Understanding the Complexities of Food Allergies and Sensitivities in Children
Food allergies are an Immunoglobulin E (IgE) mediated immune reaction while sensitivities tend to be IgG mediated gut-immune reactions and are less serious. There is no evidence to support delaying the introduction of potentially allergenic foods, such as nuts, milk products, eggs, soy, wheat, and fish, beyond 6 months of age. Delaying the introduction of these foods may actually increase the infant’s risk of allergy and atopic disease. The National Health Institute funded Randomised Control Trial, "Learning Early About Peanut Allergy" (LEAP), published in 2015, showed that Israeli children had significantly lower rates of peanut allergy compared with Jewish children living in the UK of the exact same ancestry. Israeli children are introduced to peanuts through a peanut-based snack called Bamba, as a staple of their diet. It's a horribly processed snack and I don't recommend feeding your children Bamba, but it proves that early introduction of allergens can help prevent allergies. You could try organic nut butters instead. Introducing gluten-containing foods while the child is still being breastfed can also reduce the instance of Coeliac Disease (CD) later in life. If one of the baby’s parents has CD, I recommend proceeding with caution. Food allergies and sensitivities can present in many different ways from eczema, cradle cap, asthma, stomach pains, reflux, unusual stools (soft, green, yellow or foul smelling) and of course full-blown anaphylaxis, which I hope you never experience. It’s important to identify any allergenic foods early on and avoid them. Family history, vitamin D levels of mother and baby, duration of breastfeeding and maternal diet, are all determinants of a baby’s risk of developing food allergies.
Phenols are chemicals naturally found in foods and are also used as additives. Different to food allergies, children tend to have a threshold for tolerance of phenols. Symptoms of phenol overload include red ears and face, night sweats, smelly head, bed or stools, bloated stomach, rash or thirst, dark circles under the eyes, hyperactivity or aggression, head banging, difficulty falling asleep and frequent night waking. High phenol foods include apples, bananas, oranges, cocoa, milk, cheese, berries, carob, tomatoes, peanuts, chocolate, orange juice, grapes, red grapes, vanillin flavour and food dyes.
Cow’s Milk Protein Allergy (CMPA)
Around 1 in 50 infants are diagnosed with Cow’s Milk Protein Allergy (CMPA). Most children will outgrow the allergy by age 4. The treatment of CMPA is to remove all cow’s milk products, sometimes including goat’s milk, from the babies diet including formulas. There are alternative formulas available including extensively hydrolyzed, amino acids based or soy formulas. It's best to speak to your paediatrician about which formula is best for your baby. A dairy-free diet is a huge undertaking and can lead to nutrient deficiencies so ensuring a definitive diagnosis is very important. Your medical doctor can order an antigen specific IgE blood test or a skin prick test can confirm the allergy. According to the Australian Society of Clinical Immunology and Allergy, if your child has cow's milk (dairy) allergy, these symptoms may occur:
1. Within minutes or up to 2 hours after having a small amount of cow's milk.Symptoms can include hives (urticaria), eczema, face swelling, vomiting, diarrhoea, noisy breathing or wheeze. Severe allergic reactions (anaphylaxis) may cause floppiness in babies.
2. Several hours after having moderate amounts of cow's milk. Symptoms can include vomiting and diarrhoea and sometimes-blotchy rashes or worsening eczema.
3. After a day or up to several days after having normal amounts of cow's milk. Symptoms can include eczema, vomiting, diarrhoea or asthma.
Lactose Intolerance and Fructose Malabsorption
Runny stools, diarrhoea, gas, bloating, skin rashes, and screaming are signs of abdominal discomfort, that may be associated with lactose intolerance or fructose malabsorption. Your baby may be able to tolerate some of these simple sugars but too much may lead to the above symptoms. Fruit juice is high in fructose and is not suitable for babies or children. It can cause fructose overload resulting in digestive upset. It also contains high amounts of much sugar, is low in essential nutrients, and can lead to dental cavities. A simple non-invasive breath test can confirm whether this is a problem.
Tummy friendly food and FODMAPs
FODMAPs stands for Fermentable Oligosaccharide, Disaccharide, Monosaccharides and Polyols. Put simply, these are carbohydrates that some people find difficult to digest. FODMAPs can cause tummy upset, bloating, irritable bowel syndrome (IBS) type symptoms and sometimes diarrhoea. A lot of mums avoid garlic, onions and leeks because they are under the impression that these foods will upset their baby’s tummy but this isn't always the case. Garlic, onions and leeks contain oligosaccharides known as fructans and can cause irritation to some sensitive people. They are also a great source of prebiotics to feed good bacteria in the gut. Of course, there are many other FODMAPs in foods. The Monash University has developed an app and have a lot of information on their website.
What is the deal with gluten?
Gluten is a protein found in some grains including wheat, spelt, oats, rye, barley. Some people are sensitive to gluten while others can have full blown Coeliac Disease (CD). CD is when a person’s immune system reacts to gluten and causes damage to the small bowel. You must carry one of the predisposing genes to develop CD and the condition is lifelong. But gluten isn’t always the bad guy for everyone. The Journal of Paediatric Gastroenterology and Nutrition in 2016 published findings that the early introduction or delayed introduction of gluten, does not increase the infant’s risk of developing CD, whether they carry the genes or not. My recommendation is to include limited amounts of a variety of grains (not just wheat) as apart of the infant’s diet from 6 months of age. If the infant has a first degree relative with CD, I would use caution but not exclude gluten on this basis. In the West, we have the tendency to have a diet high in refined wheat. For example, cereal from breakfast, sandwich for lunch and pasta for dinner. Overeating any food, will cause problems for most people. Give your baby a variety of grains but avoid refined and white flours. Use whole grains, preferable soaked, sprouts and/or sourdough. The hard end of a sourdough loaf is a great alternative to a rusk or a wholesome barley soup made with fresh chicken broth is a very nutrient dense family meal.