Learn how to tell if your child has a food allergy and ways to avoid or manage his allergies.

By Christina Ching 

After his meals, does your tot break out in hives, have puffy, goldfish lips, or wheeze? He may have a food allergy. Mother & Baby sets you straight on this sensitive issue. 

“In a food intolerance, the child can be fussy, spits up more, gets tummy upsets and sleeps poorly. For food allergies, you’ll see immediate reactions within minutes after feeding, such as rashes, hives, wheezing, swollen lips or lowered blood pressure.” Never take food allergies lightly since they can be potentially fatal.  Finding the actual trigger to your baby’s symptoms and banning the “culprit” food from his dinner plate will stop the reactions and ease his discomfort.  Breastfed infants are less likely to get eczema, asthma and allergies, since breastmilk boosts the growth of beneficial bacteria in the gut, just as it strengthens your child’s developing immune system.

Rashes, a runny nose, watery eyes, coughing, diarrhoea, wind in the tummy, too little sleep, poor weight gan - these are discomforts that 6-year-old Owen Tan has to grapple with whenever he takes cow’s milk products. 

Although he has been allergic to cow’s milk since 1, his allergy was not diagnosed until a year later. After mum Diana Png, 36, switched him to soy-based milk, his symptoms have eased, apart from the occasional slip-up.

Around 1 in 20 to 25 Singaporean children aged 5 to 12 have food allergies, according to a 1997 study by the National University Hospital’s (NUH) Department of Paediatrics. But the actual numbers may be lower, reckons Dr Dawn Lim, a consultant paediatrician at Kinder Clinic, who specialises in paediatric allergy and immunology. She clarifies that the study was based on a parent-reported questionnaire of 6,404 children, and “parents tend to over-report incidences of food allergy.” 

Indeed, many mums mistake symptoms like a tummy ache or vomiting for an allergy. A report by Portsmouth University in the UK showed that of 969 babies studied, 33 per cent had been diagnosed by their parents as allergic to at least one food. Yet, just 5 to 6 per cent actually tested positive. Dr Lim, a mum-of-three, estimates that less than 4 per cent of children here actually suffer from food allergies. 

SPOT THE DIFFERENCE
You should not confuse food intolerances with allergies, the experts warn. 

An allergy is an immune-system response to a substance eaten (the allergen) that the body mistakenly believes is harmful. Once the immune system decides that a particular food is harmful, it creates specific antibodies to it. The next time the individual eats that food, the immune system releases massive amounts of histamines, a chemical, to protect the body. This triggers symptoms that can range from a mild runny nose or tummy ache, to anaphylaxis - a sudden, life-threatening reaction characterised by a sharp drop in blood pressure, rash and breathing difficulties. Just a tiny portion of the food allergen can lead to serious and even fatal reactions, notes Dr Larry Williams, a renowned childhood allergy expert and a senior medical director at Abbott Nutrition.

A food intolerance, on the other hand, occurs when your child’s body may lack certain enzymes needed to digest a food. It’s not a response by the immune system and usually not life-threatening. The problem food can often be taken in smaller amounts without triggering a reaction, Dr Williams adds. While some symptoms can be similar, such as tummy troubles, others are unique to food allergies.

Dr Williams, who was an associate professor of paediatrics at Duke University Medical Centre in the US, explains the difference, “In a food intolerance, the child can be fussy, spits up more, gets tummy upsets and sleeps poorly. These are often more subjective symptoms. For food allergies, you’ll see immediate reactions within minutes after feeding, such as rashes, hives, wheezing, swollen lips or lowered blood pressure.” 

TABOO FOODS
The study of food allergies in Singaporean children is still an emerging field, note local specialists. In some ways, allergies in Asian children seem to be different from those commonly seen in the West. For example, life-threatening reactions to peanuts, rampant in the US and UK, is rare here, Dr Lim notes. Instead, more children here are allergic to seafood.

In a 2001 study by the NUH Department of Paediatrics, allergy tests on little sufferers aged 3 and below showed that they are most sensitive to cow’s milk allergy (45.9 per cent), while 38.7 per cent are sensitive to egg white, 12 per cent to peanuts, and 11.5 per cent to shrimp. A 2004 study by Dr Lim showed that 3 per cent of these children are sensitive to fish.

Never take food allergies lightly, the experts caution, since they can be potentially fatal. Food is the most common cause of anaphylaxis among children here, according to a 1992 to 1996 study by the NUH Department of Paediatrics. Food allergies are behind 15 per cent of anaphylactic shock cases. Bird’s nest is the main cause of this life-threatening reaction, followed by seafood, eggs and cow’s milk. While infants are mainly allergic to milk and eggs, older children react to bird’s nest and seafood, the study revealed. 

IT'S ALL IN THE GENES
So, how would you know if your little one will get allergies? “The only way to ensure your child doesn’t get allergies is to marry a man without any allergies!” Dr Lim quips. 

Jokes aside, genetics are often to blame, experts concur. Your child is considered high risk if there is a family member with any type of food allergy, notes Gleneagles Hospital’s clinical dietitian Rehana A Wahid. 

While Owen’s mum Diana, a full-time mum-of-five, does not suffer from any allergic conditions, his dad Markus Tan, 38, a marine engineer, has a family history of asthma. 

Owen’s siblings have reacted badly to various foods. The eyes and lips of Samuel, his 7-year-old brother, swelled immediately after taking a sour plum sweet that a stranger offered. Recently, his baby sister Gloria, 1, suffered diarrhoea every time she drank formula milk. But when Diana switched her to a soy-based formula, her symptoms stopped. 

SWEET RELIEF
If your little one has a food allergy, you usually manage it by avoiding the offending food and taking medication.

To avoid an allergic reaction, you must first know what foods to avoid. If you suspect that your child has a food allergy or intolerance, see your GP or paediatrician. He will do an allergy test, such as a skin prick test or a blood test, to confirm whether your child has a food allergy and to pinpoint the specific allergen. 

Once you uncover what triggers your baby’s symptoms and ban the “culprit” food from his dinner plate, the adverse reactions will stop and his discomfort eased. Parents of children with food allergies quickly learn that prevention is the best cure. Avoiding the allergy-inducing foods and devising new recipes become part and parcel of their family life. 

Diana is vigilant about reading food labels when buying foods for her kids. Her house rules: No chocolate, no sweets, no cookies and for her milk-allergic children, no dairy products. 

“I teach my children what they can and cannot take, especially since I’m not always with them to monitor what they eat, such as when they go to preschool. I also highlight my kids’ dietary restrictions to their teachers,” she says.

Your child may also need medication, including oral antihistamines, oral decongestants, antihistamine eye drops and nasal sprays when symptoms flare up. If the allergic reaction is so severe that it is life-threatening, the caregiver has to immediately administer adrenaline injections. 

LIVE IN HOPE
There is no cure for food allergies presently, but treatment research is ongoing, including oral immunotherapy (feeding a very small amount of the food allergen and gradually increasing the dose) and injections of food allergens. Currently, the former cannot be practically carried out for all food allergy sufferers, while the risk of reactions to the latter is felt to be too great, Dr Williams notes.

So, if your child is allergic to a food, is he destined to suffer his entire life? Children can outgrow some of their food allergies, Dr Williams says. But while early studies concluded that children usually outgrow milk allergies by 4 years, the latest findings suggest that this could happen later.

“Over time, children will outgrow allergies to certain foods like cow’s milk, eggs, wheat and soy by the time they turn 6 or 7. But other allergies like seafood and peanuts usually stay with the sufferer for life,” he elaborates. To ascertain whether it’s safe to add the problem food back into your child’s diet, your doctor may advise re-taking a blood test when he is older, he notes.

So take heart - your mini muncher may still get his first taste of chocolate and ice-cream one day!

FOOD NOTES Food allergies cannot be prevented, but proper feeding can help to keep allergic reactions at bay. Follow these simple steps:  1. Breastfeed your baby exclusively (meaning your baby is given only breastmilk with no other food or fluids, even water) for the first six months to provide the best protection. Studies show that breastfed infants are less likely to get eczema, asthma and allergies, since breastmilk boosts the growth of beneficial bacteria in the gut, just as it strengthens your child’s developing immune system, paediatrician Dr Dawn Lim notes. Continue nursing your child till he turns 1 and beyond, as long as you both desire it, experts recommend.  2. When you are not able to breastfeed, choose a milk formula containing prebiotics (which nourish the good bacteria present naturally in your baby’s tummy). This will boost your child’s immune system and develop a healthy gut, stresses childhood allergy expert Dr Larry Williams. Both prebiotics and probiotics (beneficial bacteria) help fight allergy development, he points out.  3. Introduce solid foods only at 6 months. “Offer new foods one at a time, leaving at least three to four days in between to look out for allergic reactions and to see how well the new food is digested,” clinical dietitian Rehana A Wahid advises. If you or your spouse has a family history of food allergy, she recommends that you wait six to seven days before adding a new food.  4. While most weaning literature advise avoiding highly-allergenic foods for the first year, latest research has found that restricting a baby’s diet and avoiding allergens in his early life does not make any significant difference in preventing allergies, Drs Williams and Lim agree.

If you have any comments or practical suggestions, write to us at editor@family.sg 

- Mother & Baby
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