the food on the plate
• Wash cookware very thoroughly as caked on food even after going through a dishwasher cycle can still cause a reaction
• Clean surfaces with soap and water or commercial cleansers
• Use disposable sponges, wipes and towels as allergens can remain on them 

I hope this article was helpful in getting you to understand allergies, verses intolerances and what you can do as a parent to ensure your child is getting adequate nutrition to grow and flourish optimally!  Allergies are many times a very individual situation; please be reassured that I am here as a resource to you and you can always sign up for an individual consult by clicking HERE

Cheers,

Ashley