We are so up for this episode! Today our conversation is about food allergies and sensitivities. We’ve had this topic requested/suggested by listeners so many times, but neither of us really has all that much personal experience with it, and it’s a really important subject that a lot of parents and parents-to-be have questions about.
Before we tackled this topic, we wanted to be sure we had an expert available to weigh in. Today, we do! Thanks so much to Dr. Marcie Castleberry for being our guest for this discussion. Dr. Castleberry is board certified in pediatrics. Her medical degree is from LSU, and she completed her pediatric residency at LeBonheur Children’s Hospital in Memphis, TN. She’s been a pediatrician for over 25 years—which means that by now, she’s started seeing a second generation, the children of her former patients. Dr. Castleberry has special interests in allergy, asthma & nutrition.
Welcome, Marcie!
RISE IN PREVALENCE OF ALLERGIES/SENSITIVITIES
I find it very helpful that you’ve now started seeing a second generation of patients. That puts you in our same time line of raising kids, so I’m wondering if you’ve seen things change as much as we have. Our kids were born in the late 90’s and are now all young adults in their 20’s.
Growing up ourselves in the 70’s/80’s, this topic would have been kind of a strange thing to talk about. I can’t name a single kid I knew back then who was allergic to anything. Renee? Nope.
We had classroom parties with peanut butter cookies and all kinds of baked goods and our moms just made/brought whatever. We ate at our friends’ houses and went trick-or-treating and chowed down on what we had.
20 years later….
Bonnie: My daughter, at around 12 months old, went on a “milk strike,” and refused dairy. It kinda came out of nowhere & forced us to get creative about how we got Vit D into her. Yogurt, cheese, etc… but especially milk—were off the menu. Eventually switched to soy milk which was so weird.
By the time my youngest (Ben) was in preschool, there was ONE kid in his class who had all these restrictions…no dairy, eggs, wheat, etc., and I’d never encountered that before, thought what in the world can this poor kid even eat?! One of our good friends had sons with peanut allergies—had to carry epi pens and be really careful.
FF to my daughter being in HS, and she had a friend who’d been diagnosed with celiac disease (which we’ll get into if you don’t know what that is) & had to be very serious/discerning about food. (also a new experience for me). Her husband has a peanut allergy! (we love Reeses at our house…. Ben making a smoothie in the blender!)
Renee: Our nephew, who was born in 1993, had a severe peanut allergy. That was my first introduction into food allergies. His parents never went out to eat because restaurants rarely had a list of the ingredients they used and they just didn’t want to take a chance on exposing him. My kids had a dairy sensitivity, so we eliminated that from their diets, but they weren’t allergic. On a trip to PA to see grandparents, we had a grilled shrimp dinner and Emma ended up throwing up all evening. We stayed away from shellfish till she was 12 and had her re-tested. She was fine then.
By the time my two kids were in elementary school (mid 2000’s) lots of their friends had allergies to common foods like dairy, soy, nuts etc.
Is that what you’re seeing in your practice?
One article we read said that along with the US, Germany, Italy and Norway had the highest prevalence of food sensitivity — with about 22 percent of people from each country showing antibodies against some type of food. The lowest rates were seen in Iceland (11 percent), Spain (11 percent), France and the UK (each around 14 percent).
One in 13 children now have food allergies– equivalent to 2 students per class. Nearly 5 percent of children under the age of five years have food allergies. From 1997 to 2007, the prevalence of reported food allergy increased 18 percent among children under age 18 years. (JohnsHopkinsmedicine.org)
I read that there are lower rates of allergies in developing countries. They are also more likely to occur in urban rather than rural areas. Do we know why that’s the case? Is it the case?
Factors may include pollution, dietary changes and less exposure to microbes, which change how our immune systems respond.
Let’s define a couple of things. What’s the difference between an ALLERGY & a SENSITIVITY or INTOLERANCE?
(from Children’s Mercy Hospital in Kansas City) A food allergy involves the immune system and can be life-threatening, while a food intolerance tends to only be the GI system and is never life-threatening.
Someone with a food allergy can never eat the food they are allergic to because they’ll have a reaction each and every time. During an allergic reaction, the immune system releases histamine and other chemicals to try and fight off the food allergen. Symptoms can also impact more than one body system, which include:
- Skin: hives, rash, itching
- Lung: repetitive cough, difficulty breathing
- Abdomen: immediate vomiting and/or diarrhea
- Mouth: swelling tongue and lips
- Nose: immediate runny nose, sneezing and itching
- Throat: change in voice, trouble swallowing, drooling
- Heart: fainting, dizziness, loss of conscience
- Other: sense of impending doom, doesn’t feel right
Timing of symptoms is also key. Food allergy symptoms usually happen within two hours of ingesting the food. So a kid that wakes up the next day and complains of a bellyache is not having an allergic reaction.
Kids with food intolerances have trouble digesting food and may experience belly pain, gas and constipation. The most common intolerance is to lactose, which is a natural sugar in milk.
Renee: With our granddaughter, I’m seeing products that are sold to introduce common allergens to babies. What is the protocol now in pediatrics? (Because we were told to avoid them.)
What is up with wheat and gluten?? Is this really becoming more prevalent?
Bonnie: My daughter & husband have both in the past 2 years become very sensitive to gluten & eat GF now or pay the price.
Renee: David and I notice a difference in bloating and joint pain when we eat/don’t eat wheat and corn.
This brings up another question about developing allergies/sensitivities later—they’re 24 and 54. Why now??
Does an allergen have to be actually ingested? Can a reaction occur by breathing something in or touching it? (It can, but it’s not the common reactionary pathway)
Renee: One time a family friend was doing a craft where you roll pinecones in peanut butter and then birdseed… just being in the same room caused a reaction in my nephew.
SW airlines no longer serves peanuts. E.g., SIL sometimes having to pre-board to wipe down area. Restaurants like Logan’s, Five Guys, or some steak houses that have peanuts on the table to shell while you wait. Some people who come in contact with a food may develop a rash at the site of contact. Washing with soap and water is the only way to stop the reaction from progressing. Hand sanitizers don’t kill protein and therefore cannot prevent or protect your child from a contact reaction.
The same is true for cleaning tabletops. A soap-based cleaner must be used. Simply using a wet rag won’t work.
How would this work in a school situation? I’ve heard a lot of schools now just request kids not bring PBJs to school at all.
Many schools have peanut-free or allergen-free lunch tables but isolating kids from friends is not the answer. School-aged children can safely navigate the world by not sharing food and washing hands properly.
If they’re going to be allergic, what are MOST kids allergic/sensitive to?
90% of all food allergies are caused by “the big 8”: milk, egg, peanut, tree nuts, soy, wheat, fish/shellfish. Sesame is an emerging allergy.
Peanuts, tree nuts, fish, and shellfish commonly cause the most severe reactions. (there can of course be other things…my nephew’s allergic to raspberries, e.g.,, but these are the usual suspects)
WHY?
- What we eat has dramatically changed. We now have a more industrialized diet, in which foods are being modified for factory farming, processing and mass distribution.
- We’re too clean. We sanitize everything – our hands, our homes and our work environment. Food allergies are developed when the body’s immune system thinks a certain food is harmful and the person becomes sick whenever the food is eaten. Basically, our immune system is fighting things it doesn’t need to fight
- Genetic component?
If you find out your child is allergic to a food, is that it? Will they ALWAYS be allergic? How do you treat it?
Although most children “outgrow” their allergies, allergy to peanuts, tree nuts, fish, and shellfish may be lifelong. There is no medication to prevent food allergy.
The goal of treatment is to avoid the foods that cause the symptoms. After seeing your child’s doctor and finding foods to which your child is allergic, it is very important to avoid these foods and other similar foods in that food group.
It is also important to give vitamins and minerals to your child if he or she is unable to eat certain foods. Discuss this with your child’s doctor.
For children who have had a severe food reaction, your child’s health care provider may prescribe an emergency kit that contains epinephrine, which helps stop the symptoms of severe reactions. Consult your child’s doctor for further information.
Some children, under the direction of his or her health care provider, may be given certain foods again after three to six months to see if he or she has outgrown the allergy. Many allergies may be short-term in children and the food may be tolerated after the age of 3 or 4.
Is there anything you can do prenatally to help with allergies/sensitivities? Will it make a difference what you eat while you’re pregnant? Should you eat MORE peanuts or none at all? HUGE factor is having a normal Vitamin D level during pregnancy! Reduces incidences of allergies in kids. Don’t avoid allergenic foods while you’re pregnant. Even intentionally eating allergenic foods (that you tolerate yourself) CAN help.
Given the state of things, then, what do you recommend to new parents when introducing food to their baby?
The development of food allergies cannot be prevented, but can often be delayed in infants by following these recommendations:
- If possible, breastfeed your infant for the first six months.
- Do not give solid foods until your child is 6 months of age or older.
- Introduce potential allergens early (cow’s milk, wheat, eggs, peanuts, and fish) during your child’s first year of life, between 4-6 months of age!! You can use manufactured “allergen packets” (2 TBsp, watch for 2 hours, introduce twice a week on a regular basis: a 2-2-2 method)
- A pet in the home before age 3 months has been shown to actually reduce occurrence of food sensitivity/allergy
Can you introduce allergens prematurely to your nursing baby by breast feeding (they eat what you eat)?
If you are breastfeeding, DON’T avoid allergenic foods in your diet. You can watch for a reaction…. most common one is small amount of blood in stool (from gut irritation). A lot of times this is due to cow’s milk/dairy. Usually a child will grow out of this sensitivity by a year old.
Besides having obvious symptoms and pinpointing the food culprit, how would a doctor determine an allergy/sensitivity? What happens at an allergist’s office?
Skin-prick tests?
Elimination diets?
I’ve been seeing a lot of “at-home sensitivity tests” lately—ads pop up all the time. Are these accurate at all? (everlywell, 5strands, etc…avail at walmart)
Do you find parents have a hard-time getting buy-in/compliance from extended family members who don’t understand/believe there’s an actual issue?
There’s a real education curve when it comes to nutrition. It’s one thing to leave peanuts out of the brownies. It’s another thing to check every label on sauces, salad dressings, processed foods to hunt down any mention of “wheat”.
It’s a LOT easier than it used to be in the grocery store and at restaurants to find GF options or allergen free options. Wouldn’t it be easier to go back to the way we used to eat?
If this is a real problem, consider asking your pediatrician to write a letter to family members. Information from someone family considers an authority figure rather than someone they may be labeling “a dramatic mom” might help!
RESOURCES: foodallergy.org