Non-IgE Allergies in Children: A guide for parents to understand and find solutions

Written by Kate Annat, APD

Allergies are very common in children. Some children are atopic (which means sensitivity to allergens), and when they are exposed to more things in their environment, whether that be what they eat or what they come in contact with they can develop allergies. As parents you want to protect them from anything that is harmful but of course we know that’s impossible. Our job is to know what to do when there is a problem. I’m here to help you get through challenges, like allergies, when they arise.

I hope this article gives you the knowledge and some of the answers when your child is confronted with the issue of non-IgE allergies.

We’ll look at defining a non-IgE allergy, what are the symptoms to look out for, which foods commonly trigger a non-IgE allergy and some solutions to overcome the issue.

Defining non-IgE allergy

Firstly let's define IgE allergy.

IgE stands for "Immunoglobulin E," which is a special type of protein in our body that helps us fight off allergies. When we have an allergy, our immune system can overreact, producing IgE antibodies, in response to certain things, like food or pollen. These IgE antibodies travel to cells throughout the body, triggering them to release chemicals, causing an allergic reaction. The common places in the body for these responses to occur are in the nose, lungs, throat or on the skin. And the most common reaction is itching, swelling and bloating. Occasionally more serious reactions occur like vomiting or blood in the stool. No matter the situation, your child deserves a long term solution. When we work together we will get to the root of the issue, providing you with a plan that allows your child to thrive and find happiness

What is a non-IgE allergy?

Non-IgE mediated food allergies are caused by a reaction involving other components of the immune system apart from IgE antibodies. The reactions do not appear immediately after the ingestion of the food and usually relate to reactions in the gastrointestinal tract such as vomiting, bloating and diarrhoea. Other symptoms could include mucousy stools, blood in stools, congestion, reflux and eczema.

Now I'm going to get a bit medical with you, so stay with me. I'll break down the different types of non-IgE allergies and their symptoms so you can understand more precisely your child's allergies. This information has been provided from the Royal Children's Hospital - non-IgE allergy site.

Food Protein-Induced Allergic Proctocolitis (FPIAP):

Commonly presenting in the first few months of life
Inflammation of the rectum
Look out for stools with blood +/- mucous
Your child will appear happy and well in themselves despite these symptoms

Food Protein-Induced Enteropathy:

Commonly presenting in early infancy
Inflammation of the small intestine
Look out for persistent loose stools, diarrhoea, bloating and or tummy distension and redness around the anus
Lactose malabsorption can result from inflammation (remember this is not the cause off the issue just a symptom)
Vomiting is common and there may be poor weight gain
Your child will appear unsettled and just miserable

Food Protein-Induced Enterocolitis Syndrome (FPIES):

Commonly presenting in early infancy
Infants can also present with symptoms at 6 months when starting on solids
Delayed onset of repeated vomiting on average 2-4 hours after ingestion of the trigger food
You also would see pallor, lethargy and loose stools following later after the vomiting symptoms
The most common trigger foods are rice, cow milk, soy or oats, however it can be caused by any food

Eosinophillic Oesophagitis or Eosinophillic Gastrointestinal Disease:

Presenting more commonly in children and teenagers
Slow eating
Food impaction/food bolus obstruction (FBO) – when food gets stuck on the way down the oesophagus
Choking or gagging on food
Regurgitation of foods
Abdominal (stomach) pain
This will be diagnosed via a Gastroenterologist

Food Pollen Syndrome:

Presenting in children who are already allergic to pollens and have hayfever
Look out for immediate allergic symptoms of redness, mild swelling or itching of the lips, tongue, inside of the mouth, soft palate, throat and ears
Occasionally symptoms in the oesophagus or stomach will causing abdominal pain, nausea and even vomiting
Sneezing, runny nose, or eye symptoms can also occur
Typically children will react to the fresh version of the trigger food, however with heat or cooking the symptoms should not present themselves
You can do a blood or skin prick test to diagnose which pollen your child is reacting to and from their we can work out which foods are the triggers

What are the symptoms of a non-IgE allergy?

Non-IgE allergy symptoms range from delayed vomiting and diarrhoea, reflux, eczema, congestion, loose stools, mucousy stools or blood in the stools. In some cases constipation or colic can be the presenting symptoms. The symptoms often take longer to develop, 24 - 72 hours later, rather than those of IgE mediated food allergies which frequently occur immediately up to two hours following food ingestion.

Is there a test for non-IgE allergies?

Because the symptoms are usually delayed, it is more difficult to make the association between offending food and the symptoms. For this reason there is no blood test for the diagnosis of a non-IgE allergy. The only thing you can do is exclude the suspected food and reintroduce the food to see if your little one's symptoms return.

As a practicing paediatric dietitian, I have dealt with many children with this type of allergy. I have the experience and knowledge to help your child with their unique situation.

Book an appointment in a few clicks and we can get to finding a solution to your child’s discomfort.

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What are the most common food triggers in children?

These are the most common foods that can trigger a non-IgE allergic reaction in children.

Milk
Wheat
Eggs
Soy

This is just a typical approach to my experience with allergies. Every child is unique and meeting with my will involve an individualised approach to assessing allergies.

For Infants (under 6 months) - cow’s milk and soy proteins
Older children (over 6 months) - wheat and egg

Could my breastmilk be causing a non-IgE allergy?

Yes. The thing about assessing allergies in breastfed babies is that the symptoms are often less obvious. This is due to the delay in mum ingesting the allergen and then the time it takes for baby to then feed off mums milk and absorb that allergen.

What this means is that your child might have a delayed delayed response to what you have ingested which makes it trickier to pinpoint your child's triggers. You will see all the same symptoms as I have mentioned above but they might not be as pronounced.

In a consultation we will discuss your child's triggers and then how to change your own diet so we can keep your family breastfeeding.

Otherwise the management is the same! We exclude the allergens from your diet and reintroduce after 1 month over three days to see if symptoms return. Then we avoid the allergens for 6 months before we start on the ladders.

What is the most common intolerance in breastfed babies?

In my experience the number one culprit is cow’s milk. Before you decide to eliminate cow’s milk entirely from your diet, let’s talk. There are a host of nutritional benefits your baby is receiving from cow’s milk in your diet. It's important to discuss with a dietitian the nutritionally appropriate alternatives you need to maintain the best health for you and your baby.

What about soy?? If your child has an intolerance to cow’s milk there is a 10 - 30% chance they will have an issue with soy. But….that also means they have a 70 - 90% change of not having an allergy with soy. Talk with me about your child’s symptoms and we can work through this challenge together.

Can I keep breastfeeding whilst doing an exclusion diet for my baby?

Yes!!!!!!!!!!!!!!!!!! I’m so frustrated when mothers are told to stop breastfeeding while they are on an exclusion diet. If managed properly, it’s possible to do both, without compromising your baby’s health or your health. So do not let a professional tell you to stop!

I’ve heard it all. Like, trial an allergy formula for two weeks or a month. This is awful advice for mums. It commonly leads to discontinuation of breastfeeding, either from poor supply or bottle confusion. And the transition back to breastfeeding, especially from a month long break, can be very tough and sometimes not possible.

I’ve helped mums who faced the breastfeeding and food allergen situation. Together we can work you through an exclusion diet while keeping your baby breastfed and happy!

How does non-IgE mediated food allergy differ from IgE mediated food allergy?

Non-IgE food allergies are very rarely life threatening. They cause milder pain and discomfort rather than adverse reactions such as anaphylaxis.

However, non-IgE mediated food allergy is less well understood. The symptoms are usually delayed, making it more difficult to connect the symptom to the offending food. And the usual diagnostic tests, the skin prick test or blood test, provide no insights.

So what can you do? Exclude the suspected allergen, observe the impact, reintroduce to see if symptoms return. Yes, this can be difficult to administer but as a paediatric dietitian, I can help manage the process with you. The key is patience. Reintroduce one allergen for 3 full days, or until symptoms appear, after the full 1 month exclusion. Look out for symptoms. Make no other change in your child’s diet. No reaction generally means this isn’t a trigger for them. Repeat this for the next allergen and so on.

Our approach to non-IgE allergies

My goal is long term success, by uncovering the root of the cause. But I understand it’s just as important to bring that smile back to their face with some immediate relief. We’ll work on both these goals simultaneously.

Resolving non-IgE allergies long term is a 4-step process, known as the ladder approach. The basis of this approach is for your child to build up their tolerance and use their inner strength to overcome the allergy. Mindful of this being a key growth period of their life, we also ensure they maintain a nutritionally adequate diet.

Depending on where your child is on the allergy journey, these are the general steps we’ll work through together.

Diagnosing a non IgE allergy. We’ll discuss your child’s food and symptom history, and answer questions. I’m looking for foods likely to trigger an allergic reaction. To clear up the symptoms, for 1 month we’ll remove the suspected allergens. Then progressively add them back in to see which symptoms return.
Clean up diet. We’ll swap the trigger allergens with nutritionally appropriate alternatives and discuss how to prevent other allergies from developing (especially if you little one is <6 months). For 6 months we’ll keep your child’s triggers out, to rest their immune system.
Ladder approach. Now we build up their tolerance, reintroducing the allergens in a clinical and methodical way.
Review and maintain. We’ll review the ladders and measure your child’s growth progress to check the effectiveness of the nutrition plan, ensuring you can independently manage your child’s allergy going forward.

The first step is booking an appointment with me. Whichever is most convenient for you, this can be a telehealth or in-person appointment.

Using ladders to outgrow your child’s allergy

Ladders for allergies have become very important tools to help your child outgrow their allergy. In most cases, 80% of children outgrow their allergy by 5 years of age.

What I love about the ladder approach is how systematic it is. To reach the top you take it rung by rung. Bringing this back to allergies, your body’s inner strength against the allergen is a rung on this ladder. Without its own tolerance it’s less likely to have the strength required to overcome the effects of the allergen.

The key is to do this in a systematic and harmless way. After all, we’re exposing them to an allergen which we know their body doesn’t like. We do this by tricking the body.

A baked product explains the technique well. In a baked good it’s difficult to identify, by sight or taste, each individual ingredient. The process of baking has changed the structure of these ingredients. Equally your body finds it difficult to identify the individual allergen, now in a baked form, it reacted to in the past. Allergen by allergen we trick the body into building up its inner strength. When we don’t have success with a particular allergen, we pause, let the body rest, then find another path to build the tolerance.

It may seem like a long and difficult process. I’ve also encountered, unfortunately, many ways to do an allergy ladder incorrectly. I’ll be supporting you every step of the way, navigating you and your child through this ladder, keeping them comfortable and you clear on the way forward. This is also why I created a guide for each of the main ladders - Milk, Eggs, Wheat & Soy. They're available on my resources page for you to download and follow. See all the helpful resources I provide here and continue to update regularly.

For convenience, here are each of the guides:

In the case of multiple allergies the planning is more precise. We’ll discuss where to start and I’ll provide you with exact recipes or products tailored to each ladder we’re working on. In some cases we can fast track the process and work on two or three ladders at once! I’ve successfully helped others with multiple allergies, and can apply this experience to your child’s case too.

Do you have experience with complex allergy cases?

I have experience in complex multiple allergies, food pollen syndrome, oral allergy syndrome, FPIES and Eosinophilic Oesophagitis/ Eosinophillic Gastrointestinal Disease and mixed IgE and non-IgE allergies. Having worked as both the lead dietitian in allergy and gastroenterology teams, I can confidently say I have seen it all.

Whether you are a tubie mum concerned about allergies for tube feeding and blended diet or a breastfeeding mum wanting to exclude allergens whilst continuing breastfeeding or have multiple different types of allergies I can work through all of this with you!

I encourage all of my patients and enquiries to simply give me a ring before deciding on making an appointment so we can see if we will be a good fit. As I know you want to make sure you aren’t wasting your time and are getting the best care for your little one.

How can a certified paediatric dietitian help?

I’ve helped many children overcome their food allergies, and also food intolerances. Some cases have been relatively simple, with one food as the culprit, but because of my extensive experience and years of practice, many are complicated, requiring a very personalised nutrition plan and intense management. This might sound daunting, but don’t feel like you have to do it alone.

I established Cubs because it’s my passion to bring support and help to the many families dealing with daily mealtime challenges. As the leading paediatric dietitian at Cubs, I won’t just give you a shopping list of foods to feed your distressed child. I provide you with a plan to diagnose, exclude offending allergens, prevent further allergies from forming and an endpoint to outgrow your child’s allergies. My goal is a long term solution, with plenty of short term successes along the way.

This is how working with me looks:

Book an appointment: in-person or online video call

I’ll meet with you and your child via telehealth or face to face. We’ll discuss your child’s full history from birth until today and answer all your questions.

Get a customised nutrition plan

You’ll receive a nutrition plan that meets your child’s specific needs.

See your child thrive and their confidence grow

As your child’s digestion improves happiness will return to your mealtimes.

Book an appointment

FAQ’s: Your questions answered.

Should I completely eliminate the allergenic food(s) from my child's diet, or are there situations where small amounts can be tolerated?

In my opinion, supported by clinical experience, the allergenic food needs to be completely removed for 1 month then reintroduced to determine if symptoms return. It gives us a clear picture of the impact this food has on your child’s health. With a non-IgE allergy there is no definitive test, like the skin prick or blood test, we can use to determine a diagnosis. Observing the symptoms through elimination then reintroduction is the only reliable way to diagnose a non-IgE allergy or food intolerance.

So save yourself the time, energy and pain of a blood test, kinesiology or hair analysis testing as they aren’t reliable. Check out this link from the Australian Society of Allergy and Immunology and their position statements on evidenced based tests for diagnosing allergy.

Is there a chance of outgrowing the allergy?

Absolutely! When you book in with Cubs I support you through the steps from diagnosing to outgrowing your child’s allergy. From my experience of helping many families overcome food allergies, I’ve developed a lot of techniques for both non-IgE and IgE mediated allergies. The ladder technique is one of the many tools I have used with great long-term success. It helps a child outgrow their allergy in a nutritionally supportive way.

What can you take for allergies while breastfeeding?

Well there is nothing you can ‘take’ that will make the allergies improve. But if you suspect your child might be having an allergic response from your breast milk then you are in the right spot!

I will be discussing with yourself about your baby’s allergic history and we will work out an exclusion diet for you. I will provide you with alternatives to take during the exclusion diet and I will make sure you have nutritionally appropriate supplements for a breastfeeding mum.

How long do allergens stay in the breast milk?

This is a hot topic. Some people will say a few days and some people will say longer. The answer is that it really depends on the type of intolerance your child has and what their symptoms are.

Now some of these will respond quickly to diet exclusion and some will take longer. So in my experience it is best to exclude for 1 month so that way we cover all bases. As, if your baby has a tummy upset it can take more than a week for their gut to heal, even though you removed the allergen.

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