Food Allergy is Common in Children
During the first year of life, the infant diet is the most powerful determinant of the growth and development of the child and food allergy is a common health problem. Many studies show that breast feeding is best and that the feeding of solid foods is best delayed 4 to 6 months to reduce the risk of food allergy.
Food allergy in infancy is expressed as crying, colic, vomiting, diarrhea, rashes, eczema and cold-like respiratory congestion. Some infants with food allergy become seriously ill and fail to thrive unless their allergy is recognized and corrected. Infants who develop food allergy in their first year may "outgrow" the first effects but tend to grow into children with more pervasive health, behavior and learning problems unless their diet is properly managed.
There are different types of food allergy. The immediate or type 1 food allergy pattern is easily recognized because it involves quick and dramatic symptoms. Hay fever is the most common type 1 allergy and can be diagnosed by allergy skin tests. Some food allergy is also type 1 and shows up on skin tests. The child who develops hives 30 minutes after eating strawberries has a type 1 reaction. A child who wheezes 20 minutes after eating peanut butter has a type 1 reaction and a potentially dangerous one. An infant cries, squirms, and vomits 15 minutes after ingesting a new milk-based formula has type 1 reaction triggered in the stomach.
The type 1 pattern of allergy is attractive to researchers, because of its simplicity and the ease of testing for sensitization; but, it selects only a special population of children with Type 1, IgE-mediated allergy. While this is an important reaction pattern, some physicians have claimed it is the only valid form of allergic reactions to food. Their opinion is not acceptable. A distinction between immediate, obvious allergic reactions and delayed, less obvious, chronic immune injury is useful.
Delayed patterns of food allergy are not so obvious and generally go unrecognized. Allergy skin tests do not show this problem nor do IgE antibody tests such as RAST or ELIZA. Delayed patterns of food allergy are responsible for causing common but ill-defined illness patterns in children. A cluster of physical, behavioral, and learning problems is typical of many children we see. A child may present with chronic nose congestion, cheek and ear flushing, a history of recurrent ear infections and tonsillitis, associated with infrequent attacks of abdominal pain and episodes of hyperactivity with temper tantrums. Another child may present with recurrent "flu", fatigue, lymph node swelling and appear to be depressed.
Special Note to Parents
Another phone call from an unhappy mother reminded us that there is a problem with identifying health problems as "food allergy". The call was from a well-educated, sincere, conscientious mother who had a very difficult son, now 5 years of age. She had managed physical and behavioral problems with careful diet management for two years and had identified several foods that caused symptoms in her son. She took great pains to keep him away from the problem foods. She went to an allergist, hoping that he could help her identify food and environmental factors that might be bothering him.
According to her account, the allergist was rude to her, denied that her experience with her son's food reactivity had any validity and found no skin reactions with the few foods that he skin-tested. He went on to claim that there was only "one flawed study in the 70's" that showed any connection between food and behavior. This mother soon went down the street to the local naturopath who was more sympathetic with her concerns about her son's food reactivity and offered some helpful advice about managing his diet.
The scientific issues surrounding food allergy are dealt with in detail in several locations at this web site and we encourage you to follow the links, print out the texts so that you can come to your own conclusions about this very complicated subject. Here are the main points that you need to know:
1. Skin tests are very limited in their diagnostic range and only detect one type of allergic mechanism. You cannot rely on the skin test to show the wide range of food allergic reactions.
2. Any allergist who suggests that the skin test is a definitive and final test for food allergy is misleading you.
3. Do not expect all allergists to be willing or able to help you identify food problems and revise your child's diet. Only a few allergists are interested in and knowledgeable about food allergy and its management.
4. Be prepared to make your own decisions and to manage your child according to your own observations. Become an expert yourself.
Other reports from parents remind us that "alternative" methods of diagnosing
and treating "food sensitivity" may lead to confusion, frustration and
un-necessary expense. Many have reported that they left their physicians
in frustration and went to other practitioners who used a variety of tests to
diagnosis food problems, prescribed diet revision and many other treatments.
Most alert parents recognized benefits by changing their children's diets but
were not sure about all the other treatments offered. Our advice is simple -
most often the dramatic improvement in children with hidden food allergy occurs
with proper diet revision. We are not aware of any test or treatments that
replace the intelligent parents' application of common sense.
The Complex Presentation of Delayed Pattern Food Allergy
Delayed patterns of food allergy tend to be whole-body diseases and a lottery selection of disturbances may evolve over many years. In many older children, we can trace the illness pattern back to early infancy with slow, intermittent emergence of symptoms over several years. In other children the illness begins abruptly and progresses rapidly without prior symptoms. A multi-system and polysymptomatic pattern of illness means food allergy until proven otherwise.
The illness may be mild and include nose congestion, headache, indigestion, flatulence, aching, stiffness and fatigue. The illness may be severe and present as intractable asthma, chronic diarrhea, failure to thrive, skin diseases, arthritis, urinary problems, hyperactivity, or learning disability. One child may have chronic nose congestion, cheek and ear flushing and a history of recurrent ear infections, tonsillitis, associated with infrequent attacks of abdominal pain and episodes of hyperactivity with temper tantrums. Another child may present with recurrent "flu", fatigue, lymph node swelling, loss of appetite and sleep disturbances.
The proper diagnosis of these mysterious illnesses is "delayed pattern or Type III food allergy". If you are lucky and your doctor recognizes this pattern, (s)he should suggest diet revision - perhaps beginning with the exclusion of packaged and processed foods, milk, and dairy products from your child's diet. You would keep a daily food-intake-symptom journal with a return appointment in three weeks to review the results of your efforts. If the initial changes are not successful in resolving the problem, The Alpha Nutrition Program would be the next logical step. With your physician's help, an ongoing healthy state should be achieved. if you are not lucky and your physician does not support diet revision you will have to be responsible and conduct diet revision on your own. You will need to prepare by studying the Alpha Nutrition manual and you may want to read books that are available through the library and book store.
The diagnosis of delayed pattern food allergy is based on the history of illness and physical examination. Laboratory tests have not proved very helpful in making this diagnosis and skin tests, used to uncover the allergens in hay fever, also do not help in the diagnosis of delayed pattern food allergy.
The Look of the Allergic Child
There are a set of typical physical signs which parents and teachers can easily spot and interpret:
Shiners The allergic child often has "allergic shiners" - bluish-brownish discoloration around both eyes. The shiners may be accentuated by puffiness under the eyes, created by water retention (periorbital edema). The white of the eyes may appear pinkish or red from dilated blood vessels.
Flushing Cheeks and ears may flush, appearing bright red to crimson. Sometimes only one ear will flush, like a warning light.
Nose Congestion Nose congestion may present as mouth-breathing, sniffing, snuffling, snorting or snoring, and nose rubbing (sometimes known as the "allergic salute" - pushing the nose up with the palm of the hand until a crease develops across the skin of the nose). Increased mucus flow in nose and throat, ear-plugging with muffled hearing and ringing in the ears, recurrent middle ear "infection", recurrent sore throat, swelling of the neck lymph nodes (glands), chronic or recurrent cough, episodes of chest pain, "tightness", and/or wheezing with shortness of breath.