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Dr Juan Trujillo, paediatric allergist at Cork University Hospital. Picture: Larry Cummins<\/p>\nWhenever you give your child tomato sauce, they have a reaction. But when you give them tomatoes in other forms, nothing happens. Could it be an allergy?<\/p>\n
\u201cThis is not an allergy,\u201d says Dr Juan Trujillo, a paediatric allergist and co-director of the Centre of Excellence in Allergy at Cork University Hospital and UCC.<\/p>\n
\u201cFor allergy, there\u2019s always a reaction when you have the same culprit food.\u201d<\/p>\n
The hospital\u2019s allergy centre is the only specialised allergy service outside of Dublin and the only centre in Ireland accredited by the World Allergy Organisation.<\/p>\n
\u201cIt sees 3,000 patients a year between new, return, and follow-up. They\u2019re aged from one day old to 16 years.\u201d<\/p>\n
Trujillo says the most common childhood food allergens here are milk, eggs, peanuts and tree nuts (hazel, Brazil, cashew, walnut).<\/p>\n
\u201cIn other parts of the world, it changes. Australia has the highest macadamia nut allergy in the world because they eat a lot of macadamia.\u201d<\/p>\n
Dr Maeve Kelleher, a consultant in paediatric allergy at CHI, Crumlin, says traditionally less common allergens are emerging here.<\/p>\n
\u201cWheat, fish, legumes \u2014 peas, beans \u2014 and seed allergy. Because we\u2019re increasingly using them, eating different foods than 20 years ago. When I worked in London, we saw a lot of legume allergies in cultures that used lentils a lot.\u201d<\/p>\n
There are two types of food allergy, depending on symptoms and when they happen. <\/p>\n
IgE-mediated food allergy is triggered by the immune system producing immunoglobulin E (IgE). Symptoms develop just seconds or minutes after eating. There\u2019s a greater risk of anaphylaxis with this allergy type.<\/p>\n
\u201cSymptoms come on straight away, though sometimes can appear after one to two hours. They can include swelling of the face, skin reactions, or breathing troubles,\u201d says Trujillo.<\/p>\n
Dr Juan Trujillo, paediatric allergist at Cork University Hospital. Picture: Larry Cummins<\/p>\n
Non-IgE-mediated allergic reactions are caused by different immune system cells. This type can be hard to diagnose because symptom development is delayed.<\/p>\n
\u201cIt could be two to 24 hours after ingesting the culprit food,\u201d says Trujillo. Symptoms are often gastrointestinal: Abdominal pain, mucus, bloody diarrhoea and, in young children, colic.<\/p>\n
Evidence-based tests exist for IgE-mediated food allergies, but not for the non-IgE type.<\/p>\n
\u201cTaking a good clinical history is essential \u2014 sitting with the parent, asking about the child\u2019s reaction, the timing of it, what they think the cause is,\u201d Trujillo says.<\/p>\n
He warns against removing any suspect food from your child\u2019s diet unless a doctor has advised this. Instead, keep a diary of their food intake, \u201crecord any symptoms in a calendar\u201d, and bring it to the doctor.<\/p>\n
\u201cYou have to become like Sherlock Holmes at home \u2014 start looking at things that are connecting.\u201d<\/p>\n
Trujillo believes we are in an \u201callergy epidemic\u201d due to delayed introduction of foods to very young children.<\/p>\n
\u201cTen to 15 years ago, the [advice] was to delay introduction of so-called allergenic foods \u2014 milk, eggs, tree nuts, peanuts, soya bean, fish \u2014 sometimes for one to one-and-a-half years.<\/p>\n
\u201cBut delaying introducing these in those with an allergic propensity actually increases chances of their becoming allergic to the foods.\u201d<\/p>\n
When food is the culprit <\/p>\n
With today\u2019s focus on allergy prevention, he says parents are encouraged to introduce a diversity of foods into their children\u2019s diets early \u2014 even before six months of age. Since following this changed advice, Trujillo says \u201cthe usual patient coming to our clinic now is allergic to one or two foods \u2014 instead of having five or six things they avoid\u201d.<\/p>\n
Treatment for food allergy depends on the culprit food, he says. \u201cFor milk and egg allergies, we use the \u2018milk and egg ladder\u2019 \u2014 progressively introducing different products containing milk and eggs in a stepped approach so as to increase amount of that food being eaten at home\u201d.<\/p>\n
However, he urges doing this only under supervision of a paediatric allergist or specialist.<\/p>\n
In the case of other food allergies, they will mostly not be cured and avoidance is the recommended strategy.<\/p>\n
Knowing how to treat moderate and severe reactions, such as anaphylaxis, is a must. \u201cThis is where adrenaline auto-injectors come in. We advise parents to always have them [available to their child] and to know how and when to use them.\u201d<\/p>\n
![\"Dr](\"https:\/\/www.europesays.com\/uk\/wp-content\/uploads\/2025\/04\/4563157_10_articleinlinemobile_Dr_Maeve_Kelleher.jpg\" "\\"Dr")
Dr Maeve Kelleher.<\/p>\n
Kelleher confirms that \u2014 though not available in Ireland \u2014 oral immunotherapy treatments are now emerging. She points to the Vitesse trial in which Ireland is participating. It is evaluating an investigational drug patch for four- to seven-year-old children with peanut allergy. The small amount of peanut protein in the patch is designed to potentially desensitise a peanut-allergic person by repeated exposures via the skin.<\/p>\n
\u201cBefore the patch, you might have reacted to one-tenth of a peanut. After the patch, you won\u2019t react until you have two peanuts. This is the goal \u2014 it would be a lifelong treatment rather than a cure,\u201d she says.<\/p>\n
Do children outgrow food allergies?<\/p>\n
\u201cIt depends on the food,\u201d says Trujillo. \u201cEight or nine out of 10 will outgrow milk and egg allergies by age five, two out of 10 might grow out of peanut and tree nut allergies by age eight. For most children in Ireland right now with a peanut or tree nut allergy at age 10 or 12, they probably won\u2019t outgrow it. But as we move towards new ways to treat these allergies, there could be more hope for younger children.\u201d<\/p>\n
Intolerance isn\u2019t an allergy<\/p>\n
Allergy disinformation is widespread.<\/p>\n
\u201cIt can come from healthcare professionals doing so-called allergy and intolerance tests that aren\u2019t accepted by the medical community. These won\u2019t distinguish what true allergy is \u2014 they could give false information,\u201d says Trujillo.<\/p>\n
Some 50% of patients who attend the allergy centre have had \u201cwrong or inadequate management by themselves or by other non-specialists\u201d, and it has led to avoidance of foods.<\/p>\n
He says it is very easy to eliminate a food from a child\u2019s diet, but not so easy to return it.<\/p>\n
\u201cEliminating foods can cause nutritional problems. Children learn to eat various foods in their early years.<\/p>\n
\u201cIf you stop them eating [some foods] at this stage, they become picky eaters.\u201d<\/p>\n
Trujillo acknowledges the difficulty of finding paediatric allergist support in Ireland.<\/p>\n
\u201cWhen parents are looking for information, they can sometimes look for any kind of answer.\u201d<\/p>\n
The first line of support should always be the GP. \u201cIn Cork, we meet GPs and community dietitians every two months to help build knowledge of true allergy because they are the filters.\u201d<\/p>\n
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(front middle) ) Dr Juan Trujillo, paediatric allergist with team members (rear from left) Dr Zoe Palmer, Ciara Tobin, CNS Allergies, Dr Claire Holland and Dr Sadhbh Hurley, at Cork University Hospital. Picture: Larry Cummins<\/p>\n
Terms like \u201cfood intolerance\u201d and \u201cfood insensitivity\u201d can also create confusion.<\/p>\n
\u201cIntolerance isn\u2019t an allergy \u2014 it\u2019s a food unsuitable to your body. It\u2019s almost always dose-dependent. Maybe when you drink a lot of milk, rather than a little, you get symptoms like flatulence, diarrhoea, or bloating,\u201d explains Trujillo. Food allergy, on the other hand, is not dose-dependent. \u201cSometimes it may be a mild reaction, sometimes severe, but the particular food always gives a reaction.\u201d<\/p>\n
Similarly, food insensitivity is not allergy either. \u201cIt\u2019s another way to say some foods will interrupt your system.\u201d<\/p>\n
The CHI paediatric clinic sees a couple of thousand allergy patients annually. \u201cWe\u2019ve done a lot of work to reduce it,\u201d says Kelleher, adding that long wait times can \u201cpush people\u201d to look for information wherever they feel they can get it.<\/p>\n
\u201cThere are definitely a lot of myths about food allergy. Our advanced nurse practitioner, Mair\u00e9ad Sheehan, did a study looking at people on long waiting lists and the effect of giving them myth-busting allergy information. The study showed this improved quality of life. Now, we give the information to all patients.\u201d<\/p>\n
Common myths range from \u201callergic reactions get worse each time\u201d, to \u201cadrenaline pens are dangerous\u201d.<\/p>\n
Kelleher also comes across the misplaced belief that children with eczema should be allergy tested to determine the cause of their eczema. \u201cBut eczema is a skin barrier condition.\u201d<\/p>\n
The real link between eczema and food allergy is that babies with eczema are more at risk of immediate-type food allergies. \u201cFor us, eczema is a flag to ensure the common food allergens are introduced to these children to try and prevent allergy.\u201d<\/p>\n
Kelleher and her team embrace the reality that online sources are where many people get their information today.<\/p>\n
\u201cWe want to get reliable, evidence-based information out on social media. It can be challenging to do this in a busy hospital.\u201d<\/p>\n
As Trujillo puts it: \u201cWe will fight the allergy epidemic with knowledge.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Whenever you give your child tomato sauce, they have a reaction. But when you give them tomatoes in…\n","protected":false},"author":2,"featured_media":4269,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[2420,2424,2422,2421,2423,105,117,16,15],"class_list":{"0":"post-4268","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-parenting","9":"tag-parenting-baby","10":"tag-parenting-preschool","11":"tag-parenting-school-children","12":"tag-parenting-toddler","13":"tag-health","14":"tag-parenting-advice","15":"tag-uk","16":"tag-united-kingdom"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114296275787537716","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/4268","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=4268"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/4268\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/4269"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=4268"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=4268"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=4268"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}