Sue Hubbard, M.D.

For this final column in the series, we shift the focus to food allergies. This topic was the concern of a mom who recently sent us an email question via our free iPhone app. She wrote: "Could my 9-year-old daughter be allergic to strawberries, as she gets a stomachache and sometimes vomits after she eats them? She has not had problems eating strawberries before."

This query was especially interesting because I've been reading and reviewing several articles on food allergies and their diagnosis. One piece appeared in the Journal of the American Medical Association (May 2010 issue) and another in the March issue of Consultant for Pediatricians. Both articles emphasized that there continues to be a great deal of confusion and lack of uniformity for diagnosing food allergies.

Food allergy is also not uniformly defined, but according to the National Institute of Allergy and Infectious Diseases (NIAID), it is an "adverse immune response that occurs on exposure to a given food and is distinct from other adverse responses to food such as food intolerance." Statistics show that somewhere between 1 percent to 2 percent of the population may have food allergies. It is also unclear if food allergies are on the rise, as data on this is conflicting.

With all of that being said, it sounds more like this child has developed an intolerance to strawberries, rather than an allergic response. It would be important to get more history, such as what else she has eaten with the strawberries when this occurs, if the symptoms are always the same, and if she has any other problems associated with the ingestion of this fruit. Specifically, does she complain of hives, itching, swelling of her tongue, lips, or difficulty breathing? Does she have problems with any other foods?

I also wonder if this child has the same symptoms if she picks fresh strawberries, if they're from the store, or if they're frozen. In other words, like so many things in medicine, a good history is probably the most important part of this "strawberry story."

If this child continues to have problems and the same symptoms, this sounds more like intolerance than a true allergic reaction, and she could just avoid the strawberries (not much fun, especially in the summer).

The mom might also check with her pediatrician about doing a blood test for IgE antibodies to strawberries. A food intolerance would not have an increase in IgE antibodies, as it's not an allergic reaction. If confusion persists, she could be referred to a pediatric allergist for further evaluation and even an oral food challenge.

There continues to be a great many studies surrounding the etiology of food allergies, and I'll keep you posted as new information is presented.

Dr. Sue Hubbard is a nationally known pediatrician and co-host of "The Kid's Doctor" radio show.


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Health - Medical History Key to Diagnosing Food Allergies