Ask the Pediatrician: Check for Food Allergies Before They Escalate


Food allergies in children can range from mild to life-threatening. Max J. Coppes, MD, PhD, MBA, physician-in-chief, Renown Children’s Hospital; chair and Nell J. Redfield Professor of Pediatrics, University of Nevada, Reno School of Medicine, shares why it’s important to keep an eye out for food allergies before they escalate.

By Dr. Max Coppes

Dr. Max Coppes, physician-in-chief, Renown Children’s Hospital; chair and Nell J. Redfield Professor of Pediatrics, UNR Med

Food allergies in children are common: 5 percent of children in our country are affected and about 5,000 children in Washoe County are allergic to one food or another. But beware: Not all reactions to food are allergic in nature.

Some food reactions are caused by the lack of a specific enzyme, as with the reactions seen in children who are lactose intolerant because they are unable to digest the sugar lactose in milk. Other reactions can be caused by food poisoning, a reaction to toxins in our food, whether natural (toxins in some mushrooms and puffer fish), chemical (pesticides) or infectious (bacteria, parasites). Food allergies are different in nature; they are caused by an overreaction of the immune system to a substance we should be able to tolerate because it is part of our normal diet.

The Importance of Checking for Food Allergies

Why does it matter to know whether your child’s reaction to a certain food is allergic or non-allergic? Mainly because food allergies can escalate from initial mild symptoms to life-threatening reactions, while non-allergic reactions to food can be annoying but carry a very different risk over time. So if you suspect or notice a reaction to a food product in your child, I really encourage you to discuss this with your pediatrician who may refer you to a pediatric allergist.


The most common food allergies occur with cow’s milk, eggs, peanuts, tree nuts and soy. Under normal circumstances, our immune system helps us fight against germs, microorganisms and alien substances — for example a splinter — and by doing so it keeps us healthy. As a child develops, the immune system needs to learn to distinguish between “good” and “bad.”

Obviously the immune system should not start fighting the child’s own cells, it needs to recognize them as ‘”self ” and therefore “good.” Similarly, it needs to recognize foreign substances that are good and healthy to us. The first foreign substance many children ingest is breast milk, and as the child grows older, it is introduced to cow’s milk, rice cereal and solids. Over time, the immune system expands its knowledge of what is good and what should be considered bad.

How do Food Allergies Occur?

For most of us, the immune system does a remarkable job. For reasons still not completely understood, a food allergy occurs when the immune system categorizes a substance that should be in our good column as bad. As a result, it mounts a reaction, leading to the symptoms that we associate with food allergies. These vary from mild skin rashes, asthma and gastrointestinal symptoms, to life-threatening hives or swelling similar to hives but under the skin instead of on the surface called angioedema. The latter can cause swelling around the eyes, lips and throat, and in severe forms cause difficulty with breathing.

In other words, food allergies can cause mild-to-life-threatening symptoms. And unfortunately, if a child has a mild reaction, the symptoms may worsen over time. That is why people who have been diagnosed with a food allergy need to carry an EpiPen&– their next reaction can be life-threatening.

Since the immune system has to learn to distinguish what goods are good or bad, there there have been many discussions surrounding when to introduce new food products to children. Some have argued that introducing peanuts, for example, late in a child’s life would decrease the chance of developing an allergic reaction. Others have reasoned just the opposite: Introduce peanuts early as the immune system is still young and “inexperienced.”

The American Academy of Pediatrics just updated the guidelines in favor of early introduction for children that are at a higher-than-normal risk for developing a peanut allergy. My recommendation: Discuss what is best for your child with your pediatrician. They are up-to-date on national and often international recommendations about how to optimize the health and well-being of children. They are a truly valuable resource to you.

This article also appeared in the Spring 2017 issue of The Galena Times.