Understanding Food Intolerance and Food Allergy There are several different types of sensitivities or adverse reactions to foods. One type is known as a food intolerance ; an example is lactose intolerance. Food intolerance does not involve the body s immune system. Another type is called food allergy ; food allergies involve the body s immune system. Food or Lactose Intolerance There are several types of food intolerance. The most common types are foodborne illness (food poisoning) and metabolic reactions to food. Foodborne illness can occur when foods containing toxins or harmful bacteria are consumed. This problem is short-term and usually does not produce a chronic condition. Metabolic reactions to food occur when the body cannot adequately digest a portion of the offending food. For example, a child with lactose intolerance does not have enough of the lactase enzyme, which is needed to digest the sugar in milk (called lactose). When milk or other dairy products are consumed, a child without the lactase enzyme will develop nausea, gas and diarrhea. These symptoms usually occur 30 minutes to two hours after a food with lactose is eaten. Some degree of lactose intolerance occurs in about 80 percent of Native Americans, 75 percent of Blacks, 50 percent of Hispanics and 20 percent of Caucasians. The prevalence of lactose intolerance among persons with Asian backgrounds varies from 15 to 100 percent depending on the ethnic group. Lactose intolerance can develop after weaning from breastmilk or later in life and usually does not go away. Diagnosis and Treatment of Lactose Intolerance Lactose intolerance can only be confirmed by a medical test. A positive test does not mean all lactose must be eliminated from the diet. Often some milk and milk products can be eaten without symptoms. Yogurt with active cultures and aged cheese (such as cheddar or Swiss) have less lactose and can usually be eaten. The amount of lactose can be reduced in some milk and dairy products. Special reduced-lactose milk (one brand is Lactaid ) is available in many grocery stores. Since milk and milk products are excellent sources of protein, calcium, riboflavin and vitamin Nutrition Strategies for Children with Special Needs Page 55 USC UAP Childrens Hospital Los Angeles
D, these foods should be avoided only when absolutely necessary. When milk products are restricted, children need calcium and vitamin D from other food sources or supplements. Food Allergy A food allergy is an adverse reaction that involves the body s immune system. Allergic reactions to foods begin within minutes to a few hours after eating the offending food. The reaction can affect one or more systems: gastrointestinal (diarrhea), respiratory (breathing difficulties) and/or skin (rash). Usually for an allergic reaction to occur, antigens (often protein) from the food must be absorbed from the gut. Sometimes just smelling or touching the food causes a reaction. The immune system reacts to the antigens and produces an allergic response. In persons with a family history of allergies, or in infants with an immature GI tract, allergies are more common. Most reactions are caused by just a few foods: milk, soy, egg, wheat, peanut products, nuts, shellfish and fish. Diagnosis and Treatment of Food Allergy A physician with a specialty in allergy or immunology is best qualified to determine if a child s symptoms are related to a food allergy or to another disorder. If a food is found to cause symptoms, it must be eliminated from the diet. Very sensitive children will need to omit all forms of the food. Restricted foods may be hidden in the diet in unfamiliar forms. A chart follows to help those people with known allergies to identify and avoid foods made with milk, egg, or wheat. The chart lists foods to avoid, how the food may be listed on the label, and substitute foods. The substitute foods may not have the same nutrient content. If a child must avoid a basic food such as milk, referral to a nutritionist is recommended. The nutritionist will recommend foods to the family that can take the place of milk to meet the child s nutrition needs. Prevention of Food Allergy If one child in a family has a food allergy, subsequent children are at increased risk. Breastfeeding the new baby for 4 to 6 months (with no other foods given) may prevent the development of the allergy. Also, some children outgrow allergies. Foods that caused an allergic reaction when introduced at an early age may be tolerated later. It is important to consult a physician to determine if foods can be reintroduced at a later age. Page 56 Maternal and Child Health Bureau
STRATEGIES for Children with Food Intolerance or Allergy ASSESS FURTHER Does the child have a physiological reaction (breathing difficulties, vomiting, rash) or other reaction (gas, bloating, diarrhea) to specific foods? If yes, determine if these reactions are making it difficult to obtain adequate nutrition by asking the child s parent/caregiver the questions below. PLAN FOR ACTION With the child s parent/caregiver, develop a plan using the suggestions below and the education materials in this section: Choose What You Can Use: Food Selection for a Child With Milk, Egg or Wheat Allergy 1. Has the parent/caregiver discussed the symptoms with the child s physician? 2. Are certain foods being eliminated from the child s diet to avoid an allergic reaction? 3. If the child has a lactose intolerance, is the child able to eat/drink dairy products in any quantity? 4. Has a physician diagnosed the child with a specific food allergy to any of the following? Cow s milk protein (casein, whey) Eggs Wheat Soy protein 1. If not: Encourage the parent/caregiver to discuss their concerns about food allergies or intolerance with the child s physician before eliminating or avoiding foods. 2. If the answer is yes: Make sure that the parent/caregiver has received information and has a plan to provide appropriate substitutes for the food to be avoided. Refer the child to a registered dietitian if the parent/caregiver needs more information on how to meet the child s nutrition needs. 3. If not, remind the parent/caregiver that: Sometimes children and adults with lactose intolerance can tolerate small amounts of milk and dairy products at a time. Fermented and aged dairy products, such as yogurt and hard cheese, have very little lactose remaining. Use these foods to provide the 2 to 3 servings per day of dairy foods recommended. Or, try a lactosereduced product, such as Lactaid, (milk which has the lactose removed). 4. If the answer is yes: Make sure that the parent/caregiver has received information/education materials and has a plan to provide appropriate substitutes for the food(s) to be avoided. Refer the child to a registered dietitian if the parent/caregiver needs more information on how to meet the child s nutritional needs. Nutrition Strategies for Children with Special Needs Page 57 USC UAP Childrens Hospital Los Angeles
Page 58 Maternal and Child Health Bureau