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Food for Thought: Understanding and Managing Food Allergies in Kids

Epipen in lunchbox

Food allergies are becoming increasingly common, particularly in children. We sat down with Stephanie Leonard, M.D., director of the Rady Children’s Hospital-San Diego Food Allergy Center and an associate clinical professor for the Division of Allergy-Immunology-Rheumatology within University of California San Diego School of Medicine’s Department of Pediatrics, to discuss prevalence, what’s new in research and how we can all work together to better protect kids managing allergies.

Food Allergies 101

So, just what is a food allergy?

Simply put, it’s an individual’s immune system responding to specific food proteins in an abnormal way. When those proteins are consumed, the immune system goes on high alert and releases histamines and other biological chemicals to ward off the perceived intruder. It’s this response that causes an allergic reaction.

While most of us are familiar with the “classic” symptoms — hives, swollen lips, itchy throat — they reach far beyond that and can vary greatly from person to person, and even from reaction to reaction. Potential effects include the following:

  • Skin: Hives; itching; flushing; or swelling of the lips, tongue and palate (occurs in 80 to 90 percent of reactions)
  • Airway: Itching and tightness in the throat, hoarse voice, chest tightness, wheezing or trouble breathing (occurs in about 70 percent of reactions)
  • Gastrointestinal: Nausea, vomiting, pain, cramps or diarrhea (occurs in 30 to 45 percent of reactions)
  • Cardiovascular: Chest pain, increased blood pressure, weak pulse, dizziness and fainting, or arrhythmia (occurs in 10 to 45 percent of reactions)
  • Central nervous system: Uneasiness, headache, confusion or tunnel vision (occurs in 10 to 15 percent of reactions)[1]

Allergies Rising

Although the reasons are being investigated, one thing is for sure — food allergies in kids are on the rise. Between 1997 and 2011, prevalence increased by 50 percent[2], and the rate of food allergy-related hospital discharges grew 3.5 times between 1998 and 2006[3]. Additionally, the prevalence of peanut or tree nut allergies jumped from 0.6 percent in 1997 to 2.1 percent in 2008[4].

Food allergies can go away — or, although it’s rare, develop — over time. As many as 8 percent of children have a food allergy, versus about four percent of adults. Within the most common allergens —  milk, eggs, peanuts, soy, wheat, tree nuts, fish, shellfish and, more recently, sesame — kids are most affected by milk, eggs and peanuts. While milk and egg allergies often drop off with age, peanut, tree nut and seafood allergies are the most likely to persevere into adulthood[5]. There are as many types of food allergies as there are foods, however, so one could be allergic to anything from apples to zucchini.

All About Anaphylaxis

You may have heard the term “anaphylaxis” in relation to allergies. While some people may develop a mild allergic reaction, anaphylaxis is a very serious, potentially life-threatening allergic reaction. For the sake of simplicity, allergists often explain anaphylaxis as a systemic (inner body) reaction, or a reaction that includes more than just skin symptoms, such as a rash or hives. Technically, however, anaphylaxis is defined as a reaction that involves at least one of the following:

  • Two or more body systems (e.g., skin and cardiovascular) affected
  • Breathing difficulties
  • Low blood pressure
  • Loss of consciousness

Fatalities from anaphylaxis can occur, and there are risk factors that can increase susceptibility. These include having a peanut, tree nut or shellfish allergy; underlying asthma; previous severe reaction; symptom denial or not recognizing a reaction; delayed treatment response; and being an adolescent or young adult. To treat anaphylaxis, acting quickly is essential, and Dr. Leonard emphasizes “epinephrine, epinephrine, epinephrine” as a critical first-line therapy.

Leading Toward Change

There is no current cure for food allergies, but physician-scientists and researchers — including right here at Rady Children’s — are working on innovating the way we treat them. In partnership with UC San Diego and led by Dr. Leonard, our Food Allergy Center is involved in leading-edge research and clinical trials focused on conceptualizing and investigating emerging therapies and bringing them to the patients who need them.

A huge area of emphasis is immunotherapy. This approach exposes patients to small amounts of allergens in order to retrain the immune system to not react to them, in turn decreasing the chance for or severity of a reaction. This is done under physician supervision with stringent safety guidelines, and should never be tried at home. We’re currently conducting clinical trials of oral and skin patch immunotherapies for peanut and milk allergies, and will soon begin an egg allergy trial.

Another area of opportunity for positive change? Schools. Between 16 and 18 percent of kids with food allergies have reported having a reaction at school[6], and 32 percent say they’ve experienced allergy-related bullying there. 80 percent of bullied children say they’ve been picked on by peers and, sadly, 11 percent say teachers and staff are behind the hurtful actions[7]. To help San Diego County schools protect students both physically and mentally, the Food Allergy Center has entered a coalition of medical and education professionals, parents, and allergy organizations focused on putting formalized, evidence-based food allergy policies in place. It recently standardized a countywide Allergy and Anaphylaxis Plan to ensure all schools are prepared to respond to allergic reactions and anaphylaxis in keeping with best practices. Next, they hope to align school policies to foster an accepting, informed culture and to better safeguard students from exposure to allergens.

Reducing Risk

Whether your child has food allergies or their friends or classmates do, the following steps can help keep everyone safe and feeling supported:

  • Create an individualized allergy action plan that you share with your child’s school, non-immediate family members and parents of your child’s friends.
  • Ensure kids keep sufficient doses of epinephrine and antihistamines, as recommended by their physician, with them at all times.
  • Have compassion for the fact that living with allergies can be challenging and stressful.
  • Read labels — not just on food, but on products such as soaps and lotions. Once your child is old enough to read and retain information on their allergies, teach them to survey labels so they can stay vigilant, independently.
  • Wash hands before and after eating, as well as before and after handling food, dishes and utensils. Soap, wet wipes and commercial wipes will remove allergens; hand sanitizer gels will not[8].
  • Be careful when sharing items that come in contact with the mouth, such as water bottles, because allergens can linger. For example, peanuts are detectable in saliva for hours after eating[9].
  • Prepare any allergen-free foods separately, and serve with clean utensils and dishes.
  • Ask about cross-contamination from food prep areas, utensils, dishes and cookware when dining out.
  • Plan for safe celebrations, such as birthday parties and school events, with tactics such as a “safe food stash” that allows your child to participate with their peers.

Seeing your kiddo deal with food allergies isn’t optimal — it can even be downright scary. But partnering with your child’s allergist to personalize a care plan, address questions or concerns, and regularly monitor allergies — they can change or be outgrown — can help keep kids safe and calm fears.  By knowing the facts and thinking ahead, you can nurture a healthy child and empower them to understand, manage and accept their allergies. You’ve got this, parents.

For more information on food allergy treatments and research at Rady Children’s, visit our website

[1] Identifying Anaphylaxis. (n.d.). Retrieved November 12, 2018, from

[2] Jackson, K. D., Howie, L. D., & Akinbami, L. J. (2013). Trends in Allergic Conditions Among Children: United States, 1997–2011(Issue brief No. 121). Centers for Disease Control and Prevention National Center for Health Statistics.

[3] Branum, A.M., Lukacs, S.L. (2008). Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations (Issue brief No. 10). Centers for Disease Control and Prevention National Center for Health Statistics.

[4] Sicherer et al. J Allergy Clin Immunol 2010;125:1322-6.

[5] Food Allergy Facts and Statistics for the U.S. (2018, April). Retrieved November 12, 2018, from

[6] Sicherer, J Pediatr. 2001; 138(4): 560-565.

[7] Shemesh et al. Pediatrics 2013 vol. 131(1):e10-17.

[8] Sicherer, Management of FA in the School Setting, Pediatrics 2010.

[9] Maloney, Peanut allergen exposure through saliva. J Allergy Clin Immunol. 2006 Sep;118(3):719-24.