Food allergies are very real, occurring in around 5-10% of children and 2-4 % of adults in Australia with the majority of allergies being mild and many children growing out of them over time. Allergies however may have negative health impacts for those who suffer from them, not only physically but also mentally. For parents of children with food allergies it can be a particularly worrying time especially if they have suffered an anaphylactic reaction. Allergies must be medically diagnosed and support given to those individuals and their families.
The most common triggers of food allergy are egg, cow's milk (dairy), peanut, tree nuts, sesame, soy, wheat, fish and other seafood. However, almost any food can cause an allergic reaction, including fruits. Most children diagnosed with and allergy to cow’s milk protein, soy, wheat and egg will be able to tolerate varying amounts by the time they go to school; this is in contrast to allergic reactions to tree nuts, peanuts, seeds and seafood which can be lifelong in around 75% of children diagnosed.
The recommendation for introducing solids around the 6 months of age is due to the sensitivity of infants gut linings. It is not recommended to introduce solids before 4 months as some proteins from food may leak through the lining of the gut causing irritation and potentially an allergy to the food.
Most of the time children with food allergies have parents who are allergy free however siblings of a child with an allergy are at a slightly higher risk of developing a food allergy themselves.
Degree of reaction
Underneath the lining of the skin, respiratory tract, nose and gut lining are mast cells filled with chemicals including histamine which are released when irritated. A severe reaction will affect swallowing and breathing where a mild reaction may present as a skin reaction such as hives or symptoms similar to that of hay fever. Reactions may be mild to severe depending on a number of factors such as:
the amount of the food eaten
the form of the food (liquid form can sometimes be absorbed faster)
whether the food was eaten alone or mixed with others
whether to food was cooked or uncooked
running around or other exercise can increase the severity of the reaction
A mild reaction may cause hives (small red welts) or wheels (red rings) on the skin which can be warm and itchy, swelling around the mouth and nose and vomiting within minutes to 1-2 hours of eating the food. Other symptoms include pains in the tummy, diarrhea or a blocked or runny nose. A severe reaction called anaphylaxis (due to swelling in the throat) can cause acute breathing difficulties and requires urgent medical attention. Treatment involves using adrenalin usually in the form of an “epipen” injection to dramatically reduce the reaction. Despite this deaths from food allergy are still relatively rare in Australia.
Can allergies be prevented?
It appears food allergies are on the increase which is driving further study in this area. There is no evidence that delaying the introduction of any specific food beyond 6 months of age helps to prevent allergy. A recent Canadian Paediatric Society statement recommends no delay in the introduction of food in infancy. Recent research also appears to suggest that early introduction of potentially allergenic foods including cooked egg, smooth nut butters and dairy (around 6 months of age) might actually provide a form of protection and help prevent allergy. Research has also shown that there doesn’t appear to be any link between changing the mother’s diet or delaying the start of solids in babies and decreasing children’s risk of developing a food of allergy.
Effect of food avoidance on children’s eating patterns
Food allergies affecting 2-3% of children aged 0-6 years are often confused with the more common reaction of food intolerance. There are many common symptoms including vomiting, stomach cramps and diarrhea, however the difference being an allergy involves an immune reaction and histamine release causing various forms of swelling around the body. Intolerances are less severe and the reaction can take a lot longer to appear, an example being lactose intolerance which causes bloating, gut distention and loose bowel motions. This is due to the body being unable to break down the sugar found in milk (called lactose) causing wind, stomach cramping and diarrhoea until the body has expelled it.
True lactose intolerance is less common than is widely perceived, and should be viewed as just one potential cause of cows’ milk intolerance. There is increasing evidence that A1 beta-casein, a protein produced by a major proportion of European-origin cattle but not purebred Asian or African cattle, is also associated with cows’ milk intolerance. In humans, digestion of cow’s milk A1 beta-casein, releases beta-casomorphin-7 (BCM7) which activates opioid receptors throughout the gastrointestinal tract and body. Studies have shown that milk containing A1 protein can cause symptoms such as abdominal pain and harder stool consistency, not seen in the digestion of milk containing only the A2 protein.
Food aversions and food fears unfortunately can be a flow on affect once a child has been diagnosed with an intolerance or an allergy. Treatment involves the removal of the food or food group from the child’s diet and as a consequence they live with the knowledge that the food can hurt them and they may develop a fear of that food. If a whole food group is removed and not replaced with a similar food, nutritional deficiencies can also develop.
Dietary Approaches for proper growth and development
Once diagnosis of an allergy or intolerance has been made it is important that the individual food or food group is removed from the child’s diet and replaced with a nutritionally suitable alternative. Sometimes there are traces of the food or it is listed under another name in our everyday foods; for example milk may be listed as caseinates, whey or milk solids in a muesli bar or cake. Seeing an Accredited Practicing Dietitian can identify these , provide alternatives and more importantly balance the child’s diet. Making this transition as stress free as possible will greatly reduce the risk of aversions and food fear.
We absolutely recommend a medical approach with a health care professional when working through food allergies and intolerances, to ensure the right diagnosis is made. For example if your toddler is exhibiting signs of lactose intolerance, perhaps consider trialing the Farmers Beta A2 Nutritional Toddler Milk (which only contains the A2 protein), as your child’s symptoms may be caused by the intolerance to the A1 protein, rather than lactose.
Please remember that if you or your child have been diagnosed with an allergy to cow’s milk, it means all cow’s milk products regardless of whether they are A1 & A2, or A2 only, must be avoided.