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Preventing and Understanding Food Allergies in Children
Dr. Nivedita More discusses food allergies in young children, ways to prevent food allergies from developing, and how to manage allergies and their symptoms.
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Learn more about Nivedita More, MD
Nivedita More, MD
Nivedita More, MD, completed medical school at Seth GS Medical College and KEM Hospital in Mumbai, India, and residency training at Children’s Hospital of Orange County in Orange County, California, where she worked as a critical care transport physician. She then operated Kidiatrics Medical Group in Rancho Santa Margarita, California, as a solo pediatric practice for over 15 years. She joined Bayside Medical Group in 2017. Dr. More strives to provide personal, individualized care for every patient that is sensitive to the cultural background of the patient and family. Her clinical interests include newborn care, lactation support for mothers, behavioral issues, asthma, ADHD, and teen health. She is fluent in Marathi and Hindi and speaks some medical Spanish. Dr. More is treasurer and an executive board member of AAPCA1 (American Academy of Pediatrics, California Chapter 1), which encompasses 48 counties in Northern California. In her free time, she loves staying active outdoors, gardening, cooking and spending time with my family.Learn more about Nivedita More, MD
Transcription:
Preventing and Understanding Food Allergies in Children
Scott Webb (Host): We all worry about our kids all of the time, but for parents of children with food allergies; there's good reason to be prepared for the accidental exposure or ingestion of food allergens. And joining me today to help us understand food allergies, how we can prevent and manage them, review ingredient labels, and more is Dr. Nivedita More. She's a Pediatrician at Stanford Children's Health. This is Health Talk with Stanford Children's Health. I'm Scott Webb and Dr. More, thanks so much for your time. My kids don't have food allergies, but many of their friends do. And I know it's a big concern for their parents. So, how do we, as parents know, if our kids have food allergies?
Nivedita More, MD (Guest): So, there's a lot of symptoms you can have if you have a food allergy. Some of the times, kids can get hives, for example, or they can sneeze or wheeze after eating a certain type of foods that they're allergic to. Some of the times they can throw up or have nausea or diarrhea following the foods that they're allergic to, if they eat that, or sometimes they can just become really pale and have a serious reaction called anaphylaxis after they eat something that they're allergic to. So, you have to kind of keep a look out for these kinds of symptoms when you're introducing new foods to babies specifically, that's when you see the most allergies with children, is when they're babies.
Host: Yeah, and it's good to know that there are physical signs that we can be on the lookout for. And I'm sure that this happens a lot. Are there illnesses and other symptoms that frequently get confused with food allergies?
Dr. More: All the time. There are a lot of other things that get confused with food allergies, specifically, food poisoning or food irritation, diarrhea from sugary things is this considered a food allergy when it's not, and there's a lot of confusion around what real food allergies are and what these other symptoms can mean. Which really are not food allergies.
Host: Doctor, what are some of the biggest misconceptions when it comes to food allergies?
Dr. More: You know some few that come to my mind are late introduction of these allergenic foods that has been done for many decades almost in this country, where people will worry that my child will be allergic to peanuts, for example, if I give it too soon, especially in the first year of their life. And now we have learned otherwise. People are now introducing and with the recommendation of the American Academy of Pediatrics, we are now recommending that all these allergenic foods, namely peanuts, you know, other nuts, milk products, soy and other foods that cause allergies like eggs, need to get introduced in the first four to six months of their life, rather than waiting the full year that we used to recommend in the past. With that, we have seen fewer allergies now. And fewer, reactions to these allergy kind of foods.
Host: Really interesting if I can connect these dots here is like what you are saying is that because everybody is so afraid of peanut allergies, for example, that they're not introducing peanuts as early as they used to. And they might actually be doing more harm than good in terms of allergic reactions. Right?
Dr. More: Yeah, absolutely. And the other bigger misconception and myth is if my child is allergic to peanuts, then he's also allergic to all other kinds of nuts. And that's another myth that we need to take away from everybody is because peanut is really a legume which is not grown on a tree like the other nut families. And many children who have peanut allergy can tolerate tree nuts and vice versa, for example. A lot of people are just too afraid and so confused I think with all the myths that are around the food allergies, there is a lot of disservice being done in the media about how it's advertised and how people are told things. So, really, I want people who are listening to this podcast to really go to the right sources to get their information like their pediatrician, for example.
Scott Webb (Host): Yeah, definitely. I think you're right. There is a lot of misinformation and misconceptions and social media probably plays a big part of that for people. And we want people to go to the right sources and go to pediatricians, go to the doctors when you need, you know, medical advice. So, maybe you can just take us through what are the main steps that we should do or shouldn't do. So, take us through this. What can we do to help prevent our kiddos from developing food allergies and what shouldn't we do? Or what should we avoid when we're trying to prevent them?
Dr. More: First thing to do to avoid or to prevent food allergies for little babies is to exclusively breastfeed for the first three to four months of their life, which also protects against eczema and food allergies in general. There's a lot of evidence also supporting not restricting all the mother's diet during their pregnancy and during breastfeeding as a method to prevent allergies. So, we really want pregnant women and breastfeeding moms to eat a wide variety of foods, including all the allergenic foods like peanuts and other nuts and milk. And that we talked about earlier. Earlier, it was thought that hydrolyzed formulas or broken down formulas would prevent allergies in children, but that is untrue.
So, it's not necessary to invest in really expensive formulas to avoid food allergies. And even if mom can't exclusively breastfeed, even if they can partially breastfeed, it will help children from developing food allergies earlier on. Definitely excluding peanuts and other allergic foods from the children's diet under one year of age, as previously thought, does not prevent food allergy. So, that is one thing if anybody takes home from this talk we are having is not to prevent these foods from being introduced earlier on.
Host: Yeah. So, doctor, we're talking about misconceptions there, but also maybe just some confusion that parents may have the difference between an allergy, a food allergy, and maybe just food sensitivity or intolerance. And there's a difference between the three, right?
Dr. More: Absolutely. There's a lot of confusion between what is a food allergy versus a food sensitivity versus food intolerance. A perfect example but a food allergy would be just what we talked about earlier, where people get hives, people get nausea, vomiting, maybe diarrhea, some real serious reaction like cardiovascular symptoms. But when it comes to food sensitivity, what really it is it just really causes trouble digesting certain types of foods, especially foods like wheat or bread. And the common symptoms include just bloating and stomach issues, but it really doesn't cause any hives or, you know, any cardiac symptoms.
So, that's a good thing. One perfect example for food intolerance would be lactose intolerance, for example, and that's when you lack kind of an enzyme that you need to digest the sugars in the milk, and that can just cause diarrhea. And all you need is to take a lactate pill while you're consuming those kinds of foods. And then you're fine. So, it's very different from an allergy, which is specifically a reaction to a protein, and which can cause a range of mild to life-threatening symptoms, that we discussed earlier, really. So, parents should just keep in mind that many things can cause symptoms that resemble a food allergy, but all of them are not necessarily a food allergy. They could be an insensitivity to that food, or it could be an intolerance.
Host: So, Doctor, for parents when they're looking at a food labels. So, they're at the grocery store and they're shopping, or they know their kids are going to be at a friend's house or you're going to a restaurant. You know, I think one of the complications can be just simply being overwhelmed by the list of ingredients and making sure that they can spot the things that they know they need to avoid. So, what tips do you have for parents as they kind of navigate all of that?
Dr. More: Yeah, this is a really great question, Scott. In the US, you know, the labeling laws require disclosure of peanuts, tree nuts, all the fish, soy, eggs, crustacean shellfish, all of that needs to be listed as ingredients in packaged or manufacturered food. So, when your child is allergic to any of those common allergens, then it's great. It's easy. Most do read all the labels most of the time. But manufacturers may voluntary indicate if an allergy is a potentially, you know, unintended contaminant of a food. They are also supposed to say that on the label. Some of the times that gets missed. And some of the parents are a little concerned about that as well.
So, I feel like they need to be really careful in reading labels. The disclosure is really good with most packaging, but sometimes children land up eating foods that are prepared by their friend's moms and or in restaurants. And that can be really complicated. So, to play it safe, you know, just avoid foods that the child is allergic to, even if it is prepared in a facility that processes that food. Or if it says may contain that particular food that the child is allergic to, it's just best to really avoid those foods altogether.
Host: So, maybe you can tell parents how they can be diligent and look out for their kids and take care of them safely, easily but not necessarily beyond, you know, heightened alert all the time or maybe Doctor, they have to be.
Dr. More: Right now we really don't have anything that's approved to cure a food allergy. There are some studies in the works with giving small doses of peanuts to peanut allergic children can hopefully, you know, get them over that allergy. But these are in the works and they are showing really good results right now. But in the meantime, yes, management of all food allergies is really based on avoiding the food that the child is allergic to. And more important than that, being prepared to treat the reaction, should the food be eaten or consumed accidentally is key. By, you know, preparing the school personnel, having the family being prepared ahead of time, whether it is in the school or at home, having all their ducks lined up to prevent the serious allergic reaction, like anaphylaxis, that's the key. So, as much as possible, avoiding is of course the gold standard to prevent these reactions, but sometimes it's unavoidable. Like you just said, in school settings or on a flight or some such place.
Host: Well and as we know that kids will be kids and kids want to do things that they're told not to do, and they want to try things because their friends are trying them. And so, you know, as diligent as parents can be, and as you say, getting all those ducks in line, kids will be kids sometimes, and things will happen accidentally. And we need to be prepared for all those possibilities, right?
Dr. More: Absolutely. Absolutely.
Host: Uh, Doctor, this has been a really educational today. As we wrap up here, anything else you want to tell parents about food allergies, how they can prevent them as much as possible, deal with them once they happen? Anything else we can tell parents?
Dr. More: I just want to let the audience know that food allergies are common. About 8% of children in the United States have some sort of food allergy, 40% of these kids will get some serious allergic reactions from that food allergy at sometime in their lifetime. But by avoiding those allergens, we can definitely prevent serious reactions to these foods. Being prepared is important by having anti-histamines and the EpiPen, which is the epinephrine auto injector on hand at all times is important.
So, parents can be prepared. The children can be prepared and to prevent these food allergies from happening in the first place, breastfeeding these children up to three to six months of their lives and beyond would be helpful. Introducing the allergenic foods, mainly peanuts, other nuts, eggs, milk, wheat, soy, which causes 90% of the food allergies. It'd be helpful to introduce these foods earlier on, rather than waiting the full first year of their lives.
Host: Yeah, definitely. Well, it is so great to have an expert on and to have your expertise and your advice and food allergies are common, but we can deal with them. We could be prepared for them. And we can make sure that our kids are safe and happy and healthy. So, Doctor, thanks so much for your time today and you stay well.
Dr. More: Thank you so much.
Host: For more information, visit Stanfordchildren's.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well. And we'll talk again next time.
Preventing and Understanding Food Allergies in Children
Scott Webb (Host): We all worry about our kids all of the time, but for parents of children with food allergies; there's good reason to be prepared for the accidental exposure or ingestion of food allergens. And joining me today to help us understand food allergies, how we can prevent and manage them, review ingredient labels, and more is Dr. Nivedita More. She's a Pediatrician at Stanford Children's Health. This is Health Talk with Stanford Children's Health. I'm Scott Webb and Dr. More, thanks so much for your time. My kids don't have food allergies, but many of their friends do. And I know it's a big concern for their parents. So, how do we, as parents know, if our kids have food allergies?
Nivedita More, MD (Guest): So, there's a lot of symptoms you can have if you have a food allergy. Some of the times, kids can get hives, for example, or they can sneeze or wheeze after eating a certain type of foods that they're allergic to. Some of the times they can throw up or have nausea or diarrhea following the foods that they're allergic to, if they eat that, or sometimes they can just become really pale and have a serious reaction called anaphylaxis after they eat something that they're allergic to. So, you have to kind of keep a look out for these kinds of symptoms when you're introducing new foods to babies specifically, that's when you see the most allergies with children, is when they're babies.
Host: Yeah, and it's good to know that there are physical signs that we can be on the lookout for. And I'm sure that this happens a lot. Are there illnesses and other symptoms that frequently get confused with food allergies?
Dr. More: All the time. There are a lot of other things that get confused with food allergies, specifically, food poisoning or food irritation, diarrhea from sugary things is this considered a food allergy when it's not, and there's a lot of confusion around what real food allergies are and what these other symptoms can mean. Which really are not food allergies.
Host: Doctor, what are some of the biggest misconceptions when it comes to food allergies?
Dr. More: You know some few that come to my mind are late introduction of these allergenic foods that has been done for many decades almost in this country, where people will worry that my child will be allergic to peanuts, for example, if I give it too soon, especially in the first year of their life. And now we have learned otherwise. People are now introducing and with the recommendation of the American Academy of Pediatrics, we are now recommending that all these allergenic foods, namely peanuts, you know, other nuts, milk products, soy and other foods that cause allergies like eggs, need to get introduced in the first four to six months of their life, rather than waiting the full year that we used to recommend in the past. With that, we have seen fewer allergies now. And fewer, reactions to these allergy kind of foods.
Host: Really interesting if I can connect these dots here is like what you are saying is that because everybody is so afraid of peanut allergies, for example, that they're not introducing peanuts as early as they used to. And they might actually be doing more harm than good in terms of allergic reactions. Right?
Dr. More: Yeah, absolutely. And the other bigger misconception and myth is if my child is allergic to peanuts, then he's also allergic to all other kinds of nuts. And that's another myth that we need to take away from everybody is because peanut is really a legume which is not grown on a tree like the other nut families. And many children who have peanut allergy can tolerate tree nuts and vice versa, for example. A lot of people are just too afraid and so confused I think with all the myths that are around the food allergies, there is a lot of disservice being done in the media about how it's advertised and how people are told things. So, really, I want people who are listening to this podcast to really go to the right sources to get their information like their pediatrician, for example.
Scott Webb (Host): Yeah, definitely. I think you're right. There is a lot of misinformation and misconceptions and social media probably plays a big part of that for people. And we want people to go to the right sources and go to pediatricians, go to the doctors when you need, you know, medical advice. So, maybe you can just take us through what are the main steps that we should do or shouldn't do. So, take us through this. What can we do to help prevent our kiddos from developing food allergies and what shouldn't we do? Or what should we avoid when we're trying to prevent them?
Dr. More: First thing to do to avoid or to prevent food allergies for little babies is to exclusively breastfeed for the first three to four months of their life, which also protects against eczema and food allergies in general. There's a lot of evidence also supporting not restricting all the mother's diet during their pregnancy and during breastfeeding as a method to prevent allergies. So, we really want pregnant women and breastfeeding moms to eat a wide variety of foods, including all the allergenic foods like peanuts and other nuts and milk. And that we talked about earlier. Earlier, it was thought that hydrolyzed formulas or broken down formulas would prevent allergies in children, but that is untrue.
So, it's not necessary to invest in really expensive formulas to avoid food allergies. And even if mom can't exclusively breastfeed, even if they can partially breastfeed, it will help children from developing food allergies earlier on. Definitely excluding peanuts and other allergic foods from the children's diet under one year of age, as previously thought, does not prevent food allergy. So, that is one thing if anybody takes home from this talk we are having is not to prevent these foods from being introduced earlier on.
Host: Yeah. So, doctor, we're talking about misconceptions there, but also maybe just some confusion that parents may have the difference between an allergy, a food allergy, and maybe just food sensitivity or intolerance. And there's a difference between the three, right?
Dr. More: Absolutely. There's a lot of confusion between what is a food allergy versus a food sensitivity versus food intolerance. A perfect example but a food allergy would be just what we talked about earlier, where people get hives, people get nausea, vomiting, maybe diarrhea, some real serious reaction like cardiovascular symptoms. But when it comes to food sensitivity, what really it is it just really causes trouble digesting certain types of foods, especially foods like wheat or bread. And the common symptoms include just bloating and stomach issues, but it really doesn't cause any hives or, you know, any cardiac symptoms.
So, that's a good thing. One perfect example for food intolerance would be lactose intolerance, for example, and that's when you lack kind of an enzyme that you need to digest the sugars in the milk, and that can just cause diarrhea. And all you need is to take a lactate pill while you're consuming those kinds of foods. And then you're fine. So, it's very different from an allergy, which is specifically a reaction to a protein, and which can cause a range of mild to life-threatening symptoms, that we discussed earlier, really. So, parents should just keep in mind that many things can cause symptoms that resemble a food allergy, but all of them are not necessarily a food allergy. They could be an insensitivity to that food, or it could be an intolerance.
Host: So, Doctor, for parents when they're looking at a food labels. So, they're at the grocery store and they're shopping, or they know their kids are going to be at a friend's house or you're going to a restaurant. You know, I think one of the complications can be just simply being overwhelmed by the list of ingredients and making sure that they can spot the things that they know they need to avoid. So, what tips do you have for parents as they kind of navigate all of that?
Dr. More: Yeah, this is a really great question, Scott. In the US, you know, the labeling laws require disclosure of peanuts, tree nuts, all the fish, soy, eggs, crustacean shellfish, all of that needs to be listed as ingredients in packaged or manufacturered food. So, when your child is allergic to any of those common allergens, then it's great. It's easy. Most do read all the labels most of the time. But manufacturers may voluntary indicate if an allergy is a potentially, you know, unintended contaminant of a food. They are also supposed to say that on the label. Some of the times that gets missed. And some of the parents are a little concerned about that as well.
So, I feel like they need to be really careful in reading labels. The disclosure is really good with most packaging, but sometimes children land up eating foods that are prepared by their friend's moms and or in restaurants. And that can be really complicated. So, to play it safe, you know, just avoid foods that the child is allergic to, even if it is prepared in a facility that processes that food. Or if it says may contain that particular food that the child is allergic to, it's just best to really avoid those foods altogether.
Host: So, maybe you can tell parents how they can be diligent and look out for their kids and take care of them safely, easily but not necessarily beyond, you know, heightened alert all the time or maybe Doctor, they have to be.
Dr. More: Right now we really don't have anything that's approved to cure a food allergy. There are some studies in the works with giving small doses of peanuts to peanut allergic children can hopefully, you know, get them over that allergy. But these are in the works and they are showing really good results right now. But in the meantime, yes, management of all food allergies is really based on avoiding the food that the child is allergic to. And more important than that, being prepared to treat the reaction, should the food be eaten or consumed accidentally is key. By, you know, preparing the school personnel, having the family being prepared ahead of time, whether it is in the school or at home, having all their ducks lined up to prevent the serious allergic reaction, like anaphylaxis, that's the key. So, as much as possible, avoiding is of course the gold standard to prevent these reactions, but sometimes it's unavoidable. Like you just said, in school settings or on a flight or some such place.
Host: Well and as we know that kids will be kids and kids want to do things that they're told not to do, and they want to try things because their friends are trying them. And so, you know, as diligent as parents can be, and as you say, getting all those ducks in line, kids will be kids sometimes, and things will happen accidentally. And we need to be prepared for all those possibilities, right?
Dr. More: Absolutely. Absolutely.
Host: Uh, Doctor, this has been a really educational today. As we wrap up here, anything else you want to tell parents about food allergies, how they can prevent them as much as possible, deal with them once they happen? Anything else we can tell parents?
Dr. More: I just want to let the audience know that food allergies are common. About 8% of children in the United States have some sort of food allergy, 40% of these kids will get some serious allergic reactions from that food allergy at sometime in their lifetime. But by avoiding those allergens, we can definitely prevent serious reactions to these foods. Being prepared is important by having anti-histamines and the EpiPen, which is the epinephrine auto injector on hand at all times is important.
So, parents can be prepared. The children can be prepared and to prevent these food allergies from happening in the first place, breastfeeding these children up to three to six months of their lives and beyond would be helpful. Introducing the allergenic foods, mainly peanuts, other nuts, eggs, milk, wheat, soy, which causes 90% of the food allergies. It'd be helpful to introduce these foods earlier on, rather than waiting the full first year of their lives.
Host: Yeah, definitely. Well, it is so great to have an expert on and to have your expertise and your advice and food allergies are common, but we can deal with them. We could be prepared for them. And we can make sure that our kids are safe and happy and healthy. So, Doctor, thanks so much for your time today and you stay well.
Dr. More: Thank you so much.
Host: For more information, visit Stanfordchildren's.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well. And we'll talk again next time.