Any food can trigger an allergic reaction, but 90% of food allergies in children are caused by just 6 common foods or food groups – milk, eggs, peanuts, tree nuts, soy, and wheat. In adults, a similar percentage of serious allergies are caused by only 4 types of food – peanuts, tree nuts, fish, and shellfish. Allergies to fruits and vegetables are much rarer and usually less severe.

Cow’s Milk

Cow’s milk allergy is one of the most common sensitivities in young children, probably because it is the first foreign protein that many babies consume in such large quantities, especially if they are bottle-fed. If there is an allergy to cow’s milk, even infants who are breastfed may experience colic or eczema until milk and dairy products are eliminated from the mother’s diet. Between 2 and 3 out of every 100 children under the age of 3 show symptoms related to cow’s milk allergies.

Vomiting after feeding is the most common way a child shows an allergy to milk, but more serious reactions can also occur. The amount, crying, and bloating may sometimes be the only signs of a cow’s milk allergy in very young babies. (However, it must be noted that in most cases, the cause of colic is never found, and persistent crying will eventually stop without treatment, before the baby reaches 6 months of age.) Other early and subtler symptoms of milk allergy often include itchy eczema (atopic dermatitis).

Of course, the most obvious type of reaction to milk is when a child drinks milk or eats a dairy product and immediately develops breathing problems or hives. Most children with a cow’s milk allergy are also allergic to goat or sheep milk, so these are not suitable substitutes.

Soy-based formula may or may not be suitable for babies allergic to milk, as some who are sensitive to cow’s milk may also react to soy protein. If your milk-allergic baby cannot tolerate soy formula, your pediatrician may recommend a special formula made from extensively hydrolyzed proteins or amino acid-based elements.

Many children outgrow their milk allergy as their immune system matures. However, your pediatrician will likely recommend allergy testing before your child tries milk again. If testing shows that the allergy has disappeared, milk can be cautiously reintroduced to your child, gradually increasing the amount in the doctor’s office, where any reaction can be monitored and, if necessary, treated. If your child simply has lactose intolerance, allergy testing is usually not required, and milk and dairy products can be gradually reintroduced at home while monitoring symptoms. Supermarkets offer products with reduced lactose content to help children with lactose intolerance include milk in their diet.

Milk and dairy products are important sources of calcium, a mineral essential for strong bones and teeth, muscle and nerve function, and the health of every system in the body. Dark leafy vegetables, canned fish with bones (e.g., sardines, salmon), calcium-fortified orange juice, dried figs and prunes, tofu, and dried vegetables are among the many rich non-dairy sources of calcium for older children who cannot tolerate milk, cheese, and yogurt.

Eggs

Children allergic to eggs mostly react to the protein in the egg white. However, since the yolk is often contaminated with the white, it is safer for children allergic to eggs to avoid eggs entirely. Fortunately, while eggs are nutritionally valuable and an excellent source of protein, they are not essential for a good diet. Meat, fish, dairy products, grains, and legumes are excellent alternative sources of similar proteins, minerals, and vitamins. If your child is allergic to eggs, be mindful of hidden egg ingredients, such as egg wash on certain breads or eggs used as binders in battered foods.

Peanuts and Tree Nuts

When is a nut actually a legume? When it is peanuts, a cousin of peas and beans. Since peanuts and tree nuts come from different plant families, a child who is sensitive to peanuts can often consume other nuts, such as walnuts, pecans, and others, without problems. However, caution is necessary as children who are allergic to peanuts, for unknown reasons, may also have a separate allergy to tree nuts.

Like eggs, peanuts are tasty and nutritious but are not necessary for a healthy diet. No replacements are needed in the diet. Most people with a peanut allergy can tolerate other legumes like soy and beans, although sometimes skin or blood tests may show a positive result for these other legumes.

Peanuts can sometimes be present in foods when least expected. Peanuts are often ground and used as a filler in products like sweets. Peanut butter is sometimes used by restaurants and caterers as a “glue” in food preparation to hold items together. Therefore, it is imperative not only to carefully read labels to ensure peanuts are not hidden ingredients in commercial food products but also to ask and clarify the content of food purchased and consumed in restaurants or prepared and consumed outside your home.

Tree nut allergies – walnuts, pecans, cashews, Brazil nuts, almonds, hazelnuts; all hard-shelled tree nuts – can be as serious as peanut allergies, and the same precautions apply. One child may be allergic to only one type of nut, while another may be allergic to several. Sometimes there can be confusion about different types of nuts, so individuals with tree nut allergies often avoid all nuts to be safe. Be sure to inform teachers, friends, and family that your child must avoid all products with even traces of tree nuts and peanuts, as tree nut allergies, in general, are the most severe of all food allergies.

Soy

Babies fed soy formula, like cow’s milk, may develop rashes, runny noses, wheezing, diarrhea, or vomiting from an allergy to soy protein. When switching to soy formula, some children who are allergic to cow’s milk may also be allergic to soy. If this is the case, your pediatrician may recommend a low-allergen formula made from extensively hydrolyzed proteins or amino acid-based elements.

Children with soy allergies typically tolerate soy oil as it contains minimal protein. Soy lecithin is a fatty derivative of soy that is extremely low in soy protein and is generally tolerated by individuals with soy allergies.

Wheat and Gluten

Rice and oats are typically the first grains introduced into the diet because they are less likely than other grains to cause allergy problems. If there is no issue with oats, wheat follows. Wheat is the grain most commonly associated with allergies, but despite this, it is still a rare food allergy. This is fortunate because wheat is found in so many prepared foods.

There are two types of negative immune reactions to wheat. The first is the classic food allergy, with symptoms such as hives or wheezing that occur immediately after a child eats wheat-based food.

The second is called celiac disease. Gluten is a protein found in grains like wheat, rye, and barley. In sensitive children, gluten damages the lining of the small intestine and interferes with nutrient absorption. This damage may go unnoticed for a time. Typical symptoms of celiac disease include stomach pains, diarrhea, irritability, poor weight gain, and slowed growth. Celiac disease may present soon after a child eats their first spoonful of grains, but in some cases, symptoms are so mild that the condition may “secretly” develop at a low level for years, and a diagnosis may not be made until adolescence.

If your child shows symptoms of an allergy after consuming a certain food, avoid that food in their diet žand discuss the symptoms with your pediatrician.

A child avoiding multiple foods due to allergies may be at risk of malnutrition. Talk to your doctor about seeing a registered dietitian to get expert advice on how to wisely feed a child with significant dietary restrictions.

Your child with a food allergy should be able to participate in all activities like other children, except for consuming food they are allergic to. Discuss with your pediatrician strategies for avoiding allergens, as well as dietary and therapeutic strategies to maintain a safe and healthy lifestyle.