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Daily Dose

Food Allergies at Halloween

1:30 to read

Halloween is just around the corner and for children with food allergies or sensitivities it is sometimes challenging to go trick or treating.  In the United States 1 in 13 children has a food allergy and for some children even the tiniest bit of their allergen can cause a severe reaction!!

So…have you heard about the Teal Pumpkin Project? It was introduced several years ago to enable children with food allergies to enjoy a fun and safe trick or treating experience….with no fear of being exposed to allergens.  

Nuts, milk, soy, wheat and egg are a few of the most common allergens in children  and adults). So many Halloween candies may contain many of these ingredients, and many of the miniature versions of popular candy that is given out on Halloween may not be labelled as to their ingredients. At times the “snack” size treat may even contain a different ingredient than the usual size candy bar.  Even with diligence it may be difficult for parents to determine if the candy in question is safe.

The Teal Pumpkin Project promotes having non-food treats available for children with food allergies. By putting a teal colored pumpkin on your front porch along with the traditional pumpkins and jack o lanterns, you let families know that you have special treats for a food allergic child, or for any child where candy may present a problem. In this way trick-or-treating is inclusive for everyone and the teal pumpkin ( or a poster with a teal pumpkin ) is an easy way for kids and parents to spot the houses that are participating.

Children love to get stickers, glow sticks, pencils, chalk and small toys are all suitable options for kids who have food allergies or intolerances, or for any child who prefers not to have candy. Kids get so much candy you may be the hit of the block by having a different basket for them to choose from.

Remember, if you are getting a food item for another child in your family to make sure that all candy has been unopened and to avoid choking hazards (like nuts and popcorn) for younger children

Be safe, have fun and look for a teal pumpkin….I am going to go buy some spray paint to turn one of my orange pumpkins into blue!!!  Fun project for a family and neighborhood to do together - a block of teal pumpkins!

 

Daily Dose

Your Child May Need More Than One EpiPen

It can be very frightening when a child suffers witha food allergy. What's the best treatment?I am seeing more and more children with food allergies these days.  Many parents struggle with the fear of “what if my child unknowingly eats something they are allergic to and has a full blown allergic reaction when I’m not around?"  A study published in Pediatrics confirms the advice I have been giving my patients for years: make sure your child carries more than one dose of epinephrine.

The study published in Pediatrics (March 2010) looked at the results among more than 1,200 children who were treated for food allergies in two large Boston hospitals over a 5 year period. During an allergic reaction, 44% of the young patients were treated with at least one does of epinephrine and 12% of those who received the drug needed more than one dose. Food allergies numbers are on the rise; up about 20% over the last 1o years.  Nearly three million school-aged children in the U.S. have some sort of food allergy.  Peanuts, tree nuts and milk trigger most allergic reactions.  And some children are even allergic to shellfish, eggs, fruits and vegetables. If you suspect your child has a food allergy, you should ask your pediatrician for a referral to a pediatric allergist.   You will be given instructions on foods to avoid and most likely be prescribed and taught how to use a self-injectable epinephrine pen. Besides needing more than one dosage, there are other reasons to carry more than one EpiPen.  Each pen lasts between 10 and 20 minutes; therefore, if you are more than 10 minutes away from emergency medical care you will need to administer another dose.  Also, the pens can misfire. Make sure all caregivers know that your child has a food allergy and arm them with all critical medical information to insure your child’s safety. I also recommend a medical alert bracelet.  These bracelets may not be the most fashionable, but when your child is going into anaphylaxis shock and can’t speak, the bracelet could potentially save his/her life. Always stay in contact with your child’s pediatrician to insure you’re following their advice when it comes to your child’s food allergy. That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Special Series: Food Allergies

We continue our special series on allergies. This time we look at food allergies and how they are diagnosed.We continue our series on allergies and this time we shift the focus on food allergies. This topic was top of mind for a mom who sent us an email question via our free iPhone app. She wrote “could my 9 year old daughter be allergic to strawberries as she gets a stomach ache and sometimes vomits after she eats them?  She has not had problems eating strawberries before." This is very interesting because I have been reading & reviewing several articles on food allergies and their diagnosis.

One was in JAMA (May  2010 issue) and another was in the March issue of Consultant for Pediatricians. Both of these articles emphasized that there continues to be a great deal of confusion and lack of uniformity for diagnosing food allergies. Food allergy is also not uniformly defined, but according to the National Institute of Allergy and Infectious Diseases (NIAID), it is an “adverse immune response that occurs on exposure to a given food and is distinct from other adverse responses to food such as food intolerance.”  Statistics show that somewhere between 1%-2% of the population may have food allergies.  It is also unclear if food allergies are on the rise, as data on this is conflicting. With all of that being said, it sounds more like this child has developed an intolerance to strawberries rather than an allergic response.  It would be important to get more history such as what else she has eaten with the strawberries when this occurs, if the symptoms are always the same and are there any other problems associated with the ingestion. Specifically, does she complain of hives, itching, swelling of her tongue, lips or difficulty breathing? Does she have problems with any other foods? I also wonder if she has the same symptoms if she picks fresh strawberries or if they are from the store or if they are frozen. In other words, like so many things in medicine a good history is probably the most important part of this “strawberry story”. If she continues to have problems and her symptoms, this sounds more like intolerance than a true allergic reaction she can just avoid the strawberries (not much fun, especially in the summer). She might also check with her pediatrician about doing a blood test for IgE antibodies to strawberries.  A food intolerance would not have an increase in IgE antibodies as it is not an allergic reaction.  If confusion persists she could be referred to a pediatric allergist for further evaluation and even an oral food challenge. There continues to be a great many studies surrounding the etiology of food allergies, and I will keep you posted as new information is presented. That's your daily dose for today.  We'll chat again tomorrow. What do you think?  Send your question or comment to me!

Daily Dose

Food Allergy Or Food Intolerance?

How do you know if your child has a food allergy or is food intolerant? I just received an email question via our free iPhone app.  Do you have it yet?  It's very handy! A mother with a 9 year old daughter asked “could my daughter could be allergic to strawberries as she gets a stomach ache and sometimes vomits after she eats them?  She has not had problems eating strawberries before." This is very interesting because I have been reading & reviewing several articles on food allergies and their diagnosis.

One was in JAMA (May  2010 issue) and another was in the March issue of Consultant for Pediatricians. Both of these articles emphasized that there continues to be a great deal of confusion and lack of uniformity for diagnosing food allergies. Food allergy is also not uniformly defined, but according to the National Institute of Allergy and Infectious Diseases (NIAID), it is an “adverse immune response that occurs on exposure to a given food and is distinct from other adverse responses to food such as food intolerance.”  Statistics show that somewhere between 1%-2% of the population may have food allergies.  It is also unclear if food allergies are on the rise, as data on this is conflicting. With all of that being said, it sounds more like this child has developed an intolerance to strawberries rather than an allergic response.  It would be important to get more history such as what else she has eaten with the strawberries when this occurs, if the symptoms are always the same and are there any other problems associated with the ingestion. Specifically, does she complain of hives, itching, swelling of her tongue, lips or difficulty breathing? Does she have problems with any other foods? I also wonder if she has the same symptoms if she picks fresh strawberries or if they are from the store or if they are frozen. In other words, like so many things in medicine a good history is probably the most important part of this “strawberry story”. If she continues to have problems and her symptoms, this sounds more like intolerance than a true allergic reaction she can just avoid the strawberries (not much fun, especially in the summer). She might also check with her pediatrician about doing a blood test for IgE antibodies to strawberries.  A food intolerance would not have an increase in IgE antibodies as it is not an allergic reaction.  If confusion persists she could be referred to a pediatric allergist for further evaluation and even an oral food challenge. There continues to be a great many studies surrounding the etiology of food allergies, and I will keep you posted as new information is presented. That's your daily dose for today.  We'll chat again tomorrow. What do you think?  Send your question or comment to me!

Daily Dose

Introducing New Foods To Your Child

When to introduce new foods to your child's diet.There are so many questions (including Megan's via our iPhone App) about “when” you can feed a child different foods.  More and more information is being published on this subject and the “older” recommendations around withholding certain foods from children have recently changed.  Actually, they have changed about 360 degrees!

Like so many things in medicine and life in general, “nothing stays the same”.  When I was beginning foods with my own young children we always started with them eating rice cereal and added vegetables, fruits and then meats.  The recommendations ( I don’t know if they were actually via the doctor or my friends) were to try a new food every 2 – 3 days.  We were not very “sophisticated” then either and there were only about 7 vegetables in the Gerber section and about the same number of fruits. I don’t think “organic” was even a word.

Over the years, as food allergies seemed to become more common,  there were newer guidelines which recommended restricting certain foods from a child’s diet.  In  theory it was thought that by delaying a child’s exposure to a food group,  they would have a more mature GI tract and immune system and therefore might not develop food allergies. There were even some doctors recommending that pregnant and breast feeding women avoid certain foods too.   At the time, this seemed very restrictive to me, and by now my own children were living on peanut butter and fish sticks (both newly forbidden foods).  I don’t think many of the children born in the late 90’s ever saw a jar of Skippy. In the past 2 years the theories regarding delayed introduction of foods have been “de-bunked” and we the pediatricians are returning to a more relaxed approach to feeding infants.  It seems that keeping children away from peanut butter and fish and eggs really did nothing to slow down the development of food allergies.  What it seemed to do was to make new parents quite uneasy about introducing new foods and many children were eating “less healthy” foods by avoiding some food groups. Currently, I recommend that parents begin feeding their infants solid foods at about 5 – 6 months of age. It seems logical to me to start cereal, as a baby is usually happy in the morning at breakfast time, and that is a good time to begin spoon feeding. In reality it does not have to be cereal. There is some data that we should start protein first (meat, hmmm….breakfast sausage for babies?). I then begin vegetables, simply because of taste, again with the thoughts that a baby will not eat carrots when given sweet pears first, but I really don’t think there is any study to substantiate that belief.  Then we just “plow” ahead with almost any food that can be pureed or mushed to spoon feed a baby.  So many mothers are making their own baby food, and that is really quite easy for certain foods.  There are now many more selections in the baby food aisle and babies are happily eating avocado, mango, beets, lentils and so on. There is not a “FORBIDDEN” food, except for CHOKING issues.  So, peanut butter, cashew butter and almond butter are great sources of protein.  So too are bits of flaky fish such as salmon and tilapia.  By the time a baby is 8 -9 months old they are ready to explore some mushy finger foods too, and this does not have to be limited to cheerios, goldfish and puffs.  Pieces of overripe fruits (any kind) cut into small bits are great.  So too are noodles and sauce (tomato is fine) as well as eggs. Unless you have another child with definite food allergies I would try everything.  The more foods your baby is exposed to the broader range of tastes and textures they will have tried.  Just remember to cut everything into tiny pieces and offer a little bit at a time.  The risk of choking seems to be greater than the risk of food allergies. That's your daily dose.  We'll chat again tomorrow.

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Could More Dietary Fiber Reduce Food Allergies?

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In the never–ending search for an answer as to why more Americans – from children to adults- are experiencing food allergies, several new studies suggest that the culprit could be too little fiber in our diets.  

According to the non-profit organization, Food Allergy Research and Education (FARE), 15 million Americans have food allergies. That’s a 50 percent increase from 1997 to 2011. About 90 percent of people with food allergies are allergic to one of eight types of foods; peanuts, tree nuts, wheat, soy, eggs, milk, shellfish and fish. 

So, what is going on that so many people are suffering from food allergies, particularly children? That’s what researchers around the world are trying to find out.  Many studies are beginning to suggest that it’s not just one thing but a combination of factors.

A lack of dietary fiber in the diet may be one of those factors. The notion is based on the idea that bacteria in the gut have the enzymes needed to digest dietary fiber, and when these bacteria break down fiber, they produce substances that help to prevent an allergic response to foods, said Charles Mackay, an immunologist at Monash University in Melbourne, Australia.

So far, the research related to this idea has been done mainly in mice, and dietary factors are unlikely to be the sole explanation for why allergy rates have skyrocketed, researchers say. But if the results were to be replicated in human studies, they would suggest that promoting the growth of good gut bacteria could be one way to protect against, and possibly even reverse, certain allergies, researchers say.

The modern western diet, high in fat, sugar and refined carbs seems to produce a different kind of bacteria in the gut that may be liked to food allergies.  Fiber such as beans, whole grains, nuts, berries, vegetables and brown rice promote the growth of a class of bacteria called Clostridia, which break down fiber and are some of the biggest producers of byproducts called short-chain fatty acids.

In a 2011 study in the journal Nature, researchers found that these short-chain fatty acids normally prevent gut cells from becoming too permeable, and letting food particles, bacteria or other problematic compounds move into the blood.

An overabundance of antibiotic use may also be contributing to food allergies. Not only are people being over-prescribed, we may also be getting extra doses in some of our foods.

Antibiotics, which are widely used in agriculture and for treating ear infections in babies and toddlers, kill the bacteria in the gut. So the combination of antibiotics and low-fiber diets may be a "double whammy," that predisposes people to allergic responses, notes said Cathryn Nagler, a food allergy researcher at the University of Chicago.

The new findings also suggest a way to prevent, or possibly even reverse some allergies. For instance, allergy treatments could use probiotics that recolonize the gut with healthy forms of Clostridia, Nagler said.

In fact, in a small study published in January in the Journal of Allergy and Clinical Immunology, showed that children with peanut allergies who received probiotics were able to eat the nut without having an allergic reaction, and their tolerance to peanuts persisted even after the treatment.

Many factors may contribute to the rise in food allergies, said Dr. Robert Wood, director of pediatric allergy and immunology at the Johns Hopkins Children's Center in Baltimore. Epidemiological studies have found that having pets, going to day care, having a sibling, being born vaginally and even washing dishes by hand can affect the risk of allergies.

As more and more research is being conducted on food allergies, a bigger picture is starting to emerge about possible causes. Pediatricians and family physicians are keeping a close eye on the new findings to better help their patients. Some of those findings are changing the way physicians are treating food allergies.

For years, doctors told parents of children at a high risk of developing allergies to wait until the children were 3 years old before giving them peanuts or other allergy-inducing foods, Wood said.

"We really thought we knew what we were doing, and it turns out it was 100 percent wrong," Wood said.

If your child suffers from food allergies, you might want to talk to your pediatrician or family doctor about adding more dietary fiber or probiotics to your child’s diet. However, it’s not recommended that you “experiment” on your own because some children’s health problems can be made worse from probiotic use or too much fiber. Be sure and check with your doctor first.

Sources: Tia Ghose, http://www.livescience.com/50046-fiber-reduce-allergies.html

http://www.foodallergy.org/facts-and-stats

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