It's probably not a food allergy after all


In trying to protect her, the girl's mother was literally starving her. Three months shy of her third birthday, the child had not yet reached three feet in height, and she weighed just 21 pounds--more or less the weight of the average nine-month-old. The reason?

When she was still an infant, she experienced some vomiting, which her mother attributed to food allergies. And in a well-meaning effort gone way out of control, the woman went on to remove more than 10 foods from her daughter's diet: beef, eggs, corn, chicken, soy, fish, chocolate, wheat, peanuts, white potatoes, fruits, and all fruit juices except for apple. It turns out the child wasn't allergic to any of them.

The case is an extreme one, but not as rare as you might think. Consider that out of 184 children evaluated in a national program, 11 had parents who removed an average of eight foods from their diets to "take care off" allergies. As a result, they experienced severely low rates of growth and weight gain, putting them at risk for brain damage and other developmental complications.

The irony here is that only two of the children, all of whom were under three years old, actually had any allergies to food. It's not surprising from a scientific perspective. While the common belief is that food allergies afflict large numbers of youngsters, the true figure is on the order of one in 100. And even then, it tends to be only one or two foods to which the child is allergic, not eight or more. The most common culprits: milk, eggs, shellfish, and nuts.

Still, "pediatricians say to us all the time that they have parents who unnecessarily remove foods from their children's diets because of false beliefs about food allergies," comments Thomas Roesler, MD, a child psychiatrist at the National Jewish Center for Immunology and Respiratory Medicine in Denver, where the youngsters were evaluated. "Perhaps the children they're talking about didn't have their weight gain and growth rates slowed as much as those we examined," Dr. Roesler adds. "But there can be long-term complications even for a child with a milder decrease in his rate of development." Indeed, in a national survey of youngsters five to 11 years old in Great Britain, children seen by their parents as "food intolerant" were more than half an inch shorter than others; the more foods excluded from a child's diet, the shorter he or she was.

Mixed signals at the pediatrician's office
Unfortunately, a pediatrician might unwittingly get sucked into a faulty belief system about food allergies in which a parent has become "stuck," says Dr. Roesler. "A mother or father may tell the child's doctor, 'Every time I give my kid tomatoes, he gets hives? The pediatrician hasn't seen the hives, but he tells the parent to stop feeding the youngster tomatoes." From there, Dr. Roesler says, the parent might take it upon him or herself to remove more foods as he or she sees fit.

But a more collaborative approach with the pediatrician is called for, Dr. Roesler advises. For instance, if the parent describes only mild symptoms, the doctor may recommend taking the food out of the child's diet for three months and then feeding it again in his or her presence. That's because many symptoms of food allergies--runny nose, itchy skin rash, diarrhea, vomiting--are common to all kinds of childhood illnesses and usually have nothing to do with a particular food, which a little time usually makes clear.

In those rare cases that a food is indeed responsible for any unpleasant symptoms, it's usually worth reintroducing it to the diet after a time because studies show some 90 percent of symptoms commonly associated with food allergies disappear by age three. "Oftentimes after just three months," Dr. Roesler says, "the child will not react again."

Of course, if a parent tells a physician that a child suffered, say, breathing difficulties after eating a particular food, or has reactions to many different foods rather than just one, the pediatrician may feel a referral to a pediatric allergist is in order. Such an allergist, certified by the American Board of Allergy and Immunology, will take a detailed medical and diet history as well as conduct a skin-prick test. But even if the skin-prick test is positive, more tests may be necessary. That's because in nine out of 10 cases in which a child's skin reacts to a particular food, it won't be dangerous inside his body. Some small children, for instance, get a perfectly harmless redness on the skin around their lips when they eat tomatoes or oranges. More conclusive tests than skin pricks include feeding the food in the allergist's presence and having him or her examine the child for any untoward side effects.

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