We provide testing and treatment for children with food allergies, and work with families to help them learn how to best manage their child’s allergy at home and school.

In the Food Allergy Clinic at Johns Hopkins All Children’s, we provide comprehensive care for children of all ages with suspected or confirmed food allergy. Our program is the first hospital clinic dedicated to pediatric food allergy in Florida, and we also offer the first FDA-approved treatment for children with peanut allergies.

Common food allergies

Some of the most common allergens in children are milk, egg, peanut, tree nuts (including walnut, pecan, almond, cashew, hazelnut and pistachio), wheat, soy, fish, shellfish and sesame seed. Whether your child’s reaction was mild or severe, or due to a single or multiple foods, we will work with you and your children and guide you through the process of additional testing and treatment options.

Having a food allergy can be stressful for the child and the whole family. We also focus on patient and family education, including topics like how to read food labels, how to use emergency allergy medication such as injecting epinephrine — a medication that treats an acute allergic reaction — and how to manage a child’s allergy outside the home at school, daycare, camp or other places.

Food allergy symptoms and causes in children

Typically, our immune systems work to fight infection and disease. When your child has a food allergy, it means his or her immune system reacts to that particular food as if it is harmful. When your child comes in contact with that food, their body releases chemicals to fight against the food allergen, causing allergic symptoms that can affect different parts of the body, such as the respiratory system or gastrointestinal tract.

The symptoms of food allergies can vary from patient to patient, and can develop very quickly in just a few minutes, or over the course of several hours. Some common symptoms of food allergy include:

• Skin rash, hives or itching
• Swelling of the lips, face, tongue, throat or other body parts
• Difficulty breathing, wheezing, coughing or nasal congestion
• Stomach pain, nausea, vomiting or diarrhea
• Dizziness, lightheadedness or fainting

There is no medication that can cure a food allergy, so avoidance is the most important step in managing your child’s food allergy. We work with families to help them understand how to effectively read food labels and understand ingredients lists.

Food allergies can also have similar symptoms as food intolerance, but food intolerance does not involve the immune system and is caused by the person’s inability to digest certain substances, like lactose or gluten. Symptoms of food intolerance include burping, indigestion, gas, loose stool, headaches and nervousness.

Conditions we treat in the Food Allergy Clinic

• Food allergy and its related conditions, such as eczema and anaphylaxis
• Food protein-induced enterocolitis syndrome (FPIES), or inflammation of the digestive tract that causes vomiting and diarrhea triggered by certain foods, usually milk, soy, rice or grains
• Food protein-induced allergic proctocolitis (FPIAP), or inflammation of the rectum and colon that causes diarrhea or blood in stools triggered by certain foods, usually milk or soy
• Food intolerance
• Eosinophilic esophagitis (EOE)

How to test for food allergies: Procedures we offer

• Skin testing for food allergy
• Blood test for evaluation of food specific Immunoglobulin E (IgE) levels and component resolved diagnosis (CRD)
• Oral food challenge
• Oral immunotherapy

What to expect: How are food allergies diagnosed in a child?

Your child’s first appointment will include a physical exam, and we will take a complete history, including any reactions they have experienced to foods, and review any past treatments or test results your child may have had. We will gather information about the type, timing and frequency of the reaction.

We will recommend additional testing as needed. Skin testing for food allergies takes about 15 minutes and may be done the same day if the patient is ready. We may also refer your child for a blood test.

Skin test

During a skin test (sometimes called a prick test), we apply to the child’s back or arm a set of devices coated with the known allergen extracts for which we want to test. The device has small prongs that will create minor scratches on the skin and allow the allergen extracts to penetrate. If your child has a type of food allergy known as “IgE-mediated reaction” a small wheal reaction (which looks like a raised, red bump that flairs from the middle) likely will develop at the testing site and allow us to confirm the allergy.

Skin testing is usually a reliable method for food allergy diagnosis, with results available in 15 minutes. We will carefully select the allergen extracts for your child’s skin test depending on his or her history. Skin testing can be done during a regular clinic visit.

Blood test

Blood testing, now available for a wide range of food items, is used in conjunction with a skin test for food allergy evaluation. The blood test measures the immunoglobulin E (IgE) antibody specific to each food being created by your child’s immune system. Component resolved diagnosis (CRD) to some foods such as peanut, hazelnut, egg and milk may be used in addition to IgE testing.

Oral food challenge

An oral food challenge is an elective test in which the patient slowly eats small amounts of food to confirm or rule out a suspected allergy. An oral food challenge will take three to four hours.

The family will bring the food their child is testing to the appointment. A week before your child’s oral food challenge, we will call you to confirm the foods we will test and the ingredients you should use.

On the day of the appointment, you will be required to bring two epinephrine autoinjectors with you, in case your child has a delayed reaction on the way home from your appointment. After taking your child’s vital signs, we will start by giving him or her a very small amount of the food you prepared for the test and monitor for a reaction. If your child does not have a reaction, we will increase the amount of food given every 15-20 minutes and continue to observe them for an hour after the last dose.

Completing an oral food challenge in a controlled environment allows us to monitor for and treat an allergic reaction to confirm foods your child does or does not need to avoid.

Oral immunotherapy

We offer oral immunotherapy treatment using Palforzia, the first FDA-approved treatment for peanut allergy in children ages 4-17. Patients with peanut allergy ingest very small amounts of the allergen in our office, so they can be monitored and treated for a reaction as needed. The amount ingested is gradually increased over a period of several months to help the patient become desensitized to the food.

Oral immunotherapy will not cure a child’s allergy, but the treatment can desensitize children to peanuts so that they experience less severe reactions if they come into contact with something containing peanuts, which can help to alleviate the stress many families feel in navigating their child’s peanut allergy. Patients should not consume peanuts outside of their treatment appointments.

Oral immunotherapy treatment is also available on a self-pay basis for patients with other food allergies including milk, egg, and tree nuts (cashew, almond, walnut, etc.), among others, as well as those with peanut allergy outside of the age range for Palforzia.

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