Royal Brompton Hospital,
77 Wimpole Street,
London, W1G 9RU
77 Wimpole Street,
London, W1G 9RU
Respiratory Conditions
Food allergies in children is a very popular subject with an enormous amount of information available in the lay press. It has become almost an industry. I have never met a middle class person who did not believe that either they or their child had a food allergy to something! Whilst it is undoubtedly true that a small proportion of children (about 1.5 to 2% over aged 5 years) do have significant food allergy, that is clearly not everybody. A survey of adults in High Wycombe about 20 years ago showed that 20% people believed they were allergic to a specific type of food however, when they were actually tested to the same food (which they had thought they were allergic to previously) most of them were actually not allergic to that food substance.
In children under one year, perhaps up to 5% kids are allergic to cow's milk protein (one is not allergic to milk sugar) the majority of whom grow out it by age 3. Common signs of food allergies in children are itchy rashes, eczema, gut problems and occasionally breathing difficulty. Goat and sheep milk are simiar to cow milk but should not be used as substitutes especially in babies less than 6 months. Soya milk should not be given to infants as well since it is known to be associated with allergic responses and increase the risk of peanut allergy in the future.
An extensively hydrolyzed formula (EHT) is the recommended milk if required. Recent evidence suggests that if a child is tolerant to baked milk e.g. in muffins or to UHT milk when baby is old enough, then its daily intake increases the chance and expedites the process of growing out of the allergy. The same applies to an egg allergy, the second most common reaction in kids under one year. They may react to soft scrambled egg but can tolerate baked egg in cake, so if that is the case then, even consumption of a small amount of cake will hasten the resolution of the allergy.
After the first couple of years peanut, tree nut and fish allergy become the dominant food allergies in children though no food exists that cannot cause allergy. Once established, these allergies are far less likely to be grown out of than an allergy from milk or eggs for reasons unknown. Approximately 18% people grow out of peanut allergy whereas 90%+ people out grow milk and/or egg allergy.
Blood tests and skin prick tests are guides to whether one is allergic. 50%+ people will have a positive reaction to something but that does not necessarily mean that is the cause of the symptoms of food allergy so great care is required in its interpretation. Ultimately the litmus test is - can someone eat a particular food substance without any problem or sign of possible food allergy.
If one has had an inside the body reaction such as wheezing, choking, fainting etc then one needs to carry an adrenaline injection device. However, its usage depends on a case by case basis. The threshold for those suffering with asthma as well in addition to food allergy, to carry an adrenaline device for food allergy treatment is much lower.
Despite the enormous amount of anxiety generated over food allergies in children, with proper education and understanding of the risk of serious harm, death remains extremely small although not zero. It is estimated that the risk of death from a food allergy in children is about 1/300,000 or the same as the chance of being murdered in Europe or about 1/20th the chance of dying as the result of an accident in Europe.
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Suzanne Harvey
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