Food Allergies in Children

Researchers estimate that food allergies affect 5.6 million children under age 18 in the United States. That’s one in 13 children, or roughly two students in an average classroom.

These allergies occur when the body's immune system reacts to proteins in food, triggering symptoms ranging from mild to severe. At RWJBarnabas Health, our pediatric gastroenterology services provide specialized treatment and support for children with food allergies.

Request an Appointment

What Is a Food Allergy?

The body’s immune system defends it against harmful invaders like viruses and bacteria. However, sometimes, it overreacts to innocuous things that shouldn't cause issues for most people.

Food allergies occur when the immune system reacts abnormally to specific food proteins.

While nearly any food can trigger an allergic reaction, nine foods cause the majority of these reactions in children:

1. Milk
2. Eggs
3. Fish (bass, flounder, cod)
4. Crustacean shellfish (crab, lobster, shrimp)
5. Tree nuts (almonds, walnuts, pecans)
6. Peanuts
7. Wheat
8. Soybeans
9. Sesame

Types of Food Allergies We Treat

Our pediatric gastroenterologists treat a variety of food allergies, including:

• Allergic colitis. A reaction, often to cow's milk protein, causes inflammation in the colon and symptoms like bloody mucus in the stool.
• Food protein-induced enterocolitis syndrome (FPIES). A delayed reaction in infants causes vomiting, diarrhea, and lethargy, typically triggered by cow’s milk, soy, rice and oats.
• Eosinophilic esophagitis (EoE). Inflammation of the esophagus due to allergic white blood cells leads to symptoms like vomiting and difficulty swallowing.
• Eosinophilic gastroenteritis. Inflammation of the digestive tract causes abdominal pain, diarrhea and other symptoms.
• Alpha-gal syndrome. An allergy to red meat triggered by a Lone Star tick bite leads to delayed reactions such as hives, nausea and vomiting.

Pediatric gastroenterologists do not treat Immunoglobulin E (IgE)-mediated food allergies — which occur when the immune system overreacts to a specific food protein — since those do not involve the digestive system. These would more likely be treated by an allergy specialist.

Food Allergy Symptoms

Reactions to a food allergen can start within minutes to an hour after eating. Even a small amount of the allergen can trigger a reaction in highly allergic children. Symptoms of food allergies can vary widely, including:

• Abdominal pain
• Diarrhea
• Vomiting
• Difficulty breathing

Food Allergy Diagnosis

Pediatric gastroenterologists often use a two-step process to diagnose allergies:

1. An elimination diet, in which the suspected food is removed from the child's diet to see if symptoms resolve
2. A Food challenge to diagnose food allergies. In this process and then reintroduced to see if symptoms return.

Unlike IgE-mediated food allergies, when the immune system overreacts to a specific food protein, the food allergies treated by gastroenterologists are not detected by blood tests or skin prick tests used by pediatric allergists. Instead, a food challenge, supervised by a doctor, helps determine the severity of the allergy or confirm if a child is truly allergic.

Food Allergy Treatments

The most effective food allergy treatment strategy is to completely avoid the offending allergen. For example, children with an egg allergy should avoid eating eggs.

Treatment also includes educating children and their parents on reading labels on food packages to identify sources of allergens.

Other treatments for food allergies include:

• Medications. For example, epinephrine, a life-saving injectable medication used to treat anaphylaxis; ondansetron, a medication widely used to prevent FPIES-induced nausea and vomiting; steroids and proton pump inhibitors to treat EoE.
• Biologics. These are medications derived from living organisms that target specific immune system components to help manage and treat food allergies by reducing immune responses and inflammation.
• Dietary management. For conditions like allergic colitis and EoE.

Some childhood food allergies can be outgrown. Food challenges can help determine whether an allergy has been outgrown.

Help for Pediatric Food Allergies

If your child is experiencing food allergy symptoms, contact RWJBarnabas Health to schedule an appointment with one of our food allergy specialists. If you suspect an allergy, it's important to discuss it with a health care provider who can identify potential triggers and provide guidance on managing the allergy safely.

Our dedicated pediatric gastroenterology team helps families navigate the challenges of food allergies, offering strategies and emotional support to manage the condition.

Request an Appointment