# Food allergy in a child - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Food Allergies - StatPearls (NCBI Bookshelf NBK482187) - https://www.ncbi.nlm.nih.gov/books/NBK482187/ · Food allergy in a child - disease-level clinical article (childhood-food-allergy-full.txt) · Food allergy in a child - disease-level clinical article (childhood-food-allergy-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (adrenaline monograph, p227) · Egyptian National Drug Formulary - Respiratory 2026 (cetirizine monograph, p13) - Verified date: 2026-08 ## Verified against - Food Allergies - StatPearls (NCBI Bookshelf NBK482187) - https://www.ncbi.nlm.nih.gov/books/NBK482187/ - Food allergy in a child - disease-level clinical article (childhood-food-allergy-full.txt) - Food allergy in a child - disease-level clinical article (childhood-food-allergy-clinical.txt) - Egyptian National Drug Formulary - Cardiovascular 2024 (adrenaline monograph, p227) - Egyptian National Drug Formulary - Respiratory 2026 (cetirizine monograph, p13) ## Treatment metadata - Adrenaline — 1 mg — injection - Identify the food, avoid it, and arm the family for a reaction (Recognition & Referral) - Cetirizine — 10 mg — oral.liquid ## Complete treatment card ```text FOOD ALLERGY IN A CHILD Sources: Food Allergies - StatPearls (NCBI Bookshelf NBK482187) - https://www.ncbi.nlm.nih.gov/books/NBK482187/ · Food allergy in a child - disease-level clinical article (childhood-food-allergy-full.txt) · Food allergy in a child - disease- level clinical article (childhood-food-allergy-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (adrenaline monograph, p227) · Egyptian National Drug Formulary - Respiratory 2026 (cetirizine monograph, p13) Review status: REVIEWED against 5 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - IgE-mediated reactions typically begin within minutes to 2 hours after eating the trigger food - Reactions can involve the skin (hives, swelling), gut (nausea, vomiting), airway (wheeze, distress) or heart and vessels (tachycardia, syncope) [nausea · syncope · tachycardia · urticaria · vomiting · wheeze] - Recurring hives, vomiting, diarrhea, abdominal pain or breathing trouble after meals should prompt suspicion of an allergy [abdominal pain · diarrhoea · urticaria · vomiting] - FPIES causes vomiting 1 to 3 hours after the trigger food, and with ongoing exposure can progress to bloody diarrhea, lethargy and failure to thrive [bloody diarrhoea · diarrhoea · failure to thrive · lethargy · vomiting] - FPIAP presents as blood-streaked stools in an otherwise well infant, with about 60% occurring in exclusively breastfed babies - Food protein-induced enteropathy causes chronic fatty stools, malabsorption and poor weight gain in early infancy [failure to thrive · steatorrhoea] - Skin reactions such as hives, flushing, itchy eyes and swelling under the skin usually appear within minutes to 2 hours of exposure [itching · urticaria] - Nasal congestion, sneezing, coughing or wheezing can occur, though breathing symptoms alone are uncommon [blocked nose · cough · sneezing · wheeze] - A sense of impending doom, together with generalized malaise and lethargy affecting several organ systems, can signal anaphylaxis [lethargy · malaise] SIGNS - what you find (4) - Non-IgE-mediated allergy in infants often shows as irritability, frequent spit-up, loose stools and poor weight gain [diarrhoea · failure to thrive · irritability] - Malabsorption in food protein-induced enteropathy can cause anemia, low albumin and vitamin deficiencies [anaemia] - A positive skin prick test forms a mosquito-bite-like wheal within 15 minutes, and its size roughly tracks reaction severity - Cardiovascular signs of anaphylaxis include low blood pressure, tachycardia, pallor, dizziness, syncope or collapse [collapse · dizziness · hypotension · pallor · syncope · tachycardia] TESTS (7) - IgE-mediated allergy is confirmed or excluded with skin prick testing, serum-specific IgE testing, or an oral food challenge - Both skin prick and serum-specific IgE testing have a high negative predictive value for ruling out an allergy - Serum-specific IgE testing is favored over skin testing for high anaphylaxis risk, active asthma, or skin conditions that preclude prick testing - Intradermal testing is more sensitive but less specific than skin prick testing and is not recommended for diagnosing food allergy - The oral food challenge is the diagnostic gold standard when history and initial testing leave the answer unclear - The oral food challenge carries a low but real risk of anaphylaxis or a fatal outcome - FPIES, food protein-induced enteropathy and FPIAP have no reliable lab test and are diagnosed from history and exam alone IF NOT THIS - what else fits (7) - Eosinophilic esophagitis presents with dysphagia, vomiting and reflux-like symptoms, often with a personal or family history of atopy - Mast cell activation syndrome can mimic food allergy through inappropriate release of histamine and tryptase - Celiac disease causes abdominal pain after eating gluten, chronic diarrhea, weight loss, fatigue and anemia - Panic or anxiety reactions, histamine intolerance, irritable bowel syndrome, reflux disease, fructose malabsorption and lactose intolerance are nonallergic mimics worth considering - Inborn errors of metabolism such as galactosemia can cause infant vomiting, lethargy and poor weight gain that resembles food allergy - Histamine intolerance can trigger headache, flushing and hives after histamine-rich foods like aged cheese or fermented products - Foodborne infections such as Salmonella or norovirus can be mistaken for food allergy since both cause vomiting and diarrhea Source Food allergy in a child - disease-level clinical article (childhood-food-allergy-full.txt) Status traced to the source above Rx: Anaphylaxis rescue | Main treatment | Antihistamine - symptom relief only ANAPHYLAXIS RESCUE 1. ADRENALINE [1st line] Adult 0.3 to 0.5 mg (0.3 to 0.5 mL of 1 mg/mL) INTRAMUSCULARLY into the anterolateral thigh - 0.5 mg over 50 kg. Repeat every 5 to 15 minutes if there is no response. - One dose; most respond after one or two Peds Under 6 months: 100 to 150 mcg (0.1 to 0.15 mL of 1 mg/mL) intramuscularly into the anterolateral thigh. Repeat after 5 minutes if no response. 6 months to 5 years: 150 mcg (0.15 mL of 1 mg/mL) intramuscularly into the anterolateral thigh. Repeat after 5 minutes if no response. 6 to 11 years: 300 mcg (0.3 mL of 1 mg/mL) intramuscularly into the anterolateral thigh. Repeat after 5 minutes if no response. 12 years and over: 500 mcg (0.5 mL of 1 mg/mL) intramuscularly into the anterolateral thigh. Repeat after 5 minutes if no response. (Intramuscular, 1 mg/mL solution, into the anterolateral thigh. Under 6 months: 100 to 150 mcg (0.1 to 0.15 mL). 6 months to 5 years: 150 mcg (0.15 mL). 6 to 11 years: 300 mcg (0.3 mL). 12 to 17 years: 500 mcg (0.5 mL). Repeat after 5 minutes if there is no response; if life-threatening features persist, further doses every 5 minutes until critical care arrives.) Choice Nothing else in an anaphylactic reaction opens the airway or restores the blood pressure. The antihistamine below relieves the rash and does neither, so it is given after the injection and never instead of it. Source Egyptian National Drug Formulary - Cardiovascular 2024 (adrenaline monograph, p227) Why The cited article states that prompt administration of adrenaline is the first-line treatment for anaphylaxis, that the family should give the auto-injector at the first sign and transfer immediately, and that a second injection is often needed 5 to 15 minutes later. It also records the failure that kills: it is commoner for adrenaline not to be given when it is needed than to be given unnecessarily, and delayed use is a risk factor for a severe reaction. The formulary lists anaphylaxis and other severe immediate hypersensitivity reactions as the first indication for adrenaline and gives both the adult intramuscular dose and the paediatric age bands used here. Caution GIVE IT FIRST AND GIVE IT EARLY. The cited article states that antihistamines, corticosteroids and inhaled beta-agonists must never replace adrenaline as the initial treatment, and that families commonly reach for an antihistamine first and lose time doing it. INTRAMUSCULAR, MID-OUTER THIGH. The formulary states the subcutaneous route absorbs more slowly and less reliably. The intravenous route is for a patient who has not responded to intramuscular adrenaline, and is specialist use. IF THERE IS MORE THAN SKIN, IT GOES IN. The cited article records this as the working rule taught in primary care: any allergic feature beyond urticaria is a reason to use the auto-injector. AFTER THE INJECTION THE CHILD STILL GOES TO HOSPITAL. Adrenaline is short-acting and a second dose is often needed; the guidelines the article cites ask for prompt medical assessment and transport for monitoring. THE MILLIGRAM-PER-KILOGRAM FIGURE IN THE ARTICLE DOES NOT AGREE WITH ITSELF. It states 0.1 mg/kg with a maximum of 0.3 mg in a child - but 0.1 mg/kg passes 0.3 mg in any child over 3 kg, so the two halves of that sentence cannot both hold. The age bands here are the formulary's instead, and no milligram-per-kilogram rule is printed. The formulary states there is no absolute contraindication to adrenaline in a life- threatening situation. NO ADRENALINE AUTO-INJECTOR IS ON THE EGYPTIAN REGISTER. The Egyptian products listed below are 1 mg/mL ampoules, so what a family can actually be sent home with is an ampoule, a syringe and a taught technique - not a place-and-press device. The written action plan and the practice matter more here, not less. TEACH THE TECHNIQUE, AND WRITE THE PLAN DOWN. The article asks for a written action plan, a demonstration device to practise on, the place-and-press technique into the thigh, and the auto-injector carried at all times including at school - about a quarter of first reactions happen there. Egypt EPINEPHRINE-MEMPHIS 1 MG/ML 5 I.M./S.C. AMP. MEMPHIS 10.00 EGP ADRENAMAX 1 MG/1ML 10 AMPS. CHEMIPHARM 75.00 EGP EPINEPHRINE-MISR 1 MG/ML 100 AMP. MISR 750.00 EGP ADRENALINE-CID 1 MG/1ML 100 I.M./S.C. AMP. CID 850.00 EGP MAIN TREATMENT 2. IDENTIFY THE FOOD, AVOID IT, AND ARM THE FAMILY FOR A REACTION (RECOGNITION & REFERRAL)[1st line] Adult Source Food Allergies - StatPearls (NCBI Bookshelf NBK482187) - https://www.ncbi.nlm.nih.gov/books/NBK482187/ Why Between reactions the treatment is avoidance and a written plan. The treatment of a reaction is adrenaline, and it is now printed above with the formulary's intramuscular doses by age band. Caution NINE FOODS DO ALMOST ALL OF IT - most reactions trace back to just 9 foods: peanuts and tree nuts, sesame, egg, cow's milk, wheat, soy, fish and shellfish. Ask about all nine by name rather than asking whether the child has an allergy. THE CLOCK IS THE STRONGEST CLUE - where the mechanism is IgE, the reaction usually starts somewhere between a few minutes and 2 hours after the food goes in. A rash six hours after a meal is usually not this. A MILD FIRST REACTION PREDICTS NOTHING - a first reaction may be mild and the next one severe, or life-threatening. Even a child whose reactions have so far amounted to very little can go on to react systemically, or to have anaphylaxis, on a later exposure. This is the point to make to a family who think a little urticaria settles the matter. DO NOT DIAGNOSE OFF A PANEL - skin-prick testing and specific IgE show sensitisation only, not allergy in the clinical sense, so a positive result that no history supports is worth very little. A negative one is worth more: both tests carry a high negative predictive value, which is what lets you exclude the allergy and stop a diet being restricted for nothing. So test the child whose story already makes the allergy likely, and not the rest. THE NON-IgE PRESENTATIONS THAT DO NOT ITCH - where the mechanism is not IgE, the trouble is in the gut, and in babies and toddlers it shows as diarrhoea, vomiting or constant possetting, a baby who is miserable, and weight that does not come on. Two named patterns: in FPIES the vomiting comes 1 to 3 hours after the food; and in food protein- induced allergic proctocolitis, FPIAP, a baby who is otherwise thriving passes stools streaked with blood, in the first months of life. THE MANAGEMENT BETWEEN REACTIONS - three parts: keep the food out altogether; teach this particular family what that means for them; and review at intervals, to see whether tolerance has come and whether the diet can be relaxed. Reviewing matters because the picture changes - egg, milk, wheat and soy are commonly grown out of, whereas an allergy to shellfish, fish, tree nuts or peanut usually stays for life. ADRENALINE FIRST, ALWAYS - in anaphylaxis, adrenaline given at once is the first-line treatment, and nothing else substitutes for it. An antihistamine, a steroid, an inhaled beta-agonist: those are add-ons that take the edge off the symptoms, and they must NEVER stand in for adrenaline as the first thing given. The failure seen in practice is precisely this - families reach for an antihistamine while a systemic reaction is building, the auto-injector waits, and that delay is what raises the risk of anaphylaxis. WHY NO ADRENALINE DOSE IS PRINTED HERE - the cached article states a per-kilogram figure for epinephrine that does not agree with the age-band intramuscular doses carried on the anaphylaxis entry, and a per-kilogram number that is out by a factor of ten is the worst kind of thing to copy onto a card. No per-kilogram adrenaline dose is therefore printed here. Use the anaphylaxis entry for the dose. THE FAMILY MUST CARRY IT AND MUST USE IT - adrenaline only works if it is within reach, so the device travels with the child everywhere: to school, to work, on any journey. And the error that actually happens is the opposite of the one families fear - far more people fail to use the injector when it was needed than use one they did not need. Teach the technique too: into the outer thigh, front and side, held against the leg and pressed, to AVOID injuring a finger with the needle. ASTHMA IS THE RISK MULTIPLIER - a child who also has asthma runs a greater risk of a reaction that threatens life, and more so again where anaphylaxis has already happened once. A child with both needs the asthma controlled as part of allergy management, not as a separate problem. DO NOT LET THE DIET GET BIGGER THAN THE ALLERGY - cutting foods out on an allergy that was never confirmed costs a child the nutrients he needs. The harm runs wider than nutrition, too: a diet narrowed too far, and the anxiety about food that travels with it, worsen the outlook - growth suffers, feeding suffers, and so does the child's quality of life. One line is useful in clinic: where the symptoms carry on even though the elimination diet is being kept to, food allergy is probably not the explanation. ANTIHISTAMINE - SYMPTOM RELIEF ONLY - give alongside 3. CETIRIZINE [add-on - not a substitute] Adult 10 mg once daily by mouth - While symptoms last Peds Oral. 2 to 6 years: 2.5 mg once or twice daily. 6 to 12 years: 5 mg twice daily, or 10 mg once daily depending on severity. Over 12 years: 10 mg once daily. The formulary's oral indications start at 2 years; below that its cetirizine entry is intravenous only, for acute urticaria from 6 months of age (2.5 mg once daily up to 5 years). Source Egyptian National Drug Formulary - Respiratory 2026 (cetirizine monograph, p13) Why The cited article names antihistamines among the adjunctive medicines that reduce the symptoms of an allergic reaction, and is explicit that they never replace adrenaline. The article names no antihistamine and gives no dose; the formulary's cetirizine monograph names relief of chronic idiopathic urticaria and treatment of acute urticaria among its indications and gives the doses used here. Caution IT IS NOT THE TREATMENT FOR ANAPHYLAXIS AND MUST NOT DELAY THE INJECTION. It settles itch and rash. It does nothing for the airway or the blood pressure. Do not give to a child with known hypersensitivity to cetirizine, levocetirizine or hydroxyzine, or in end-stage renal disease. An antihistamine taken before allergy testing interferes with the result. The article asks for it to be stopped about a week before skin prick testing. Egypt ALERID 10MG/ML ORAL DROPS. 10 ML GLOBAL NAPI P... 29.00 EGP ZYRTEC 10MG/ML ORAL DROPS 10 ML GLAXO SMITHKLINE 43.00 EGP LERGFREE 5MG/5ML SYRUP 120ML DEBEIKY 9.00 EGP -> ? strength differs, ? different route - not oral liquid EPIRIZINE 5MG/ML SYRUP 60 ML EIPICO 19.00 EGP -> ? strength differs, ? different route - not oral liquid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)