Is baby’s rash a food allergy or contact reaction?
Ada had a bit of a contact reaction (we think) to aubergine and or tomato last weekend, so Penny Barnard, Paediatric Dietitian, PhD RD Cert Allergy MBDA (who wrote my super popular blog on Introducing Allergens During Weaning), has written a blog for me about babies having a contact reaction to foods. This is something I’m asked about a fair amount, so I’m glad to be able to share fab information on this from Penny.
‘My little one has a red rash around their mouth when eating certain foods. Is it a food allergy?’
Does this sound familiar? It’s so important to remember that not all reactions to food are food allergy. Children & babies in particular have very sensitive skin. In addition to that children who have eczema have a damaged skin barrier so their skin can be even more sensitive. Remember that one of the main functions of the skin is to protect the body from things in the outside world getting in. So although eventually it becomes a robust organ, early on in life it is delicate.
What is a contact reaction?
A contact reaction to food is NOT a food allergy. It is an irritation to the skin where food has touched. Some foods are more likely to effect the skin when in contact with it than others. Foods that are salty, acidic or rich in histamine can cause this.
What foods are more likely to cause this problem?
- Tomato and tomato base sauces such as ratatouille
- Citrus fruits and fruits that are acidic.This could be fruits such as orange, satsumas, pineapple & lemon.
- It could also be berries such as strawberries and raspberries.
- Foods rich in histamine such as aubergine and spinach.
- Salty foods such as marmite.
What should I do if I think my little one has a contact reaction?
You do not necessarily have to stop giving you little one the food. With lots of babies a barrier cream around the mouth before the meal will help. If your little can feed themselves with a loaded spoon or if you can feed them the troublesome food this will help. However completely stopping little ones smearing food around their face and squashing it in their hands is nigh on impossible as it is all part of their learning experience.
The reaction is likely to be a dose response. By that I mean the more of the troublesome food there is in the meal the stronger the reaction is likely to be. So for example your little one may manage a little spinach combined with scrambled egg with no reaction. However if mashed spinach as a sauce was given with pasta then a reaction may occur. Again looking at this example the form of the food may also dictate how severe the reaction is. So with the spinach and scrambled egg the egg is likely to be the predominant food touching the skin compared to the spinach. Compare this to pasta coated in a sauce containing spinach. Here the spinach is far more likely to touch the skin.
Below I have given you some pointers to help you think through whether you think a contact reaction is likely.
How do I know if it’s a contact reaction (and not an allergy)?
If I think my little has had a contact reaction what should I do next?
Below is my suggested plan of action:
- Call your GP if you need reassurance that it is a contact reaction. Send or take a photo of the affected area if you have one.
- Avoid the food you suspect caused the problem for a few days.
- Reintroduce the food after a few days with a small portion. If the reaction was widespread then start with just one teaspoon and offer a bigger portion each time you offer it. If you don’t want to reintroduce the food that is fine too. If you suspect something like aubergine or satsuma then this is fairly easy to avoid in the diet. However something like tomato is more difficult to avoid.
- Think how you are going to offer the food. Try and avoid any contact with your child’s skin, so from a spoon will be best to begin with. Try and offer it whilst your child is busy with another food. This way they are less likely to reach out and grab the food with their little hands.
- Apply a little barrier cream to the skin around the mouth before the meal.
- Have a flannel at the ready to swipe away any of the suspect food should it get smeared on the face or hands.
- As your child gets older and their skin matures they will probably be able to tolerate the foods without too many problems.
A precautionary note.
If your little one had any of the scenarios indicated with the red cross then the troublesome food should not be given again without speaking to healthcare professional about it first. Below is a reminder of what you would do if your child has an allergic reaction:
- Give anti histamine if you have some.
- Call 111 for advice.
- Call 999 if your little one develops a wheeze, becomes floppy or sleepy.
- Go to A & E if you are out and about and near a hospital.
This blog was written by:
Dr Penny Barnard, BSc, PhD, Cert Allergy, RD, MBDA
The information in this article should not replace advice from a healthcare professional. It is intended for general advice only. If you have any concerns about your child’s health and well-being then you should speak to your GP.