When food makes you sick

Dr Mahesh Hiranandani

Four-year-old Ananya was having a gala time with other children her age at a birthday party. They were all feasting on doughnuts being served by the hosts. Suddenly, the celebrations came to a standstill by the loud shrieks of Anaya’smother, violently shaking her little girl who was breathing with difficulty and developing a scary looking rash and swelling of the lips. Nobody could understand the cause of this sudden emergency. Later it was found to be a case of severe peanut allergy. Luckily, the girl survived, as she was treated well in time. Food allergies can cause serious and even deadly reactions. So it’s important to know how to recognise an allergic reaction and to be prepared if one happens. The problem is, most parents have no idea if their children have food allergies until they try the food for the first time and have a reaction. That’s why it’s important for parents — as well as teachers, babysitters, and everyone else who spends time with the child — to be alert for signs and foods that can cause an allergy.

Food allergies are on a rise across the globe, so much so that it is almost fashionable to announce that one is allergic to a certain exotic food item like celery, eggplant, kopi luwak, durian, etc., which actually is not allergy but probably intolerance. A true allergy is to the protein content of a food article and can manifest immediately or sometimes gradually, in hours to days. It is crucial to identify mild to moderate manifestations from severe presentation as immediate treatment can be instituted and a life saved.

Food allergy symptoms

Food allergy can affect breathing, intestinal tract, heart, and skin. A child with food allergy will develop one or more of the following symptoms within a few minutes to an hour after eating the food:

Mild to moderate allergy: Swelling of lips, face or eyes, Redness of skin/ hives/ eczema/ itchy mouth, running nose, vomiting, stomach ache, diarrhoea

Anaphylaxis (Severe allergy): This can be a serious life threatening reaction that needs urgent medical attention. It is vital to lay the victim on a flat surface with legs raised to keep the BP stable, loosen clothes and call for medical help. Some of the symptoms include noisy breathing, breathlessness, tightness in chest, throat persistent wheeze, fainting, low BP.

Delayed onset of food allergies: Some children may show mild symptoms like bloating, vomiting, abdominal pain and a running nose, a few hours after consumption of the offending food. Since they are so non-specific, a mild food allergy is difficult to detect and can be missed for a long time.

Stamping the diagnosis

There is no single foolproof laboratory test to stamp an individual allergic to a certain food item. The popular skin prick tests can sometimes produce a severe reaction, hence should be avoided in individuals who present severe manifestations. Elevated level of specific IgE antibody does not always mean that the child is allergic to a given food item but is only suggestive of sensitisation. Claims of various popular clinical labs in providing a detailed allergy testing based on IgG antibodies are Bogus and sometimes result in unnecessary withdrawal of many food items from the diet. This results in a life-long fear of the reported foods. In delayed food allergy, diagnosis is usually made through an ‘Elimination and Re-challenge test’. Remember, your doctor is the best person to analyse your child’s health history and clinical signs to make an exact diagnosis before advising any one of the above tests. So don’t be in a hurry to make the diagnosis yourself by falling prey to one of those catchy slogans put out by labs.

Managing a child with food allergy

There is currently no cure for food allergies; however, many children grow out of them. It could be very frustrating to have a child with food allergy because food is everywhere and children by nature are curious to try new foods outside of their homes. This poses a risk of allergic reactions at places where they are unsupervised, like at school, playgrounds and parties.

The recommended strategy is to:

AVOID FOOD that has caused problems in the past. Even a tiny amount of food or contact with cutlery can cause a reaction. Learn to scan the labels on all foods for common offenders. It is sensible to enquire about ingredients in the dishes from the chef who may be the best informed person in the restaurant to help you.

HAVE AN ACTION PLAN in case of a severe reaction. Do not hesitate to use EPIPEN (adrenaline auto-injector) if a child presents with symptoms involving two body systems, example hives and vomiting. It’s important that key people like family, babysitters and teachers know how and when to use your child’s adrenaline auto-injector. Always have emergency numbers ready. Consider a medical bracelet that lets people know that the child has an allergy.

Prediction of food allergy in a child

Food allergy does not travel down through generations. But if a child’s parents have other allergies like asthma, hay fever or eczema, the child has an increased risk of food allergies. Micro breaches in skin of an infant allows passage of protein molecules in foods like milk, wheat, nuts etc to produce sensitisation, which on subsequent exposure to the same foods by mouth may manifest as food allergies. So, as a rule, avoid ‘milk baths’, ‘atta loi’ and ‘badam rogan’ massage to avoid development of allergies to these food articles in the future.

Can we reduce the risk of food allergies?

By following these simple steps, risk of food allergies can be reduced:

• Exclusive breast feeding for first 6 months and introduction of animal milk after one year of life eliminates the risk of cow’s milk protein allergy.
• Complimentary feeding (without animal milk) should be started around six months. New food items can be started in a gradual, graded manner without avoiding any particular allergenic foods (eggs, peanuts etc), as introducing them by nine months of age can actually reduce the risk of your child developing food allergy. Only caution is to cook such foods well.
• Mother’s diet during pregnancy and lactation must include a variety of healthy foods including fruits, vegetables, grains, pulses and dairy or other calcium enriched products. Avoiding common allergenic foods like eggs, peanuts will not reduce the risk of baby developing allergies. In-fact avoiding too many foods can be dangerous and may deprive a growing baby of important nutrients.

Allergy foods

While peanut allergy alone has tripled in last 15 years, there are eight food items that are most likely to trigger a similar allergic reaction in children:

• Cow milk n Peanuts
• Egg n Soy n Wheat n Tree nuts
• Shell fish n Fish

Although most children “outgrow” their allergies, allergy to peanuts, tree nuts, fish, and shellfish maybe life long.

— The writer is HoD, department of paediatrics, Cloudnine Group of Hospitals, Chandigarh