If you have a child with a food allergy, you understand the seriousness of the condition. Food allergies are a big deal because when a child’s immune system reacts to certain proteins in a food, symptoms may be mild (think hives) or life-threatening (think difficulty breathing). And there’s no rhyme or reason to the severity of each reaction.
Food allergies are a growing problem in children that affects daily life at home and school. The most common food allergies in kids are:
But if a child has a reaction to a certain food, how do parents know if it’s a true food allergy or an intolerance? When should a child undergo allergy testing? And do all food allergies come with the threat of anaphylaxis?
Geisinger allergist and immunologist Puneet Bajaj, MD, answers your top questions about common food allergies in kids. While there’s no cure, recognizing symptoms, getting a precise diagnosis and learning how to avoid triggers and prepare for emergencies can help keep your child safe and confident.
When should a child see an allergist?
Anyone who’s had an allergic reaction, especially a severe reaction, to a certain food should schedule an appointment with an allergist.
Symptoms of food allergies typically appear within minutes after exposure and can range from mild to life threatening. Food allergy symptoms include:
Itchy skin
Hives
Tingling of the mouth and throat
Swelling of the lips or mouth
Coughing
Throat tightness
Stomach pain or vomiting
“The most severe allergic response is anaphylaxis, which is a whole-body reaction that comes on fast and is life threatening,” says Dr. Bajaj. “It requires immediate medical attention.”
Call 911 or head to the nearest emergency room if your child has any of these severe food allergy symptoms:
Swelling of the tongue and throat
Wheezing and shortness of breath
A sudden drop in blood pressure
Rapid heartbeat
Pale skin or blue lips
Dizziness
Fainting or loss of consciousness
“Most serious reactions happen after eating the food and not from skin contact or inhalation of food proteins,” says Dr. Bajaj.
What’s the difference between a food allergy and food intolerance?
A food allergy is an abnormal immune response to a specific food protein. The immune system mistakenly identifies these proteins as threats and in defense releases chemicals like histamine, which triggers mild to severe symptoms within minutes and up to 2 hours.
A food intolerance doesn’t involve the immune system. Instead, food intolerance occurs when the body has trouble digesting a certain food. It’s uncomfortable, but not dangerous, with delayed symptoms such as bloating, gas, stomach cramps or diarrhea.
A food intolerance to lactose is common in kids. Lactose intolerance occurs when the body lacks the enzyme lactase needed to digest lactose (milk sugar).
An intolerance often depends on the amount eaten and small portions may not cause symptoms. However, food allergies require strict avoidance — even trace amounts can trigger a severe allergic reaction.
“For a true food allergy, a reaction has to happen every time, immediately and up to few hours after exposure, and it has to happen when exposed to any amount of the food,” says Dr. Bajaj. “If symptoms don’t indicate an immune response, then the likelihood of a true food allergy is low, and there may not be a need for food allergy testing.”
When is food allergy testing recommended?
If your child has food allergy symptoms after eating a certain food, an allergist can perform a blood test to look for allergen-specific antibodies or a skin test, where the skin is pricked and exposed to small amounts of the food. If your child reacts, the affected area will swell like an insect bite.
But food allergy testing is recommended only if a child has an allergic reaction to a certain food. Symptoms like gastrointestinal issues, skin rashes or eczema from food intolerance aren’t indicative of a food allergy. And in most cases, food allergy testing is not recommended.
False positives can occur with both skin and blood tests, meaning results can be positive in children who can tolerate the food. This leads to misdiagnoses and kids avoiding safe foods in their diet.
“Broad screening isn’t recommended because it can lead to unnecessary diet restrictions and do more harm than good,” says Dr. Bajaj. “So, we don’t recommend testing foods at random. We only test for those foods that a child has had an allergic reaction to.”
If your child’s food allergy test comes back positive, a pediatric allergist will consider the test results and your child’s reaction history and may recommend a supervised oral food challenge to confirm the diagnosis.
Are all food allergies an emergency?
“Any food allergy carries a risk of anaphylaxis,” says Dr. Bajaj. “And severity can’t be predicted based on past reactions alone.”
If a food allergy is confirmed, your child’s allergist will prescribe an epinephrine auto-injector, such as an Epipen®. It should be used if your child develops anaphylaxis symptoms after exposure.
How can I prepare for a food allergy emergency?
Take these steps to prepare for an emergency:
Teach your child not to share food and how to recognize food allergy symptoms.
Work with your child’s provider to complete a Food Allergy and Emergency Care Plan.
Make sure epinephrine auto-injectors are available at school, childcare and during sports.
“Staying informed is key to handling any allergy,” says Dr. Bajaj. “The only way to prevent an allergic reaction is to eliminate the food and any risk of exposure from your child’s diet. With some preparation and prevention, your child can feel their best.”
Will my child outgrow a food allergy?
Many kids outgrow food allergies to milk, eggs, soy and wheat. But severe allergies to peanuts, tree nuts, fish and shellfish often persist into adulthood.
Regular follow-ups with an allergist help track changes over time and determine when to retest or consider a supervised oral food challenge. Do not reintroduce an allergen at home without a provider’s guidance.
“The likelihood depends on the specific food and your child’s test results and reaction history,” says Dr. Bajaj. “However, only an oral food challenge in a clinical setting can confirm that an allergy has resolved.”
Next steps:
Learn about allergy care at Geisinger
Are you using your EpiPen correctly?
What to know about peanut and tree nut allergies
Dining and Cooking