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Foods Matter – a monthly magazine supporting anyone on a restricted diet.

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Food Allergy and Intolerance

Food allergy and intolerance are becoming increasingly common, especially among very young children but although many will ‘grow out’ of the condition it is important to understand it and treat it. This is partly because a small proportion of these children will have an allergy so serious that even a small contact with the relevant food could prove fatal and partly because if a child continues to eat a food to which he/she is reacting a pattern of allergy may be created and child’s system may be damaged.

Allergy
In true food allergy the child’s immune system becomes confused and reacts to a particular, but essentially harmless, protein in the food as though it was a dangerous infection. No one knows why this happens.

Immune reactions can be varied but usually include the release of histamine which can cause itching and skin eruptions, swellings, shortness of breath and obstruction of the airwaves. In really serious cases the person can go into Anaphylactic shock in which the mouth, tongue and airways swell up and the blood pressure plummets. If not treated very quickly (within 10 minutes) with adrenaline (epinephrine) this can be fatal. This kind of reaction is normally seen with peanut allergy but can also occur with allergy to sesame seeds, tree nuts and milk proteins. Anaphylactic reactions in babies are extremely rare but do occur in young children.

Allergic reactions to milk proteins can also cause digestive problems – vomiting, diarrhoea, constipation, wind, colic – so if you have on going problems it is worth checking with your doctor.

As yet there is no cure for allergy although there is much research being done worldwide. The only treatment therefore is to avoid the food. Before you do that, however, you need to identify which food is causing the problem. Because true food allergy causes a biochemical reaction in the body it is possible to have skin prick and blood tests to identify the allergen. If you suspect this type of allergy you should go immediately to your doctor to ask for a test. If the test is positive you will be supplied with an ‘epipen’ with which to inject adrenaline/epinephrine in the case of a reaction.

Avoiding the allergen will require considerable vigilance. You will need to:

Intolerances
Many children react to food without having the kind of immune system reaction described above.

Lactose Intolerance
Lactose is the sugar that is found in all milks, human, cow, sheep and goat. To digest it we need an enzyme called lactase. Occasionally a child either does not produce any lactase or not enough to digest the lactose sugar in the milk. Much more often the lactase is ‘washed’ out of the gut by a tummy upset or a bout of gastroenteritis.

Lactose intolerance can be dealt with by taking a lactase supplement (such as Colief – www.colief.com) which can be put into the milk (either expressed breast milk or formula) or using a lactose free formula milk (several manufacturers make them). If the intolerance was caused by gastroenteritis then the lactase enzyme will re-establish itself again quite quickly; if it is more permanent then you may need to use the supplement or lactose free formula regularly.

Other intolerances
In the ideal digestive system the ‘walls’ of the gut (the intestines) are made up of tightly packed cells which only allow liquids and properly digested nutrients through into the blood stream. However, the gut walls, especially in young children, can very easily get damaged by a stomach upset or an infection.

If the gut walls get damaged then partially digested food proteins can get through the gut walls into the blood stream in which they travel all round the body. Since they are not meant to be there they can cause all kinds of unexpected reactions in different parts of the body. They can even sometimes get across what is known as the ‘blood-brain barrier’ and get into the brain where they can cause mood and behavioural problems.

The gut is also populated with millions of bacteria, both good and bad. If the balance of the gut flora is upset (by an infection or by anti-biotics) so that you have more bad than good bacteria, this can cause all kinds of digestive problems and may, if not ‘re-balanced’, cause problems elsewhere in the body.

Symptoms
Symptoms can be hugely varied from all kinds of digestive upsets to eczema (common in new born babies who are not able to tolerate something either in their formula feed or something that they mother is eating if they are being breast fed), breathing difficulties, headaches, behavioural problems, aching joints etc etc etc.

Diagnosis & Treatment
There is no way of diagnosing intolerances on the NHS as there is no completely reliable testing method – intolerances do not show up in the blood in the way an allergy does.

If there is an intolerance/allergy problem with a very young baby it is nearly always to cow’s milk or lactose so it is worth a breastfeeding mother staying off cow’s milk products for a week or so to see if this makes a difference, or experimenting with alternative formulae if the baby is not being breast fed.

It is also wise to delay weaning for as long as possible if you suspect an intolerance problem – at least to six months and probably longer. And when you wean, to avoid potentially dangerous foods such as dairy, wheat and nuts for as long as possible – up to a year if you can. If you are worried about calcium intake you should take a calcium supplement – Biocare (www.biocare.co.uk) do supplements for babies and small children.

For older children you will need to try and identify the problem food. Start by keeping a food diary (writing down everything the child eats over a 5 – 7 day period and how it feels/behaves). If a food looks as thought it could be a problem, eliminate that food from their diet for a week and see if things improve. Then re-introduce it and see if things get worse.

If you identify a problem food - or problem foods – you will then need to eliminate that from their diet on a longer term basis. See above for how to do this.

Resources
Dealing with a child with a food allergy or intolerance can be a difficult and lonely experience so you need as much support as you can get.

Learn as much as you can about the problem and try to involve the rest of the family. The internet is crammed with sites, many of which can be very helpful. On the Foods Matter site (www.foodsmatter.com) you will find a links page with lots of suggestions for other sites to check out.

If you have a serious food allergy, join the Anaphylaxis Campaign (www.anaphylaxis.org.uk) who are really helpful and supportive.

Unfortunately, although there are lots of food intolerance sites, there are no support groups as such. However, at Foods Matter we have a childrens’ club and provide on going support to many, many families with children in our monthly magazines. We also have lists of foods that you should be avoiding, all their various names (in 6 different languages), lists of books you can read, an Agony Allergy Aunt and ten years worth of specialist articles on anything and everything to do with food sensitivity. Check out www.foodsmatter.com (where you can also subscribe) to see what we offer our subscribers.