This article provides a comprehensive guide for physicians to help them understand and manage food allergies in children. Additionally, it introduces specific oral tolerance induction (SOTI) as a promising alternative treatment for certain childhood food allergies.

---

Childhood signifies a phase of exploration, growth, and boundless vitality. However, for some children, this journey encounters an unforeseen obstacle: Childhood allergies.

These immune system responses to various substances have the potential to cast a shadow over the radiance of childhood joy. Nonetheless, armed with awareness and effective management, children grappling with allergies can continue to thrive.

Whether it involves child allergies such as food sensitivities, prompting meticulous label scrutiny, or environmental triggers demanding proactive precautions, understanding and addressing these sensitivities becomes pivotal for every caregiver.

Let’s discuss allergies in children – Their identification, diagnosis, and management.

Food allergies among children have seen a substantial rise in recent years, posing a significant challenge for healthcare providers. These allergies can range from mild to severe, impacting a child's quality of life and requiring vigilant identification and management strategies. As a healthcare professional, recognising and effectively managing food allergies in children is paramount.

Here's an in-depth guide to aid in this critical aspect of paediatric care.

Understanding food allergies

1. Definition and common triggers

Food allergies occur when the immune system reacts adversely to certain proteins in food, triggering an allergic response.

The most prevalent allergenic foods include peanuts, tree nuts, milk, eggs, soy, wheat, fish, and shellfish. However, any food can potentially cause an allergic reaction.

2. Identification and symptoms

Identifying food allergies can be challenging as symptoms vary widely and may manifest within minutes to hours after ingestion.

Common symptoms include:

• Hives
• Swelling
• Eczema
• Vomiting
• Diarrhoea
• Abdominal pain
• Respiratory issues (such as wheezing or nasal congestion)

In severe cases, anaphylaxis is characterised by difficulty breathing and a drop in blood pressure.

---

Diagnosis

1. History and physical examination

A detailed medical history, including a thorough exploration of symptoms and potential trigger foods, is essential. Physical examinations might reveal dermatological, respiratory, or gastrointestinal signs indicative of allergic reactions.

2. Allergy testing

Allergy testing, including skin prick tests, blood tests measuring specific IgE antibodies, and oral food challenges, plays a vital role in confirming suspected food allergies. These tests help identify allergens and determine the severity of the allergy.

---

Management and treatment

1. Patient education

Educating parents and caregivers about food allergies, potential triggers, and the importance of avoidance is crucial. Guiding reading food labels, recognising hidden allergens, and developing an emergency action plan in case of an allergic reaction is imperative.

2. Allergen avoidance

The cornerstone of managing food allergies involves strict avoidance of allergenic foods. Encourage families to meticulously read food labels and be vigilant about cross-contamination risks, especially in shared kitchen spaces or restaurants.

3. Emergency preparedness

Prescribing and teaching the use of epinephrine auto-injectors is essential for children with severe allergies. Healthcare providers should ensure that families understand when and how to administer this life-saving medication in emergencies.

H1-antihistamines have long been used for mild, isolated, non-progressive cutaneous reactions to help relieve pruritus, hives, angioedema and conjunctivitis. However, H1- and H2-receptor antagonists cannot be used as substitutes for epinephrine, but only as adjunctive medications during anaphylaxis.

In a recent EAACI systematic review on FA management, it has been reported weak evidence (level of evidence III, grade C) to support the benefits of H1 antihistamines for children and adults with acute non-life-threatening symptoms of FA

4. Collaborative care

Collaboration among healthcare professionals, including allergists, paediatricians, dieticians, and school personnel, is vital for comprehensive care. Developing individualised management plans and ensuring their implementation across different settings is key.

Specific oral tolerance induction: A promising alternative treatment

1. Over the last two decades, alternative treatment strategies have been investigated for Food Allergy (FA) mainly targeting foods that commonly trigger IgE-mediated FA in children (i.e. cow’s milk, egg and peanut).
2. As FA develops due to failure or loss of oral tolerance to food allergens, one of the most promising therapeutic approaches pursued is oral immunotherapy or specific oral tolerance induction (SOTI).
3. SOTI consists of the oral assumption of increasing doses of the relevant allergen performed in a controlled setting; this build-up phase is followed by a daily regular assumption of the tolerated dose which typically occurs at home.

The aim is to induce an immune modulation to achieve a permanent oral tolerance.

---

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Khemeswar Agasti is an MD in General Medicine from Cuttack.