8 Food Allergy Questions Answered

For families with food allergies, fall can be the start of a season of hyperawareness. There’s going back to school, monitoring trick-or-treat candy, minding the holiday treats and bringing your own dishes to family meals.

The University of Kansas Health System allergist Marissa Love, MD, answers some of the most common questions about food allergies and sensitivities.

The top 9 allergens are peanut, tree nuts, cow's milk, egg, soy, wheat, fish, shellfish and sesame.

“Sesame is a new one that's been around, more predominant in Europe, but definitely a top allergen now in the US,” says Dr. Love.

The recommendations for giving potentially highly allergenic foods to kids have changed dramatically. Dr. Love says its generally best to introduce earlier than previously thought, based off studies on the development of peanut allergy.

"If allergic disease runs in the family, it would be ideal to introduce potentially highly allergenic foods once the baby is developmentally appropriate. In highly allergic families, that's around 4-6 months," she says.

It's recommended to introduce highly allergenic foods by 12 months for all babies.

Eating it is the best way. Start with very small amounts and prepare it in a way that is easy to ingest. Dr. Love recommends checking with your pediatrician to make sure an infant can swallow the type of texture of the food you’re introducing.

“I like to take about a teaspoon to 2 teaspoons of peanut butter, warm it up and thin it out, and then I mix it in with a fruit puree that the child has already tolerated, like applesauce,” says Dr. Love.

She recommends doing this first thing in the morning to monitor for any rashes or reactions. Wait 10 minutes and if nothing happens, give them a little more.

“Many times, people will say, well, the child got a rash on their face. Peanut butter itself can be very irritating to the skin, so if your son or daughter has sensitive skin, put Vaseline around the mouth before you introduce a new food, and that way they won't get what we call an irritant dermatitis,” says Dr. Love.

In some cases, the first reaction may just be a rash, often a rash on the face.

Frequently with a true food allergy, there are additional symptoms, such as widespread hives, lip swelling, tongue swelling, trouble breathing, drooling or vomiting.

If food allergies run in the family and you are very concerned about food introduction, discuss it further with your pediatrician or primary care physician and see if your child would benefit from seeing an allergist. Sometimes, in specific cases, the first food introduction may be done in the clinic.

There is an increasing incidence of food allergies. Additionally, we are better at recognizing and diagnosing food allergies.

“If you talk to perhaps an older generation, they said, ‘Well, we just continued eating that food in small amounts.’ And so, things are a little bit different today, where patients and families are a little bit more cautious,” says Dr. Love.

“There's a lot of exciting things coming along the way for future treatments of food allergies, such as a skin patch or a tablet that goes under your tongue," says Dr. Love. “Some folks are even trying to see if drops under the tongue are an appropriate thing to use. We do have the adult vaccine trial going on as well for peanut allergies.”

There are also good options available now to help lessen the effects of ingesting an allergen.

There's an oral immunotherapy that has been FDA-approved to help make the person less reactive to peanut over time. With that, very small amounts of peanut protein are given over the course of time.

There's also an FDA-approved biologic for food allergies. It’s an injectable medicine called omalizumab. It doesn’t cure the food allergy, but Dr. Love says it can make life a lot easier.

“It reduces your risk of a severe reaction if you should accidentally eat your food allergen. So that helps with quality of life for patients,” she says. “I just had a little boy tell me that he did not want to go to school this fall because he was so nervous about what other middle schoolers would say and didn't want to go to the lunchroom. So I said, what do you think about this shot? It's just once a month. It'll help reduce your risk of a severe reaction so that we don't have to worry about going to the emergency room every day that we go to school. He went for it, and he's so much happier now.”

Food sensitivity tests have become widely available online and commercialized. These are usually IgG food testing, and Dr. Love says that board-certified allergists do not offer IgG testing. For food reactions that seem to be IgE driven, our allergists typically use skin prick testing and/or IgE blood testing to look for food-specific allergy antibody.

“That being said, I do see quite a few patients with food intolerance or non-IgE mediated food sensitivities, and I help them navigate that,” Dr. Love says. “I feel that it's so important to help the patient navigate their diet. I definitely want to make sure they have access to nutritious food that doesn't make them feel terrible all the time.”