We provide comprehensive care including allergy testing and treatment for children of all ages with suspected or confirmed food allergy in the Food Allergy Clinic at Johns Hopkins All Children’s in St. Petersburg, Florida. We work with families to help them learn how to best manage their child’s allergy at home and school.

Why Choose Johns Hopkins All Children’s

Expert, Specialized Pediatric Food Allergy Care

Our program is the first hospital clinic in Florida dedicated to pediatric food allergy. Our expert team treats children with all types of food allergies, including the most severe, practicing evidence-based medicine to provide your child with the testing and treatment that best meets their individual needs.

Whether your child’s reaction was mild or severe, or due to a single or multiple foods, we will work with you and your children and guide you through the process of additional testing and treatment options.

Comprehensive Testing and Treatment Options

We provide in-depth diagnostic services for food allergies, including skin testing and blood testing. We offer oral immunotherapy as well as Xolair, currently the only FDA-approved biologic for food allergies.

Safe, Hospital-Based Oral Food Challenges

We are among the few centers that provide oral food challenge services. An oral food challenge (OFC) is the "gold standard" medical test used to accurately diagnose or rule out a food allergy. It is a highly supervised medical procedure where a patient is given gradually increasing amounts of a suspected allergen to see if a physical reaction occurs. As a hospital-based program, we are able to offer this service in a safe environment with access to the hospital’s emergency medicine services if a patient has a severe reaction during an oral food challenge.

Our food allergy team is experienced in providing oral food challenge services, and the hospital’s emergency medicine specialists have expertise in responding to a full range of emergency medical needs in children of all ages. We serve as a referral center for providers who refer patients to us for oral food challenges.

Family Education for Food Allergies

Having a food allergy can be stressful for the child and the whole family. We provide patient and family education, including topics like:

• Recognizing the signs of an allergic reaction
• When and how to use emergency allergy medication such as epinephrine (a medication that treats an acute allergic reaction, and is available as an injection or a nasal spray)
• How to read food/nutrition labels
• Dietary guidance and recommendations on food avoidance and safe alternative substitutes
• Safe reintroduction of foods back into the diet under medical guidance
• Recommendations on new and emerging therapies and treatment options

We provide information and guidance to help you manage your child’s allergy outside the home at school, daycare, summer camp, social events like birthday parties and other places.

How We Diagnose Food Allergies

Skin test

During a skin test (sometimes called a prick test), we apply to the child’s back or arm a set of devices coated with the known allergen extracts for which we want to test. The device has small prongs that will create minor scratches on the skin and allow the allergen extracts to penetrate. If your child has a type of food allergy known as “IgE-mediated reaction” a small wheal reaction (which looks like a raised, red bump that flairs from the middle) likely will develop at the testing site and allow us to confirm the allergy.

Skin testing is usually a reliable method for food allergy diagnosis, with results available in 15 minutes. We will carefully select the allergen extracts for your child’s skin test depending on his or her history. Skin testing can be done during a regular clinic visit. Patients should avoid antihistamines for five days prior to testing.

Blood test

Blood testing, now available for a wide range of food items, is used in conjunction with a skin test for food allergy evaluation. The blood test measures the immunoglobulin E (IgE) antibody specific to each food being created by your child’s immune system. Component resolved diagnosis (CRD) to some foods such as peanut, hazelnut, egg and milk may be used in addition to IgE testing.

Oral food challenge

An oral food challenge is an elective test in which the patient slowly eats small amounts of food to confirm or rule out a suspected allergy. An oral food challenge will take three to four hours.

The family will bring the food their child is testing to the appointment. A week before your child’s oral food challenge, we will call you to confirm the foods we will test and the ingredients you should use.

On the day of the appointment, you will be required to bring two epinephrine autoinjectors with you, in case your child has a delayed reaction on the way home from your appointment. After taking your child’s vital signs, we will start by giving him or her a very small amount of the food you prepared for the test and monitor for a reaction. If your child does not have a reaction, we will increase the amount of food given every 15-20 minutes and continue to observe them for an hour after the last dose.

Completing an oral food challenge in a controlled environment allows us to monitor for and treat an allergic reaction to confirm foods your child does or does not need to avoid.

Treatment Options for Food Allergies

There are several treatment options for food allergies. We will discuss which treatments may best meet your child’s needs, depending on their individual condition.

Some treatments include:

FDA-approved treatment Xolair

This is the only FDA approved treatment that can be used to reduce allergic reactions, including severe reactions such as anaphylaxis, following accidental exposure to one or more foods. It may be used alone to reduce the risk of anaphylaxis in some patients, or in some patients it may be used along with oral immunotherapy to help reduce reactions during the process of oral immunotherapy. We will discuss your child’s candidacy for Xolair with you as not all patients are candidates for this treatment.

Oral immunotherapy

We offer oral immunotherapy treatment for common food allergies including peanut, tree nuts (cashews, pistachios, walnuts, pecan, hazelnuts), egg, milk and sesame. Other foods can be considered. Patients ingest very small amounts of the allergen in our office, so they can be monitored and treated for a reaction as needed. The amount ingested is gradually increased over a period of several months to help the patient become desensitized to the food.

Oral immunotherapy will not cure a child’s allergy, but the treatment can desensitize children to their food allergen so that they experience less severe reactions if they come into contact with something containing the allergen, which can help to alleviate the stress many families feel in navigating their child’s food allergy.

Oral immunotherapy is available as a self-pay service due to current insurance billing limitations; eligible patients may be able to use HSA/FSA funds.

What to Expect

Your child’s first appointment will include a physical exam and we will take a complete history, including any reactions they have experienced to foods, and review any past treatments or test results your child may have had.

Families should bring the following to their child’s appointment:

• A list of all suspected reactions, including what food was eaten, symptoms, and timing
• A list of your child’s current medications
• Previous allergy testing results if available

Skin testing for food allergies may be done the same day if the patient is ready and takes about 15 minutes. In most cases you will receive the results of your child’s skin test before you leave. Your child will need to stop taking any antihistamines five days prior to the appointment for skin testing.

This appointment will generally be about an hour. We will recommend additional testing, such as blood testing, as needed.

If your child’s allergist has referred your child for an oral food challenge, please bring allergy testing results, labs, and previous appointment notes to your child’s appointment.

Learn More About Food Allergies

Typically, our immune systems work to fight infection and disease. When your child has a food allergy, it means his or her immune system reacts to that particular food as if it is harmful. When your child comes in contact with that food, their body releases chemicals to fight against the food allergen, causing allergic symptoms that can affect different parts of the body, such as the respiratory system or gastrointestinal tract.

Food Allergy Symptoms

The symptoms of food allergies can vary from patient to patient, and can develop very quickly in just a few minutes, or over the course of several hours. Some common symptoms of food allergy include:

• Skin rash, hives or itching
• Swelling of the lips, face, tongue, throat or other body parts
• Difficulty breathing, wheezing, coughing or nasal congestion
• Stomach pain, nausea, vomiting or diarrhea
• Dizziness, lightheadedness or fainting

There is no medication that can cure a food allergy, so avoidance is the most important step in managing your child’s food allergy.

Food allergies can also have similar symptoms as food intolerance, but food intolerance does not involve the immune system and is caused by the person’s inability to digest certain substances, like lactose or gluten. Symptoms of food intolerance include burping, indigestion, gas, loose stool, headaches and nervousness.

• Allergy testing may be needed for children who have experienced:
• Sudden onset of these symptoms after ingesting a food
• Anaphylaxis
• A reaction to the same food more than once
• Have moderate to severe eczema

Allergy testing that is used to screen for foods that have never caused symptoms is generally not recommended because it may identify sensitization without a true allergy, leading to unnecessary food avoidance, anxiety and testing.

When to seek emergency care

Food allergic reaction can lead to anaphylaxis, which is a severe allergic reaction that requires immediate treatment with epinephrine. Families should administer epinephrine immediately and call 911 if their child eats a food and has symptoms that may include:

• Sudden onset of new rash
• Hives
• Breathing problems, including wheezing or coughing
• Facial/throat swelling
• Vomiting
• Feeling dizzy
• Fainting or passing out

Treatment with an epinephrine autoinjector should be given immediately. Do not wait to see if symptoms improve, and do not use antihistamines instead of an epinephrine autoinjector.