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Children With Special Dietary Needs

Get the facts about your kids’ food allergies and intolerances.
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WebMD Feature

Many day cares and preschools in the U.S. have prominently posted signs asking parents not to pack food for their kids containing peanuts, because so many children are allergic. It seems like special dietary needs are an ever-growing issue.

Food allergies affect as many as 8% of children in the U.S., leaving a challenge for parents: What can you pack for lunch? How can you be sure your kids don't trade snacks with a friend? How should you handle occasions like birthday parties?

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To find answers -- for causes, symptoms, diet, and more -- WebMD talked to Wesley Burks, MD, chief of the division of pediatric allergy and immunology at Duke University Medical Center.

Fast Facts About Food Allergies

Q. What are the most common food allergies in children?

A. Of the 6% to 8% of children below school age who have a food allergy, the majority are allergic to eggs, milk, and/or peanuts. Milk allergies affect about 2.5% of children, egg allergies affect 1.5%, and peanut allergies about 1%.

Other food allergies that become more common as kids reach school age are allergies to wheat and soy, shellfish, fish, and tree nuts.

Q. Do children outgrow food allergies?

A. By the time they're about 7 years old, most kids outgrow allergies to milk, wheat, and soy, but they generally do not outgrow peanut and tree nut allergies and allergies to fish and shellfish. Be aware of what allergies might be outgrown, and continue to go back to seek medical care as your child gets older to see if he or she might no longer be allergic.

Q. What predicts the severity of a food allergy?

A. There's no test that will predict the severity of a reaction. The amount of IgE antibodies produced doesn't correlate with how severe a reaction is. [Immunoglobin E antibodies (IgE) are produced in excess by allergic people.] At one point, a child may have a severe reaction, and another time, it may be much less severe. It could be due to the amount of the food they ate, whether or not it was an empty stomach, if they already had a viral infection -- all kinds of factors.

Q. What other kinds of food sensitivities are there?

Two common kinds of food sensitivities are lactose intolerance and gluten intolerance. These are not "allergies" in that they are not IgE-mediated, but they can cause problems with certain foods.

Lactose intolerance is not typical in young children. It happens more in adults, and when we do see it in children, it's more in school-age kids than in babies and toddlers. Lactose intolerance is caused by the relative lack of an enzyme that helps to digest the lactose in the milk product. Because it's not caused by the immune system, it just involves gastrointestinal symptoms like abdominal pain, bloating, diarrhea, and sometimes vomiting. It's really related to how much milk you ingest and is usually fairly manageable.

It takes a fairly large amount of lactose to cause significant symptoms, like about a glass of milk on an empty stomach. Management is just avoiding lactose-containing products to a significant degree.
Gluten sensitivity is also not an IgE-mediated allergy. It's caused by a T-cell in the body that reacts to gluten proteins. (Gluten is a highly complex protein found in wheat, rye, barley, and oats, and therefore in baked goods made from these grains, like bread, cookies, and pizza.) Again, it's more seen in adults and is relatively uncommon in children, and the typical symptoms are gastrointestinal -- you don't have the hives and wheezing you see with a classic wheat allergy.

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