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The A to SneeZe of Baby Allergies

Dr. Rima Sanka discusses allergies in babies and young children.

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The A to SneeZe of Baby Allergies
Rima Sanka, DO
Dr. Sanka is a fully licensed, board certified allergy, asthma and immunologist trained and educated in the United States.

She completed her Internship and Residency in Pediatrics at University of South Florida/All Children’s Hospital in 2005. She completed her Fellowship in Allergy and Immunology at University of South Florida/All Children’s Hospital in 2007. She published research about red tide, aeroallergies, and primary immune deficiency during her fellowship. Serving as a distinguished lecturer at several state and local conferences, she is well known in the medical community.

Dr. Sanka is originally from upstate New York and attended Cornell University (‘97). She spent a year volunteering with the AmeriCorps in Washington DC, after which she attended medical school at the Philadelphia College of osteopathic medicine, graduating in 2002.

Dr. Sanka maintains an active interest in teaching medical students, residents and fellows in addition to patient care.

Learn more about Madhurima Sanka, DO

Melanie Cole (Host): Like older children, and even adults, babies can have allergies to the foods that they eat, the things they touch and the unseen particles they inhale in the home or outdoors and when your little baby has symptoms of any kind, it can be so difficult to figure out what’s wrong and what it’s from because they can’t describe those symptoms and it can be quite scary for parents. My guest today is Dr. Rima Sanka. She’s an allergist and immunologist at BayCare Health. Dr. Sanka, I’m so glad to have you with us today. When I was a new mom, I remember watching every little thing the baby ate or why does she have the sniffles or runny eyes, tell us the most common allergies in babies that you see, the main types.

Dr. Rima Sanka (Guest): Thank you for having me Melanie and I’d be happy to talk to you about that topic. It’s certainly a very common problem that we see in practice and one of a lot of immediate concern for parents and families. In babies and infants the most common types of allergies are to food, environmental allergens and medications. Typically very young children, less than 2 years of age are more likely to have food and indoor allergens rather than outdoor pollen allergies that you see in the older child and the adult. You can see them sooner in some children, but often the presenting symptom of allergy in a baby will be eczema or atopic dermatitis.

Host: So our babies maybe have some symptoms, maybe they’ve got runny nose or watery eyes. How can we tell that it is an allergy in a baby as opposed to a cold?

Dr. Sanka: There are a lot of overlapping symptoms between a cold and allergies, but some of the easy ways to tell a difference is that a cold or an upper respiratory infection will usually be accompanied by sore throat or fever, body aches, malaise, but an allergy the baby will be otherwise active and eating and not as irritable, and itching is a predominant symptom of allergies. So being – scratching of the eyes, scratching of the skin, scratching of the nose is going to be another clue that it’s more allergies, and of course the response to mediations also gives us a clue to that. Allergies will of course last longer than a cold will. Colds will typically get better within two weeks but it can be very confusing initially.

Host: Well it sure can and I think one of the biggest fears parents have is food allergies. Dr. Sanka, so when we start feeding our little 4 month, 6 month, 8 month old’s solids, what should we be concerned with? Because it seems to change over the years, you know peanut butter, eggs, fish, all of these different things. What now should we be thinking about as parents, new parents about feeding our babies once we start with solids?

Dr. Sanka: Yes, this is a very hot topic of concern and one that affects everyone we know, and we know food allergies are very common and they are increasing in prevalence. The reasons for that are debatable, but we do know that it costs a significant amount of not just monetary costs but psychological costs and concern for parents and families of children with food allergies. The guidelines have changed, which also leads to confusion. Back in 2008, we used to recommend delaying the introduction of potentially allergenic foods such as peanuts, waiting until 3 years of age to introduce peanuts into a child’s diet and eggs as well waiting until 1 year of age. Then in 2015, the Learning Early About Peanuts allergy study, or LEAP study came out concluding that it was safe to introduce peanuts early to high risk infants and the most striking data that came from that study was that in that high risk group of infants, there was an 81% relative risk reduction in subsequent development of peanut allergy if peanuts were introduced as early as 4 months of age. So that led to a complete flip in the recommendations in 2017 and those are the guidelines that we as pediatricians and allergy immunologists are recommending to our families.

Host: Wow that’s quite a change and thank you so much for clarifying that. So we’ve got food allergies, we’ve got seasonal allergies, things going on outdoors, are there certain things we as parents can do for our sweet little babies that can help prevent some of these allergens? Because in their crib we’re not putting any bumpers, we’re not putting pillows or blankets or anything, so what can we do to help maybe stave off because the pollen counts could be bad? Is there anything we can do?

Dr. Sanka: So there’s no perfect cure or a pill or a medicine that will prevent allergies, but we do know there’s evidence to support breast feeding. Breast feeding for at least 4-6 months really is protective and beneficial for the child’s immune system. We also know that using emollients or moisturizers, applying those regularly and liberally to the skin can also help with the introduction of allergens through the skin, and we also recommend avoidance of second hand smoke and having a diverse diet early and often. The recommendation to avoid or purposely have exposure to furred pets has gone back and forth in terms of the data, and so at this point there’s not enough evidence to support one way or the other with regards to exposure to pets.

Host: Yeah pets is a big thing too, right? I mean a lot of families have babies and pets. So you know let’s talk about some of those kinds of allergies, and you mentioned atopic dermatitis or eczema. How do they get that? Is that hereditary? Is that something that just shows up out of the blue? Rashes can be alarming for parents.

Dr. Sanka: Yes and eczema or atopic dermatitis can occur at any age, but most often I see them around 4-6 months and that’s also the age when solid foods are being introduced, so then it’s additionally confusing and oftentimes the foods are blamed for the development of the eczema, but it can be tricky to really clearly extricate the causes. Eczema is allergic about 40% of the time and that’s what I tell parents. So when we do perform allergy skin testing to determine what they may be allergic to, and of course we only test them for certain things that are relevant for that child and that age group, we tell them that there’s a 40% chance they may have an allergy to a food or an indoor allergen, but there’s a 60% chance that they may not, and the skincare recommendations of frequent emollients and moisturizers, topical steroids sparingly and generally avoidance of irritants and allergens is universal, we would still recommend that regardless.

Host: Interesting and that’s good to know. We worry about eczema. Is it an autoimmune disease Dr. Sanka? Does it put – if our children have eczema, does that put them at risk for other autoimmune diseases down the line?

Dr. Sanka: No it doesn’t. There’s no data that suggest eczema will put them at higher risk for autoimmune diseases. So rest assured, eczema often improves by school age, around 5 to 6 years of age, so you rarely see an older child or an adult with significant eczema. So it is definitely a young child’s problem and with proper skincare with avoidance of allergens and irritants and controlling the itch/scratch cycle, it’s very manageable.

Host: Thank you for clearing that up and anytime our babies vomit, you know we right away think colic or maybe they have an allergy to formula or even that they’re just not tolerating breast milk well. Tell us a little bit about eosinophilic esophagitis, what that is and why that might cause some of those kinds of symptoms in a baby.

Dr. Sanka: So eosinophilic esophagitis is only one reason you may see vomiting in a young child. An IGE mediated immune food allergy also is a common reason for a child to vomit immediately after eating a food. So you need to always take a very good history and determine what are the likely scenarios in that child, but eosinophilic esophagitis can be immune or nonimmune. So sometimes there are allergies in association with it and some of the presenting symptoms in a young child would be vomiting, abdominal pain, trouble swallowing, failure to thrive due to poor appetite and poor nutrition and then reflux symptoms – you know arching of the back, discomfort, bloating, indigestion.

Host: That’s so interesting. So all of these things, our little babies, our little sweet babies, we feel like they’re so fragile, tell us what you’d like us to know as we wrap up about preventing some of these allergies in babies, whether they are environmental or food and medicine related or seasonal, what would you like us to know as an allergist/immunologist for our little sweet babies that we should know about keeping an eye on it, symptoms, things we should watch out for and when you feel it’s emergent, when we need to get in to see somebody right away.

Dr. Sanka: Okay, so eczema is very common. It is not an emergency but it is often the first sign of the atopic march or the progression of allergy symptoms in a child. So if you do notice eczema or your pediatrician tells you your child has eczema, then I would definitely seek further evaluation from an allergy immunologist to help you determine if there are any food or environmental allergy triggers for that eczema because not only will that help treat the eczema but it will prevent the progression of that atopic march into asthma, into allergic rhinitis or hay fever, and that is a crucial time in your baby’s development to intervene and potentially stop other further complications from developing, and I can’t emphasize enough to moisturize your child early and often with a good emollient. It’s such a simple recommendation but it really goes a long way and it’s easily accessible and if we all start doing these things to help our children, hopefully one day we’ll start to see a decrease in the prevalence of food allergies and a decrease in these lifelong peanut allergies for example that we see occurring at this point in time.

Host: Thank you so much for coming on, really, really important information and so great for new parents to hear that are nervous about everything. Dr. Sanka thank you again. That wraps up this episode of BayCare HealthChat. For more information on pediatric services at BayCare, head over to our website at for more information and to get connected with one of our providers. If you found this podcast informative, please share it with other parents, share it with your friends, share on social media, and be sure to check out all the other interesting podcasts in our library. I’m Melanie Cole.