Food allergy symptoms: Mild vs. serious
Sasha was a fussy eater – often just turning her head away and rubbing at her lips. She also had frequent eczema spots on the inside of her elbows and on her cheeks. Little Will had a small rash around his mouth and a nagging cough.
Parents who tell me about these seemingly minor symptoms – which might even be considered "normal" – are often surprised when I tell them it could be food allergy.
A food allergy reaction isn't always sudden and dramatic, especially in young children, but most will appear within minutes or a couple hours after consuming the food.
Babies and young children may cry, look flushed and break out into hives. They may vomit or begin wheezing. It could happen the first time a child tries a new food or after they've safely eaten it a few times. Children might also experience ongoing symptoms that are hard to link to a specific food – eczema is the most common.
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Older children and adults may react more with flushing, hives and wheezing, or with stomach discomfort but not necessarily vomiting. If breathing is difficult or there's dizziness or confusion, it's likely anaphylaxis.
Mild allergy symptoms can erupt into serious events without warning. That's why it's important to talk with your child's pediatrician about any and all symptoms. Simple skin testing by a board-certified allergist will confirm or disprove a suspected food allergy, so a safe and nutritious diet can be developed and followed.
There's no such thing as a "mild food allergy." There are mild symptoms, for sure, but there's no way to predict the severity of a reaction from one day to the next – which is why allergists recommend staying away from any food that you're truly allergic to.
Ask a board-certified allergist for a written Allergy and Anaphylaxis Emergency Plan, with specific instructions about what to do if symptoms appear, plus what to do if you suspect you or your food-allergic child has been exposed to a food allergen. The American Academy of Pediatrics recently published a sample form at aap.org.
Always follow the instructions on your Allergy and Anaphylaxis Emergency Plan, if you have one. If not, for mild symptoms call your doctor; for serious symptoms, call 911 and use an epinephrine auto-injector as soon as possible. A general rule of thumb in an emergent situation is if skin symptoms are rapidly spreading or you have any other symptom with it – nausea, vomiting, cramps, dizziness, coughing or wheezing – it's serious.
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Food allergy symptoms can be broken down into types: skin, gastrointestinal, respiratory and cardiovascular.
1. Skin symptoms are the most common: a skin rash or hives; itchy mouth or lips; flushing of the face; swelling of the lips or tongue.
- A few hives around the face.
- Itchy mouth, tongue, lips or eyes; this is a form of hives, developing under the skin.
- Mild swelling of lips.
- Hives that pop up and spread across different parts of the body; this indicates that the allergic reaction is spreading through the bloodstream.
- Swelling of the mouth or tongue that interferes with breathing or swallowing.
- Any amount of hives or swelling is considered serious in a person who has experienced a serious allergic reaction in the past.
- When hives appear along with symptoms in another part of the body, like respiratory or gastrointestinal, this is considered serious.
- Some people with hay fever will experience mild food allergy symptoms – an itchy mouth, for example – when eating certain fruits and vegetables that are related to the tree, grass or weed pollens they are allergic to. This is called OAS, or oral allergy syndrome. Call your physician if you notice these symptoms.
- Others may experience sensitivities to food, such as lactose intolerance. These sensitivities make food difficult to eat, but they are not a true allergy. That's why it's important to see an allergist for testing.
2. Gastrointestinal symptoms like vomiting are particularly common among infants and children.
- Stomach discomfort
- Severe pain or cramping
3. Respiratory sympotoms are also quite common and often serious – especially for people with both asthma and food allergies.
- Small cough
- Hoarse voice
- Shortness of breath
- Hoarse voice
- Uncontrollable cough
- Respiratory symptoms are always serious in people with asthma; if they arise in a person with food allergies soon after eating, they should be treated with epinephrine, not albuterol. Epinephrine will improve breathing whether the reaction is to a food allergen or asthma trigger. Fatal cases of anaphylaxis have been reported in people with both food allergy and asthma, so you should not hesitate to use your epinephrine.
4. Cardiovascular symptoms are always serious and require immediate treatment – use an epinephrine auto-injector or call 911.
- Dizziness, fainting or confusion; this indicates decreased blood flow to the brain.
- Pale skin, blue-tinged lips or fingernails; this indicates restricted oxygen and blood flow throughout the body.
There is no substitute for the care of an allergist when food allergy is suspected. Be sure to have allergy testing under the guidance of a board-certified allergist if you think you or your child may have a food allergy. There are many tests that have not been validated for allergies, so you want to be sure you are undergoing accurate and reliable testing. Misinformation for food allergies can be dangerous.
|• Few hives||• Hives plus any other symptoms|
|• Eczema||• Hives spreading across the body|
|• Mild swelling of the lips||• Swelling that affects breathing|
|• Flushing||• Vomiting or diarrhea|
|• Itchy nose, mouth, eyes||• Shortness of breath, wheeze, cough|
|• Stomach discomfort||• Pale skin; blue lips or fingernails|
|• Fainting or dizziness|
|• Feeling of doom, confusion, agitation|
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