Top 7 Food Allergies in Children

Allergy to egg, milk, soy, wheat, peanut and tree nuts represents 90% of all food allergies in children. Fish and shellfish are two other commonly seen food allergies, usually more common in adults. Each of these individual foods is discussed, including the prevalence, severity and potential outgrowth of the food allergy.
1. Milk
Allergy to cow’s milk is common in children, affecting about 2.5 percent of all infants. These children tend to also react to other milks, such as goat and sheep milk. The allergy is usually directed against one or both major milk proteins, casein and whey. The sugar in milk, lactose, does not cause allergy, but can cause food intolerance.
While 85% of children will outgrow milk allergy by age 5, being allergic to milk is a risk factor for developing other food allergies, as well as nasal allergies. Up to 10% of cow's milk allergic children will be allergic to beef.
2. Egg
Allergy to egg is the most common food allergy in children, affecting about 2.5 percent of young children. Children may be allergic to the white, yolk, or both. Many will outgrow the egg allergy by age 5, although these children are at increased risk of developing nasal allergies and asthma.
The influenza vaccine is the only routine immunization which should not be given to egg allergic children. The MMR vaccine, which was once was a concern in egg-allergic children, does not require any special procedures and typically can safely be given to children with egg allergy.
Find out how to follow a egg-free diet.
3. Soy
Soy is a legume, and related to peanut, although cross-reactivity rarely exists between the two. Allergy to soy affects approximately 0.3 percent of children, is usually outgrown at a young age, and rarely causes life-threatening reactions. Because soy is a common food allergy, and can occur in children also allergic to milk, infant formulas using hydrolyzed proteins are preferred in infants allergic to cow’s milk.
Find out how to follow a soy-free diet.
4. Wheat
Children and adults can experience a variety of immunologic reactions to wheat protein, only some of which are allergic. Wheat allergy is commonly outgrown at an early age, and it is rare for children with wheat allergy to be clinically allergic to other cereal grains (such as rice, oat and barley), although skin testing to these other grains may be positive.
Find out how to follow a wheat-free diet.
5. Peanut
Allergy to peanut occurs in approximately 0.6 percent of all people, and tends to cause a severe form of food allergy. Peanut allergy can be associated with life-threatening allergic reactions, particularly in children with asthma. Only about 20 percent of children outgrow peanut allergy, making it the most common food allergy seen in adults.
Accidental exposure to peanut containing foods is a common problem, so it is important for peanut allergic children to follow a strict peanut-free diet, wear a medical alert bracelet and always have injectable epinephrine available.
6. Tree Nut
Tree nut allergy occurs in approximately 0.5 percent of all people, tends to be severe and is less likely to be outgrown. There is a high likelihood that if a child is allergic to one type of tree nut, he or she will be allergic to another type of tree nut. While tree nuts and peanuts are unrelated foods, cross-contamination is a concern, so some experts recommend a complete “nut free” diet in children with either peanut or tree nut allergy.
7. Seafood
Allergy to seafood includes both fish and shellfish. While fish and shellfish are not related foods, these foods are usually found in the same place (restaurants). Reactions to seafood can be severe and potentially life-threatening. Allergy to either of these foods is less likely to be outgrown, and therefore is commonly seen in adults.
Since patients with allergy to one shellfish are at a high risk of being allergic to other shellfish, complete avoidance of this category of foods is advised. The same is true for allergy to fish; however, exceptions exist for both.

Do People With Atopic Dermatitis (Eczema) Get More Skin Infections?

Question: Do People With Atopic Dermatitis (Eczema) Get More Skin Infections?
Answer: Yes, people with atopic dermatitis are more prone to infections of the skin, particularly those of the viral, bacterial and fungal kind.

In people with atopic dermatitis, the immune system is more focused on allergies than fighting infections. This means that the skin has less infection-fighting chemicals, giving various bacteria -- especially Staphylococcus aureus -- any easier shot at colonizing.

Colonization and infection by Staphylococcus aureus causes various problems in people with atopic dermatitis. This bacterium not only causes skin infections, such as impetigo, but also produces bacterial toxins to which many people with atopic dermatitis are allergic. These bacterial toxins can worsen eczema, and treatment with antibiotics can improve symptoms in people with bacterial colonization even if there is no obvious skin infection.
Fungal infections, such as tinea and yeast infections, are also more common in people with atopic dermatitis. This may be partially due to the use of topical steroids, which can suppress the immune system of the skin, but it may also be because of the lack of special infection-fighting chemicals in the skin of people with atopic dermatitis. Treatment of fungal infections can improve the symptoms of atopic dermatitis.

Viral infections are also more common in people with atopic dermatitis. These infections can be on certain areas of the skin, such as is the case with herpes infections and molluscu contagiosum, but can also involve the entire body, as they are with eczema herpeticum. People with atopic dermatitis and severe herpes infections may require oral or intravenous antiviral medications to treat these infections.

Lastly, people with atopic skin are also more susceptible to infection, because the barrier function of atopic skin is compromised. This means that the disease itself causes breaks in the skin, where infection-causing microorganisms can enter.

What are Elidel and Protopic?

Elidel (pimecrolimus) and Protopic (tacrolimus) are topical medications used for the treatment of atopic dermatitis (eczema). These medications, called topical calcineurin inhibitors (TCIs) were the first non-steroid topical medications developed to treat eczema.
Unlike topical steroids, TCIs do not cause skin thinning, pigment changes, blood vessel formation, striae formation, or loss of response with prolonged use. TCIs are also not absorbed into the body to any significant degree, unlike topical steroids. In addition, TCIs can be used on any skin, including the face and eyelids.
Elidel and Protopic are topical versions of calcineurin inhibitors, which are medications used to suppress the immune system in people receiving organ transplants as well as for people with autoimmune diseases. These medications, such as cyclosporine, can have severe side effects, including causing various forms of cancer.
While Elidel and Protopic were only approved for use in people two years and older, many doctors used these medications for infants and younger toddlers. These medications became very popular due to the lack of side effects compared to topical steroids.
Learn the basics of atopic dermatitis.
What Risks are Associated with Elidel and Protopic?
Elidel and Protopic both currently have a “black box” warning, which is a precautionary statement given to the medication by the Food and Drug Administration. This warning came about as a result of reports of children and adults who developed cancer (such as skin cancers and lymphomas) while using these medications.
The decision of the FDA to give these medications a “black box” warning was quite controversial, and went against recommendations from the professional societies of allergists and dermatologists. The reason for this was because the available data did not support that TCIs caused any increase in the risk of any form of cancer. The rate of cancer development occurring in people using Elidel and Protopic was actually below the rate expected in the general population, and the types of cancers seen were not the types seen in people using cyclosporine.
In addition, even when TCIs are used over large areas of the body, the medication cannot be detected in the bloodstream. There is also no evidence that TCIs suppress the body’s immune system whatsoever, which is probably the main reason why oral forms of these medications cause cancer.
Despite any real scientific basis for the FDA’s “black box” warning, however, Elidel and Protopic were being used by doctors for purposes for which they were never intended. These medications were probably over-prescribed for just about any itchy rash in children and adults, which is inappropriate. TCIs are still very useful medications, and I frequently prescribe these medications in my practice.
When Should Elidel and Protopic Be Used?
Elidel and Protopic are indicated as second choice treatments (topical steroids are first choice) for atopic dermatitis in adults and children two years and older. These medications should only be used for short-term flares of eczema, and should not replace the liberal use of moisturizers to maintain good skin hydration.
I tend to use Elidel and Protopic more often for skin that is prone to side effects from topical steroids, especially the thin skin on the face and eyelids and in body folds such as the armpits and groin. Because TCIs are more expensive (and there is no generic form), I tend to use cheaper topical steroids for other areas on the body with thicker skin, such as the arms, legs, hands, feet, neck and trunk.
I also discuss the above risks with any patients and parents of children for whom I prescribe Elidel and Protopic. While in general I do not have serious concerns regarding the safety of these medications (see above for my reasoning), it is the right of my patients to know what I know. I also want my patients to hear the risks of these medications from me, rather than from the internet, where they might find false information.