  𝐆𝐚𝐬𝐭𝐫𝐨𝐞𝐬𝐨𝐩𝐡𝐚𝐠𝐞𝐚𝐥 𝐑𝐞𝐟𝐥𝐮𝐱 (GOR) is likely one of the most common causes of concern for 👫parents of infants/newborns. ⁉️Signs can some time be hard to understand, as not in all cases you will see the feed coming out. This is what is commonly called “𝘴𝘪𝘭𝘦𝘯𝘵 𝘳𝘦𝘧𝘭𝘶𝘹”. 🔶️There are common behaviours that can be used to make that diagnosis, though all need to be put into context as not always it means the child has reflux. ❓So what are they? ▶️Back arching ▶️Unsettled when lying flat ▶️Need to wind in an upright position for long periods ▶️Need to fall asleep upright ▶️Frequent hiccups (stimulation of phrenic nerve by acid in the oesophagus) ▶️Frequent feeding (feeding leads to release of endorphins, decreasing pain caused by acid reflux – if not treated, can lead to food refusal) ❓Do all need investigation and/or treatment? 🔹️Not at all. 🔹️In reality, most cases just need conservative measures. ⚠️When GER becomes severe (leading to GERD - GastroEsophageal Reflux Disease), there are several aspects we need to worry about, and appropriate action is required. ➡️The following are the complications to pay attention to: ✅Failure to thrive ✅Respiratory compromise ✅Acute life-threatening events ✅Oesophagitis (endoscopy needed to make a diagnosis) ✅Feed refusal ✅Haematemesis (vomiting blood) 𝐈𝐧𝐯𝐞𝐬𝐭𝐢𝐠𝐚𝐭𝐢𝐨𝐧𝐬 𝐟𝐨𝐫 GER ▶️Oesophageal pH study and/or impedance study ▶️Barium swallow/meal ▶️Upper GI (gastrointestinal) endoscopy ‼Do bear in mind that a significant proportion of GER in infants might be associated with a🥛 milk allergy: 🔸️204 infants (<1yr) with GER 🔸️40% respond to cow’s milk exclusion (hydrolysate) 🔸️Responders typically had other GI symptoms and atopic features (eczema) (𝘐𝘢𝘤𝘰𝘯𝘰 𝘦𝘵 𝘢𝘭 𝘑 𝘈𝘭𝘭𝘦𝘳𝘨𝘺 𝘊𝘭𝘪𝘯 𝘐𝘮𝘮𝘶𝘯𝘰𝘭 𝟷𝟿𝟿𝟼; 𝟿𝟽: 𝟾𝟸𝟸-𝟽) If you are worried and see any of the symptoms described above, go to your GP, and he/she will address those issues and eventually refer to a 𝐏𝐚𝐞𝐝𝐢𝐚𝐭𝐫𝐢𝐜𝐢𝐚𝐧, a 𝐏𝐚𝐞𝐝𝐢𝐚𝐭𝐫𝐢𝐜 𝐀𝐥𝐥𝐞𝐫𝐠𝐢𝐬𝐭 or 𝐃𝐢𝐞𝐭𝐢𝐭𝐢𝐚𝐧. ⚠️Do not try a Lactose Free formula if there are worries of a milk allergy! Lactose is the sugar in milk, not a protein. ⚠️Do not try medication for colic, as evidence suggests they are of no use. Often, it is either coincidental improvement or even the placebo effect on parents, as they feel something is being done. www.facebook.com/permalink.php?story_fbid=250736886756552&id=109164090913833 
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  ⚠️Simple Food Protein Induced Enterocolitis Syndrome (𝐅𝐏𝐈𝐄𝐒) or Food Protein Induced Proctocolitis (𝐅𝐏𝐈𝐏) is often mistaken for a viral infection causing vomiting and diarrhoea, with occasional blood in stool. ‼️Often, and not wrongly, it may be diagnosed as a 𝘯𝘰𝘯-𝘐𝘨𝘌 𝘢𝘭𝘭𝘦𝘳𝘨𝘺, with the most common being CMPA. ✅This is because it normally tends to have mild symptoms. ⁉️Important to note that severe 𝐅𝐏𝐈𝐄𝐒 is relatively rare and less common than Anaphylaxis! ✴𝐅𝐏𝐈𝐄𝐒 most common triggers: ▶️Milk ▶️Soy ▶️Rice# ▶️But can be associated with a long list of food proteins 🧒👧Most children will be able to tolerate the food causing the reaction by the age of 2 or 3 years old. In some cases, it may persist throughout life. ❗Children with recurrent episodes may suffer from poor growth and weight loss - failure to thrive. ✅Usually children will recover very fast from an episode of 𝐅𝐏𝐈𝐄𝐒, as long as appropriate diagnosis and treatment is made. 🔴For severe cases, the best treatment is fluid resuscitation. ⚠️What does not work to treat them: ➡️Adrenaline auto-injector ➡️Antihistamines ➡️Steroids ➡️Antibiotics Though you will often see all of them being used due to the worry it is either Anaphylaxis or Sepsis. ✴In the case of 𝐅𝐏𝐈𝐏, most symptoms tend to resolve by 6 months of age (50%) or 9 months of age (95%). ✳The advice is to reintroduce the causing food into the mother's diet after an exclusion period of 6 months or give it to the child when reaching 12 months of age. ⚠️For both cases, if the child is formula fed be aware that: 1️⃣Medical and dietetic advice needs to be sought before a restriction diet is done 2️⃣It might take 2 weeks for improvement to be seen 3️⃣The child will need and Extensively Hydrolysed Formula (EHF - first choice) or eventually an Amino Acid Formula (AAF - second choice) ❗In the case of a breastfeeding mother, a restriction diet needs to be guided by a dietitian. ✅This is to be sure appropriate nutrition (focusing on protein and calcium) is achieved. ‼️For 𝐅𝐏𝐈𝐄𝐒, there seems to be a 30% chance of people involved to develop either 𝘢𝘵𝘰𝘱𝘪𝘤 𝘥𝘦𝘳𝘮𝘢𝘵𝘪𝘵𝘪𝘴 (eczema), 𝘢𝘴𝘵𝘩𝘮𝘢 or 𝘩𝘢𝘺𝘧𝘦𝘷𝘦𝘳 (allergic rhinitis). www.facebook.com/permalink.php?story_fbid=247380117092229&id=109164090913833   Which came first: the chicken or the egg?
❓The (almost) eternal debate on what came first has persisted through decades. 🌆Countless evenings have been spent around a table, with a 🍷wine glass (or plenty more), with people throwing arguments against or in favour of one of the answers. 🤔Despite all thoughts, in reality, the answer is relatively simple. ⚠️The first animals to lay eggs were the dinosaurs. 🥚𝐒𝐨 𝐭𝐡𝐞 𝐞𝐠𝐠 𝐜𝐚𝐦𝐞 𝐟𝐢𝐫𝐬𝐭!🐣 🇺🇲A discovery made in 1990 in North America showed a nest of eggs from a carnivore dinosaur called “Maniraptoran”. 🦕This dinosaur is believed to be the animal from which birds came to develop into new species. ✅Some suggest the new question: What came first, the dinosaur or the egg? But we will leave that one for another time… www.facebook.com/permalink.php?story_fbid=246672547162986&id=109164090913833   𝐂𝐡𝐢𝐜𝐤𝐞𝐧 𝐌𝐞𝐚𝐭 𝐀𝐥𝐥𝐞𝐫𝐠𝐲 and 𝐁𝐢𝐫𝐝 𝐄𝐠𝐠 𝐒𝐲𝐧𝐝𝐫𝐨𝐦𝐞 ❓How many times have I been asked if children should avoid chicken if they are allergic to eggs? ❗Not as often as parents telling me their child is allergic to chicken meat or start sneezing when there is either cooked eggs or cooked chicken around. ⁉️Can this really happen? ✔Actually, it can, but we need to understand that 𝘢𝘭𝘭 𝘢𝘳𝘦 𝘳𝘦𝘭𝘢𝘵𝘪𝘷𝘦𝘭𝘺 𝘳𝘢𝘳𝘦. Chicken Allergy can be primary or secondary; this one often called Bird Egg Syndrome. ✳But let us take this into the several aspects that might cause any of the above symptoms. ➡️The main difference between the two types is that the primary kind is associated with a protein called 𝘎𝘢𝘭 𝘥 𝟽 and the second called 𝘎𝘢𝘭 𝘥 𝟻. What does it mean? ✴𝐆𝐚𝐥 𝐝 𝟕 is 𝘩𝘦𝘢𝘵 𝘴𝘵𝘢𝘣𝘭𝘦 (long term allergy), and 𝐆𝐚𝐥 𝐝 𝟓 is 𝘩𝘦𝘢𝘵 𝘥𝘦𝘨𝘳𝘢𝘥𝘢𝘣𝘭𝘦 (very likely to outgrow the egg or chicken meat allergy). 🔻The symptoms vary, according to age group: ▶️In adults, the signs are usually respiratory associated (asthma or wheeze) or affect the eyes or nose (rhinoconjunctivitis). ▶️In children, it will mainly affect the gastrointestinal tract or leading to breathing problems. 👫Children with egg allergy and respiratory symptoms related to bird egg syndrome, tend to either acquire tolerance later or not outgrow it. 𝘜𝘴𝘶𝘢𝘭𝘭𝘺, 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴 𝘴𝘵𝘢𝘳𝘵 𝘭𝘢𝘵𝘦𝘳 𝘪𝘯 𝘵𝘩𝘦𝘪𝘳 𝘭𝘪𝘷𝘦𝘴. ⛔As with egg allergy, be aware of the cross-reactivity between chicken meat and turkey meat. 🚫But there can also be reactions to duck or goose meat, 𝘵𝘩𝘰𝘶𝘨𝘩 𝘵𝘩𝘦 𝘳𝘦𝘢𝘤𝘵𝘪𝘰𝘯𝘴 𝘵𝘦𝘯𝘥 𝘵𝘰 𝘣𝘦 𝘮𝘪𝘭𝘥𝘦𝘳. So you will need to avoid all those meats until a proper diagnosis is made. www.facebook.com/permalink.php?story_fbid=242488257581415&id=109164090913833    ❓One of the most common questions I get from mothers is "𝐢𝐬 𝐦𝐲 𝐜𝐡𝐢𝐥𝐝 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐜 𝐭𝐨 𝐬𝐨𝐦𝐞𝐭𝐡𝐢𝐧𝐠 𝐈 𝐚𝐦 𝐞𝐚𝐭𝐢𝐧𝐠?". 🤱Many have decided to go on a food exclusion, without any 𝘗𝘢𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘈𝘭𝘭𝘦𝘳𝘨𝘺 𝘋𝘪𝘦𝘵𝘦𝘵𝘪𝘢𝘯'𝘴 or 𝘗𝘢𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘈𝘭𝘭𝘦𝘳𝘨𝘪𝘴𝘵'𝘴 advice, meaning potential nutritional deficiencies and substantial confusion to what is the causative agent, if any. ⚠️Fortunately, when there is a relationship between maternal food ingestion and an allergic reaction in a baby, they tend to be non-IgE mediated. ➡️Excellent information on the management of those reactions can be seen in an 𝐄𝐀𝐀𝐂𝐈 𝐏𝐨𝐬𝐢𝐭𝐢𝐨𝐧 𝐏𝐚𝐩𝐞𝐫: "Diagnosis and management of Non‐IgE gastrointestinal allergies in breastfed infants — An EAACI Position Paper. 👨⚕️For all the others, referral to a 𝘗𝘢𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘈𝘭𝘭𝘦𝘳𝘨𝘪𝘴𝘵 should be considered, so investigations (mainly skin prick tests - SPTs) can be done. ▶️After that, coordination with a 𝘗𝘢𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘈𝘭𝘭𝘦𝘳𝘨𝘺 𝘋𝘪𝘦𝘵𝘪𝘵𝘪𝘢𝘯 will lead to re-introduction of foods into the maternal diet and, eventually, into the child's diet as well. ▶️The dietitian will also advise on the need for supplementation if the diet is not adequate. ✅Before that appointment happens, it is always a good idea for mothers to keep a food and symptoms diary. ‼That often, on its own, can be enough for us to make a diagnosis and management plan. ⚠️Please do bear in mind that though only four main allergens have been investigated so far, it is highly likely all or most others will also be expressed in breast milk. 🔀Unfortunately, there is significant variability of allergen presentation in breast milk, which is often related to the method used to detect the proteins associated with those allergens. 👨💻Further research into a unified and conclusive investigative tool is of great importance, so clarifying and establishing a causal relationship between allergen ingestion on a mother and allergic reaction on a baby can be achieved. ⚠️Bottom line if worried about a potential allergic reaction in your breastfed child: 1️⃣Start a food and symptoms diary. 2️⃣Speak to your GP. 3️⃣Potential referral to a Paediatric Allergy Dietitian and/or Paediatric Allergist. 4️⃣Do not start a food exclusion on your own, especially extensive food exclusions. www.facebook.com/permalink.php?story_fbid=241380731025501&id=109164090913833    🎄So it is 🎅Christmas, and how many of you are 🍰 baking with 🥚eggs? ‼️This is probably one of the seasons where we should be cautious with this type of allergy! In what comes to allergies in children, and due to the nature of baby´s weaning, egg sits almost at par with 🥛cow’s milk as the most prevalent form of allergy. This is closely followed by 🥜peanut allergy. ⚠️Up to now, it was believed roughly 50% of children would outgrow their egg allergy by 3 years of age, with that percentage increasing to roughly 66% at 5 years of age. But it seems those percentages are decreasing with time. ❓The reason for that is unknown still. ✅So the earlier a diagnosis and intervention is made, the higher will be the chances for children to outgrow their allergy. ➡️The initial step is to perform skin prick tests, eventually followed by an open food challenge to baked egg. 😊If the child passes this step, they will have roughly 95% chance of outgrowing their egg allergy. 😔As you might imagine, failing that challenge will give them less than 5% of outgrowing the allergy. ⚠️𝐑𝐞𝐦𝐞𝐦𝐛𝐞𝐫: ▶️If you suspect your child has an egg allergy, don’t give up or become demoralized. ▶️There is a pretty good chance he/she will outgrow it. ⛔Exclude egg and peanut from their diet, exception if already eating peanut. ⚕Ask for a Paediatric Allergy referral and see if their department will also involve a Paediatric Allergy Dietitian. ✳Very important to understand that when we speak about removing chicken eggs from the diet, we also talk about removing eggs from other birds due to cross-reactivity. 🚫The birds’ eggs you should also exclude are 🦃turkey, 🦆duck, 🦢goose, seagull and quail. www.facebook.com/permalink.php?story_fbid=207452784418296&id=109164090913833    🥚Some children who are allergic to egg can eat small amounts of egg that is well baked (in cakes and biscuits, for example).
❗Often they will not tolerate raw egg, whole egg or lightly processed such as mayonnaise or meringue. ⚠️𝐂𝐡𝐢𝐥𝐝𝐫𝐞𝐧 𝐰𝐡𝐨 𝐜𝐚𝐧 𝐞𝐚𝐭 𝐛𝐚𝐤𝐞𝐝 𝐞𝐠𝐠𝐬 𝐚𝐫𝐞 𝐦𝐨𝐫𝐞 𝐥𝐢𝐤𝐞𝐥𝐲 𝐭𝐨 𝐨𝐮𝐭𝐠𝐫𝐨𝐰 𝐭𝐡𝐞𝐢𝐫 𝐚𝐥𝐥𝐞𝐫𝐠𝐲. 😔Unfortunately, those children who cannot tolerate baked egg are less likely to grow out of their egg allergy. ✅It is important to know that egg may be found in a wide range of foods, including: ➡️𝘊𝘢𝘬𝘦𝘴 ➡️𝘉𝘪𝘴𝘤𝘶𝘪𝘵𝘴 ➡️𝘗𝘢𝘴𝘵𝘳𝘪𝘦𝘴 ➡️𝘋𝘦𝘴𝘴𝘦𝘳𝘵𝘴 ➡️𝘊𝘶𝘴𝘵𝘢𝘳𝘥 ➡️𝘔𝘦𝘢𝘵 𝘱𝘳𝘰𝘥𝘶𝘤𝘵𝘴 ➡️𝘚𝘢𝘭𝘢𝘥 𝘥𝘳𝘦𝘴𝘴𝘪𝘯𝘨𝘴 ➡️𝘎𝘭𝘢𝘻𝘦𝘴 ➡️𝘌𝘨𝘨 𝘱𝘢𝘴𝘵𝘢 ➡️𝘉𝘢𝘵𝘵𝘦𝘳𝘦𝘥 𝘰𝘳 𝘣𝘳𝘦𝘢𝘥-𝘤𝘳𝘶𝘮𝘣𝘦𝘥 𝘧𝘰𝘰𝘥𝘴 ➡️𝘚𝘰𝘮𝘦 𝘪𝘤𝘦 𝘤𝘳𝘦𝘢𝘮𝘴 ➡️𝘚𝘰𝘮𝘦 𝘤𝘩𝘰𝘤𝘰𝘭𝘢𝘵𝘦𝘴 ➡️𝘚𝘰𝘮𝘦 𝘴𝘸𝘦𝘦𝘵𝘴 ✅Also, food labels with the below items may suggest the presence of egg so look out for: ➡️𝘈𝘭𝘣𝘶𝘮𝘪𝘯, which suggests the presence of egg; ➡️𝘓𝘺𝘴𝘰𝘻𝘺𝘮𝘦, which is an enzyme derived from egg; ➡️𝘌𝘨𝘨 𝘓𝘦𝘵𝘤𝘪𝘵𝘩𝘪𝘯, (𝘌𝟹𝟸𝟸), which may, in rare cases, be made from egg; It works as emulsifiers and often is in trace amounts. Though trace amounts are not common to cause an egg allergy. ➡️𝘌𝘨𝘨 𝘸𝘩𝘪𝘵𝘦, in some bread it is used as a washing agent. In wine, alcohol-based drinks, coffee drinks and soup stocks (and sometimes along with eggshells) it might be used as a clarifying agent. ✴Resolution of egg allergy tends to occur in stages, starting with tolerance to baked egg. ▶️Further steps will involve cooking the egg so that the protein causing the allergy will be less degraded. ▶️It will end on the last step, which is raw egg. (𝘧𝘰𝘳 𝘰𝘵𝘩𝘦𝘳 𝘰𝘱𝘵𝘪𝘰𝘯𝘴 𝘰𝘯 𝘦𝘢𝘤𝘩 𝘴𝘵𝘦𝘱 𝘰𝘧 𝘵𝘩𝘦 𝘭𝘢𝘥𝘥𝘦𝘳, 𝘢𝘴𝘬 𝘺𝘰𝘶𝘳 𝘋𝘪𝘦𝘵𝘪𝘵𝘪𝘢𝘯 𝘧𝘰𝘳 𝘢𝘥𝘷𝘪𝘤𝘦) ✔The suggestion is to have an initial dose of ¼ of the age-appropriate dose the child would have in one day. ✔From then double the dose every other day and aim to give it 2 to 3 times per week. ‼️Remember to always be guided by your Paediatric Allergy Team, which should include a Paediatric Allergy Dietitian. www.facebook.com/permalink.php?story_fbid=235349184961989&id=109164090913833   𝐓𝐨𝐝𝐚𝐲'𝐬 𝐩𝐨𝐬𝐭 𝐢𝐬 𝐟𝐮𝐥𝐥 𝐨𝐟 𝐦𝐢𝐱𝐞𝐝 𝐟𝐞𝐞𝐥𝐢𝐧𝐠𝐬:
😊Happy as I have diagnosed a very rare disorder. 😊Happy as in a way, I have managed to provide closure to a mother that was looking for answers. 😊Happy because now there is a plan of treatment that should improve symptoms and quality of life. 😔Sad also because of having diagnosed a rare disorder that has so many complications associated and makes such a young child suffer so much and, with it, parents as well! ❗Many of you have never heard of 𝐌𝐚𝐬𝐭 𝐂𝐞𝐥𝐥 𝐀𝐜𝐭𝐢𝐯𝐚𝐭𝐢𝐨𝐧 𝐃𝐢𝐬𝐨𝐫𝐝𝐞𝐫 or, in fact, all other mast cell disorders that exist. ⚠️𝘔𝘢𝘴𝘵 𝘤𝘦𝘭𝘭𝘴 are an important part of our immune system, and we could not survive without them. 🐛It is thought the way this line of cells has evolved was mainly to fight against invasion and proliferation of 𝘱𝘢𝘳𝘢𝘴𝘪𝘵𝘦𝘴 in the human gut. ➡️It leads to significant histamine release, which originated from abdominal pain, cramps, and diarrhoea, intending to force the parasites out. 🔷️Now it works as the main mediator for allergic diseases but also to fight infections. 🔶️Only recently (around 𝟐𝟎𝟎𝟕) it has been named a known disorder and, due to that, its incidence and other epidemiological information are really not known. 🔸️As with other Mast Cell Disorders, it is believed it goes highly undiagnosed. The reason being, not many are aware of its symptoms or even how to investigate appropriately. ‼️As a rough idea Mastocytosis (another Mast Cell disorder) is thought to affect between 𝟓 𝐭𝐨 𝟏𝟎 cases per 1 million world population per year. ▶️In this case, it affects more children (around 𝟔𝟓%) than adults (around 𝟑𝟓%). ▶️It affects both genders more or less equally. ▶️Some say it affects more white people from northwestern Europe. ✳As 𝘔𝘢𝘴𝘵𝘰𝘤𝘺𝘵𝘰𝘴𝘪𝘴 is more common than 𝘔𝘊𝘈𝘚, we can only imagine how many cases are diagnosed worldwide per year. The rest of the data might be comparable, but it is not truly known. 💊Treatment is focused on a decrease of symptoms and trying to prevent as many 𝘈𝘯𝘢𝘱𝘩𝘺𝘭𝘢𝘤𝘵𝘪𝘤 episodes as possible. ❗Please do remember that MCAS's symptoms overlap with plenty of other conditions, mainly 𝐂𝐡𝐫𝐨𝐧𝐢𝐜 𝐒𝐩𝐨𝐧𝐭𝐚𝐧𝐞𝐨𝐮𝐬 𝐔𝐫𝐭𝐢𝐜𝐚𝐫𝐢𝐚(𝐂𝐒𝐔) and 𝐂𝐡𝐫𝐨𝐧𝐢𝐜 𝐒𝐩𝐨𝐧𝐭𝐚𝐧𝐞𝐨𝐮𝐬 𝐀𝐧𝐠𝐢𝐨𝐞𝐝𝐞𝐦𝐚 (𝐂𝐒𝐀). 🔜Soon I will also talk about this condition, which is fairly frequent. 🏨So, if you believe your child, or someone you know, fits into the signs and symptoms I speak about here, please do ask for a referral to either a 𝐏𝐚𝐞𝐝𝐢𝐚𝐭𝐫𝐢𝐜 𝐀𝐥𝐥𝐞𝐫𝐠𝐢𝐬𝐭 or an 𝐀𝐝𝐮𝐥𝐭 𝐀𝐥𝐥𝐞𝐫𝐠𝐢𝐬𝐭. www.facebook.com/permalink.php?story_fbid=230187078811533&id=109164090913833   You might think the answer is obvious, but you would be surprised. ⁉️I still receive referrals to my allergy clinic asking patients to be tested as they might have a coeliac allergy! 🔷️𝐂𝐨𝐞𝐥𝐢𝐚𝐜 𝐝𝐢𝐬𝐞𝐚𝐬𝐞 is a serious pathology where the body's immune system attacks itself. 🔷️𝗪𝐡𝐞𝐚𝐭 𝐚𝐥𝐥𝐞𝐫𝐠𝐲 is a reaction to proteins found in wheat. It can be either IgE (immediate) or non-IgE (delayed). 🔷️𝐍𝐂𝐆𝐈/𝐍𝐂𝐆𝐒 has symptoms similar to coeliac disease. Still not well known if or how the immune system is involved. There doesn't seem to have damage to the lining of the gut. 🔶️Gluten is a protein found in cereals. 🔶️When it is ingested, it leads to damage of the internal wall of the bowel with malabsorption associated problems: ➡️Less absorption of nutrients, minerals, and the fat-soluble vitamins A, D, E, and K (this one potentially leading to bleeding problems). ➡️Anaemia due to iron deficiency, low Vit B12 and Folic Acid. ➡️Osteopenia and osteoporosis due to lack of Calcium and Vit D. ➡️Weight loss, growth failure and/or delay in puberty and lethargy as side effects of a lack of carbohydrates and fats. ➡️Potential copper, selenium and zinc deficiencies. ➡️Pregnancy problems. ⚠️𝐅𝐚𝐜𝐭𝐬: ▶️It can develop at any age. ▶️Diagnosis sometimes is not easy as symptoms can be vague. You need to be eating gluten for a diagnosis to be done. ▶️Even a breadcrumb can be damaging. It is a lifelong exclusion of gluten. ▶️It can be inherited, though there are new mutations. The chance to get it if a close relative has it is 1:10. ▶️It is neither an allergy nor an intolerance. ▶️It was thought to be rare, but it is believed to be underdiagnosed. ▶️People can have normal weight or overweight at diagnosis. ▶️You cannot grow out of it! How to investigate and diagnose: ✅𝐂𝐨𝐞𝐥𝐢𝐚𝐜 𝐝𝐢𝐬𝐞𝐚𝐬𝐞 - Blood tests (TTg IgA and Endomysial Antibodies. Sometimes HLA DQ2 and HLA DQ8). ✅𝗪𝐡𝐞𝐚𝐭 𝐚𝐥𝐥𝐞𝐫𝐠𝐲 - Skin prick tests. Eventually, specific IgE and/or component diagnostics. Sometimes there is also the need for a food challenge. 🔜I will address this issue in another post. ✅𝐍𝐂𝐆𝐈/𝐍𝐂𝐆𝐒 - No validated test. Food exclusion, followed by food inclusion with symptoms coming back again, is the diagnostic took. Before this, Coeliac disease must be excluded. www.facebook.com/permalink.php?story_fbid=226738099156431&id=109164090913833    It is an Allergy or an Intolerance?
🥛In a milk allergy, the body reacts to milk proteins, not milk sugar. ❗In lactose intolerance, there is little to no lactase (an enzyme produced by our body), so the milk sugar (lactose) cannot be digested. ⚠️Cow's milk protein allergy (CMPA) affects from 2 to 6% of children, with the highest prevalence during the first year of age. ➡️About 50% of children have been shown to resolve CMPA within the first year of age, 80-90% within their fifth year. ➡️Symptoms usually develop within a week of cow's milk introduction, although it may be delayed for many weeks, reported up to 24 and 36 weeks. 🔶️Lactose intolerance has 4 types: 1️⃣Primary (the most common form in which our bodies decrease the production of lactase from 5 years of age) 2️⃣Secondary (after a gut injury, illness or surgery our bodies produce less lactase) 3️⃣Developmental (mostly affecting preterms and resolving soon after birth) 4️⃣Congenital (rare and genetic in origin, where there is little to no lactase production - higher incidence in Finland) 💉The tests for both are different. ➡️skin prick tests or blood tests (specific IgE) for IgE mediated for milk allergy ➡️hydrogen breath test or stool sample for lactose intolerance ➡️no tests available for non-IgE mediated (normally food exclusion is the only option) ⚠️Obviously, the symptoms are also different. ➡️IgE mediated (immediate kind) affects the skin most commonly, then the gastrointestinal tract, and least frequently the respiratory system. Cardiovascular symptoms are rarely reported. Symptoms can range in severity from mild to life-threatening. Their onset is typically within minutes of exposure. ➡️Non-IgE-mediated (delayed kind) have typically an onset several hours and in some instances several days after ingestion. They tend to cause skin changes (eczema) and gastrointestinal disturbances (reflux with or without vomiting; constipation or diarrhoea). ➡️Lactose intolerance presents mainly with gastrointestinal problems (abdominal pain, flatulence and diarrhoea). If you or your child have an immediate reaction to a food, avoid it and ask for a referral to either a Paediatric Allergist or an Adult Allergist. In case the reactions are delayed (2 hours to several days), your best option is to be seen by either a Paediatric Dietitian or an Adult Dietitian. www.facebook.com/permalink.php?story_fbid=218595863303988&id=109164090913833 |
AuthorDr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health. Archives
February 2021
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Email address: officedrcosta@gmail.com
Contact number: 07949990798
Website design & content by LIT Communication: www.litcommunication.com
