Treatment is mainly through dietary manipulation. We encourage mothers to continue nursing and monitor their own diet because many antigenic proteins pass through breast milk. Casein and whey are the primary antigenic proteins in cow’s milk, and dairy is the biggest culprit.
In children that are not nursing, we often will try a hypoallergenic formula. Our favorites include Elecare, Neocate, and Neutramogen. However, they can be quite expensive, and Neutramogen has an odd smell. We suggest buying these formulas on ebay. EO28 Splash is another excellent option. Goat’s milk is a good alternative for some. Soy milk is excellent if they are not soy-allergic. Rice milk is also a good option.
In the case of emergency treatment, epinephrine is the drug of choice for an emergency response to reactions. A self-administered epinephrine is readily available and patients can be trained to self-administer this medication. Antihistamines can be a secondary therapy. It is also good to have an emergency plan in writing, available to schools, spouses, caregivers, mature siblings and friends. We also recommend an emergency identification bracelet.
If the history and testing confirms a cyclic food allergy, then you will be asked to abstain from feeding your child this food for a period of three to six months. After this time you can slowly reintroduce the food, not be eaten more frequently than every four days (once or twice a week).
Gastrochrome or AlkaSeltzer Gold are mast cell stabilizers, which help some patients. Antihistamines (type 1 and 2) and oral steroids (systemic and topical) may also be helpful in controlling symptoms when avoidance fails. Xolair is a relatively novel drug, which actually binds all IgE in the body. It is actually a genetically engineered antibody against IgE. It is incredibly expensive but effective, especially in those patients with life threatening food allergies.
Immunotherapy is controversial in the treatment of ingestant allergies. It can be helpful to some patients, however, so it may be initiated with thought and care. We do now offer the LaCrosse protocol, which has proven extremely helpful for many of our patients. Aggressively treating inhalant allergies can often lessen the patient’s food allergy problems as well.
Food allergies are complicated and controversial. The diagnosis and treatment of inhalant allergies is far more standard, and aggressively treating these can often improve the patients overall allergy symptoms. In considering pediatric food allergies the parent must remember that a history and physical examination are paramount. IgE and non-IgE (IgG) associated conditions do exist.
Fortunately, food allergies peak in infancy and childhood and we tend to out grow them. Unfortunately, many children go on to develop inhalant allergies and asthma (termed the “allergic march”).
Diagnosis is performed by dietary elimination and challenge, as well as by laboratory testing (skin and blood tests).
Avoidance, education, and preparation for emergencies are current universal therapies.
Medications and immunotherapy can be useful adjuncts in the right patient. A patient’s tolerance can be periodically monitored by re-challenging or retesting. Although food allergies are very complicated, most patients can be helped.