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Anne Borgmeyer: Hi, my name is Anne Borgmeyer. I'm a pediatric nurse practitioner at St. Louis Children's Hospital, where I take care of children with asthma and allergies. And I'm a mom doc.

Melanie: Hey, this is Mom Docs, the podcast from St. Louis Children's Hospital. And today, we're talking about food allergies in children. Anne, it's a pleasure to have you with us. What a great topic. Tell us a little bit about food allergies and what's the difference between a food allergy and a food intolerance.

Anne Borgmeyer: Actually, that's a really important discussion because, as everyone knows, I think that food allergies are on the rise. So there's about 5.6 million children in the United States right now under age 18 with food allergies and anybody, children or adults, can really have a physical reaction or an adverse reaction after eating a food. Sometimes it really is a food allergy and sometimes it's just a food intolerance. And the difference really is important.

So a food allergy is an immune system response. It is your body making IgE antibodies in response to a certain food and that causes a histamine release. Any amount of food can trigger that the reaction can be mild to very severe, even anaphylaxis and death. You can use epinephrine to reverse it.

But a food intolerance really is just the body having difficulty digesting a certain food. So there is no immune system response. Epinephrine won't help that. Usually, the symptoms for a food intolerance are going to be GI symptoms. It's like gas or bloating, abdominal pain. And it's usually less serious. It's a slower onset too. So a food intolerance can even be in 48 hours whereas a food allergy usually happens almost immediately and certainly within a couple hours.

So, there's a lot of differences. An example of an intolerance would be like lactose or gluten. For lactose intolerance, it's not that immune response. So you can drink milk that doesn't have lactose, that's lactose free, or you could take like Lactaid, that would be something to help you digest the milk. So it's a digestion problem, not that real food allergy like if you have a true milk allergy,

Melanie: Well, thank you for that very important distinction. So what foods are we talking about? I mean, we've heard over the years about obviously peanuts and now that goes back and forth. It seems like some of the foods that we hear about for food allergies are very severe and some of them, there's all these exciting treatments. So tell us about what foods most commonly would come up as a food allergy.

Anne Borgmeyer: A good question, because any food can really be an allergy. I can remember a long time ago before I really knew about food allergies, someone I knew said they had an allergy to onions. And I said, "Oh, nobody's allergic to onions." Well, no, people can be allergic to onions. People can be allergic to anything.

But there's really eight foods that are the most common for children. And so it's milk, eggs, soy, wheat, peanuts, fish, tree nuts and shellfish. So those eight foods really account for 90% of food allergies. So that's pretty remarkable. So where you can have other foods, the most common are those eight.

Melanie: So then you told us a little bit about some symptoms of bloating and that sort of thing when you were telling about the differences between an allergy and an intolerance. If for parents, especially new parents that are feeding their children new foods, and this can be a very scary time, but also a pretty exciting and cool time for parents, I remember it well. So, signs and symptoms. What are we looking for when we're feeding our child scrambled eggs for the first time? Or we're feeding them whole milk or any of these things, what are we looking for, Anne?

Anne Borgmeyer: So, really the symptoms you look for food allergy can be various systems. So you could really have mouth symptoms. You could have itchy mouth or swelling of your tongue or lips. You can have throat symptoms where it's itchy or tightness or closure, a hoarseness or trouble breathing or swallowing.

So for babies, that one might be a little bit harder, right? Because as new eaters, sometimes there's a little coordination of eating involved there too. So that one might be a little tricky and certainly infants can't tell you that they're feeling anything in their throat or their mouth other than that they react to it, they cry, it makes them feel bad.

Skin symptoms. So you can begin to have a rash. And, you know, babies have lots of rashes, but if you're feeding a baby a new food and they develop a rash on their cheeks, around their mouth, that would be something to kind of take note of. But rashes with food allergies can get very, very severe. It can be hives all over if you were looking at a really severe reaction,

And then we did talk about those kind of gut reactions, the vomiting or the diarrhea. Lung reactions can happen with foods too, where you would act short of breath. You could have a cough or a repetitive cough. Heart reactions, we're talking about severe reactions usually. It's when all of a sudden there's paleness or even blueness or the child looks like they're going to pass out or seems like they've gotten weak. And then there are neurological symptoms that are probably more important in older kids. Older kids will even tell you this impending feeling of doom or they'll have a drastic change in their mood or their alertness. So even babies, I guess, could do that. So there's a whole range of symptoms going from mild to severe.

One thing with babies, I think, is when you start any food, not even those eight foods, when you start a food that you started in small amounts and that you give it over a period of a few days, that you start the food and you give the same food and you give the same food and you give the same food.

So let's say you're starting, I don't know, peas. Let's say just peas. You're starting peas, that you give the peas several days, even a week in a row so that you can see if there's anything that happens, if they do have diarrhea with that food, if they do develop that rash. So introduction of foods kind of slowly, one at a time, a single food, it's really a good idea to give that single food so maybe what they're reacting to. And give them a chance to get used to the consistency and the taste, because in the beginning they may act like they just don't like it, whereas after a day or two of giving the same food, they begin to appreciate the taste, the consistency, they're doing better with it.

So any food, start slow. Give it a few days in a row. And if you see a reaction, stop. You should always check with your healthcare provider. But remember, for most of these foods, fruits and vegetables especially, the chance of her reaction is very low to those foods. They may notice that they don't tolerate it, but the chance of having a big reaction is very, very, very low.

Melanie: Well, thank you for all of that information. Now, I'd really like to talk about what treatments are available for parents. And while you're telling us about how you're working with these children that have some of these severe food allergies, I'd like you to briefly touch on anaphylaxis. And for parents that do have this very scary situation because they eventually are sending their kids to school or camp and we hear about EpiPens and things that they might need in case they come into contact with some of these foods that they have that severe allergic reaction to. So while you're telling us some of the exciting treatments, what you do, how you work with the children, tell us a little bit about how also parents can deal with the allergic reaction itself.

Anne Borgmeyer: So it's really important to talk about how you treat food allergy. You'll hear me say this several times in this conversation, because the food allergy and anaphylaxis emergency care plan is crucial. It's crucial for everybody with a food allergy. It guides you through what to look for and what to do for your child. It guides you what to look for and what to do when your child has a food reaction. So there are many different styles of food allergy and anaphylaxis emergency care plans.

At Children's Hospital, we have a website called FAME. It's the Food Allergy Management Education website. On that website, there's links to several different emergency care plans for food allergy. Your primary care provider or your specialist may have a certain plan that they like to use. But having that plan is crucial. It's important that everybody who cares for your child knows what to look for and what to do.

So having epinephrine available, every child with food allergy should have epinephrine available. It is the one thing that will reverse food allergy. So we've talked about that you can have any variety of symptoms from mild to severe with anaphylaxis being the most severe, and you can even have fatality. So it is the EpiPen, it's the epinephrine, that is going to prevent that, to reverse that, and it's the only thing that will help.

So sometimes you see anti-histamines incorporated in an emergency care plan. And that might be advised by your care provider for a mild reaction. It will not reverse anaphylaxis, only epinephrine. And then knowing how to use your EpiPen is crucial. So there are many online sites that will guide you through that. The emergency care plan even has directions because there's various styles of epinephrine pens. There's some auto-injectors. There's EpiPens. They're made by different companies, but they all have epinephrine and they're all dosed perfectly for the size of your child. So on the emergency care plan, on the reverse side of it, it even gives you the how-to to use various epinephrine injectors. And so that's important.

And then avoidance, if we don't live with food allergy, I don't think you realize what parents deal with if their child has to strictly avoid one of these foods that are so common. So if you're avoiding milk, if you're avoiding wheat, you have to be a really good food label-reader. And that sounds like, "Oh, who can't read a label." It is very difficult.

On the children's website, they give you tips of other names of foods to look for. Like, if you're allergic to milk, there's probably 50 different names of milk that you need to avoid as you read that label. So we all know that some of those common foods, the FDA has labeling that's necessary for those common foods, if they're included in food, but you have to read it every time.

Food packaging changes, the foods themselves change. Just because you've always given your child X Brand of crackers, doesn't mean that if you go to the store and buy a new box of those crackers, you don't have to read that label again. You have to read it each and every time.

If your child goes to school or camp, the school or camp needs to have all the tools to take care of your child. They need to know what foods to avoid, what medicine to have on hand. They need a copy of your food allergy and anaphylaxis emergency care plan, so that they can put into action what your child needs.

And then calling 911, so you cannot just give epinephrine and sit at home. You give epinephrine and you call 911. Whether they're at camp, at school, at home, at grandma's, it doesn't matter. So once you give that medicine, you just can't sit back and relax. You need to call 911 so that you have the emergency personnel there. Sometimes it's not just one dose of epinephrine that can reverse the symptoms. Sometimes multiple doses are needed or sometimes other treatments are needed and you need the emergency personnel there.

So, as far as treatment, I think there's some really exciting things happening with food allergy. One thing that as you're starting to feed your child, talk with your primary care provider or your specialist about early introduction of foods, especially if there's a history in your family of allergy, so that you get some guidance. We used to say hold off on introducing some of these allergic foods, and now we're saying, go for it early. And so talk with your doctor or nurse practitioner about when you should start foods and how you should start them.

The other thing is there's some really exciting things with peanut allergy. There are some ways of doing some immunotherapy to prevent serious reactions, to allow children to eat a little bit more of the food. But again, it's something you would only do in conjunction with your provider. So talk to your provider about those things that are new and upcoming.

The other thing is there's so many resources that I know people that are dealing with food allergy need. So here in St. Louis, Children's Hospital has a great that FAME site online. There's the Asthma and Allergy Foundation right here in St. Louis that can help. There is also the FARE, F-A-R-E. That site is just tremendous with giving you education as well as tools as well as things like getting your child ready for camp or ready for school. The Quad AI, American Academy of Allergy Asthma and Immunology, another great site.

Make sure you're looking at reliable sites. And again, talk with your provider. So having a specialist, if your child has food allergy, is key and I'm sure your primary care provider is going to give you a good referral to somebody who's just excellent at taking care of children with food allergy.

Melanie: What a great episode, so informative. And while you have packed a lot of information for parents, thank you so much for sharing your incredible expertise for other parents today. And that concludes this episode of Mom Docs with St. Louis Children's Hospital. For more advice and articles, check out the Mom Docs website at childrensmd.org.

Please also remember to subscribe, rate and review this podcast and all the other St. Louis Children's Mom Docs podcasts. Share this show with your friends and family on your social channels, because we're learning from the experts at St. Louis Children's Hospital together. And I'm sure you know somebody with food allergies. This was a great episode. I'm Melanie Cole. Thanks so much for listening.