Food allergies in the Pediatric population

The incidence of food allergies among the pediatric population has been surging globally in the last few decades. Data shows almost 8% of children below the age of 5 in the USA have food allergies. A meta-analysis conducted from worldwide studies showed significant variation, with the prevalence of food allergies ranging between 3-and 35% in the overall population. Can it be attributed to genetics, lesser environmental allergen exposure, late introduction of common food allergens in the early years of life, or a combination of all the above factors? – is a question that remains deprived of a definitive answer.

Food allergy OR Food intolerance?

Food allergy is an unwanted reaction of one’s immune system to something ingested orally – food protein specifically. The reaction can be mild in the form of hives, nausea/vomiting, or severe and even life-threatening in some cases, manifesting as throat tightness, facial swelling, trouble breathing/wheezing, and/or low blood pressure, eventually leading to circulatory failure and death. Henceforth, there is a need to pay attention to the causes and potential preventive and treatment modalities for food allergies in children.

Although food allergies can develop to any food, some of the most commonly implicated food allergens are Peanuts, tree nuts, Shellfish, Fish, Soy, Wheat, Diary protein, Eggs, and Sesame—the first four cause severe allergic reactions in most cases.

It’s important not to confuse food allergy with food intolerance. The latter is milderand caused by digestive issues without the immune system’s involvement.

Therefore, allergy testing is recommended to confirm the diagnosis of food allergy.

What is the current available therapy for food allergy?

There isn’t any cure for food allergy. For decades, the go-to advice was to avoid the allergen.In case of accidental exposure, Oral antihistamines, and Epinephrine Inj are recommended depending on the severity of the allergic reaction. However, is it practical? Imagine the life of a child with a food allergy not being able to eat out, be it at a restaurant, a birthday party, or a picnic, without worrying about getting an allergic reaction, which could be life-threatening. Counting how many food items are labeled as May Contain these days is impossible. The only way to avoid a food allergen is to isolate a child socially and always provide home-cooked food with known ingredients. Nonetheless, it is easier said than done. Food allergies affect the quality of life on a mental,social, and emotional level for both parents and Children.

Evolving current therapiesfor food allergies include Oral immunotherapy (OIT), which is desensitizing an individual’s immune system to a food allergen by giving it orally in fractional amounts initially and then gradually increasing the dose until the individual stops reacting to a certain amount of the allergen.Oral food challenges may be given during the therapy to see how much allergen a person can tolerate without having an allergic reaction.OIT isn’t a mainstream practice and involves some risk of life-threatening reactions occurring during OIT. The inconvenience of daily dosing remains another hurdle, and the exact duration of treatment and whether an individual will remain desensitized to the food allergen after stopping OIT needs further research and studies. The first oral immunotherapy drug, Peanut Allergen Powder (Palforzia), has also been approved to treat children ages 4 to 17 with a confirmed peanut allergy.

The U.S. Food and Drug Administration (FDA) recently approved omalizumab (Xolair) to help reduce allergic reactions to multiple foods in certain adults and children 1 year old or older. Omalizumab is a monoclonal antibody that is given as an injection. Therefore, it prevents an allergic reaction in case of accidental exposure to the food allergen as long as the patient is on it.

The implausible cost of these drugs is only one barrier to providing a sustainable long-term benefit with improved quality of life for patients with food allergies.

What are Probiotics, and how can they help with food allergies?

Simply put, Probiotics are friendly live microorganisms.Since they are friendly, they benefit us by co-residing with other beneficial microorganisms in our body and fighting off the non-friendly microorganisms that cause infections.They can be taken as an oral supplement or topical product where normal microbiomes reside in our body, such as the nose and genitals.

Probiotics can stimulate primarily the innate immune system, thereby improving one’s defenses and supporting a balance between pro- and anti-inflammatory cytokines, which is our body’s messenger system. This decreases allergic inflammation and promotes epithelial integrity and permeability in the intestines. Many studies have shown that gut microflora and probiotic intake can support immune system maturity during the early years of life due to different physiological and metabolic reactions in the host. Lactobacillus and Bifidobacterium genera have shown the most encouraging results.

As we advance, can probiotics be a potential savior in the Pediatric population with Food allergies?

Promising results have been observed in studies with the use of probiotics in pregnancy as well as early years of life in preventing Atopic Dermatitis- a recurrent and chronic skin condition causing rashes and itching believed to be due to the ineffective skin barrier and dysregulated local and systemic immune responses.

A Meta-analysis of 9 trials involving a Pediatric population with cow milk allergy (CMA) showed moderate certainty in improving CMA symptoms.

However, individual factors such as age, immune status, and gut microbiomebefore initiating probiotics must be taken into account before anticipated benefits are expected. Last but not least, further studies and evidence remain pivotal in establishing the beneficial role of probiotics in food allergies. 

References:

Food allergies in children and babies. (2025, March 20). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/food-allergies-in-children#:~:text=Peanuts%2C%20tree%20nuts%2C%20fish%20and,5%20years%20have%20food%20allergies.

Wong G. W. (2024). Food allergies around the world. Frontiers in nutrition, 11, 1373110. https://doi.org/10.3389/fnut.2024.1373110

Food allergy – Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/food-allergy/symptoms-causes/syc-20355095

Food allergy – Diagnosis and treatment – Mayo Clinic. (n.d.). https://www.mayoclinic.org/diseases-conditions/food-allergy/diagnosis-treatment/drc-20355101

Professional, C. C. M. (2025, May 9). Probiotics. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/14598-probiotics

Lopez-Santamarina, A., Gonzalez, E. G., Lamas, A., Mondragon, A. D. C., Regal, P., & Miranda, J. M. (2021). Probiotics as a Possible Strategy for the Prevention and Treatment of Allergies. A Narrative Review. Foods (Basel, Switzerland), 10(4), 701. https://doi.org/10.3390/foods10040701

Anania, C., Brindisi, G., Martinelli, I., Bonucci, E., D’Orsi, M., Ialongo, S., Nyffenegger, A., Raso, T., Spatuzzo, M., De Castro, G., Zicari, A. M., Carraro, C., Piccioni, M. G., & Olivero, F. (2022). Probiotics Function in Preventing Atopic Dermatitis in Children. International journal of molecular sciences, 23(10), 5409. https://doi.org/10.3390/ijms23105409

Carol Stephanie C. Tan-Lim, Natasha Ann R. Esteban-Ipac, Probiotics as a treatment for food allergies among pediatric patients: a meta-analysis,World Allergy Organization Journal,Volume 11,2018,25,ISSN 1939-4551, https://doi.org/10.1186/s40413-018-0204-5