5 Things Clinicians Should Know About Food Allergies

Food allergies are a major concern for parents with young children, and many are taking their kids to local retail clinics for guidance on how to treat or even prevent these allergies.

With new research on food allergies regularly emerging, clinicians should keep the following information in mind when counseling parents about the potential for food allergies.

1. Food Allergies Can Be Prevented Through Proper Introduction

Although many parents avoid feeding allergenic foods to their young children, introducing potential allergens to children early can reduce their risk of developing food allergies later.

Peanut allergies in particular were researched in arecent studythat examined 640 babies aged 4 to 11 months who were considered to be at high risk of developing a nut allergy. The children were each tested for peanut allergies using a skin-prick test and then randomly assigned to either consume peanuts or avoid them until 5 years of age.

Among the 530 babies who initially tested negative for a peanut allergy, 13.7% of those who avoided peanuts had developed an allergy, compared with only 1.9% of those who had consumed peanuts.

Among the 98 babies who had initially tested positive for a peanut allergy, 35.3% of those in the avoidance group retained their allergy at 5 years of age, compared with only 10.6% of those in the consumption group.

Overall, the research team determined that the children who consumed peanuts from their infancy experienced an 81% reduction in peanut allergy compared with children who did not.

Following the publication of this study in theNew England Journal of Medicine, the American Academy of Allergy, Asthma, and Immunology established the following recommendations for introducing new foods, which retail clinicians can pass to parents.

1. Introduce a new food every 3 to 5 days in a manner that prevents choking and that is appropriate to the child’s age.
2. Begin by introducing grains, as well as yellow and orange vegetables and fruit.
3. If well-tolerated, introduce potential allergens—such as cow’s milk, soy, and eggs—in small amounts.
4. Make sure to introduce highly allergenic foods at home.
5. Increase the quantity of food over the course of several days.

2. Consuming Allergens During Pregnancy Could Decrease a Child’s Allergy Risk

Mothers may be able to help prevent food allergies in their children by eating potential allergens while pregnant, according to anotherstudy.

To evaluate the relationship between maternal food consumption and childhood food allergies, researchers administered food frequency tests to 1277 pregnant women. The participants later completed questionnaires about food allergy, asthma, allergic rhinitis, and atopic dermatitis after their children reached approximately 8 years of age.

The research team determined that higher levels of maternal peanut intake during the first trimester led to a 47% reduced risk for peanut allergies among children. Additionally, increased milk intake during the first trimester was associated with a reduced risk for both asthma and allergic rhinitis, while higher wheat intake during the second trimester was linked to a reduced risk atopic dermatitis.

3. Inner-City Kids Are at Higher Risk for Food Allergies

Nurse practitioners and physician assistants who treat patients in inner-city clinics should be aware that food allergies may be more prevalent among children in these areas.

A 2014studypublished in theJournal of Allergy and Clinical Immunologyanalyzed data on 516 children living in inner-city Baltimore, Boston, New York City, and St. Louis. The researchers measured the presence of food-specific immunoglobulin E (IgE) antibodies to milk, eggs, and peanuts in the children at 1, 2, 3, and 5 years of age.

The researchers found that more than half of these children experienced sensitivity to at least one of the 3 allergens, with 10% meeting the criteria for a full food allergy. Additionally, 17% of the participants had elevated IgE antibodies that classified them as “possibly allergic,” although none had a history of allergic reactions.

The study authors acknowledged that the prevalence of food allergy could be even higher than indicated by their results, as they researched only 3 of the more common food allergies.

4. Siblings of Kids with Food Allergies Aren’t Always Allergic Themselves

Many parents believe that if one of their children has a food allergy, then their other children do, too. However, this may not be the case.

A recent study examined 1120 children who had a sibling with a documented food allergy. While 53% of these participants had food sensitivity, only 13% had an actual food allergy.

Based on their findings, the study authors suggested that food allergy testing in siblings of kids with food allergies should be limited in order to decrease the potential consequences of a misdiagnosis.

“Too often, it's assumed that if one child in a family has a food allergy, the other kids need to be tested for food allergies,” said lead study author Ruchi Gupta, MD, MPH, in a press release. “But testing for food allergies if a reaction hasn't taken place can provide false-positives, as we saw in our research. More than half the kids in the study had a sensitivity to a food, but they weren't truly allergic. Kids who have a food sensitivity shouldn't be labeled as having a food allergy.”

The results of this study were presented at the American College of Allergy, Asthma and Immunology Annual Scientific Meeting.

5. No Link Has Been Found Between DTaP Vaccine Timing and Food Allergies

The age at which children receive the diphtheria-tetanus-acellular pertussis (DTaP) vaccine has no bearing on their risk of developing food allergies, according to a new study.

Researchers from the Murdoch Childrens Research Institute in Australia administered skin prick tests to 4433 12-month-old infants, 2.5% of whom received their first dose of DTaP one month late. Infants who were found to be sensitive to the tests were given oral food challenges to determine whether they had a food allergy.

After examining vaccination data from a national immunization register, the research team determined that children who received their first DTaP dose late were no more susceptible to food allergy than those who had received it earlier.

However, they also found that delayed DTaP vaccination was associated with reduced eczema and reduced use of eczema medication, which suggested that there might be some connection between vaccine timing and allergic disease.

The study was published inAllergy.