How Do I Address My Child’s Food Intolerances or Allergies? - Canadian Digestive Health Foundation (2024)

When it comes to childhood nutrition, understanding and managing food allergies and intolerances is essential for parents and caregivers alike. Plus, with the prevalence of these conditions on the rise, it’s crucial to understand the differences between them so they can be appropriately treated.

Read on to learn about the key differences between children’s food allergies and food intolerances, plus tips for managing both conditions.

What is a Food Allergy?

A food allergy is when the immune system mistakenly sees a particular food as dangerous or harmful and triggers an allergic reaction. 

There are two types of food allergy: Immunoglobulin E (IgE) mediated and non-IgE mediated. 

IgE-mediated allergies are symptoms that result from the body’s making IgE antibodies in response to a food protein. They cause severe allergic reactions that can be life-threatening if not treated quickly and appropriately with epinephrine (e.g., EpiPen).

No one knows why people develop IgE-mediated food allergies. In addition, there is no known cure, and the food that causes the allergy must be completely avoided to prevent anaphylaxis from occurring.

Non-IgE-mediated food allergies occur when other parts of the immune system react to a certain food. Symptoms often involve the digestive tract, including vomiting and diarrhea. Unlike IgE-mediated allergies, non-IgE-mediated allergies are not life-threatening. Generally, the best way to treat these allergies is to avoid the food that causes them.

What are the Top Food Allergens in Canada?

Health Canada has a list of priority food allergens. These foods are associated with 90% of allergic reactions and include:

• Shellfish
• Egg
• Fish
• Milk
• Mustard
• Peanut
• Sesame
• Soy
• Tree nuts
• Wheat and triticale

Are Food Allergies More Common in Children?

Age is a risk factor for food allergies, with food allergies being more common in young children than older children and adults. Notably, it’s estimated that around 4% of children worldwide have food allergies, compared to just 1% of adults.

Common Symptoms of Food Allergies in Kids

Typically, symptoms will occur within minutes of eating a food your child is allergic to. However, they can sometimes arise several hours after exposure to the allergen. Symptoms may start as mild and worsen quickly. 

Symptoms of anaphylaxis can include:

• Skin: Hives, swelling, redness, itching.
• Breathing: Coughing, shortness of breath, wheezing, throat and chest tightness, runny and itchy nose and eyes, trouble swallowing.
• Gastrointestinal: Nausea, vomiting, diarrhea, cramps, light-headedness.
• Other: Anxiety, headache, metallic taste.

It’s important to note that while anaphylaxis typically involves at least two of the above body systems, a drop in blood pressure alone can also indicate anaphylaxis.

In addition to the above symptoms, an allergic reaction can also lead to a change in the sound of a child’s cry, uncontrolled passing of stool or urine, spitting up, drooling, and behaviour changes (like irritability, becoming very sleepy, or appearing frightened) in extremely young children under two years of age. 

What to do if you Suspect your Child has a Food Allergy

If you suspect your child has a food allergy, it’s important to visit their doctor for a referral to an allergist. The allergist will take a patient history, asking about when the suspected reaction occurred, how long it lasted, how it was treated, and whether other family members have allergies. They will then typically do skin prick and blood tests to determine what your child is allergic to.

Kid-Friendly Food Swaps for Common Allergens

When your child has an allergy, they will need to avoid the food they’re allergic to. Here are some kid-friendly food swaps for common allergens:

• Dairy: Switch cow’s milk for plant-based milk, such as almond, soy, oat, coconut, or rice milk. Be sure to choose plant-based milks that are fortified with calcium and vitamin D. In addition, be mindful that only soy milk contains a comparable amount of protein to cow’s milk. If you’re using other plant-based milks, try to include a source of protein as well. Use dairy-free cheese alternatives made from soy, almonds, or cashews. Use yogurt alternatives such as coconut milk yogurt or soy yogurt.
• Eggs: When baking, use mashed bananas or applesauce as a binding agent. Tofu can also be used in place of eggs in dishes like scrambles or quiches.
• Wheat/Gluten: Use gluten-free flour blends for baking. Substitute wheat pasta with gluten-free alternatives like quinoa or chickpea pasta. Use lettuce leaves or gluten-free wraps instead of traditional wheat wraps.
• Peanuts: Swap peanut butter for alternatives like almond, cashew, sunflower seed, or soy nut butter. Choose snacks made with seeds like sunflower and pumpkin seeds instead of peanuts. When choosing nut and seed snacks to replace peanuts, ensure they have been produced in a peanut-free facility to avoid cross-contamination.
• Tree Nuts: Opt for seed butter or soy nut butter and use seeds like sunflower, pumpkin, or sesame seeds in recipes.
• Soy: Use coconut aminos instead of soy sauce. Replace tofu with chickpeas or other beans in stir-fries and salads.
• Fish/Shellfish: Use other protein sources like chicken, turkey, lean pork or beef, tofu, beans, and lentils in recipes.

Dining Out with a Child that has a Severe Food Allergy

Dining out can be stressful if your child has a severe food allergy. Here are some tips to make dining out safer and less stressful:

• Research the restaurant before you go so you can see whether it offers allergen-friendly options or has a good reputation for accommodating food allergies.
• Call ahead to discuss your child’s allergies with the restaurant staff. Also, ask if they can accommodate your child’s needs and procedures for preparing allergen-free meals.
• Plan to eat out at less busy times so the kitchen staff will have more time to discuss and prepare your child’s food.
• Bring a card listing your child’s specific allergies. After discussing the allergy with the restaurant staff, you can have the staff give the card to the chef.
• Be cautious with buffets and salad bars, as the risk for cross-contamination is high.
• Always carry your child’s emergency medication, such as epinephrine auto-injectors (EpiPen), in case of accidental exposure.

Using the above preparation steps, you can make your child’s dining-out experience as smooth and safe as possible. 

Can a Child Outgrow a Food Allergy?

According to the Canadian Paediatric Society, your child may outgrow their food allergy, especially if it started before they turned three. For example, milk allergies usually go away as your child gets older. However, allergies to nuts and fish usually don’t go away.

What is a Food Intolerance?

Food intolerance differs from food allergy because it doesn’t involve the immune system. When you have a food intolerance, your digestive system cannot digest certain foods, leading to uncomfortable digestive symptoms. While inconvenient, a food intolerance is not life-threatening like food allergies can be.

An example of a common food intolerance is lactose intolerance. People with lactose intolerance don’t produce enough of the enzyme needed to break down the lactose found in dairy products. The lactose enters the large intestine undigested, where it pulls water into the bowel and is fermented by the gut bacteria. This leads to the characteristic gas, bloating, and diarrhea associated with lactose intolerance. 

Other common food intolerances include gluten, histamine, caffeine, sulphites, salicylates, monosodium glutamate (MSG) and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). Irritable bowel syndrome (IBS) is thought to be due in part to a FODMAP intolerance.

What are the Symptoms of Food Intolerance?

Symptoms of food intolerance typically arise a few hours after consuming certain foods and can include:

• Abdominal pain
• Diarrhea
• Gas and bloating
• Nausea
• Skin rashes and itching

The symptoms of food intolerance are typically dose-dependent. Therefore, the more of the food consumed, the worse the symptoms. 

Can Children Have Food Intolerance?

Food intolerances can occur in children, with one study in Switzerland indicating that 16% of participants aged between 1 month and 18 years avoided foods due to intolerance. Overall, lactose intolerance was found to be the most frequent intolerance reported.

What do I do if my Child has a Food Intolerance?

If your child has a food intolerance, it’s important to determine which foods they’re intolerant to. This can be achieved by keeping a food and symptom diary and using trial and error. By looking at what your child ate before they developed symptoms, you may be able to pinpoint which foods they’re intolerant to.

In addition, your child may need to trial an elimination diet to determine food triggers. On an elimination diet, the foods suspected of causing symptoms are eliminated for a set period (e.g., two weeks). Then, the suspected foods are added back to their diet one at a time. If your child develops symptoms after adding a food back, they’re likely intolerant.

Working with your child’s healthcare provider and a registered dietitian is extremely important if your child is following an elimination diet. Elimination diets increase the risk of malnutrition and may also activate eating disorders in susceptible children. This can occur when a child develops a fear of food that causes negative symptoms. Working with a healthcare provider who can screen for malnutrition and eating disorder risk is important for ensuring an elimination diet doesn’t do more harm than good.

The most common treatment for food intolerance is avoiding the food your child is intolerant to. For example, if your child is lactose intolerant, they will need to eat lactose-free dairy or use over-the-counter lactase enzymes when consuming dairy with lactose in it. If your child has several food intolerances, working with a registered dietitian is key to ensuring they meet their nutrient requirements. 

Are Food Intolerance Tests Accurate?

Tests are available for certain food intolerances, such as lactose intolerance. The most common lactose intolerance test is the hydrogen breath test. This test measures the hydrogen gas content of your breath before and after drinking a lactose-containing liquid. An increased level of hydrogen usually means you have lactose intolerance.

Many of the other food intolerance tests available are not accurate. Food-specific immunoglobulin G (IgG) testing is becoming increasingly popular for identifying food intolerances. However, this test has yet to be validated or supported by research. 

Your body normally produces IgG in response to exposure to food, which means a positive IgG result is expected in healthy people. If you consume a food often, you will have high IgG levels for that food. Therefore, the long list of food “intolerances” these tests give you is inaccurate and can lead to unnecessary dietary restrictions.

The Canadian Society of Allergy and Clinical Immunology released a statement discouraging the use of IgG testing to identify food intolerances. As a result, the best way to identify food intolerances is through trial and error or an elimination diet.

Do Food Intolerances Ever Go Away?

Some food intolerances, such as FODMAP intolerance in people with IBS, can change over time. For this reason, it’s a good idea to re-test foods your child has been avoiding occasionally to see if their tolerance has changed. You may find that their tolerance to certain foods improves as your child gets older.

To Wrap Up

All in all, while food allergies involve the immune system and can be fatal, food intolerances involve the digestive system and, while unpleasant, are not life-threatening. If your child has a food allergy, it’s important to completely avoid the food they’re allergic to and carry an EpiPen in case they’re accidentally exposed.

If your child has a food intolerance, they may be able to tolerate small portions of the food they’re intolerant to. Food intolerance is dose-dependent, with symptoms worsening with increased portion sizes. While avoiding the food they’re intolerant to is the best way to treat a food intolerance, it’s important to re-test tolerance occasionally, as tolerance can change over time.

Whether your child has a food allergy or food intolerance, it’s important to work with a healthcare provider like a registered dietitian to ensure they get the nutrition they need to grow and thrive while avoiding the foods that make them sick.

References

1. Food Allergy Research & Education (n.d.). Facts and Statistics. Retrieved May 3, 2024, from https://www.foodallergy.org/resources/facts-and-statistics

2. Food Allergy Canada (n.d.). What is food allergy? Retrieved May 1, 2024, from https://foodallergycanada.ca/food-allergy-basics/food-allergies-101/what-are-food-allergies/

3. Food Allergy Canada (n.d.). Priority food allergens. Retrieved May 1, 2024, from https://foodallergycanada.ca/food-allergy-basics/food-allergies-101/what-are-food-allergies/priority-food-allergens/

4. Elghoudi, A., & Narchi, H. (2022). Food allergy in children—The current status and the way forward. World Journal of Clinical Pediatrics, 11(3), 253-269. 

5. https://doi.org/10.5409/wjcp.v11.i3.253 

6. Food Allergy Canada (n.d.). Reaction signs and symptoms. Retrieved May 1, 2024, from https://foodallergycanada.ca/food-allergy-basics/preventing-and-treating-allergic-reactions/reaction-signs-and-symptoms/

7. Canadian Paediatric Society (n.d.). Food allergy vs. Food intolerance: What is the difference and can I prevent them? Caring for Kids. Retrieved May 1, 2024, from https://caringforkids.cps.ca/handouts/healthy-living/food_allergies_and_intolerances

8. Harvard Medical School (2020, January 30). Food allergy, intolerance, or sensitivity: What’s the difference, and why does it matter? Harvard Health Publishing. Retrieved May 1, 2024, from https://www.health.harvard.edu/blog/food-allergy-intolerance-or-sensitivity-whats-the-difference-and-why-does-it-matter-2020013018736

9. Cleveland Clinic (2021, August 11). Food Intolerance. Retrieved May 2, 2024, from https://my.clevelandclinic.org/health/diseases/21688-food-intolerance 

10. Canadian Digestive Health Foundation (2022, December 1). What is a Food Intolerance? Retrieved May 2, 2024, from https://cdhf.ca/en/what-is-a-food-intolerance/ 

11. NHS (2022, November 25). Food intolerance. Retrieved May 2, 2024, from https://www.nhs.uk/conditions/food-intolerance/ 

12. Gargano, D., Appanna, R., Santonicola, A., De Bartolomeis, F., Stellato, C., Cianferoni, A., Casolaro, V., & Iovino, P. (2021). Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns. Nutrients, 13(5), 1638. https://doi.org/10.3390/nu13051638 

13. Légeret, C., Lohmann, C., Furlano, R. I., & Köhler, H. (2023). Food intolerances in children and adolescents in Switzerland. European Journal of Pediatrics, 182(2), 867-875. https://doi.org/10.1007/s00431-022-04755-7 

14. Children’s Hospital of Philadelphia (n.d.). Food Intolerance. Retrieved May 2, 2024, from https://www.chop.edu/conditions-diseases/food-intolerance

15. Bora, S., & Rindfleisch, J. A. (2018). Integrative Medicine (4th ed., pp. 849-862e6). Elsevier. https://doi.org/10.1016/B978-0-323-35868-2.00086-4 

16. NIH National Library of Medicine (n.d.). Lactose Tolerance Tests. Medline Plus. Retrieved May 2, 2024, from https://medlineplus.gov/lab-tests/lactose-tolerance-tests/ 

17. Abrams, E. M., & Sicherer, S. H. (2016). Diagnosis and management of food allergy. CMAJ : Canadian Medical Association Journal, 188(15), 1087-1093. https://doi.org/10.1503/cmaj.160124

18. Carr, S., Chan, E., Lavine, E., & Moote, W. (2012). CSACI Position statement on the testing of food-specific IgG. Allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology, 8(1), 12. https://doi.org/10.1186/1710-1492-8-12

19. Hill, P., Muir, J. G., & Gibson, P. R. (2017). Controversies and Recent Developments of the Low-FODMAP Diet. Gastroenterology & Hepatology, 13(1), 36-45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390324/