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The baby’s tiny back was full of welts, another rising each time her skin was pricked.
At 3 months old, Danyel Bigger had horrible colic and skin rashes, says her mother, Chay Bigger of Bellevue. The baby was being breastfed, but friends thought maybe she was allergic to the cow’s milk her mother was drinking. Chay and her husband, Shawn, took her to an allergist.
“They did a skin prick test, and she was allergic to every single thing – wheat, dairy, eggs, chicken, soy, nuts, rye …,” Chay Bigger says. It was a shock because neither of the parents, nor their family members, had any food allergies. “I remember how overwhelming it as when I first found out,” she says.
“I cut all those things out of my diet. I had to learn to eat what I wasn’t used to,” she adds. She limited the offending foods while breastfeeding Danyel, now 8, and her sister, Josie, now 5. Josie also has allergies, but not as many as Danyel has. The whole family eats a rotating diet of the many foods Danyel can eat, including all vegetables, most fruits, most meats, potatoes, oats, rice, sweet potatoes and more exotic grains, such as quinoa and amaranth. “They’re tasty and you get used to them,” Bigger says.
The Food Allergy & Anaphylaxis Network (FAAN) estimates that 12 million Americans, including 3 million children, have food allergies – about 4 percent of the population (and 6 percent of the children under age 3). Because the line between true allergies and food sensitivities is blurred, figures can vary. The U.S. Food and Drug Administration estimates food allergies affect 11 million people in the United States. The National Institutes of Health states that less than 1 percent of the population has true food allergies.
Rates are higher for small children because many kids outgrow food allergies, especially to milk, eggs, soy and wheat. Allergies to peanuts and tree nuts are more likely to persist into adulthood. Fish and shellfish allergies may develop later in life and are rarely outgrown.
What’s a Food Allergy?
A true food allergy is an immune system reaction to a particular food.
An allergic response is always a reaction to a protein, explains Dr. Clifton Furukawa of the Northwest Asthma and Allergy Center, affiliated with Children’s Hospital and Regional Medical Center. As member of FAAN’s national medical advisory board, he helps insure that information about food allergies is medically accurate.
The immune system mis-interprets carbon-based trains of proteins as foreign, potentially harmful substances and sends out antibodies, most commonly immunoglobulin E (IgE).
The next time a person comes in contact with the food by touching or eating it, or even inhaling its particles, the body releases chemicals, including histamine, to “protect” itself, according to information dispersed by Children’s Hospital and Regional Medical Center. These antibodies cause rapid inflammation which shows up in some of these ways:
• Skin: itchy red bumps or hives, eczema, swelling and redness of the face or extremities, tingling, or itching and swelling of the lips, tongue or mouth;
• Gastrointestinal tract: abdominal pain, nausea, vomiting, or diarrhea;
• Respiratory tract: runny or stuffy nose, sneezing, watery eyes, coughing, congestion, wheezing, or shortness of breath;
• Cardiovascular system: lightheadedness, or fainting;
• Anaphylaxis: a sudden, potentially life threatening allergic reaction involving two or more of the body areas listed above, accompanied by swelling of the airway, difficulty breathing, a drop in blood pressure, loss of consciousness or (very rarely) death.
With a true allergy, there is always a response to the offending food. Symptoms typically appear within minutes to two hours after eating the food. (Eczema may seem to be a delayed response, but the actual itchiness occurs right away and the repeated scratching leads to the patches of eczema visible in the next few days, Furukawa clarifies.)
In addition to the symptoms above, colic, frequent illnesses – with the child never seeming to get better – or stomach aches can also be an indication of a food allergy, adds Sheila Kingsbury, N.D., R.H., a faculty member at Bastyr University. Some naturopaths also see a link between food allergies and learning disabilities, such as ADHD, possibly because the antibodies are communicating with nerves, she says.
Food sensitivities and intolerances are often placed under the general label of food allergies. However, they do not involve the immune system, and the onset of symptoms may be delayed. The sensitivities may be caused by a deficiency in enzymes needed to digest certain foods – the most common being lactose intolerance, in which the person lacks the enzyme to digest milk. In my own case and in many others, when the enzyme deficiency is addressed, the allergic reactions disappear. Celiac disease, an inability to digest gluten, can also mimic food allergy.
Food sensitivities and intolerances produce many of the same symptoms of true allergies, especially in the gastrointestinal tract, but they are rarely life-threatening. They may produce other symptoms such as achy joints, skin rashes, fatigue, depression, headache and attention deficit disorders.
Why Is the Incidence of Food Allergies Increasing?
“I never once knew a kid who had allergies when I grew up,” Bigger comments. “I talk to my friends and they say the same thing. Why is there such increase?”
Most experts, including FAAN, agree that there has been an increase in food allergies over the past 50 years, especially in the life-threatening ones that can cause anaphylaxis. Allergies to peanuts and tree nuts have definitely increased. “I don’t think there’s a study showing that other allergies – such as milk and wheat – have gone up,” Furukawa says.
In the last 10 to 20 years, tests to detect allergies have improved and that accounts for some of the increase, Kingsbury adds.
“We eat a lot more processed food which drives more inflammation in the body,” Kingsbury says. “If you make it inflamed, the body will react to foods more than it would otherwise. If the gut is inflamed or immature, gaps open up – we call that ‘leaky gut syndrome.’ Food proteins, which normally go through the gut, gets absorbed (into the blood stream) before they’re all digested. The body puts out antibodies.”
Furukawa points to the fact that as we’ve improved cleanliness and use products to kill bacteria, our babies’ immune systems are moving from an anti-bacterial system to an anti-parasitic one. “The antibodies attack the big protein molecules because they think they’re parasites,” he says.
“Peanut is its own unique story,” Furukawa says. “When peanuts were first eaten, they were boiled. Then they were roasted in oil. Now we have dry roasting.” The increase in peanut allergies corresponds to the move to dry roasting, which uses much higher temperatures. “In dry roasting, the peanut allergen binds into groups of three. It becomes a super-allergen. It looks more like a parasite,” he explains.
Most doctors and naturopaths believe there is a genetic component to many allergies. “One inherits a tendency to develop allergies from a bunch of immune response genes, not just one gene,” Furukawa elaborates. “Development of a specific allergy is a question of exposure, timing and luck.”
The frequency of allergies to a particular food depends on the degree of exposure. “In Japan, there are more children allergic to soy; in the United States, it’s cow’s milk because that’s what children get more of,” he says. He points out that during the Sputnik era, orange juice was promoted as a health food for astronauts, and more babies and toddlers developed allergies to oranges. About 30 years ago, a baby formula based on bananas came out, and banana allergies spiked.
Timing is important because until age 2, a child’s gastro-intestinal system is immature and leaky. Complex proteins that are not fully digested will get into the blood stream and get attacked by antibodies, Kingsbury and Furukawa explain.
“La Leche League is right. Babies don’t need anything else but mother’s milk for the first six to 12 months,” Furukawa adds. “But parents get bored. Americans like to play with babies and stick foods in their mouths.”
Can I Ward Off Food Allergies?
If a child is born with multiple allergies, as Danyel Bigger was, it is difficult to prevent them, except by cutting out the eight highest-offending allergies from your diet while breast-feeding.
However, being careful with the introduction of new foods during the first two or three years often reduces the likelihood of a child developing allergies. Most new allergies develop in the first three years of life, and fewer will arise by the school age years, according to Furukawa.
The American Academy of Pediatrics recommends breast milk alone for the first six months. It recommends introducing solid food as a complement to breast milk, in the next six months.
Although the usual recommendation is to begin with rice cereal, Kingsbury says research from the last four years indicates that no grains should be introduced before 9 months of age to prevent allergic reactions. She recommends beginning with fruits and vegetables such as apples, blueberries, carrots, squashes, bananas, sweet potatoes and apricots. Introduce one a week and look for any reactions. “It often takes three days to see any reaction (the first time),” she says. “We won’t know which food is causing a problem if we’re introducing them too fast.”
At 9 months, she recommends looking at whole grains such as quinoa and brown rice, as white rice has little nutritional value. The timing for introducing wheat depends on whether there’s a family history of wheat allergy, she adds.
She recommends caution in adding cow’s milk to the diet. “In half the infant problems we see, dairy is a problem; it increases mucus in the body and leads to more ear infections,” she says. “Our bodies aren’t designed to digest it.” It can be introduced at 12 months, but Kingsbury prefers using soy, oat or hazelnut milk until 2 years of age.
To meet a baby’s protein needs, meats can be introduced at 12 months and eggs a little earlier, as long as there’s no egg allergy in the family. Nine to 12 months is also a good age to introduce nuts such as sesame and sunflower seeds, but she recommends avoiding peanuts and tree nuts until much later.
“If there’s a family history of an allergy to anything, avoid it in the kids for as long as possible,” she adds.
Furukawa agrees that “not being in too much of a rush to introduce foods would help a lot.” He recommends the more traditional introduction of solids, beginning with rice cereal and progressing to yellow and green vegetables and fruit, added one at a time.
“Listen to your pediatrician; you don’t want to advance beyond what he or she says in regards to food introduction,” he concludes.
Should My Child Be Tested for Food Allergies?
If your child is experiencing some of the symptoms listed under “What is a Food Allergy?” it may warrant a visit to a pediatrician, nutritionist, allergist or naturopath for further evaluation. FAAN and Children’s Hospital in Seattle recommend keeping a food diary to tell your health care practitioner about your child’s symptoms, how often reactions occur, the time between eating a particular food and the start of the first symptoms, and how long the reactions lasted. It’s also helpful to include information on family members’ allergies or conditions such as eczema and asthma.
“Elimination is the gold standard for determining food allergies,” Kingsbury says. “We remove a (suspected) food for a month, reintroduce it, and see what happens.” She emphasizes that we should eliminate only one food at a time, under the direction of a medical practitioner, so that children do not miss out on necessary nutrition.
If the allergy is not matched with one of “the big eight” allergens and there isn’t an obvious, severe reaction to one particular food, finding the allergens can be “like finding a needle in a haystack,” Kingsbury says. Skin or blood tests may give more answers.
A prick skin test is done in a doctor or naturopath’s office. The medical provider places a drop of the substance being tested on a patient’s forearm or back and pricks the skin with a needle, allowing a tiny amount to enter the skin. If the patient is allergic to the substance, a wheal or bump will form in about 15 minutes. The test only detects true allergies, which prompt a release of immunoglobulin E (IgE) antibodies.
A RAST test (radioallergosorbent test) is a laboratory blood test which measures the levels of IgE antibodies to a panel of foods.
The tests are not infallible, Kingsbury says. “Some doctors may just do a prick test and if nothing reacts, they say, ‘You don’t have allergies.’ That may not be true.” The RAST test may also yield some false positives, but could give some clues into which foods to try eliminating.
Given the thousands of foods available and the impossibility of testing for them all, Bigger rubs a tiny amount of a new food on Danyel’s face to see if there’s a reaction. If there isn’t, she will give her a tiny bite and see if her throat starts itching. She also uses this method for food that seems safe, but which may contain unlabeled fillers.
“What applies to one child doesn’t necessarily apply to another,” Furukawa warns. “So don’t believe someone who says, ‘This worked for my kids; this should work for yours.’ Every child is unique.”
Wenda Reed is a Bothell writer and mother of two.
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