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.

How Do I Know if My Child Has Allergies?

Does Your Child Have Allergies?

By Daniel More, MD, About.com

The Progression of Allergies in Children

Allergies present in different ways in different age groups. In infants and young children, allergic disease occurs as atopic dermatitis or as food allergies. Children with atopic dermatitis are at increased risk of developing allergies and asthma, which are more likely to occur in the toddler years to school-age. This pattern of progression from one form of allergic disease to another is referred to as the “atopic march”. Atopic is a term that physicians use to mean that someone is allergic to various things (foods, environmental triggers such as pollens, molds and pet dander, for example).

Atopic Dermatitis

Typically this is the earliest manifestation of allergies, is seen in 10 to 20 percent of all children, and frequently seen during infancy. Atopic dermatitis, or eczema, is characterized by itching, with rash formation at the sites of scratching. The rash is typically red and dry, may have small blisters, and can flake and ooze over time.

In infants and very young children, this rash involves the face (especially the cheeks), chest and trunk, back of the scalp and may involve the arms and legs. This distribution reflects where the child is able to scratch, and therefore usually spares the diaper area. The location of the rash changes in older children to classically involve the skin in front of the elbows and behind the knees. Food and environmental allergies have been shown to worsen atopic dermatitis.

Food Allergies

Food allergies can also present in infants and young children, and usually occur after the introduction of solid foods. Almost all children with food allergies will have some form of skin symptoms as a result of eating the culprit food, such as hives, swelling, itching or redness of the skin. These symptoms typically occur within a few minutes of eating the food in question, although can be delayed up to a couple of hours.

Other symptoms of food allergies in young children can include nausea, vomiting, stomach aches, diarrhea, breathing difficulties (asthma symptoms), runny nose, sneezing, and lightheadedness. In some cases children can experience a severe allergic reaction, called anaphylaxis, which can be lifethreatening.

Nasal Allergies

Allergic rhinitis will occur in about 50 percent of those children with atopic dermatitis. While most children won’t start to experience allergic rhinitis until grade school age, some children develop it sooner. Most children with allergic rhinitis experience symptoms from pets, dust and mold at an earlier age and from pollens at a later age.

Symptoms of allergic rhinitis include sneezing, runny nose, itchy nose and eyes and nasal congestion. Some children may also experience post-nasal drip, allergic shiners (dark circles under the eyes), and a line across the nasal bridge from an upward rubbing of the palm of the hand on the nose, a sign called the “allergic salute”.

Asthma

Asthma occurs in about 8% of all people, and is the most common chronic disease in children. The majority of cases of asthma are due to allergies. In fact, 1 in 4 children with allergic rhinitis will develop asthma. Asthma can occur at any age, although is most often seen in males in the pre-teen years and in females in the teenage years. Sometimes asthma is difficult to diagnose in very young children, and may require a physician who is an asthma specialist.

Symptoms of asthma may include:

• Coughing. This can be the only symptom in some children who have “cough-variant asthma”. The cough is often dry, hacking, and worse at night and after exercise. Some children cough so hard that it causes them to vomit. Keep in mind that there are many causes of a cough, and not all coughing is due to asthma.

• Wheezing. This is a high-pitched, musical-like sound that can occur with breathing in and out in children with asthma. This usually gets worse with other asthma symptoms, and flares with exercise and other asthma triggers. Keep in mind that not all wheezing is due to asthma.

• Shortness of breath. Some children may get out of breath faster than their friends, and as a result become less active. Children with more severe asthma have shortness of breath at rest or wake-up with this during the night.

• Chest tightness. A child may describe this as a feeling of someone squeezing or hugging them. Other children say that the chest hurts or feels “funny”.

• Other symptoms that are not specific to asthma include infants with feeding difficulties, children who are tired all of the time or who avoid sports and other activities, and children who have difficulty sleeping.

If your child is experiencing any of the above signs or symptoms, he or she may have allergies. It is recommended to see your child’s doctor so that a diagnosis can be made, or a referral sent to an allergist/immunologist for specialized allergy testing.

The Basics of Atopic Dermatitis

By Daniel More, MD, About.com

Overview

Atopic dermatitis is a chronic, recurrent skin disease which commonly occurs in infancy and early childhood but can continue or start in adults. Like other allergies and asthma, atopic dermatitis tends to run in families. The skin rash associated with atopic dermatitis is called eczema.

It is important to note that atopic dermatitis is not a rash that itches. Rather, it is an itch, that when scratched, results in a rash. Therefore, if the itching can be controlled, and there is no scratching, there will be no rash (eczema).

Atopic dermatitis is very common in childhood, affecting up to 20% of kids, usually before the age of 5. The disease is less common in adults, affecting only 1 to 3% of the population, although can start at any age. It is rare to see atopic dermatitis in adults over 50 years of age.

In general, when atopic dermatitis occurs in infants, it usually is more severe, although many cases resolve or improve in later childhood. Children with atopic dermatitis are much more likely to have other allergic diseases, including allergic rhinitis and asthma.

Diagnosis

The diagnosis of atopic dermatitis is made by the history of the symptoms and the examination of the patient by a physician. There is no laboratory test to diagnose this condition.

There are three criteria that must be present in order to diagnose atopic dermatitis:

1. Atopy. The person must be atopic, or have a family history of allergic diseases in close relatives. There may be rare cases in which a person has atopic dermatitis without evidence of atopy.

2. Pruritis. Pruritis is the medical term used for itching. The patient must have itching and scratching in order for the rash to occur. If the skin or areas of the rash do not itch or have not been scratched, then the person does not have atopic dermatitis.

3. Eczema. Eczema refers to the appearance of the rash in patients with atopic dermatitis, and occurs in other skin diseases as well. The rash appears red, with small blisters or bumps present. These may ooze or flake with further scratching. Over the long-term the skin appears thickened and leathery.

Location of Eczema

The location of eczema is dependent on the area of the body that is scratched. In infants and very young children this rash involves the face (especially the cheeks), chest and trunk, back of the scalp and may involve the arms and legs. This distribution reflects where the child is able to scratch, and therefore usually spares the diaper area.

In older children and adults, the location of the rash changes to classically involve the skin in front of the elbows and behind the knees. Eczema can also involve the face (especially the eyelids), and may be limited to the palms of the hands and soles of the feet in certain people.

Triggers for Itching

Itching of the skin can be caused by irritants, infections, allergies and stress. Irritants cause itching through direct stimulation of the skin, and include harsh soaps, chemicals, wool fabrics, heat and sweating. Avoidance of these irritants through use of gentle soaps, wearing cotton clothing, and keeping cool and dry can help prevent itching.

People with atopic dermatitis are more susceptible to skin infections by various bacterial, fungal and viral infections. Many are have large amounts of a common skin bacterium, called Staphylococcus aureus, which can worsen the itching and eczema. Herpes infections (similar to the kind that causes cold sores) and the virus responsible for chicken pox and shingles can cause severe skin infections in people with atopic dermatitis.

Allergies can be a significant trigger for itching in people with atopic dermatitis. Usually allergens that come in direct contact with the skin, such as animal danger and dust mites, cause the most problems, although pollens and mold spores in the air can also worsen the condition.

Food allergies can also be a major trigger for people with atopic dermatitis, particularly in children. Egg and milk allergy are the most common food allergies in children worsening eczema, although other food allergies are also common.

Allergy testing is an important part of the evaluation of patients with atopic dermatitis, and avoidance of these triggers, both environmental and food allergens, can significantly improve the disease.

Common Allergic Rashes

By Daniel More, MD, About.com

This person has atopic dermatitis on the arms. Red, scaly plaques can be seen on the inside of the elbows. In adults, atopic dermatitis usually involves the body creases, or flexural areas.

There are many types of itchy skin rashes. However, not all rashes that itch are related to skin allergies. The following are the most common types of allergic skin rashes.

Atopic Dermatitis (Eczema)

Atopic dermatitis frequently occurs in young children, although may start in young adults, and can continue into adult life.

The rash of atopic dermatitis, often called eczema, occurs where a person scratches. In infancy, the rash occurs on the chest, cheeks and scalp, where the child is able to scratch. Older children and adult typically have the rash in the skin folds of the elbows and behind the knees, although may also occur on the face, neck, hands, feet and back.

The rash is red, often flakes or oozes, and has small blisters or bumps. There are often excoriations, or areas of broken skin, from aggressive scratching.

Urticaria (Hives) and Angioedema (Swelling)

Urticaria, commonly called hives, is an itchy rash that can occur at any age. This rash appears as raised red bumps of various shapes and sizes, and typically lasts for only minutes to hours. While it can be very itchy, a person will generally not excoriate (scratch to the point of breaking the skin and cause bleeding) themselves.

The swelling that sometimes goes along with urticaria is called angioedema, and often involves the lips, the eyes, and the hands and feet. Angioedema is usually not itchy or red, it tends to burn, sting or cause a tingling sensation. Severe swelling that blocks the ability to breathe can be dangerous and even life-threatening.

Contact Dermatitis

Contact dermatitis is caused from skin contact with a substance that causes a rash-like reaction. People react to a variety of chemicals, including cosmetics, hair dye, metals, topical medications and dental materials. An example of a contact dermatitis is a rash from poison ivy, which is an extremely itchy and appears as blisters that ooze and crust after contact with plants of the Toxicodendron family.

A contact dermatitis rash may look like atopic dermatitis, but the rash is typically located only in the area of contact with the offending chemical. Common locations include the face, especially the eyelids, neck, hands and feet. Contact dermatitis to metals, such as in jewelry or snaps/buttons/zippers on clothing, commonly occurs on the neck, wrists/hands, earlobes and at the waistline.

Itching Without a Rash

It is a relatively common problem for people to have itching without a rash being present. The medical term for itching is pruritus, and this symptoms can represent a skin problem, or even an internal disease within the body.

When the itching is limited to a certain area of the body, the most likely reason is a disease process limited to the skin. The area of the body that itches often gives a big clue as to the cause of the itching.

Pruritus the involves the entire body may still represent a disease of the skin, or may be caused by metabolic problems such as thyroid disease or iron deficiency. Many medications can cause itching, particularly pain medications like codeine and morphine.