A child’s suspected allergy is often unfounded

Published 23.07.2018
Docent and Pediatric Gastroenterologist Taina Arvola spoke about food allergy diagnostics and treatment at Tampereen Lääkäripäivät, an education event for physicians in Tampere, on 21st March 2018.
Docent and Pediatric Gastroenterologist Taina Arvola spoke about food allergy diagnostics and treatment at Tampereen Lääkäripäivät, an education event for physicians in Tampere, on 21st March 2018.

Often, children’s ambiguous stomach symptoms disappear if no one makes a fuss of them, Docent Taina Arvola says. Getting overly worried might just make the situation worse.

A large proportion of parents suspect that their child may have a food allergy. Yet only 5-8 percent of children have confirmed food allergies.

Food allergies with intestinal symptoms in particular can be difficult to diagnose, Docent Taina Arvola explains. She works as a pediatric gastroenterologist at Kanta-Häme Central Hospital and Tays Allergy Centre.

Bowel symptoms caused by foods are seldom IgE-mediated. No currently existing laboratory or skin test can reliably show an allergy, she says.

Intestinal symptoms are often variable and tricky to interpret. All changes in diet can cause temporary changes in intestinal functions.

According to Taina Arvola, a large proportion of children have vague bowel symptoms that disappear without treatment if nobody pays special attention to them. On the other hand, if the parents worry about the symptoms, it can create a cycle that feeds the symptoms.

If the parents are constantly and negatively monitoring their child, their interactions change and the child begins to worry too. A similar cycle can begin if the child refuses to eat for any reason and the parents start to feed the child differently, for example by using tricks or force or feeding the child while it is sleeping.

When the crying, vomiting and eating problems then worsen, it reinforces the parents’ suspicions of a food allergy, and off we go again, Arvola says.

An elimination-reintroduction test confirms the allergy

When diagnosing a food allergy, it is essential to establish a temporal connection to the food. During a 2-3 week-long elimination diet, the symptoms should disappear or at least significantly improve.

A supervised elimination-reintroduction test is the best and only reliable diagnostic method for food allergies. The most reliable results are achieved with a double-blind test, where the patient and their family do not know if the patient is being exposed to the suspected allergen or a placebo.

If a grain allergy is suspected, coeliac disease tests should be conducted before eliminating grains. Taina Arvola warns that the tests will no longer be reliable after that elimination.

The patient should be sent for tests in specialist health care if there is any suspicion of anaphylaxis in reaction to a foodstuff if the child is allergic to staple foodstuffs or if the patient avoids several foodstuffs and is in a nutritional crisis as a consequence.

It is not recommended to conduct IgE tests and component diagnostics in primary health care, because their interpretation requires allergological expertise, Arvola adds.

If the symptom is mild, gradual reintroduction can help

Taina Arvola emphasizes that a majority of children’s food allergies run their course during the first years of the child’s life. The food avoided should therefore be retried every six months so that the elimination diet is not continued for any longer than necessary.

If the allergy symptoms are mild, the foodstuff should not be avoided entirely. Minor exposure to it can improve tolerance for it, she explains.

If a foodstuff has caused serious reactions like anaphylaxis, it should not be tried at home.

Nutritionally important foodstuffs should always be replaced with other foodstuffs in order to ensure that the child does not suffer from undernutrition or nutrient deficiencies.

Consultation with a dietician is necessary if the child has a milk or grain allergy, a broad-ranged or difficult food allergy or issues with growth or eating, Arvola summarizes.

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