Why Seeing a Paediatric Allergist Matters
Avoiding Misdiagnosis and Getting It Right the First Time
Recently, I saw a 4-year-old who hadn't eaten eggs, dairy, or wheat for six months. Her parents had been told to avoid these foods after skin prick testing at a non-specialist clinic, despite the fact she'd eaten them without problems before. When we properly assessed her, she could safely eat all three foods. Those were two years of unnecessary restrictions, social difficulties, and nutritional challenges that could have been avoided.
Unfortunately, this story isn't unique. As a paediatric allergist and immunologist, I see families every week who arrive confused, worried, and overwhelmed after allergy testing that wasn't properly indicated or interpreted. Let me explain why specialist care makes such a crucial difference for your child's health and your family's peace of mind.
The Problem with "Quick" Allergy Testing
It's tempting to seek out clinics that offer same-day allergy testing without the wait for a specialist appointment. I understand – when you're worried about your child, you want answers quickly. However, allergy testing without proper clinical context can create more problems than it solves.
Here's what often happens: A child with eczema or general food concerns undergoes skin prick testing to "check for allergies." The results show several positive reactions. The family is handed a list of foods to avoid, often including foods the child has been eating safely. Suddenly, family meals become a minefield of restrictions.
But here's what parents aren't always told: a positive skin prick test doesn't equal an allergy.
Understanding the Difference: Sensitisation vs True Allergy
This is where specialist training becomes crucial. Many children, especially those with eczema, will show positive skin prick tests to foods they can actually eat without any problems. This is called sensitisation – their immune system recognises the food but doesn't react to it when eaten.
Current guidelines from both ASCIA (Australasian Society of Clinical Immunology and Allergy) and the Royal Australasian College of General Practitioners are clear: allergy testing should only be done when there's a clear history of immediate allergic reactions (the type that happen within minutes to 2 hours of eating a food) to a specific food. Testing "just to check" or using panels of multiple foods often leads to false diagnoses and unnecessary avoidance.
When Misdiagnosis Causes Real Harm
Incorrectly diagnosing food allergies isn't just inconvenient – it can actively harm your child:
Nutritional Impact
Avoiding major food groups like dairy, eggs, or wheat can lead to:
Poor growth
Calcium and vitamin D deficiency
Inadequate protein intake
Iron deficiency
Increased Allergy Risk
Ironically, avoiding foods unnecessarily can actually increase the chance of developing a true allergy to that food later. Current evidence strongly supports early and regular exposure to allergenic foods.
Social and Emotional Effects
Think about birthday parties, playdates, and school camps. Unnecessary food restrictions can lead to social isolation and anxiety for both children and parents.
The Hidden Condition You Might Miss
When families focus on avoiding foods based on positive tests alone, the real cause of symptoms might be missed. I've diagnosed conditions like eosinophilic oesophagitis, food protein-induced enterocolitis syndrome (FPIES), and other non-IgE mediated conditions that standard skin prick testing cannot detect.
What Makes Paediatric Allergist Care Different?
After completing medical school and general paediatric training, paediatric allergists undergo an additional 3 years of advanced training specifically in immunology and allergy. This isn't about being "better" than GPs – it's about having the specific expertise to:
1. Take a Detailed Clinical History
We spend time understanding not just test results, but your child's whole story. When did symptoms start? What exactly happens when they eat certain foods? How quickly do reactions occur? This context is everything.
2. Interpret Tests Accurately
We understand that in an infant with moderate eczema, up to 50% of positive skin prick tests may be false positives. We know which test results matter and which don't.
3. Perform Supervised Challenges
When we're assessing if a child has outgrown an allergy or if a positive test represents a true allergy, we can safely conduct food challenges in a controlled medical setting. This is something that requires specialist facilities and training.
4. Develop Evidence-Based Management Plans
We follow international best-practice guidelines and can offer treatments like immunotherapy for certain allergies, helping children overcome their allergies rather than just avoiding foods forever.
When Should You See a Paediatric Allergist?
Consider specialist assessment if your child:
Has had immediate or delayed reactions to foods
Has been diagnosed with food allergies based on testing alone
Is avoiding foods without a clear history of reactions
Has severe eczema that started before 3 months of age
Has multiple food allergies or complex symptoms
Needs clarity after confusing or concerning test results
What to Expect from Specialist Care
When you see a paediatric allergist, the consultation is comprehensive:
First, We Listen: I want to hear your child's full story, not just recent symptoms. Understanding their feeding history, growth, and any reactions is crucial.
Testing When Appropriate: We only test for foods when there's a clear indication. If testing is needed, we explain what the results actually mean for your child.
Clear Action Plans: You'll leave with a written plan that clearly outlines what foods to avoid (if any), what foods are safe, and what to do if reactions occur.
Ongoing Support: Allergies change over time. We monitor your child's progress and retest when appropriate, with the goal of expanding their diet whenever safely possible.
Real Families, Real Outcomes
The 4-year-old I mentioned at the start? She's now enjoying scrambled eggs for breakfast, cheese sandwiches for lunch, and pasta for dinner. Her parents tell me the biggest change isn't just her improved nutrition – it's the freedom from fear and the joy of normal family meals.
Another recent patient, a 2-year-old, came to me avoiding 15 foods based on previous testing. After proper assessment, he truly needed to avoid just two. His mother cried with relief when she realised she could simplify their lives so dramatically.
Making Specialist Care Accessible
I understand that seeing a specialist might seem daunting. You might worry about long waits or complex referral processes. In my practice, we've worked hard to make specialist care as accessible as possible:
Flexible appointment times
Telehealth options for follow-ups
Clear communication with your GP
Support between appointments when you have questions
A Partnership in Your Child's Health
My approach isn't about doing more tests or finding more problems. It's about getting the right diagnosis the first time, giving you confidence in managing your child's health, and helping your family thrive without unnecessary restrictions.
With over 11 years of clinical experience, including specialized training in both paediatrics and allergy/immunology, plus roles at the Royal Children's Hospital and major Melbourne hospitals, I've seen how proper specialist assessment can transform a family's life. It's not about medical hierarchy – it's about ensuring your child gets the specific expertise they deserve.
Your Next Step
If you're feeling uncertain about previous allergy testing or confused about what foods your child should avoid, you don't have to navigate this alone. Together, we can develop a clear, evidence-based plan that's right for your child.
Remember: every child deserves an accurate diagnosis, not just a quick test. Your family deserves confidence, not confusion. And you deserve a specialist who takes the time to get it right the first time.
Dr. Gabby Mahoney
Paediatric Allergist & Immunologist
FRACP, ASCIA Member
Ready to get clear answers about your child's allergies? Book a consultation for expert, personalised care that puts your family's wellbeing first.
Does Food Allergy Cause Eczema?
Understanding Your Child’s Skin.
As a paediatric allergist and immunologist, I meet many worried parents who wonder if their child's eczema is caused by something they're eating. It's completely natural to look for a cause when you see your little one struggling with itchy, inflamed skin. Let me share what we know from the latest research and my experience caring for children with both eczema and food allergies.
The Short Answer: It's Complicated (But Not How You Might Think)
Here's what might surprise you: eczema is not caused by food allergies. Instead, eczema is a condition your child is born with – it's part of how their skin is made. Think of it like having blue eyes or curly hair; it's simply how their body works.
However, in some children who already have eczema, certain foods can make their skin flare up. This is different from causing the eczema in the first place.
Understanding Eczema: Your Child's Unique Skin
Eczema (also called atopic dermatitis) affects about 1 in 5 Australian children. Children with eczema have skin that:
Doesn't hold moisture as well as it should
Has gaps in its protective barrier
Tends to overreact to everyday things like soap, heat, or scratchy clothes
Eczema often runs in families and is linked to genes that affect how the skin barrier works. If you or your partner had eczema, asthma, or hay fever as children, your little one is more likely to have sensitive skin too.
The Food Connection: What Parents Need to Know
While food doesn't cause eczema, here's where it gets interesting:
For Most Children with Eczema
Research shows that fewer than 30% of children with eczema have any food triggers at all. This means that for most children, changing their diet won't improve their skin.
When Food Might Be Involved
In some children, particularly those with moderate to severe eczema that doesn't improve with good skin care, certain foods might trigger flare-ups. The most common culprits in young children are:
Egg
Cow's milk
Wheat
Soy
Peanuts
But here's the crucial part: even in these children, avoiding the food won't cure the eczema – it will just help reduce flare-ups.
Why Restricted Diets Can Do More Harm Than Good
I often see families who've put their child on very restricted diets hoping to cure eczema. Unfortunately, this approach can:
Lead to nutritional deficiencies affecting growth and development
Make social situations difficult (birthday parties, childcare)
Actually increase the risk of developing food allergies later
Cause unnecessary stress for the whole family
As noted by Allergy & Anaphylaxis Australia, unnecessary food restrictions can significantly impact a child's quality of life without improving their skin condition.
The Right Approach: Evidence-Based Care
So what should you do if your child has eczema? Here's the approach recommended by leading allergy specialists:
1. Start with Good Skin Care
Regular moisturising (2-3 times daily)
Gentle, fragrance-free products that do not contain any food products
Lukewarm baths
Appropriate use of prescribed treatments
2. Consider Allergy Testing Only When Needed
Testing should be done if:
Your child has immediate reactions to foods (hives, vomiting, swelling, difficulty breathing)
3. Work with a Specialist
Random allergy testing without proper interpretation can be misleading. Many children will test positive to foods they can actually eat without problems. That's why it's important to work with a paediatric allergist who can:
Interpret test results in context
Distinguish between true allergies and false positives
Create a safe, practical management plan
Support proper nutrition for growing children
Early Introduction: Prevention is Key
Here's something exciting: research now shows that introducing common allergy-causing foods early (around 6 months) can actually help prevent food allergies in children with eczema. Current guidelines recommend not delaying the introduction of any foods, including those commonly associated with allergies.
When to Seek Help
Consider seeing a paediatric allergist if your child has:
Eczema that isn't improving with regular treatment
Suspected reactions to foods
Severe eczema starting before 3 months of age
Eczema along with poor weight gain or growth
A Message of Hope
I want you to know that with the right approach, most children with eczema can have comfortable, healthy skin. While we can't change the fact that your child has sensitive skin, we can work together to:
Identify and manage any true food triggers
Optimise skin care routines
Ensure proper nutrition
Help your family live confidently without unnecessary restrictions
Remember, you're not alone in this journey. As both a paediatric allergist and immunologist with over 11 years of experience, I've helped hundreds of families navigate these challenges. My approach combines the latest evidence-based medicine with practical strategies that work for real families.
Taking the Next Step
If you're concerned about your child's eczema or wondering about food allergies, I'm here to help. Together, we can develop a clear, practical plan that's right for your child and your family.
Dr. Gabby Mahoney
Paediatric Allergist & Immunologist
Consultant at MACCS, Royal Children's Hospital, and Sunshine Hospital
Resources for Parents:
Would you like to discuss your child's eczema and any concerns about food allergies? Book a consultation to get expert, personalised advice for your family.