Saturday, February 14, 2009

Adverse Food Reactions: Allergy and Intolerance

Our son is allergic to certain molds in food, corn, eggs, milk, soy, bananas, green peas, salmon and chocolate. On one hand, it is very time consuming and a little stressful having to think about, prepare and manage what our son eats at home, at restaurants, in parties, and with friends. But on another hand, we feel so blessed that his reactions to food allergies are not deadly. It is difficult even for us to understand how stressful it must be for parents with children who have severe reactions to food allergies. In a way, we also feel relieved that he cannot eat processed foods. After learning how to decipher food labels for derivatives of corn, eggs, milk and soy, we are astonished at how many ingredients there really are in processed and manufactured foods. Because of our son's allergies, we are eating food that is much healthier, much fresher and more homemade than we would otherwise.

What we've learned from our son's allergy experience:
- there are only a handful of processed cereals we can eat at home
- there are only 2 kinds of manufactured cookies we can/want to buy
- corn is in everything so BRING YOUR OWN FOOD when eating out. Chefs, cooks and friends may not know that corn derivatives are found in baking powder (unless you buy a special kind like Featherweight brand), citric acid, some tomato pastes and pizza sauces, white vinegar, etc.
- banana allergies are related to kiwi and latex allergies
- there are so many things we could have done... even before our son was conceived to prevent his allergies
- there is such a thing as the food challenge to help reintroduce foods back to our son's diet after eliminating them for a period

An excellent book we've recently discovered is Dealing with Food Allergies in Babies and Children by Dr. Joneja. Here are some things we've learned.

A food allergy or food hypersensitivity is the term used to describe how the immune system reacts to nonthreatening food proteins similar to the way it would respond to a pathogen (a disease-causing microorganism).

A food intolerance does not involve the immune system, but instead is caused by other factors such as the lack of certain digestive enzymes.

There are two schools of thought about allergic sensitization. On one hand, it is thought that allergenic foods must be avoided during the last trimester of pregnancy so that any allergies can be prevented or reduced. On the other hand, it is thought that the baby's body must be taught how to tolerate foreign material that is harmless to the body.

50-70% of cases of asthma and allergy are hereditary. However, parents and children are not necessarily allergic to the same things.

Prevention of food allergy in early infancy prevents or reduces food allergy - but not airborne and environmental allergens.

Food allergy is not a stand-alone disease. It can affect many different tissues and organ systems, resulting in a variety of different symptoms: eczema, asthma, increase severity of hay fever, upset digestive tract - all at the same time.

Conditions that predispose a newborn baby to allergy:
1. immaturity of immune system
2. leaky gut - intestine can absorb larger molecules of food, which trigger immune-type reactions
3. breastfeeding - again 2 schools of thought: a) breastfeeding protects baby against allergy and reduces risk of asthma in the first 24 months of life, when baby is exclusively breastfed and mother eliminates highly allergenic food from her diet, and b) breastfeeding has no effect on baby's allergies (one reason is that breast milk of mothers who suffer from allergies may be different immunologically from that of nonallergic mothers)

It is yet not clear whether allergens in breast milk affect baby. However, the most important diet advice to breast-feeding mothers - breast feed exclusively for 6 months and AVOID your own allergens! This means - even BEFORE pregnancy, a mother must determine her own food allergies!

When to introduce solid food to babies? According to the American College of Allergy, Asthma and Immunology, after the allergic infant is 6 months old, and introduction to highly allergenic foods after 1 year old: cow's milk at 12 months, eggs at 24 months, and peanut, tree nuts and fish at 3 years. Other highly allergenic foods are: corn, wheat, citrus fruit, beef and chicken. AND give baby COOKED and pureed foods first before giving food in raw form. Evaluate foods individually so that tolerance can by determined before introducing the next foods. Click here for detailed information for the sequential incremental dose method, sequencing and an appropriate food chart for allergic babies.

90% of all food allergies are caused by milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soy.

Milk Allergy:
It is often the earliest indicator that a baby has food allergies. 80-90% of children outgrow this allergy by the age of 5. More than 25 proteins in cow's milk can cause allergies. It is possible for a milk allergy to occur in the body at the same time as lactase deficiency (the deficiency of the digestive enzyme which causes lactose intolerance). Lactose intolerance is not an allergy. Milk allergy and lactose intolerance show similar symptoms: abdominal pain, diarrhea, nausea, vomiting, gas and bloating. However, milk allergy and not lactose intolerance also shows up in symptoms in the upper respiratory tract (mucus), pain, itching, fluid drainage from ears, or skin reactions (eczema). Some milk proteins change in nature when heated, so some milk allergic people may be able to consume milk after it has been cooked or boiled. About 50% of children with milk allergies develop an allergy to soy. Besides the obvious foods to avoid like butter, buttermilk, cheese, all milk products, ice cream, yoghurt, casein, whey, lactose, these other ingredients may contain milk proteins: brown sugar flavoring, caramel flavor, high protein flour, margarine, chocolate, natural flavor, simplesse. Lactic acid, lactate and lactylate DO NOT contain milk.

Egg Allergy:
Egg white contains a greater amount of allergens in comparison to the egg yolk. And some egg proteins are destroyed by heat. Eggs from different birds affect allergic people differently. A person allergic to duck and goose eggs may not be allergic to hen's eggs. However, children under 7 who have a known allergy to hen's eggs should not eat eggs from other birds, as egg allergies can cause anaphylaxis. Egg allergy shows up in the skin (hives, reddening), gastrointestinal reactions, respiratory reactions and anaphylaxis. Vaccines that may contain egg protein: MMR, flu and yellow fever virus. Ingredients that indicate presence of eggs: albumin, ovalbumin, globulin, ovoglobulin, ovomucin, ovomucoid, ovovitellin, livetin, lysozyme, mayonnaise, simplesse - also in some salad dressings, battered foods, clarifiers in some soft drinks (root beer), ice cream, glazes, binding agents in desserts, meat loaf, dumplings and other foods. Nonfood items that may contain eggs: photographic film, printed natural fabrics, some fur garments and pet foods.

Egg substitutes:
Egg as leavening agent:
1 egg = 1 tbsp egg free baking powder + 2 tbsp liquid
1 egg = 2 tbsp flour + 1/2 tbsp shortening + 1/2 tsp egg free baking powder + 2 tbsp liquid
Egg as binder:
1/3 cup ground flax seed + 1 c water, boil and simmer 3 minutes. Refrigerate. Use 1 tbsp of mixture for 1 egg.
Egg as liquid:
1 egg = 1/3 c apple juice or 1/4 c pureed apricot or 1 tbsp vinegar

Hypoallergenic baking powder = 1 part baking soda + 2 parts cream of tartar +1 part of rice flour

Soy Allergy:
Both peanuts and soy belong to the leguminosae family. Individuals who are allergic to one or both are not necessarily allergic to others in the legume family. Up to 43% of babies who are allergic to cow's milk develop an allergy to soy. Symptoms include eczema, respiratory tract symptoms, loose stools, diarrhea, vomiting, abdominal discomfort, irrtability, crying, intestinal blood loss, anemia and slow or no weight gain. Soy allergy in infants is usually outgrown by 3 years old. Ingredients that indicate soy: tofu, kyodofu, miso, okara, shoyu, sobee, spuro, tamari, tempeh, yuba, soy milks and beverages, soy nuts, soy sauce, soybean, soy flour, soy grits, soy albumin, soy protein, soy lecithin, texturized vegetable protein. Ingredients that may contain soy: emulsifiers, stabilizers, lecithin, bean sprouts, hydrolyzed plant or vegetable protein, MSG, vegetable broth/gum/paste/protein/shortening/starch.

Allergy to Tree Nuts and Seeds:
Did you know almonds are members of the Drupacea family, which include peaches, apricots, plums, nectarines and cherries? Cashews and pistachios to mangoes? Coconuts to dates and palm? Foods that may contain nuts: marzipan, artificial nuts, nougat, nutella, gianduja, candy, chocolate bars, dessert toppings, cheese balls, gourmet cheese spreads.

Corn Allergy:
There are very few studies of corn allergens - only since 2000, have there been evidence that corn allergies are more prevalent than originally thought. Corn is easy to avoid when the diet does not include prepared, processed or manufactured foods. However, as experience has taught us, corn is in EVERYTHING: baking powder, some tomato pastes have corn starch, dextrose, caramel, distilled white vinegar, cosmetics, adhesives, paper plates, aspirin, throat lozenges, vitamins, anything that lists for modified starch and it just goes on and on! When you eat out, make sure you have your own food. Some chefs and cooks do not know that when you say you have a corn allergy, this includes corn derivatives. Click here for a complete list.

Seafood Allergy:
Recent evidence suggests that regular fish consumption during the first year of life reduced risk for fish allergies by 4 years old. Foods that may contain fish protein: Asian dishes, Caesar salad, chili, baked goods, cookies, candy bars, prepared and frozen desserts.

Use of Probiotics: is particularly effective in reducing eczema in children.

Food Challenge: how to reintroduce foods to your child after foods have been eliminated for 4 weeks or more

1. do the early warning test: rub food on child's cheek and wait 20 minutes to see if there is a reaction to the food, then place on child's outer lip and wait 30 minutes and wait for any reaction, optional place a small amount on tongue and wait another 30 minutes

2. 2 - 4 day introduction: test foods are introduced between meals (if there is any bad reaction, discontinue challenge and wait at least 48 hours after a reaction has subsided before testing for another food)

Day 1
Morning between breakfast and lunch - eat a small quantity of food, monitor reactions, wait 4 hours before testing again
Afternoon between lunch and dinner - if there is no reaction, double the quantity of the test food eaten in the morning, monitor reactions, wait 4 hours again before testing again
Evening after dinner - double quantity given in the afternoon, monitor again

Day 2
Test food is not given again. Monitor child for any delayed reactions. If there is no reaction, food can be considered safe to eat.

Day 3
If there are no reactions, another food can be tested. If results are unclear, test same food again today but give greater amount of food thane eaten on Day 1. Double the amount every four hours and monitor.

Day 4
Monitor as in Day 2.

IMPORTANT SEQUENCE OF TESTING FOODS: start with a category and stick to the category until all components of that food are tested (e.g. if testing for corn, first test corn as a vegetable (corn on or off the cob), then test processed whole corn (popcorn), then corn meal, then corn starch, then corn oil, then corn syrup.

IMPORTANT QUANTITY OF TEST FOOD: you would need the book to determine specific foods (e.g. for egg, test 1 would be for egg yolk: morning 1/2 tsp, afternoon 1 tsp and evening 2 tsp; test 2 would be for egg white: same quantities)

STATES OF TEST FOOD: cooked foods are less allergenic usually and therefore cooked foods must be tested before the raw ones.

No comments:

Post a Comment