Q: I have a 2-year-old who is highly allergic to milk, eggs, wheat and tree nuts and is still on his hypoallergenic infant formula. It’s so difficult to move forward with introducing new foods, and I can’t bring myself to experiment with rice drink (milk). I’m fearful he’ll have an anaphylactic reaction, such as he had with milk and eggs (he was admitted to the hospital).
My son doesn’t have rice in his diet, only baby food chicken, vegetables, applesauce, pear and banana. I am so scared; do you think I should try rice drink and wean him off the formula? Should I get him retested for allergies?
Dr. Sharma: For families who have a child with multiple food allergies, it can be very challenging, especially initially, to figure out what to feed a child.
Meeting with an allergist and a dietitian should help you to navigate the introduction of new foods. A dietitian can evaluate your child’s current diet, and offer advice on how to meet any nutritional deficiencies while still avoiding his allergens.
Although your son has multiple allergies, there are likely many foods that he would tolerate. For example, rice does not share any structural similarity, or “cross-reactivity,” with his other food allergens.
Although rice milk and cow’s milk have the term “milk” in common, they are not cross-reactive, and the vast majority of children with cow’s milk allergy can safely drink rice milk. So discuss this with your allergist, who may recommend that rice milk, or perhaps soy milk, be introduced.
For foods that are “cross-reactive” with your son’s food allergens, your allergist may recommend limited testing. However, indiscriminate testing of panels of foods is not recommended because of the risk of false positive results, which may result in unnecessary diet restrictions.
If test results are not conclusive, medically-supervised oral food challenges, in which the suspect food is eaten in gradually increasing amounts, are also sometimes used to help expand a child’s diet. These challenges can definitively confirm or rule out a food allergy.
Finally, given the severity of prior reactions, it’s understandable that many parents can have significant anxiety about introducing new foods into a child’s diet. In those cases, meeting with a psychologist or therapist to discuss those feelings can also be very helpful.
Dr. Sharma is an allergist, clinical researcher and assistant professor of pediatrics. He is Clinical Chief of the Division of Allergy and Immunology at Children’s National Health System in Washington, D.C. and Director of the Food Allergy Program. Questions submitted below will be considered for answer in the magazine.