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Food Allergies and Anaphylaxis in Newborns

This week is anaphylaxis awareness week! People of ages can have allergies and even allergies that cause the person to have an anaphylactic reaction.

When babies are born- they are the most beautiful things in the world. Their skin is soft and smooth- a magnificent representation of the miracle of life. Within a few days, their skin can develop a red rash, white spots, or other imperfections, which is the normal development of the body’s exposure to the world. So how does a parent know when normal skin defects cross over to allergies? Can a newborn baby develop food allergies? And if a parent suspects something is amiss, what are the first steps they should take?

 

Eczema/Skin Rash

Babies are born with susceptible skin, making them more likely than adults to develop some skin rash. Simply using the wrong body wash or not drying the crevices under a baby’s chin or arms is enough for them to develop a rash.

Eczema is one of the most common skin conditions in babies. Although there are different types of eczema, atopic eczema is most likely to affect babies and small children. Symptoms of an eczema rash are; tiny red bumps, scaly or dry skin. Babies younger than 6 months tend to develop the rash on the scalp, face, and forehead, while infants ages 6 months to 1 year are more likely to rash on the knees and elbows.

 

Food allergies in babies

“According to the American Academy of Allergy, Asthma & Immunology, about 6 percent of children aged 2 and under have food allergies.”

Although considered rare, babies can have allergic reactions to foods before they start eating them. This happens when they develop a food allergy to the foods the person breastfeeding them eats.

Babies are most likely to be allergic to:

  • Milk/dairy products
  • Peanuts
  • Shellfish

Once they start eating solid food (6 months and up), they may start showing symptoms of additional allergies.

 

Symptoms:

Signs of a food allergy fall under 3 areas: Skin reactions, respiratory or intestinal symptoms. Some of the main symptoms are:

  • Hives (which can develop anywhere on the body and are often found in clusters)
  • itching
  • coughing
  • vomiting
  • diarrhea
  • blood in the stool

What to do for a suspected food allergy in a baby?

If you suspect your baby is having a (mild) allergic reaction to something, you’re eating while breasting them. There are several steps you should consider.

  1. Try to eliminate the top 3 foods that babies can be allergic to (listed above) from your diet and watch if you see any improvements. Bear in mind. It may take over a month to see any noticeable changes.
  2. If you cannot pinpoint the foods causing the problem after an elimination diet, consider keeping a food diary to determine the underlying cause effectively. Hopefully, you’ll notice a pattern emerge as you have more data to work with.
  3. After you have identified the allergen, avoiding eating the food while breastfeeding could solve the problem. However, it's best to speak to your doctor before making any long-term changes to your diet while breastfeeding. The good news is that many babies outgrow their food allergies by their first birthday.

When to go to a Doctor?

If any of the symptoms you are seeing (rash, bad diaper) spreads or worsen over time- consult a doctor. Also, seek medical advice if the skin begins to show signs of an infection such as; bleeding, blistering, or mucus.

Other symptoms to see a doctor for are:

  • Fever
  • Lethargy
  • Poor feeding
  • Coughing
  • Excessive crying

Anaphylaxis in babies

Anaphylaxis, although rare in babies- can be fatal. It is often difficult to diagnose a severe food allergy in babies for 2 reasons. Firstly, they cannot communicate subjective symptoms such as itching, and secondly, some signs of anaphylaxis such as regurgitation and loose stools also occur in healthy babies. Other symptoms include; swelling of the lips or tongue or trouble breathing. If you notice any of these symptoms, call your local emergency services immediately. Don’t try to make your child vomit- it won’t help and will only make the situation worse. Lay the baby flat on their back until help arrives. If the child is having trouble breathing, hold the baby in an upright position to help them breathe better.

The paramedics will most likely administer a shot of adrenaline as soon as possible. Depending on how big the baby is, it will either be administered via a standard syringe (7.5kg or less) or an auto-injector (7.5kg or more.) The paramedics may also give the baby antihistamines to help with other symptoms. Even after the baby is stabilized- the doctors will want to keep a close eye on it- usually about 6-12 hours to ensure they will have a complete recovery. While in hospital, you may be offered a blood test to confirm the symptoms resulting from anaphylaxis and not something else.

Make an appointment to see a specialist as soon as possible after a reaction to discuss your options, create an emergency plan, and work on a protection strategy. Feel free not only to discuss the technical details with your doctor but also your emotional state. It is important not to neglect your emotional needs at what is bound to be a terrifying time in your life. However, your doctor may refer you to a professional with better expertise in that area to help you.

Testing for food allergies in babies

While there are various options available for testing for food allergies for children and adults regarding babies, the situation becomes more complicated. Medical professionals are divided on allergy testing in young infants is often not reliable, so their advice may vary. There are 2 types of skin tests- percutaneous and intradermal. Although they vary slightly in the methods they are administered, both are generally considered safe and relatively accurate- although percutaneous testing is rarely conducted on infants younger than 6 months old.

Is there a higher risk for food allergies in an infant if a parent or sibling has one?

For a baby, having an older sibling or parent with a food allergy “certainly increases the risk, but probably not by a very substantial amount,” Dr. Keet said. Australia’s recent guidelines, for instance, don’t recommend pre-emptive screening of these high-risk groups at all.” 

Doctors refrain from pre-screening before symptoms are seen of a possible food allergy as allergy tests can only indicate if the body produces antibodies against an allergen, but which doesn’t necessarily mean the child has a real food allergy. If a positive test is inaccurately used to diagnose a food allergy and the food is removed from the child and the mother’s diet (when breastfeeding), it’s not just unnecessary. Still, doctors now believe could cause an allergy to develop.

“That is absolutely heartbreaking because that is now a medical professional absolutely causing harm to somebody else and creating an allergy that did not exist before,” he said. If your baby does have any allergy testing, how the results are interpreted is key, and you don’t want it to unnecessarily delay the introduction of foods.” Dr. Stukus says

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For high-risk babies, a pediatrician or allergist may order a blood test to measure peanut-specific antibodies. If the test is negative, the parent can be confident that a peanut allergy is unlikely and go ahead with peanuts' introduction into the infant’s diet. If the test results come back positive- the allergist will probably consider further testing.

“Dr. Fleischer said he once saw a huge wheel after a peanut skin test on an 8-month-old patient with severe eczema. The wheal was big enough that many allergists might have diagnosed it as a peanut allergy. But Dr. Fleischer gave the baby a food challenge with a small amount of peanut, and he didn’t react. He told the parents to continue regularly feeding him peanuts at home, and the child, who was 3 at his last appointment, can now completely tolerate peanuts.” According to Dr. Fleischer, this child would likely have developed an allergy to peanuts without exposure.

Conclusion:

After living with a food allergy or experiencing a child's reaction, it is only natural for parents to worry about their newborn baby’s future. It is always a wise idea to consult with the medical professional you trust who, besides already having your confidence - has intricate knowledge for the food allergies that run in your family and is, therefore, the best person to treat and guide your family further. Never refrain from exposing your baby either through breastfeeding or tasting (from 4 months and onwards) certain foods without your doctor's say-so since doing this can actually cause the very thing you are trying to avoid- happen. Remember that it is equally important to take care of your emotional needs and validate your feelings.

Food Allergy Concierge doesn’t take any responsibility for the information provided- this article is for informational purposes only. Please consult your doctor for any medical advice. Resources for this article can be found by clicking the link below.

Resources

Developing food allergies later in life
Food Allergies & Honeymooning
 

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