More children are going to emergency rooms for allergic reactions than ever before. Children visited the ER with anaphylaxis in increasing rates, from 1.4 visits per 10,000 children in 2010 to 3.5 visits in 2016, according to a recent report from Blue Cross Blue Shield Association. That's a growth of 150 percent.

The researchers looked at 9.6 million commercially insured American children age 18 and under.

Though the exact reason is unclear, it may be because the number of allergies, especially food allergies, among children is increasing. Certain food allergies are known to trigger more severe reactions than environmental allergies. Among food allergens, peanuts, tree nuts, sesame seeds, egg, milk, wheat, and seafood tend to cause the most problems. All of these foods can cause anaphylaxis, but peanut allergies are the number one offender for life-threatening reactions in children. About two percent of children have a peanut allergy, though studies suggest the number is increasing.

If your child has eaten a food they are known to be allergic to, follow the written Allergy Action Plan provided by your child's allergist. Generally, you will want to observe your child closely for symptoms if there has been an accidental exposure to a trigger food. Your child's allergist can tell you when to give diphenhydramine and when to give epinephrine, if these medications have been prescribed.

If your child needs emergency care, call 911. Your child's doctor may request to see your child for a follow up visit after a reaction has occurred. If your child has eaten a food they are not known to be allergic to but has symptoms of an allergic reaction, seek care immediately. Subsequently, you should schedule an appointment with an allergist to confirm the allergy and learn more about management.

The best way to confirm a suspected food allergy is by skin prick testing completed by an allergist several weeks after a reaction has occurred. Based on results of the testing, your child may also have blood work completed. If there is uncertainty about a reaction based on the history and testing results, an allergist may schedule an oral graded food challenge in the office. During this procedure, under close medical supervision, the child is given increasing amounts of the allergenic food over several hours and observed and treated for any reaction. Oral graded food challenge by an allergist is the only way to definitively diagnose a food allergy.

For children with food allergies, there are times when an emergency room visit may be needed:

  • It's your child's first reaction.
  • Your child experiences a reaction that involves more than one mild symptom. For example, hives and sneezing.
  • Your child is having one or more moderate or severe symptoms. For example, trouble breathing, coughing, wheezing, persistent vomiting or belly pain, passing out, or extreme anxiety.
  • Your child is having an allergic reaction and you do not have medication available for treatment.
  • Your child has a known allergy, you've tried the instructions your doctor has given you, but your child is not improving or seems to be getting sicker.
  • You've given epinephrine to treat anaphylaxis.

Depending on the severity of your child's reaction, you may need to call 911. After you administer epinephrine, you should always call 911 in case a second reaction occurs en route to emergency care.

Although fatal reactions very uncommon, food allergies can be deadly, especially in children with asthma. Fatal reactions are more likely to occur if epinephrine is needed but not given right away. If your child has a confirmed food allergy, always carry two doses of auto-injectable epinephrine with you at all times.

Hillary Gordon, MD is a Pediatric Allergist at Nemours/Alfred I. duPont Hospital for Children.