Food allergies in children: spotting them, testing them, and living with them

Allergy versus intolerance

A food allergy is an immune reaction — it can involve hives, swelling, vomiting, wheezing and, at worst, collapse, and it typically starts within minutes to two hours of eating. An intolerance is a digestive problem — bloating, gas, loose stools after milk, for example — uncomfortable but not dangerous.

The distinction matters because the management is different: intolerance means reducing or timing a food; allergy may mean strict avoidance and an emergency plan.

In India, the common triggers are cow's milk, egg, peanut, tree nuts, wheat, soya, fish and shellfish, and sesame. Cow's-milk protein allergy is the commonest in babies and often shows as blood or mucus in stool, eczema, reflux and poor weight gain rather than dramatic hives.

Introducing allergenic foods

Current guidance reversed the old advice: delaying allergenic foods does not prevent allergy and may increase it. Introduce egg, peanut (as smooth paste or powder, never whole nuts), wheat, fish and dairy in the normal weaning window from around six months, one at a time.

Give a small amount early in the day, at home, when you can watch for two hours, and do not introduce two new foods on the same day. If tolerated, keep the food in the diet regularly — sporadic exposure is more likely to cause problems than routine eating.

For a baby with severe eczema or a known family history of serious allergy, ask the paediatrician before introducing the high-risk foods; they may want it done under supervision.

Testing and diagnosis

Diagnosis is clinical first: a careful history of what was eaten, what happened and how fast, sometimes supported by skin-prick or specific IgE blood tests, and confirmed where needed by a supervised food challenge in hospital.

Be sceptical of the wide 'food intolerance panels' sold by labs and some clinics, which test dozens of foods and typically produce long lists of false positives. Children have been put on damagingly restricted diets on the strength of those reports.

Never diagnose and restrict on your own for more than a short trial. Removing milk, wheat or eggs from a growing child's diet without cause creates real nutritional gaps. Two weeks off a suspect food, then a careful reintroduction with the doctor, gives a far more honest answer.

Living with a diagnosed allergy

Learn the label language and the hidden sources — milk in biscuits, egg in cakes and some breads, peanut in chutneys and gravies, sesame in many Indian sweets and breads. In restaurants and at functions, ask about the cooking oil and the shared kadhai; cross-contamination is the usual cause of surprise reactions.

Make the plan portable: a written emergency plan from the doctor, prescribed antihistamine, and an adrenaline auto-injector if prescribed — carried, in date, and with at least two adults at school knowing where it is and how to use it. Tell the class teacher, the ayah and the canteen, in writing.

Teach the child, in words they can use: which foods are theirs, that they must not share tiffin, and that they must tell an adult immediately if their mouth tingles or they feel unwell. Many childhood allergies to milk, egg, wheat and soya are outgrown — ask about periodic re-testing rather than assuming a lifetime sentence.

When to see a doctor

Emergency — call 108 and give adrenaline if prescribed: difficulty breathing, wheeze, noisy breathing or a hoarse voice; swelling of lips, tongue or throat; widespread hives with vomiting; pale, floppy or collapsing; a child who says their throat feels tight. Lay them flat with legs raised (or sitting up if breathing is hard) and go to hospital even if they improve after the injection.

Same-day, non-emergency: hives after food without breathing symptoms, repeated vomiting after a specific food, blood or mucus in a baby's stool, worsening eczema with feeding problems, or poor weight gain with suspected food reactions.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: My baby gets a rash around the mouth when eating tomato or citrus — is that allergy? — Usually contact irritation from acidic food on delicate skin, not an allergy — it stays where the food touched and settles quickly. A rash spreading elsewhere, with swelling or vomiting, is a different matter and needs assessment.

Q: Is lactose intolerance the same as milk allergy? — No. Lactose intolerance is difficulty digesting milk sugar, causing gas and loose stools; it is uncommon in young Indian children but rises with age. Milk protein allergy is an immune reaction and is a different, more serious condition.

Q: Can allergies develop later, after eating a food for years? — Yes, though it is less common. Any new pattern of reactions after a specific food should be taken seriously regardless of history.

Q: Do home remedies or 'allergy-clearing' treatments work? — No. There is no home cure for food allergy, and delaying real management with alternative treatments is dangerous. Avoidance, an emergency plan and medical follow-up are the treatment; supervised immunotherapy for some allergies exists in specialist centres.