Australia has the highest incidence of food allergy in the world, and it’s growing at a rapid rate. There are an estimated 800,000 Australians with a diagnosed food allergy, and many more undiagnosed. So it’s understandable that parents may worry about food allergies in their child. Paeds in a Pod paediatric allergist and immunologist, DR ASHISHA KALLUKARAN, debunks some common food allergy myths.
MYTH: PEANUTS ALLERGY IS THE MOST COMMON FOOD ALLERGY IN YOUNG CHILDREN
FACT: In Australia, egg allergy is the most common food allergy. The nine most common food allergens are cow’s milk (dairy), egg, peanut, treenuts, sesame, soy, fish, shellfish and wheat.
MYTH: PARENTS SHOULD WAIT UNTIL A CHILD IS 2 YEARS OF AGE BEFORE INTRODUCTION OF COMMON FOOD ALLERGENS
FACT: It is recommended that all babies be given common allergy causing foods in an age-appropriate form (eg: smooth pureed) before 12 months of age. Once tolerated it is important to keep these foods in your child’s diet on a regular basis. Delayed introduction has been shown to increase the chances of developing food allergies.
MYTH: EACH ALLERGIC REACTION IS WORSE THAT THE LAST
FACT: Multiple factors influence severity of any given allergic reaction in a child including dose ingested, form ingested (eg: roasted, baked, raw), exercise, concurrent illness and use of medications. Therefore, allergic reactions do not predictably get worse with each subsequent exposure.
MYTH: EVEN IF YOU ARE ALLERGIC TO A FOOD, ONE SMALL BITE IS OKAY
FACT: Even a small amount of the food allergen has the potential to cause serious reaction. It’s also important to be vigilant about cross-contact from one food to another as this could result in an allergic reaction.
MYTH: CHILDREN UNDER 2 YEARS OF AGE CANNOT BE TESTED FOR FOOD ALLERGIES
FACT: There is no specific age limit for food allergy testing and a qualified Paediatric Allergy Specialist can assess and perform these tests on your child (allergy.org.au has a list of accredited allergists in Australia). Generally, infants under 6 months of age are not commonly given allergy tests.
MYTH: THE SIZE OF SKIN PRICK TEST OR LEVEL OF FOOD SPECIFIC IGE BLOOD TEST CAN PREDICT ANAPHYLAXIS
FACT: There is currently no test that can accurately predict if or at what dose of an allergen a child would develop anaphylaxis to a food they are allergic to. A higher result on skin prick test/ Food specific IgE test correlates with an increased likelihood of IgE mediated allergic reaction and is not indicative of the severity of the reaction.
MYTH: ANTIHISTAMINES OR STEROIDS WHEN USED EARLY IN AN ALLERGIC REACTION CAN PREVENT ANAPHYLAXIS
FACT: Neither antihistamines nor steroids prevent progression to or treat anaphylaxis. Their use may result in a delayed administration of Adrenaline which is the best first line treatment for anaphylaxis.4 Non-sedating antihistamine helps with itchiness or hives, however if concerned of anaphylaxis Adrenaline MUST be administered.
MYTH: FOOD ALLERGIES CAN BE CURED
FACT: Although some food allergies resolve with time, there are currently no scientifically proven cures. In 2020, US FDA approved Palforzia, an oral immunotherapy for peanut allergy, which involved exposing the child to increasing amounts of peanut allergen to be continued daily under strict supervised conditions. Follow up research indicates that this could lead to temporary state of desensitisation; however, it has not been shown to lead to permanent tolerance.
MYTH: FOOD INTOLERANCES AND FOOD ALLERGIES ARE THE SAME
FACT: The simple answer is they are not the same. Food allergy involves an immune mediated reaction to the food which can result in a range of symptoms that can be severe or life threatening. In contrast food intolerance or sensitivities, do not involve the immune system, they predominantly present with gut symptoms and although they can cause discomfort, they are rarely life threatening.
MYTH: CHILDREN WITH EGG ALLERGY SHOULD AVOID INFLUENZA VACCINE
FACT: As per ASCIA “There is no evidence that having egg allergy increases the risk of having an allergic reaction to the currently available influenza vaccines.” The influenza vaccine in Australia is derived from influenza virus and grown in hen’s egg. The residual amount of egg protein present in this vaccine is <1 microgram which is substantially lower than the dose required to trigger an allergic reaction. Therefore, people with an egg allergy can receive an influenza vaccine in a primary care facility, such as a GP clinic, where clinic staff are trained to recognise and treat suspected anaphylaxis if this occurs. Observations should occur for 15-20 minutes after vaccination
Based in Queensland, Paeds in a Pod is a multidisciplinary team of specialist paediatricians and allied health professionals that provide care to newborns, infants, children and adolescents.