Managing Food Allergies in Children: A Functional, Whole-Family Approach

Understanding Food Allergies: What They Are and Why They Matter

In our practice, we get lots of questions from concerned caretakers about managing food allergies in children. Food allergies are a growing concern among children and their families, and for good reason. A food allergy occurs when the immune system overreacts to a food protein, mistakenly identifying it as harmful. This triggers the production of IgE (immunoglobulin E) antibodies, which cause the release of histamines and other chemicals in the body, leading to symptoms like hives, swelling, vomiting, wheezing, or even life-threatening anaphylaxis.

It’s important to distinguish food allergies from food intolerances. Unlike allergies, intolerances do not involve the immune system. Instead, they arise when the digestive system has difficulty breaking down a food, often due to enzyme deficiencies or sensitivities to natural food chemicals. Common symptoms of intolerance include bloating, gas, and stomach pain, usually after consuming larger quantities.

Both can cause distress, but food allergies carry a much higher risk. having the right tools to identify and manage them is essential for protecting your child’s safety and quality of life.

“With awareness, preparation, and compassion, food allergies can become manageable—not just medically, but emotionally and practically.”

Diagnosing Food Allergies: What to Know Before You Eliminate Foods

If you suspect your child has a food allergy, it’s important to work closely with your pediatrician or allergist to get an accurate diagnosis before removing foods from the diet.

Here’s what that process typically includes:

• Skin prick testing: A small amount of allergen is introduced into the skin (usually on the back or forearm) to observe for a reaction.
• Blood testing: Measures the level of allergen-specific IgE antibodies in the blood.
• Oral food challenge (OFC): Considered the gold standard, this test involves gradually introducing the suspected allergen under medical supervision to confirm or rule out a diagnosis.

⚠️ It’s important to note that IgG food sensitivity testing is not reliable for diagnosing allergies or intolerances. These tests simply show that the immune system has been exposed to a food, not that it’s reacting to it harmfully.

The Top 9 Food Allergens (Plus One Condition You May Not Know)

In the U.S., there are nine major food allergens that are responsible for the majority of severe allergic reactions. These are:

• Milk
• Eggs
• Fish
• Shellfish (especially crustaceans)
• Tree nuts
• Peanuts
• Wheat
• Soy
• Sesame

What About FPIES?

There’s also a lesser-known but important condition called Food Protein-Induced Enterocolitis Syndrome (FPIES). This type of allergy doesn’t involve IgE but can still be serious. It usually affects infants and young children, causing severe vomiting, diarrhea, and lethargy hours after eating the trigger food. Common triggers include cow’s milk, soy, oats, and rice. Since there’s no specific test for FPIES, diagnosis relies on a detailed history and often a referral to a pediatric dietitian.

Prevention and Safety: At Home and On the Go

When your child has food allergies, your home and daily routines become part of their treatment plan. The good news? With mindful preparation, your family can create a safe and empowering environment.

Label Reading 101

Always read ingredient labels. Every. Time. Manufacturers can change recipes without notice. Look for allergen names listed in plain language either within the ingredients or in a “Contains” statement. Avoid foods with ambiguous terms like “natural flavors” or “spices” unless you verify what they include.

📝 Tip: Check out this handout on label reading from MGH’s Food Allergy Center for more clarity.

Cross-Contact: The Hidden Danger

Even a crumb or trace of an allergen can cause a reaction. Cross-contact can happen through:

• Shared utensils, cutting boards, or surfaces
• Saliva (e.g., shared drinks or pacifiers)
• Bulk bins or buffet-style service

To prevent cross-contact at home:

• Wash hands before and after eating or prepping food
• Use separate utensils and cookware for allergen-free meals
• Clean surfaces with soap and water—not just sanitizing wipes
• Store allergen-containing foods separately from safe foods

Some families choose to keep the allergen out of the house entirely, while others take extra steps to prevent exposure. Do what feels realistic and supportive for your family.

Dining Out Safely

Yes, eating out is still possible! It just takes a bit of extra prep:

• Choose restaurants with clear allergen protocols (call ahead if needed)
• Carry your child’s epinephrine auto-injector at all times
• Wipe down tables and high chairs before use
• Use a chef card to clearly list your child’s allergies and cross-contact concerns
• Avoid high-risk venues like buffets, bakeries, and deep-fried foods unless you know the kitchen practices

Navigating Childcare and School

School should be a safe space, not a source of stress. Here’s how to set your child up for success:

• Meet with staff (nurse, teacher, principal, cafeteria manager) before the school year starts
• Provide an Emergency Action Plan developed with your allergist
• Supply epinephrine and ensure staff are trained to use it
• Educate your child on not sharing food and recognizing symptoms
• Review menus and food policies ahead of time
• Plan for special events, field trips, and after-school programs

Creating open communication with school staff and empowering your child with age-appropriate knowledge builds both safety and confidence.

Supporting Nutrition with Safe, Whole Foods

One of the biggest concerns with food allergies, especially when multiple foods are involved, is meeting your child’s nutrient needs. This is where working with a pediatric dietitian is invaluable.

Here’s how to approach it:

Focus on What They Can Eat

Instead of fixating on restrictions, we emphasize abundance. What nourishing, safe foods does your child love? How can we creatively meet their needs? Managing food allergies is not only about avoidance. A pediatric dietitian can help you to structure a nourishing and fulfilling meal plan for your child with food allergies.

Nutrient Replacements

When your child has multiple food allergies, ensuring they still get the nutrition they need is critical. A dietitian can help you create a balanced, allergen-free eating plan that focuses on nutrient-dense foods. For example, if your child can’t consume dairy or eggs, there are plenty of safe, nutrient-rich alternatives to provide calcium, zinc, and vitamin D. Common alternatives include:

• Calcium: Fortified plant milks, canned fish with bones (if tolerated), leafy greens
• Zinc: Legumes, beef, poultry, seeds, and root veggies
• Vitamin D: Fortified foods, sunlight, or supplementation

Children with milk or egg allergies may tolerate baked versions of these foods. Your provider can help guide an introduction plan if appropriate.

For formula-fed infants with cow’s milk allergy, extensively hydrolyzed formula (EHF) is usually the first line. If not tolerated, amino acid-based formulas (AAF) are an option. These therapeutic formulas will supply protein and calcium, which are vital nutrients found in cow’s milk.

For breastfeeding infants, maternal dietary elimination is only necessary if the baby reacts—work with a provider before making changes in your diet to support managing food allergies in your child.

Working with a dietitian can help ensure your child’s diet remains balanced, and supplementation can be suggested if necessary.

Emergency Treatment and Emerging Therapies

What to Do in Case of Anaphylaxis

• Administer epinephrine immediately
• Call 911—even if symptoms improve
• Follow your child’s Emergency Action Plan

New in 2024: the FDA approved neffy, a needle-free epinephrine nasal spray for kids over 66 lbs. It offers another option for families who are hesitant about using auto-injectors. While the traditional epinephrine auto-injector remains effective, this new option provides an easier alternative for both children and adults.

Food Allergy Therapeutic Treatments

There are exciting developments in food allergy treatment beyond avoidance:

• Oral Immunotherapy (OIT): Gradual exposure to allergens by mouth
• Sublingual Immunotherapy (SLIT): Allergen placed under the tongue
• Epicutaneous Immunotherapy (EPIT): Allergen delivered through a skin patch
• Biologic medications (e.g., omalizumab): Target immune pathways to reduce sensitivity

Beyond epinephrine, there are emerging treatments for managing food allergies, including immunotherapy. Oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) are all methods that involve controlled exposure to allergens in an attempt to build tolerance. These treatments should be supervised by a medical professional, as they can carry risks, and are often used in combination with antibody treatments like omalizumab.These options aren’t for everyone, and may be still evolving, but they offer hope for reducing risk and increasing tolerance over time—especially when used under the care of an experienced allergist.

Final Thoughts: Empowerment Through Education

Managing food allergies is a journey—one that affects your child, your family, and your peace of mind. But with a solid foundation of education, preparation, and support, your child can thrive, feel included, and grow up confident in their body and food choices.

At Whole Lifecycle Nutrition, we believe in building bridges—not barriers—between safety, nourishment, and joy. Whether your child is navigating their first diagnosis or you’re seeking new strategies after years of managing allergies, you’re not alone. We’re here to help guide your path forward with compassion and clarity.

✨ “You are not just keeping your child safe—you are teaching them how to advocate for their body with confidence and courage.” ✨

If you want to chat further about how to effectively manage food allergies in children, feel free to book a call here!

A special thank you to Emily Woo, our incredible dietetic intern from Simmon’s University, for her thoughtful research and support in shaping this blog post.

Note: Whole Lifecycle Nutrition requires a release of information to coordinate care with all involved healthcare professionals when working with clients with diagnosed eating disorders. In most cases, we require the patient to additionally participate in behavioral health counseling with a licensed mental health provider.

Medical Disclaimer:

The information provided on this blog is for educational and informational purposes only and is not intended as a substitute for medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as your physician, pediatrician, or registered dietitian, before making any changes to your or your child’s diet, health routine, or treatment plan.

While we are a medical practice specializing in integrative and functional nutrition, the content shared here reflects general knowledge and holistic guidance, and may not be appropriate for every individial. Reliance on any information provided on this site is solely at your own risk.

References:

1. Facts and Statistics. FoodAllergy.org. Accessed November 5, 2024. https://www.foodallergy.org/resources/facts-and-statistics.
2. Food Intolerance Versus Food Allergy. American Academy of Allergy Asthma & Immunology. Published December 27, 2023. Accessed November 13, 2024. https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/food-intolerance.
3. Food Allergy Testing and Diagnosis. ACAAI Public Website. ACAAI Patient. Accessed November 13, 2024. https://acaai.org/allergies/testing-diagnosis/food-allergy-testing-and-diagnosis/.
4. The myth of IgG food panel testing. American Academy of Allergy Asthma & Immunology. Published January 10, 2024. Accessed November 13, 2024. https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/igg-food-test.
5. Food Protein-Induced Enterocolitis (FPIES). ACAAI Public Website. ACAAI Patient. Updated March 21, 2019. Accessed November 6, 2024. https://acaai.org/allergies/allergic-conditions/food/food-protein-induced-enterocolitis-syndrome-fpies/.
6. Food Allergy Stages: Food Allergy Basics for All Ages. American Academy of Allergy Asthma & Immunology. Published June, 2022. Accessed November 5, 2024. https://www.aaaai.org/Aaaai/media/Media-Library-PDFs/Tools%20for%20the%20Public/Conditions%20Library/AAAAI-0622-205-FA-01.pdf.
7. Food Allergy Management and Prevention Support Tool for Infants and Toddlers: How to Read a Label. FAMP-IT. Accessed November 5, 2024. https://famp-it.org/ige/read-label/.
8. Tips for Keeping Safe at Home. FoodAllergy.org. Accessed November 5, 2024. https://www.foodallergy.org/resources/tips-keeping-safe-home.
9. Pistiner M, LeBovidge J. Living Confidently with a Food Allergy. 2nd edition. Food Allergy Canada; 2015. Accessed November 5, 2024. https://foodallergycanada.ca/wp-content/uploads/NDHB_eng_web.pdf.
10. Parlak Z, Gürel Dİ, Soyer Ö, Şekerel BE, Şahi̇ner ÜM. Nutritional risks in children with food allergy. Turkish Journal of Medical Sciences. 2023;53(4):845. doi:10.55730/1300-0144.5648.
11. Katella K. 5 Things to Know About neffy, the New Nasal Spray for Anaphylaxis. Yale Medicine. Published October 8, 2024. Accessed November 6, 2024. https://www.yalemedicine.org/news/5-things-to-know-about-neffy-the-new-nasal-spray-for-anaphylaxis.
12. Food Allergy Treatment Research. NIAID: National Institute of Allergy and Infectious Diseases. Updated August 30, 2024. Accessed November 6, 2024. https://www.niaid.nih.gov/diseases-conditions/food-allergy-treatment-research.