Health Watch

Food allergies in children! Be alert!

Charmaine Fernando

With the season of merriment and good cheer knocking at your door its hard not to show your flare for hospitality. Being Sri Lankans, we have a penchant to go overboard when it comes to treating our guests who drop by to wish us a Merry Christmas. I have always wondered how the ‘merry’ got attached to the holy bible story of Christmas, but never gathered enough clues for conviction.

Merrymaking has come home to stay. Christmas brings home to us the sweet scent of pine mingled with the hard to ignore spicy aroma of irresistible rich foods, baking in every Christian home and hearth. A wise man insists that Christmas is for children. Next to playing the merry old Santa on Christmas Eve, filling the sock with enchanting toys that light up kiddies world we need to pay attention to what the kiddie might consume during the season. Getting carried away with the glorious intricacies of enjoyment we may tend to forget the babe, like we all do at Christmas, losing its very essence.

Talking about food and children against a season of merrymaking and hospitality have your eyes open and mind alert to the slightest symptom of food allergies, especially in children. It doesn’t mean you should loosen your grip on sensitivity to it throughout the year. Food allergies are more common in children than adults. About seven out of 100 kids have them. Only about three to four out of 100 adults do. Children often outgrow their food allergies. But if you have a food allergy as an adult, you will most likely have it for life.

True food allergies are not as common as most people believe and only affect about two percent of children, although they are more common in younger children, affecting about five to eight percent of younger children. Fortunately, younger children will outgrow these food allergies by the time they are three years old. Now

that’s what I call good news for parents of toddlers who suffer from allergies.

Symptoms of a food allergy can include wheezing and difficulty in breathing, itchy skin rashes, including hives, vomiting, diarrhea, nausea, abdominal pain and swelling around the mouth and in the throat. These symptoms usually develop fairly quickly after your child ingests the food he is allergic to, often within minutes to hours. You must note that nasal symptoms by themselves, such as congestion or a runny nose, are usually not caused by food allergies.

Symptoms may be mild or very severe, depending on how much of the food your child ingested and how allergic he is to the food.

A severe reaction can include anaphylaxis, with difficulty in breathing, swelling in the mouth and throat, decreased blood pressure, shock and even death. So, be alert, season or no season. The babe should be in focus at all times.

More common than food allergies are intolerances to certain foods, which can cause vomiting, diarrhea, spitting up, and skin rashes. An example of such a reaction occurs in children with lactose intolerance, which occurs because of a deficiency of the enzyme lactase, which normally breaks down the sugar lactose. Children without this enzyme or who have a decreased amount of the enzyme, develop symptoms after drinking lactose containing food products, such as cow’s milk. However, because this reaction does not involve the immune system, it is not a real food allergy.

If you notice that your child develops symptoms after being exposed to certain foods, then you should avoid those foods. The most common foods that can cause allergies include: peanuts, tree nuts (walnuts, pecans, etc. and rarely coconut), fish, shellfish, eggs (especially egg whites), milk, soy, and wheat. Keeping a diary for a few weeks and recording what foods your child has been eating, especially new foods, and when he develops symptoms may help figure out what he is allergic to. Finding out the root cause is crucial.

Once you determine what your child is allergic to, it is important to learn to read food labels because the food your child is allergic to may be an ingredient of many other foods.

You should also avoid eating foods that may have been prepared using equipment that was also used to prepare the types of food that your child is allergic to.

When trying to determine what your child is allergic to, parents often incorrectly assume that if he has eaten a food before and not had problems, then he probably is not allergic to that food.

They usually only suspect new foods as being able to cause a food allergy. However, it is important to keep in mind that it takes time for the immune system to build up a reaction against something that the body is allergic to. It may take days, weeks, months or even years to build up enough of a response to cause noticeable symptoms.

So your child may be allergic to a food even if he has eaten it many times before without problems. In addition to avoiding what you think your child may be allergic to, children with more severe reactions should be evaluated by their Pediatrician or an allergist.

Testing may be done, either skin testing or RAST, a blood test to check for antibodies against certain things your child may be allergic to, and see if specific food allergies can be found. In addition, your child should wear a medical alert bracelet to notify others of his allergy.

Now you know how important it is to have ‘the babe’ in focus especially at Christmas! Fill your heart instead of the sock, with goodness. Have a spirited season!

Important Reminders to Parents

While children often outgrow their food allergies, if your child had a severe reaction to a food, then you should talk with your Pediatrician or allergist before reintroducing the food.

Talk with and educate other family members and caregivers about your child’s food allergies. Most people do not understand how serious food allergies can be, and may think it is all right to give just a small amount of a food that your child is allergic to.

Educate your child about his allergy, so that he can learn to avoid foods that he is allergic to.

If your child does not improve with these interventions or if he has had a severe allergic reaction, then you should consider having him see an allergy specialist for testing to figure out what foods he is allergic to and to possibly start allergy injections.

Children with severe allergic reactions or anaphylaxis should wear a medical alert bracelet to notify others of his condition and should carry an epinephrine autoinjector (such as the EpiPen JR) to ensure rapid treatment during an allergic reaction.

Most importantly, learn to read food labels and look for ingredients that your child may be allergic to and practice strict avoidance of those foods. If you don’t know what an ingredient is, then call the manufacturer before giving it to your child to be safe.

Common Food Allergies

A food allergy is an adverse immune response to a food protein. Food allergy is distinct from other adverse responses to food, such as food intolerance, pharmacological reactions, and toxin-mediated reactions.

The food protein triggering the allergic response is termed a food allergen. It is estimated that up to 12 million Americans have food allergies and the prevalence is rising. Six to eight percent of children under the age of three have food allergies and nearly four percent of adults have them.

Food allergies cause roughly 30,000 emergency room visits and 100 to 200 deaths per year in the US. The most common food allergies in adults are shellfish, peanuts tree nuts, fish and eggs and the most common food allergies in children are milk, eggs, peanuts, and tree nuts.

Treatment consists of either desensitization or avoidance, in which the allergic person avoids all forms of contact with the food to which they are allergic. People diagnosed with a food allergy may carry an auto injector of epinephrine such as an EpiPen or Twinject, wear some form of medical alert jewellery or develop an emergency action plan, in accordance with their doctor.

The most common food allergies are many but the following top the list.

1. Dairy allergy
2. Egg allergy
3. Peanut allergy
4. Tree nut allergy
5. Seafood allergy
6. Shellfish allergy
7. Soy allergy
8. Wheat allergy

These are often referred to as ‘the big eight’. They account for over 90 percent of the food allergies.

The top allergens vary somewhat from country to country but milk, eggs, peanuts, tree nuts, fish, shellfish, soy, wheat and sesame tend to be in the top 10 in many countries. Allergies to seeds, especially sesame seem to be increasing in many countries.

Flu Pandemics:

Be alert for H1N1 pandemic

Dr. Sarath Tennakoon

The smallest known infective agents are the viruses, human beings, animals, plants and bacteria are susceptible to infection by appropriate viruses. The small size, the genome (contains only one kind of nucleic acid) and inert metabolism (viruses have no metabolic activity outside susceptible host cells and these are intracellular parasites) are the three main properties of viruses.

Viruses can effect the host cell in four ways. If the infection is lethal the cell gets killed (cell death). The cell may get transformed to one with properties of a cancer cell and continue to proliferate haphazardly. The virus could also remain hidden inactive state without producing obvious ill effects (latent infection).

Some viruses have protein in their outer coats that get stuck to red blood cells of the host and make them sticky (haemadsorption).

Viruses are important as they cause human disease especially among children. But most viral infections are mild and the patient makes a complete recovery. However they can cause severe disease in an unusually susceptible patient and even cause death. The response of the host to virus infection is twofold.

The body has a non-specific defence mechanism consisting of barriers to infection. These are the skin, the respiratory tract, the gastrointestinal tract, the urinary tract, conjunctiva, the white blood cells of the blood. The specific immunological defence responses are of two types. Firstly the humeral mechanism neutralizes the viruses. Secondly the cellular response is very important for eliminating virus infected cells.

Occasionally virus infections may erupt suddenly in the form of huge waves of epidemics known as pandemics which effect large populations in several countries. Flue pandemics come in waves and become worse as they spread. Such pandemics have erupted in 1781, 1847, 1890 and 1918.

In 1918-19 there was a particularly severe and great pandemic that killed between 20 and 40 million people as it spread around the world (Greenwood et al, 1992).

In 1933 Sir Christopher Andrews and others isolated influenza a virus. Continuation of virus studies revealed that epidemic behaviour of viruses is related to changes in the virus itself.

A phenomenon known as “original antigenics in” was identified. This means that infection with a current virus type stimulates antibody to earlier strains. By antibody studies of older people the antigenic components that were prevalent back to the end of the previous century were deduced. In 1890 the subtype was H2N2, in 1900 it was H3N8, in 1918 it was H1N1 (Swine like Spanish influenza), in 1957 it was HaN2 (Asian influenza), in 1968 it was H3N2 (Hong Kong influenza), in 1977 it was H3N2+H1N1 and in 1990 it was H3N2+H1N1 respectively. The major pandemics have been associated with antigenic shifts - when the viral H or N or both have changed (Greenwood et al 1992). The WHO (World Health Organization) monitors influenza A and B throughout the world to see the appearance of their variants. It is usually the influenza A virus that undergoes antigenic shift, and not B and C.

Unlike in 1918 currently there are antiviral drugs and vaccines. In 1918 two waves of virus attack were identified. The first was the mild attack with few deaths and gave a protective effect to the rest to fight against the severe attack. On the average there was 70 per cent protection says Simonson who analysed the 1918 flu (Mackensie 2009).

If the current H1N1 virus follows the same pattern as the 1918 virus, then the same trend could occur. The problem with antivirals is the development of resistance of the virus either by mutation or through swapping genes. The cost is yet another issue. Preparation of vaccines too is a big and costly issue.

“If production begins in June under the best possible conditions, we could have 190 million doses by September, jumping to a billion by October, not nearly enough for the world’s people” (New Scientist, 2009).

There are some population groups who are at special risk. The obese, children, pregnant mothers, Diabetics, those with immunodefieciency and chronic disease conditions etc, are at special risk. In 1918 it was found that the practice of social distancing was very helpful in curbing the pandemic.

Measures like isolating patients and their contacts, closing schools, banning large gatherings, closing some business and staggering working hours to this out rush hour, kept the infection levels low in many places (New Scientist, 2009).

References

1. Greenwood David et al (1992) Medical Microbiology, Churchill Livingstone.

2. MacKanzie Debora (2009) New Scientist, 9 May 2009

3. Timbury Morag. C (1994) Medical Virology, Churchill Livingstones, U.K.