Food Allergy & Eczema in Children: Symptoms, Testing & Treatment in Hyderabad

Food allergy is one of the most common and concerning conditions for parents — affecting approximately 6–8% of children under 5. It is closely linked to eczema — the 'atopic march' describes the progression from eczema in infancy to food allergy, then allergic rhinitis, then asthma. Understanding the relationship between these conditions helps parents and paediatricians manage them more effectively.

True Food Allergy vs Food Intolerance — Key Difference

Food Allergy: Involves the immune system. IgE-mediated reactions cause rapid symptoms within minutes to 2 hours of eating. Non-IgE-mediated reactions cause delayed gut symptoms (4–48 hours).

Food Intolerance: Does NOT involve the immune system. Lactose intolerance (lack of lactase enzyme) causes bloating, diarrhoea, and cramping — but no hives, swelling, or breathing problems.

This distinction matters because: intolerance does not carry an anaphylaxis risk, does not require allergen avoidance at trace levels, and is often dose-dependent (small amounts are tolerated).

The Most Common Food Allergens in Children

The 'Big 8' account for over 90% of food allergies:

1. Cow's milk — most common in infants
2. Egg
3. Peanut
4. Tree nuts (cashew, almond, walnut)
5. Wheat
6. Soy
7. Fish
8. Shellfish

In India, sesame and mustard are also important allergens.

Symptoms of Food Allergy in Children

IgE-Mediated (Immediate) — Within 2 Hours

• Hives (urticaria) — raised itchy red welts anywhere on the body
• Angioedema — swelling of lips, tongue, or face
• Vomiting shortly after eating
• Runny nose, itchy eyes
• Wheezing or coughing
• Anaphylaxis (severe): throat swelling, difficulty breathing, drop in blood pressure — EMERGENCY

Non-IgE-Mediated (Delayed) — 4–48 Hours

• Worsening of eczema (atopic dermatitis flare)
• Colic in infants — excessive crying, arching back
• Blood and mucus in stool in infants (allergic proctocolitis)
• Gastro-oesophageal reflux
• Poor weight gain / faltering growth

Eczema and Food Allergy — The Connection

Moderate-to-severe eczema in infancy significantly increases the risk of food allergy — particularly to peanut and egg. The damaged skin barrier allows food proteins to be absorbed through the skin and prime the immune system to become allergic.

However, most eczema is NOT food allergy-related — it is driven by skin barrier dysfunction, environmental allergens (dust mites, pet dander), and climate. Treating the eczema with emollients and topical corticosteroids often improves eczema without any dietary restriction.

Allergy Testing — What Is Reliable?

Tests that have evidence:

• Skin prick test (SPT): Quick and informative — but only meaningful in clinical context. A positive SPT means sensitisation, not necessarily clinical allergy
• Specific IgE blood test (RAST/ImmunoCAP): Useful when SPT is not possible or for monitoring
• Oral food challenge: The gold standard — supervised food introduction to confirm or refute allergy

Tests that are NOT evidence-based (avoid): IgG food testing, hair analysis, kinesiology, VEGA testing — these have no scientific basis for food allergy diagnosis.

Management of Food Allergy

1. Confirmed allergen avoidance: Strict avoidance of confirmed allergens. Read food labels carefully (FSSAI requires allergen labelling)
2. Adrenaline auto-injector: For children at risk of anaphylaxis — EpiPen Jr. Every child with a history of anaphylaxis, or peanut/tree nut allergy, should carry one. Dr. Sushma B provides training for parents and school staff
3. Allergy action plan: Written plan for school, babysitters, and family members — what to do if a reaction occurs
4. Dietary support: Milk-free diet for milk allergy in infants needs calcium supplementation and appropriate formula (extensively hydrolysed or amino acid formula)
5. Follow-up for outgrowing: Milk and egg allergy are often outgrown. Dr. Sushma B schedules repeat testing every 1–2 years to assess whether food can be reintroduced

Early Peanut Introduction — A Revolution in Prevention

The LEAP trial showed that early introduction of peanut (from 4–6 months) in high-risk infants (those with severe eczema or egg allergy) reduces peanut allergy risk by 80%. Dr. Sushma B advises on the correct, safe way to introduce peanut and other allergenic foods in high-risk infants.

For child allergy evaluation and management: Sri Anand CNC, Chanda Nagar, Hyderabad. Dr. Sushma B (DNB Paediatrics). Call +91 90633 66983.