A Nutty Question

This year at my child's preschool, there are several children with severe nut allergies. It seems like more and more kids have these allergies. How come-and is there anything parents can do to protect their kids from developing one?

Another great question and one I get all the time from my own patients. We recommend that women with allergies stay away from highly allergenic foods, like peanuts, while they're pregnant. Taking preventive steps during breast-feeding may be even more helpful: We recommend that nursing moms stay away from peanuts, tree nuts, and shellfish, but they should not avoid milk and eggs, since both contain vital nutrients. Breast milk has a protective effect on a baby's immune system.

If there are no allergies in the family, wait until your child is 2 before introducing allergy-causing foods. If one of the parents, especially the mother, has any sort of allergy, then doctors suggest avoiding peanut butter until age 3. This may determine whether a child develops a lifelong peanut allergy or not.

The major strategy for preventing food allergies is to delay exposure to potentially allergenic foods and liquids, since newborn infants may be more likely to become allergic to foods than older infants. Infants should not be fed solid foods until they are six months old. When infants are six to 12 months old, vegetables, rice, meat, and fruit can be introduced to their diets. Each food should be introduced one at a time so parents can identify and eliminate any foods that cause a reaction. After the child is one year old, milk, wheat, corn, citrus, and soy may be added. At two years of age, the child may have eggs.

Elimination of a particular food can be tricky. For example, a spatula used to serve cookies both with and without peanut butter can contaminate the peanut-free cookie with enough protein to cause a reaction. Similarly, contamination can occur when chocolate candies without peanuts are processed on the same equipment used for making peanut-containing candy. Hidden ingredients can also cause a problem. For example, egg white may be used to glaze pretzels, or peanut butter may be used to seal the ends of egg rolls.

The Food Allergy Network (telephone: 1-800-929-4040) is a organization that provides educational materials to assist families, physicians and schools in the difficult task of eliminating allergenic foods and in approaching the treatment of accidental ingestions. When multiple foods are eliminated from the diet, it is prudent to enlist the aid of a dietitian in formulating a nutritionally balanced diet.

Fortunately, young children often lose their sensitivity to most of the common allergenic foods (egg, milk, wheat, soy) in a few years, particularly with avoidance of the foods. Serial diagnostic food challenges over time are often helpful in managing these food-allergic children. Unfortunately, sensitivity to certain foods, such as peanuts, tree nuts, fish and shellfish persists into adulthood in the majority of cases.