Food Allergy in Children

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Oliver Rice
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Publication on 15.5.2013 / Posted on 17.5.2013 He

1 Publication on / Posted on Health - 3 Mind - 5 Price - Rs. 5/- Yearly Subscription - Rs. - 60/- only Food Allergy in Children Dr Shafath Ahmed. M.D.D.C.H. Former Professor of Neonatology, Madras Medical College Consultant Pediatrician Padma Clinic & Nursing Home Introduction:- Food allergy (FA) is an important public health problem that affects adults and children, and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment:the disease can only be managed by allergen avoidance or the treatment of symptoms. Moreover, a diagnosis of FA may be problematic given that non - allergic food reactions, such as food intolerance, are frequently confused with FA. Additional concerns relate to the differences in the diagnosis and management of FA in different clinical settings. Basic as well as clinical research in this field is very active, aiming to both improve the diagnosis and provide a more detailed clinical pattern of this disease.this article is a synthesis of the current concepts of the pathophysiology and diagnosis of FA. Differences and Similarities in Food Proteins Any food can trigger an allergic response, but few protein families account for the vast majority of allergic reactions: egg, milk, peanut, tree nuts, fish, shellfish, wheat and soy Cross-reactivity may exist between foods. Diagnosing a Potential FA; Medical History Taking As always in medicine, taking a thorough medical history and a detailed physical examination allows, most of the time, a good evaluation of the medical issue, ascertaining the possible FA triggers and approaching the likely general pathophysiological basis, i.e. whether the food-induced allergic disorder is IgE mediated or not. FA may be responsible for different clinical symptoms that can affect the skin, and the digestive and respiratory tracts. Skin symptoms are mainly atopic dermatitis and urticaria. Digestive symptoms are very protean and include permanent distress (colic), protracted regurgitations or gastroesophageal reflux, vomiting, diarrhea, constipation, failure to thrive or blood in the stool. Respiratory symptoms may manifest as asthma or even some ear-nose-throat conditions. The clinical setting may very considerably. In young infants, especially in those fed formula, milk is the more likely food allergen. In older children, especially in the case of eczema, the potential role of eggs is at its highest. In the growing child, the first

2 consumption of peanut-containing food may trigger on acute reaction owing to an allergy that had not been notices before. Symptoms commonly ooverlap: for example, children with cow's milk-sensitive eczema commonly have Gr-related symptoms, and, indeed, these can be an important clue as to the role of cow's milk allergy in the underlying eczema Symptoms Diagnosing the Clinical Pattern Based on the different tests and clinical situation, it is now possible, and probably better, to classify patients not only in reference to the responsible allergen but also to a typical clinical pattern. This allows a better understanding of the clinical conditions, and better information of the patient or his parents on the severity of the potential acute episodes and the prognosis of the condition Remarks IgE-mediated disorders pruritus, mild edema confined to the oral cavity, uncommonly progressing beyond mouth (7%) or anaphylaxis (^2%) More frequent in adults than in young children Urticaria/ triggered by ingestion or by direct skin contact angioedema Anaphylaxis rapidly progressive, allergic reaction: rhinitis, asthma, severe pruritis multiple-organ-system reaction can include cardiovascular collapse Rhinitis and asthma triggered by inhalation of aerosolized food protein, e.g. fish or seafood Typically acute in nature; food is less involved in chronic cases related to the massive release of mediators, e.g.histamine May be related to the consumption of a major food allergen, e.g. milk or wheat Mixed IgE-and non-ige-mediated disorders EoEGI reflux, abdominal pain and dysphagia Other eosinophilic less clearly defined, may vary disordersin terms of sit(s) and degree of eosinophilic inflammation, may mimic irritable bowel syndrome; likely persistent Eczema/atopic moderate-to-serve skin disease dermatitis Distinct entity; mainly in children 5-15 years old Proctocolitis caused by CMPA (20%); diarrhea and colic in infants, even when they are exclusively breastfed associated with food in 35% of children, particularly milk and egg affects infants and usually resolves after the age of 2 years; responsible foods are cow's milk, soy, rice and oat

3 Symptoms emesis, diarrhea, poor growth and lethargy; following elimination and re-exposure, symptoms may be severe, with emesis, diarrhea and hypotension (15%) occurring 1-5 h after ingestion Food protein-protracted diarrhea, sometimes inducedassociated with vomiting, which enteropathymay result in malabsorption and syndrome faltering growth GI dysmotilityuncertain mechanism; patient presents with impaired GI motility abnormalities Remarks Affects infants and usually resolves after the age of 2 years; may be difficult to distinguish from untreated celiac disease Allergic GI motility disorders are common in infancy and early childhood and are shared by many IgE CMP-induced disorders Explaining the Disease to Parents: Some Clues FA remains difficult for parents to understand as well as for practitioners, particularly since education on this matter in medical schools is largely lacking. Here are some concepts that can be addressed by physicians directly to explain to parents when they are confronted with this kind of disorder. What Kind of Allergy Is It? E x p l a i n t h a t a c e r t a i n c l a s s o f immunoglobulins (i.e. IgE) is responsible for an allergy, but that some allergies are IgE mediated and some are not. To detect an IgE-mediated allergy, a blood sample test (which measures the sige serum level) is mandatory. However, a 'negative' test cannot rule out an allergy, if the latter is non-ige mediated. IgE-mediated CMPA reactions usually occur within 20 min of exposure and always within 2 h thereof. Non-IgE-mediated immune reactions are typically more delayed in onset. What Allergen Is Responsible for the Symptoms? In young children, allergies to cow's milk tend to dominate, whereas this is not true later on: allergies to wheat, egg and peanut tend to largely outgrow milk allergy after age I year Health & Mind 3 Can Breast Milk Be Responsible for the Allergy? (Very Frequent Question) The question is not appropriate. Breast milk in itself is not responsible for the allergy. However, breast milk is able to transmit small amounts of allergens, such as cow's milk, to the infant's digestive tract, and infants sensitive to these allergens will react. The treatment is not to stop breast-feeding but to start the elimination diet in the mother. When Did the Child Get Sensitized to the Allergen? The answer is still tricky: sensitization may have occurred in utero (probably through swallowing of the amniotic fluid), following birth, through the digestive tract(so-called 'dangerous bottle' given in the maternity ward during the first days of life, or allergens transmitted via the breast milk or given at the beginning of complementary feeding), through inhalation of particles or even through skin contact. What Is the Reason Why Some Children React to Heart Treated Milk or Eggs and Others Not? Heating transforms the allergen and modifies its structure in some locations. If those locations are

the ones involved in the child's reactivity to the allergens, then the child will tolerate the heated food even though he/she does not tolerate the raw food.

4 the ones involved in the child's reactivity to the allergens, then the child will tolerate the heated food even though he/she does not tolerate the raw food. What Is the Relationship with Allergic Disease? This depends on the FA reaction the child suffers from. When children have IgE-mediated CMPA, they are likely to have eczema, at least 25% of children with CMPA will go on to develop additional FAs and infants with FAs are a risk for the development of asthma. In addition, asthma in itself is a risk factor for more severe food-induced allergic reactions. If CMPA is not IgE mediated, then, most of the time, it is a self-limited, isolated disease. Conclusion FA has been transformed by the availability and constant improvement of replacement dietary foods and, more recently, through the investigation of desensitization techniques, which seem to affect the outcome of protracted FAs. In the meantime, new aspects of the disease, seem to expand, underlining the fact that many questions still remain, especially as to the origin of the diseases. The development of future treatments requires a perfect description of the clinical pattern of the disease and research focusing on the physiopathological mechanisms in the ongoing promising studies. Health & Mind 4 Dealing With Fear Dr. Kannan Gireesh. M.D. Consultant psychiatrist & Phychotherapyst, Padma Clinic and Nursing Home What is the cause? All children have fears of one kind or another. Fear is an emotion just as love, happiness, anger, hurt and sadness. Babies are unpredictable. In the early days of their lives they are quite fearless. They go boldly into the great unknown. As the child grows older, her imagination and curiosity also develops. She learns the potential dangers of certain actions and objects and the reasons for it. As she makes these connections, her awareness makes her cautious and sometimes frightened. It has been observed that these fears develop more often in children for whom feeding and toilet training have been contentious issues, or in those who have over protective parents or who have been regularly warned or cautioned against doing certain things. On the other hand, some children are just born sensitive. They will slowly grow out of them with your understanding and help. Fear of the dark Fear of the dark is one of the most common childhood fears. This fear is common in adults too. If your child's scared of the dark you can indulge her by leaving her bedroom door open or leaving a night light on. Keep her well occupied with games and other activities throughout the day so that she has no time to brood on her fears. In time, she will realize that there is nothing to fear. Tangible fears Sometimes children develop fears of tangible objects such as dogs, cockroaches, water and men in uniform. It is not necessary for the child to have had a

5 frightening experience with any of the objects of their fears. It will certainly not help them to overcome their fear by forcing them to confront the object of their fears. Children generally outgrow these fears themselves. Fear of death Some children are scared of death and dying. They cannot understand what happens to their pets or people who die. I t is necessary for the parents to explain to the child that the deceased has gone up to God in heaven. On the other hand, parents can deal with death by saying that the person was old, weak and too tried to go on living. It is important that parents reassure their child that they will be around for years to come. Feat at the movies Some children begin to wail in the theatres and demand to be taken home. Parents must remember that children below the age of 7 often find it difficult to separate fiction and reality because of their overactive imagination. Thus, movies may not be a good idea for children in this age group. Fear of separation Although separation anxieties are normal among infants and toddlers, they are not appropriate for older children or adolescents. They may represent symptoms of separation anxiety disorder. Children with separation anxiety may cling to their parent and have difficulty falling asleep by themselves at night. Their need to stay close to their parent or home may make it difficult for them to attend school or stay at friend's houses, or be in a room by themselves. Fear of separation can even lead to dizziness, nausea or palpitations. Health & Mind 5 Separation anxiety is often associated with symptoms of depression, such as sadness, withdrawal, apathy or difficulty in concentrating, and such children often fear that they or a family member might die. Young children experience nightmares or fears at bedtime. Social Phobias Children with social phobias (also called social anxiety disorder) have a persistent fear of being embarrassed. They get embarrassed in social situations such as during a performance, or if they have to speak in class or in public, or get into conversation with others or eat, drink or write in public. Feelings of anxiety in these situations may produce physical reactions such as palpitations, tremors, sweating, diarrhea, blushing, muscle tension, etc. Children may be afraid that others will notice their anxiety and consider them odd and make fun of them. Divorce At some point all children are afraid of being abandoned, but when parents separate, the fear of being left alone becomes all too real. The child may assume that since one parent has left, the other will too. Suddenly a child's natural desire to explore the world gets replaced by the anxiety of being left alone at home. Children of parents intending to divorce need extra care and they should be made to feel safe as the world can seem a threatening place to youngsters in such a situation. It is very important to handle the situation with sensitivity. How to help the child? While you may not understand the child's fear, it is very real to her. Ridiculing the fear or chastising

6 Registered newspaper Posted at Egmore RMS Patrika Channel your child for being a coward is not going to make the situation better. Encourage her to talk about her fears. You must instil confidence in her by assuring her that nothing bad is going to happen and that you are right there by her side, while it is important to be sympathetic, do not overdo it. Your child may get the message that her fears are justified. You can help the child develop the skills and confidence to overcome her fears. The following steps will guide you in helping your child deal with her fears and anxieties Recognize that the fear real even if it seems trivial to you. It feels real to the child and it is causing her to feel anxious and afraid. Being able to talk about fears can help. Never belittle the fear as a way of forcing the child to overcome it. It will not make the fear go away. Let her know that both of you are there for her whatever your differences as a couple. Parents who display frequent fears and worries themselves, or who protect their child from potentially risky experiences, will train their child to carry more fears than necessary. Anxiety is transferred to the child by this kind of display. Read books and stories to your child about children who have experienced similar fears. This helps children to talk about their fears and to find ways to cope. Postal Registration Number: TN/CCN/550/11-13 R.N.I.no. TN ENG/2011/38850 As with all emotions, fears become less of a problem for children as they gain self confidence, see their world as a safe place, and find that fear is normal and can be dealt with. Some fears are normal and even helpful. But too many fears and anxieties can get in the way of enjoying everyday things such as learning in school, playing with a friend.that is the time when help is needed. You should take the child to a doctor who can help find out if a medical problem is making the child feel anxious. He can help find a way to lessen the anxiety through talking, relaxation exercises, medication or a combination of these activities. Parents have to be very patient while dealing with separation anxiety in their children. If they plan to go away for a few days leaving their child in someone else's care, they should give the child enough time to get accustomed to the new person. It has been observed that children who are used to being around different people right from a young age tend to be more independent and outgoing. Over protective children are likely to be timid and withdrawn. Printed by : S. Bakthan, Printed at : Devi Suganth Printers, 17, Jani Batcha Lane, Royapettah Chennai-14. Published at : 432/753, Poonamallee High Road, Kilpauk, Chennai - 10, Editor : Dr.Kannan Gireesh Health & Mind 6

Food-allergy-FINAL.mp3. Duration: 0:07:39 START AUDIO

Food-allergy-FINAL.mp3. Duration: 0:07:39 START AUDIO BMJ LEARNING VIDEO TRANSCRIPT File: Duration: 0:07:39 Food-allergy-FINAL.mp3 START AUDIO Adam Fox: Food allergy is an inappropriate immune response to food. Our immune systems should ignore food completely,