In recent years, food allergies have been in the news frequently. This is partly because food allergies are increasing; currently, they affect approximately 6 to 8 percent of children under age 5, and about 3 to 4 percent of adults. Another reason they have been in the news is that new research may soon allow a treatment that might help the allergy go away.
Only some food reactions can truly be called “allergies.” Many people have intolerances to food. For example, lactose intolerance causes tummy pain in some people after drinking milk, and many parents feel that sugar or food dyes contribute to behavior problems. Although intolerances may cause discomfort or annoying symptoms, they are not dangerous. A true food allergy is caused by the body’s own immune system reacting to a food protein. Food allergies often cause an itchy skin rash, but symptoms can include vomiting, wheezing, difficulty breathing, throat swelling and even death. Even a tiny amount of the problem food can cause severe symptoms in sensitive patients.
Allergy to peanuts and nuts is one of the more common, and often more severe, food allergies. It is also an allergy that is usually not outgrown, unlike milk and egg allergy that usually resolve before a child starts school. In a child who has had symptoms from peanuts or nuts in the past, there is no way to predict how severe a future reaction may be. In fact, many patients who had fatal or near-fatal reactions to nuts had never had severe symptoms before.
Because peanut and tree nut (almond, pecan, walnut, etc.) allergies are so common and can be so severe, many preschools have a “no nut” policy. Preschool children can be messy eaters, and even a trace of peanut butter left on the table could be very dangerous to another child. It may seem frustrating to have to check labels if your child is not allergic, but keeping the environment safe for all children is critical.
So when should you allow your baby to have peanuts or tree nuts? That answer is not very clear. Peanuts and tree nuts can be a choking hazard, so many pediatricians recommend avoiding them until age 3 anyway. From an allergy standpoint, avoidance used to be recommended until age 3, but recent research has not proven that this helps avoid the allergy. Factors such as family history, presence or absence of asthma and eczema also need to be considered. It is best to discuss all these factors with your pediatrician before introducing nuts or peanuts to your young child.
Dr. Laura Esswein is a Mercy Clinic pediatric allergy and immunology physician with Mercy Children’s Hospital.