Food allergies are a growing concern in the United States, with an estimated 8% of children, or two students per classroom, have food allergies, according to the Centers for Disease Control and Prevention. Since there is no cure for food allergies, it’s important for parents to understand what they are, how to avoid allergic reactions and how to keep their child safe. Allison Hicks, MD, an allergy and immunology specialist, and Jane Robinson, PhD, a clinical pediatric psychologist, answer common questions about food allergies.

Understanding food allergies and sensitivities

What is a food allergy?

A food allergy is an immune response. The immune system sees a certain food (allergen) as harmful and reacts by causing symptoms. Symptoms of food allergies in kids include:

• Itching of the mouth and throat
• Throat tightness
• Nausea
• Vomiting
• Abdominal pain
• Sneezing
• Wheezing
• Itchy skin
• Hives
• In rare cases, death

In the U.S., the eight most common food allergens are milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish. 

Food allergies are repeatable, which means they happen every time the child eats a specific food. Allergic reactions happen very quickly, but prompt treatment will relieve symptoms within a few hours. Taking proper precautions and having a plan of action can help you effectively manage this chronic condition.

What is food intolerance or sensitivity?

Food sensitivities or intolerances are not immune responses. Instead, they are related to how your digestive system processes certain foods. While intolerances can be uncomfortable, they are not life-threatening. The symptoms are often delayed and can appear several hours after eating. Symptoms of food intolerance can include bloating, gas, stomach cramps, diarrhea, fatigue or headaches. 

Introducing allergenic foods

Dr. Hicks says introducing allergenic foods early and regularly can prevent the development of food allergies. She recommends introducing foods, such as peanuts like in thinned out peanut butter and eggs, to babies when they are between 4 and 6 months old.

Check with your child’s primary care doctor about introducing milk, wheat, soy, tree nuts, fish and shellfish. There is limited information about how these allergies develop.

Start by introducing one food at a time. That way, it’s easier to tie a reaction to a specific food. Allergenic foods can be introduced two to three days apart.  There isn’t a particular timeline for the introduction of other foods.

When you give new food, you don’t need to eliminate the other foods your baby is eating because you already know those foods are safe.

How to identify the problem

How are food allergies diagnosed?

Doctors diagnose a food allergy by gathering information about your child’s history of eating certain foods. They perform tests to help establish trends and confirm allergies, which may include skin and blood tests.

Dr. Hicks does not recommend using any at-home food allergy or sensitivity tests. These tests are not FDA-approved, and they do not follow the evidence-based testing methods used in a hospital or lab.

“If your child may have a food allergy, we advise families not to try testing at home,” Dr. Hicks says. “At-home testing carries risks because we don’t know how severe the allergy may be. Instead, contact your primary care physician. They may refer you to an allergist for specialized testing.”

If you believe your child has a food allergy, contact your primary care physician. They can refer you to an allergist at the Allergy and Immunology Center.

What is a food challenge?

A food challenge can diagnose or rule out food allergies. During a challenge, your child slowly consumes a small amount of potential food allergen under medical supervision. At Children’s Colorado, we have the largest dedicated Food Challenge and Research Unit in the country.

Dr. Hicks says children and families benefit from testing food allergies in a low-stress environment. Even if the child has a reaction, the doctors and nurses can intervene immediately. Witnessing a reaction in a controlled environment can help relieve anxiety around severe reactions.

What is an elimination diet?

An elimination diet removes foods to help identify foods that may be causing symptoms of food intolerance. The first step of this process is removing potential problem foods for a period of time. Then, you gradually reintroduce the foods one by one to determine which one is causing the symptoms. It’s important for your child’s doctor or a registered dietitian to guide you through this process to ensure they’re getting appropriate nutrients.

After a diagnosis

What can I expect after my child is diagnosed with a food allergy?

After receiving a food allergy diagnosis, you’ll meet with a dietician and talk about managing your child’s diet safely. Next, you’ll create a food allergy action plan. You can expect yearly follow-ups, as some children may outgrow their allergies over time.

What is a food allergy action plan?

A food allergy action plan is a guide to help you respond in case of an allergic reaction. This tool is personalized to your child’s specific allergies. You should give this to all your child’s caretakers, school nurses and teachers. Include the following information:

• Foods that should be avoided
• Possible symptoms
• Medicines and the dose to give based on symptoms
• Emergency contact information (physician and parents/guardians)

Long-term allergy care

What are the treatment options?

The best way to manage food allergies is to strictly avoid the problem foods. There are some newer treatment options, such as oral and injectable immunotherapies, that help desensitize patients to allergies. This is a long-term care strategy that often takes months to complete.

Children’s Colorado is conducting clinical trials for epicutaneous (under the skin) and sublingual (under the tongue) immunotherapies. Still, there is no cure for allergies. These treatments lower the chance of a severe reaction in case of accidental exposure.

What is an EpiPen?

EpiPen is the brand name for a drug that injects a dose of epinephrine, a medicine that treats anaphylaxis (severe allergic reaction). Anyone can use this medication, which is injected into the outer thigh.

When should I administer an EpiPen?

Use the EpiPen if your child is having trouble breathing or two or more body parts are affected. For example, if a child has hives and vomits, the skin and the digestive system are affected.

“In general, it’s better to use the EpiPen when in doubt,” Dr. Hicks says. “It’s a very safe medicine and it’s out of the body relatively quickly.”

Will I need to alert the school about my child’s allergy?

Yes. Discuss your child’s allergy with their teacher as soon as possible and talk about how to create a safe environment in the classroom. You can also request a 504 plan, which provides support for students with disabilities and chronic health conditions. As a parent, one of the most important things you may do is advocate for your child’s physical and emotional well-being.

“We want everyone to be aware, and each school is a little different,” says Dr. Robinson. “The 504 plan includes whatever the school and parent agrees to. For example, if there’s a young kid with a peanut allergy, maybe that kid sits in the same spot for lunch every day.”

Managing the family’s well-being

How do I help my family navigate this new normal?

Learning your child has a food allergy can feel overwhelming, but you are not alone. And this new normal doesn’t have to define or limit your child’s life. The key is to help your child build a foundation of knowledge, skills and routines that promote safety and independence over time.

As you add new family rules around foods and allergies, it’s important to let everyone in your family know. The more people who are aware of the allergy, the safer your child will be. 

For other kids in the home, it’s important to recognize their feelings about their sibling’s food allergy. They might be mad that you don't keep peanut butter in the house or don't eat at a certain restaurant. Sometimes they might feel left out.

Model flexible problem solving by trying alternative products such as coconut milk (for a dairy allergy) or packaged, frozen peanut butter and jelly sandwiches (for a peanut allergy). You could also have one parent take just that sibling to the restaurant of their choice for a special meal.

How do I help ease anxiety around food allergies? 

"For some families, learning your child has a food allergy can be extremely anxiety-provoking," Dr. Robinson says. “If you’re feeling anxious, your child may feel anxious as well. Try to maintain composure and model positive coping skills.”

Thankfully, this stress usually decreases with time. For example, if you’re going to a new restaurant, look up the menu online. Are there allergy-free options? Alert your server about your child’s allergies and their severity before ordering. If you don’t trust the restaurant will take the proper precautions, it’s okay to walk out.

Dr. Robinson says there’s a healthy balance between being overly worried and not being worried enough. She encourages families to work with their child’s allergist to create a care plan. At the Allergy and Immunology Center, Dr. Robinson and the team work with families to help them address the root causes of anxiety.

How do I keep my child safe without disrupting their development?

In most cases, your child will be able to have a safe, healthy life, even with allergies.

“Parents need to put some bumpers in place but also approach it as something that won’t disturb your lives too much,” Dr. Robinson says.

Early on, you’ll play a larger role in managing your child’s allergies. But the ultimate goal, Dr. Robinson says, is to allow them to manage their allergies on their own. Parents can assess their child's ability to manage their allergy based on three questions:

• Can they be responsible for having their medication available at all times?
• Can they assess their own symptoms and tell someone if needed?
• Can they self-administer their auto injector (i.e. EpiPen)?

Helping children feel safe and capable is just as important as managing risks. However, as children become teenagers, new challenges often emerge that require parents to adjust their approach.

“Teens are growing and separating, so the parents aren’t around them as much,” Dr. Robinson says. “Parents need to make sure that their child has their EpiPen and knows what to do with it.”

Ultimately, long-term allergy care is about balancing awareness with empowerment, giving children the tools to live confidently.