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Q: I was surprised that I had to list all the ingredients in the snack I took to preschool last week. Turns out several kids in my 4-year-old's class have serious food allergies. Are food allergies more common now? How are they diagnosed?

A: It's not your imagination that food allergies seem more common in children. About 8 percent of children and 2 percent of adults have food allergies. While some children will outgrow allergies, studies also show there are more children now with food allergies (and all allergies) than ever before.

In children, six foods cause the majority of reactions: cow's milk, eggs, peanuts, wheat, soy and other tree nuts (walnuts and pecans). Children often outgrow allergies to cow's milk, eggs, wheat or soy.

In adults, four foods cause the majority of reactions: peanuts, tree nuts, fish and shellfish (lobster, shrimp and crab). The peanut allergy is the worst of all—most likely to be deadly and least likely to outgrow.

There's a good reason to list all ingredients in a school snack. For example, a nibble of a peanut butter sandwich for some children and adults can prove deadly. Food allergies are so serious for many that even a kiss on the lips from someone who just ate an allergenic food can cause a deadly reaction called anaphylactic shock (a life-threatening reaction when the airway swells closed, blood pressure drops and the person will die if not treated with epinephrine and other emergency care).

What Happens?
Allergic reactions occur because the body's immune system makes antibodies against food proteins after exposure to the food. When the body is exposed to that food again, these antibodies release chemicals in the body that cause allergic reactions. With certain people and certain foods the reactions get more serious each time they are exposed to that food. Symptoms include: hives; eczema rash; runny nose; itching or swelling of the lips, tongue or throat; wheezing or difficulty breathing; colic; upset stomach; cramps or diarrhea (often with blood in it); and anaphylactic shock.

Diagnosis
If a child has some of the above symptoms, she needs to be seen by a doctor or an allergist to consider allergies as the cause. The most common tests for allergies are skin testing and the RAST panel—a blood test.

With a skin test, a shallow scratch is made in the skin, and liquid containing an allergen (like eggs) is applied to the scratch. If the area swells and gets red and itchy, it usually indicates an allergy.

Another approach is the elimination diet, during which the most common foods to cause allergies are temporarily eliminated from the child's diet (or mother's diet if breast-feeding); then a single item is added back to watch for reaction. After days with no reaction, another item is added back.

Prevention
If both parents have allergies, a child has a 75 percent chance of being allergic. Preven-tative measures include choosing to breast-feed, only supplementing with hypoallergenic formula and choosing to start solids later rather than sooner—many doctors say wait until 6 months of age, and then only rice cereal.

Treatment
The number-one treatment is to avoid the foods proven allergenic (easier said than done at times). The use of antihistamine medicines helps decrease symptoms temporarily, but does not cure. Many adults and children receive desensitization allergy shots. Over time, these shots help many to have fewer symptoms.

Be Prepared
Children (and adults) with severe allergies need to wear a medical alert bracelet or necklace. Those at risk of anaphylactic shock, need to have an Epi-pen (which injects epinephrine) with them at all times. It's best to have one in the car, at home, at school, in a purse or backpack. Caregivers and family members need to learn how to use it before there is an emergency.

Life Gymnastics
Severely allergic children and families struggle continually with fear and difficult logistics in everyday life. Parents try to create as "normal" a life as possible, but have to anticipate every possible way their child may be at risk. These families often feel isolated and discouraged—especially since most families don't have this burden and often don't understand the seriousness of a life-threatening food allergy.

Support groups for families with severe food allergies can provide encouragement, understanding and information—either locally or online.

Dr. Carrie Carter is a mother and national speaker on health issues. She served as a pediatrician for more than 10 years in San Diego, California, and wrote A Woman's Guide to a Healthy Lifestyle (Spire, Revell, 2006).

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