FOOD ALLERGY

A food allergy is an immunological reaction to one or more proteins. Egg, Cow's milk and peanuts are the three most
common food allergens. The offending proteins enter the bloodstream, and the immature immune system treats it like
a foreign object or antigen (i.e. virus), and reacts to it forming an IgE antibody. This antibody then joins with histamine
in the body resulting in an allergic reaction, which can include a range of symptoms from rashes and swelling through to
difficulty in breathing.
Most food allergies begin in infancy. With food allergic children usually having a history of eczema. Allergic reactions to
food are usually quite immediate although can be delayed, with blood and skin tests also being used to identify problem
foods. However intolerances can also show up as allergies in infancy skin tests, so are used in young children as a guide
only.

FOOD INTOLERANCE

Food intolerance is the term used for non-immune reactions to food; however they do involve the immune system. The
offending food (generally protein) enters the bloodstream, and the immature immune system treats it like a foreign object
or antigen (i.e. virus), and reacts to it forming a non IgE antibody. The effects of food intolerance can be dose related and may build up over days from eating a range of foods containing the same problem substance.

Symptoms of food intolerance may include:

- Recurrent hives
- Gastrointestinal symptoms (reflux, colic, wind and loose motions)
- Blocked nose
- Leg cramps
- Irritable behaviour

The onset of symptoms after eating a problem food can vary from almost immediate to delayed (up to 24 - 48 hours). Food intolerances, including those involving milk, can only be assessed by means of an elimination diet, followed by a series of challenges. As food intolerance isn't an IgE immunological reaction to food, but does involve an immunological reaction, blood and skin tests are not helpful, as they may or may not show up on these tests.

Some researchers are now theorising that untreated food (protein) intolerance may sensitize the immune system, making the infants more prone to allergies. This is because the incidence of allergies later in life appears to be higher in children who had symptoms of protein intolerance as infants. This is still only a theory and there has been no research done yet into this area that we are aware of.

MILK INTOLERANCE

Milk intolerance is a different problem from cow's milk allergy. It may be an isolated problem or part of a broader range of food intolerances. This is an intolerance to the protein in dairy foods, and gets worse as the amount of cow's milk in the diet is increased.

An intolerance is the term used for non-immune reactions to food, and initial research indicated that milk protein intolerance fell into this category. It was suggested that the infant was born without enough enzymes to break down all the protein in the feed, resulting in undigested protein building up in the large intestine creating gas and gastrointestinal symptoms. However this didn't explain why it was worse when these babies had a virus, were teething or had just been immunised, or why some parents reported rashes that coincided with the gastrointestinal symptoms. It is now believed by specialists working in this area that milk protein intolerance is more complex, and does involve the immune system, and that protein intolerance occurs when the infant is born with an immature immune system that is unable to distinguish what should and shouldn't be in the blood.

In Infants with protein intolerance it is now theorized that two things are happening

• The first is that the infant because of an immature digestive system does not have enough enzymes to break down all the protein in the feed, allowing undigested protein to enter
  - the large intestine creating gas
  - the bloodstream,
  
  
• The second is that when the undigested protein enters the bloodstream, the immature immune system treats it like a foreign object or antigen (i.e. virus), and reacts to it forming an non IgE antibody. This antibody then causes an array of reactions in the body ranging from reflux and intestinal spasming, through to rashes and irritable behaviour.
  Pliease note, the antibodies formed in intolerances are different to the IgE antibodies formed in allergies. This is why intolerances are referred to as non-IgE mediated allergy.

This would explain why the symptoms reappear when the immune system is compromised and why many parents of known milk protein intolerant children say there is unsettled behaviour associated with the gastrointestinal symptoms as well as coinciding rashes.

As a number of milk protein intolerant infants in the past responded to a soy formula, it was wrongly confused with lactose
intolerance for some time. However we now know that lactose intolerance is relatively rare and generally occurs in children of Asian background. As many milk protein intolerant infants will be sensitive to soy protein as well, a soy formula cannot be used for this condition. The two conditions are not related. Lactose intolerance is an inability to break down large amounts of lactose, a sugar in milk, resulting in undigested lactase building up in the large intestine creating gas, whilst milk protein intolerance is a reaction to protein as a result of an immature immune system. The resulting symptoms are similar, causing confusion even for medical professionals.

Milk protein intolerance we now know is the more common type of food intolerance in infants. Occurring both in breastfed and bottle fed babies as protein is passed through breast milk, research is indicating that at least 8% of all infants born will present with this condition. Some specialists believe this figure is understated. This is an immaturity that the infant will grow out of eventually, although it is thought now that if it is left unaddressed, and the infant continues to have the offending protein, they may become sensitised to the protein increasing the risk of allergies.

Symptoms
Symptoms of milk intolerance in babies may include one or more of the following:

• Aggravation of reflux
  Wind
  Reflux
  Vomiting
  Colic
  Discomfort
  Irritability
  Obstructive nasal symptoms / blocked nose
  Loose stools, mucus in stools
  Constipation
  Disturbance of sleep due to discomfort
  Distress
  Rashes, recurrent hives
  Leg cramps
  Apparent difficulty w3ith passing bowel motions

Diagnosis
Infants presenting with this condition may exhibit one or more of the above symptoms, with the range of symptoms
differing among different infants For example, one may be distressed with infrequent bouts of diarrhoea and constipation,
while another infant may simply be distressed. This makes it a difficult condition for medical practitioners to diagnose.

A diagnosis is hence made by removing all milk and other diary products from either the infant's or, if breastfeeding, the
mother's diet. As 50% of these infants are also intolerant to soy protein, soymilk or soy formulas are to be eliminated as
well. Goat's milk formulas are not a viable alternative. Often babies are put on a formula such as Nutragimen which has
the protein component already broken down into its subunits. However as this is based on cow's milk this only works in
some instances (around 15% of cases).

Milk protein intolerance is most successfully treated by the introduction of Neocate, which is a totally non-allergenic
extensively hydrolyzed formula that is completely broken down into amino acids and is not based on cow's milk. It is
the only available formula that can be used to identify and treat milk protein intolerance. Although your GP can prescribe
it, you will need to see a specialist paediatrician (paediatric gastroenterologist) for repeats.

In breastfed infants the lactating mother is required to eliminate all diary and soy products from her diet for at least two
weeks. To compensate for the loss of protein, carbohydrates, vitamins and minerals, she should eat an additional meal,
as well as take a calcium supplement of at least 1200gms each day. It is also recommended that she try this diet only
under medical supervision so as to monitor her nutritional needs. Please note that breast milk is the safest, least irritant
and most nutritious diet for sensitive babies.

Most parents report an improvement within a couple of days, yet it may take up to three weeks before any change is noted, longer if the infant is teething, immunized or has a virus.

Reflux and Milk Protein Intolerance
We've known for some time that a baby with reflux is likely to be milk protein intolerant as well. What we've learned
since then is that in some infants the reflux is a symptom of the milk protein intolerance, that the intolerance is causing the reflux and that once the milk protein intolerance is treated the reflux improves.

This has important ramifications in the treatment of reflux, as the only sign exhibited by some infants that they have milk
protein intolerance caused reflux, is that they have reflux. So we are now seeing specialists in the field treating diagnosed
reflux with dietary changes as a first step in the treatment of reflux.

Some parents become confused when their baby, on medication for reflux, find on going to a specialist that they are
advised to stop all medications and instructed to avoid diary and soy foods if breastfeeding, or switch to Neocate if bottle
feeding. They become more confused as Neocate is a watery solution that is refluxed more easily, so can appear to make
the reflux worse! However, as we are learning more about milk protein intolerance this is becoming a necessary step in the
treatment of reflux.

Please note that it is now being theorized that if you are protein intolerant and it is not addressed, this may compromise your immune system so that it becomes more sensitive, and more likely to form an allergy later in life to the offending protein.

LACTOSE INTOLERANCE

Lactose intolerance exists when there is difficulty in digesting lactose. It is caused by a deficiency of the enzyme lactase
in the baby's intestines. This enzyme breaks down the amount of lactose in the feed, so the result is that undigested lactose
builds up in the intestines, causing pain.

Symptoms of lactose intolerance include:

- Abdominal discomfort
- Bloating and excessive wind
- Diarrhoea

People with lactose intolerance can usually still digest some lactose without adverse reactions. However more severe
symptoms may develop in infants for whom milk is the staple food. Lactose intolerance may also occur temporarily after
gastroenteritis in infants and children. It is important to understand the lactose content of various foods. Milk, ice cream
and yogurt have significant amounts, but other dairy products have significantly less. Yogurt is less likely to cause symptoms
because the enzymes present may break down some of the lactose. Diagnostic tests are possible if confirmation of lactose
intolerance is required, although they are usually reserved for severe cases. Lactose intolerance is much less common than
milk protein intolerance.

MULTIPLE PROTEIN INTOLERANCE

A small percentage of babies have been found to be multiple protein intolerant, which simply means they are sensitive to
more than one protein. These may include eggs, fish, peanut, soy, meat or gluten, however all foods are a potential problem.

All foods contain protein, with each type of food having different proteins, so apple has different proteins to pear, etc. Some foods have higher levels of protein than others, with meat, fish, poultry, milk, eggs, cheese and other foods from animals, generally having high amounts of protein, whilst plant foods usually have small amounts of protein in comparison. Animal proteins generally are referred to as complete proteins because they contain all the essential amino acids that are needed by our bodies. Plant food proteins do not contain all the necessary amino acids, so are referred to as incomplete proteins except for Soya beans protein which is a complete protein

Proteins are made up of amino acids, with there being about twenty two amino acids that occur naturally in foods. It is the
number of, types of and different combinations of amino acids that determine the type of protein it is, whether it is milk or a carrot protein.

Now some of these amino acids are made by our bodies and others we gain from food. Our bodies need protein to function. When we ingest protein, enzymes break the protein down, allowing the amino acids to be absorbed into our bloodstream; we then use these amino acids to form and grow body tissue, produce antibodies, enzymes, and hormones as well as store oxygen, assist in blood clotting and provide energy. So protein is essential to life

Multiple Protein Intolerant Infants are identified and treated in much the same way as milk protein intolerant infants,
although obviously this has ramifications for a breastfeeding mother. As breast milk helps develop both the digestive and
immune system, and is the most nutritious form of food available for an infant, treatment is dependant on a number of
factors and is tailored to each individual situation. Neocate on the other hand is already broken down into amino acids, so when it is absorbed into the bloodstream, the immune system is unable to react to it.
.
Multiple protein Intolerance can only be properly diagnosed and treated by a paediatric gastroenterologist who deals with
intolerances.

Milk Protein Intolerance and Food Chemical Intolerance

Food chemical intolerance is thought to occur when the infant's body reacts to chemicals,

- Salicylates
- Amines
- Glutamate
- Food Additives (colours & preservatives)

in the bloodstream, causing a similar range of symptoms to intolerances. However it is generally, but not always classified
by behaviour, ranging from sullen, withdrawn behaviour through to irritable, hyperactive, angry behaviour such as is found
with ADD. Food chemical diets are achieving a lot of success and awareness in children who are having behavioural issues or alternatively not doing well at school. However it can in infants present as colicky behaviour.

It is theorized that in food chemical intolerance the following is happening. Firstly, the food chemicals such as amines,
salicylates, glutamate or food additives are absorbed into the bloodstream, where they begin to rise slowly over time.
When they reach a certain level in the blood stream, a threshold, the chemicals stimulate or aggrevate the nerve endings
of the body resulting in a host of symptoms.

Salicylates Amines and Glutamate are naturally occurring chemicals that are found in foods, in plants they act as a natural
pesticide or deterrent to pests. They also act as a natural preservative in plants. Generally the tastier the food the higher
the level of chemicals, and they tend to be concentrated near the surface of foods. The level of Salicylates tends to decrease with the ripening of foods, where as Amine levels increase with ripening or aging.
High protein foods tend to be low in food chemicals and vica versa.
Children that are sensitive to food chemicals are often found to be sensitive to colours and preservatives as well, so
information on them is often grouped together.

Food Additives comprise a range of both natural and artificial chemicals that we use to colour, preserve or enhance the
flavour of foods the most likely problems are
102,107,110,122,123,124,125,126,127,128,129,,132,133,142,151,155,160b,210,211,212,213,214,215,216,217,
218,219,200,201,202,203,220,221,222,,223,224,225,226,227,228,249,250,251,252,280,281,282,283,310,311,312,
319,320,321,621,622,623,624,625,& products labelled "Natural flavours' or HVP TVP

Although protein intolerance generally occurs at birth and is common in infants, food chemical Intolerance is quite rare in
infants, in comparison. With chemical intolerance becoming more common or identified as the child moves onto solids or
in the toddler years. Both are identified in the same way with the introduction of Neocate, then trials of the suspected
trouble foods; or with breastfed infants, an elimination diet of the suspected problem foods.

Please note, it is now being theorized that if you are protein intolerant, and you are eating the offending protein, this may compromise your immune system so that it becomes more sensitive, causing it to start reacting to food chemicals or preservatives on entering the bloodstream as well, leaving you with a multiple food sensitive infant who reacts to everything.

This is important because it means that although your child may appear to be food chemical intolerant and even though they may react to food chemicals, as one specialist told me it may not be the food chemicals that is the problem

Also some researchers are now theorising that untreated protein intolerance may sensitize the immune system to other
chemical substances such as amines and salicitates later in the child's life. This is because the incidence of food chemical
intolerance appears to be higher in children who had symptoms of protein intolerance as infants. This is still only a theory
and there has been no research done yet into this area that we are aware of.

Colitis

In some infants untreated food intolerance may result in inflammation of the colonic mucosa or the lining of the large
intestine, which becomes red and sore, and may even form lesions that bleed resulting in bloody diarrhoea.

Until this heals, it can cause the peristaltic action of the bowel to spasm, cramp and, in general, not work as it should.
It can also cause pressure receptors in the bowel which stimulate the passing of bowel movements in infants to not work
as they should. This is why constipation, apparent bowel pain, or difficulty in passing bowel movements, diarrhoea and
bloody faeces are all indicators of colitis. Like food intolerance, this is a transitionary condition, which responds well to
eliminating the offending foods so will get better with time.

If milk protein intolerance is suspected and the child fails to respond to the introduction of Neocate or changes in the
maternal diet, a colonoscopy may be necessary to identify the problem. Although the treatment is the same, a baby
with colitis will take longer to respond to the dietary changes. This is a transient disorder, which responds well to
eliminating the offending foods.

Once you've got a good idea what your child is or isn't reacting to, its worthwhile contacting the following

• Department of Immunology
  Royal Prince Alfred Hospital
  Camperdown, N.S.W. 2050
• AESSRA
  P.O. Box 298 Ringwood VIC 3134
  Ph 03) 888 1382
• Dept of Allergy
  Royal Childrens Hospital
  151 Flemington Rd
  North Melbourne 3051
  
  

DISA Guidelines on introducing foods to food intolerant infants.

1. Basically if your baby is on something like Neocate you are dealing with a baby that is likely to be sensitive to protein
and possibly food chemicals, so playing it safe is the key.

2. You will need help don't start foods until given the all clear and then in the order as advised by your specialist. Discuss
with your specialists guidelines for doing so
.
3. Don't use commercial products as there is always more than one factor, IE Even the plainest rice cereal has rosemary
in it, so that in order to know what is the problem

- You buy fresh,
- You cook it,
- You prepare it
- And you don't add anything
- Besides boiled water,
- Or water if you know waters okay!

4. If introducing a food for the first time and your baby has had severe or allergic reactions, try the food first on their finger, wait a while (I.e. a couple of hours), their cheek, and then their lip. If no sign of a reaction, you can try giving the child a quarter of a teaspoon.

5. You may have thought a food diary was for Neurotics but not any more. Use a calendar, a scrap of paper, but you write down every time you introduce a food and watch for any reaction.

6. Any change is a reaction, miserable behaviour, distress, constipation, diarrhoea, pain, rash swelling etc Rashes, swelling
or any reaction involving breathing needs to be reported to your specialist immediately.

7. Start small and introduce the one food for a week, starting of with a quarter of a teaspoon and doubling the amount once a day over the week. If at the end of the week it's okay it can be included in the Childs diet if not, mark it according.

1 for not to bad
2 for bad reaction
3 for absolute hell!
This will help you later on!

8. Introduce foods in the following order

1. Rice
2. Fruit (Excluding citrus/berry & kiwi fruits) & Vegetables(excluding onions, tomatoes, mushrooms)
3. Cereals(one at a time I.e. wheat/oats/rye
4. Meats(starting of with white meat excluding fish)
5. Other (sees your specialist in regards to soy/ milk/ nut/ fish and egg products).

9. Generally with soy milk nut and eggs you introduce them in things first like milk in baking etc once well established and
generally not within the first year and certainly not until your specialist tells you to.

10. Once you feel your Childs reacting you stop the food, if unsure you keep going and if still unsure cease it and see if
there's an improvement on ceasing the food. You then mark the food according and give the child a break before trialling
the next food.

11. A break between trials of different food ranges from a week or more, depending on the child and the reaction.

12. Once you've gone through a variety of foods you can go back and try foods that scored low on the initial trial. We've
found 2 months at least for foods rating 1, 4 months for foods rating 2 and 6 months for foods rating 3, was a good guide
for our children. If your child rates higher on retrial we found it best not to retry that food within 6 months.

13. We found it impossible to determine everything on labels due to all the names given to soy, milk nut and egg
products I.e. Vegetable oil has soy in it as soy's a vegetable, Lecithin and Emulsifier is often soy, also we found numerous
cases of cross contamination, I.e. a child had a reaction to nuts from rice bubbles because of cross contamination, the
company used the same machinery to make a cereal with nuts as they did the rice bubbles, so found it best if you stick
to the general rule that you don't buy commercial or manufactured products in sensitive infants until that infant is well
established on foods..

14. We also found all takeaway and deli foods, especially hot chips to be a problem because of the above! It's not only
what they've used in the cooking process but what they've cooked before, i.e. fish in the oil, before cooking your chips
in it! So again we found it best to go by the general rule of no take away until the infant is well established on foods.

15. Many mums where told if their child couldn't have one food that means they couldn't have another, I.e. pear then
they couldn't have apple, we have found this not to be the case, it is much of a much ness and unless you are talking
dairy foods which all have milk in them, then we found no rhyme or reason to the foods.

16. We found that the following where best avoided until the child was over twelve months and well established on foods

1. Spices, herbs, sauces, stock
2. Fizzy, alcoholic drinks and commercial cordials
3. Commercial and Manufactured Foods
4. Deli and all Take Away/Restaurant Food
5. High Protein Foods (dairy, soy, nut, egg, fish)

TIPS

The more a food is cooked or prepared the more protein your child will ingest, so try steaming the food so they just lose
their crispness instead of boiling it and offering as a finger food instead of pureeing it when introducing for a trial. Fruit is
often best offered as a finger food for the same reason when introducing it.

Sandwich bags are invaluable for these children

If you weren't organized before now you will need to be, try not to leave the house without a meal packed for
emergencies, including a treat bag, it will stop you from being tempted to take a risk on foods whilst you're out.

Don't trial foods if there teething or sick

We found they recover quicker from a reaction on straight Neocate, even if for just 24 hours.

Don't have untolerated food out unless necessary, as they will find it.

Explain to visitors the situation before they come or on arrival, as being a good host may cost you three days of their life

A badge that clearly states NO FOOD PLEASE can stop many frustrating situations for both you and your infant when out.

DISA, its members and volunteers are unable to accept any liability for any advice or information given.
Professionally qualified advice should always be obtained if required