Often people ask me what they should do when they see a "𝘮𝘢𝘺 𝘤𝘰𝘯𝘵𝘢𝘪𝘯" label.
My first question to them is, how many variations of that wording have they seen?
𝐒𝐨 𝐭𝐡𝐚𝐭 𝐲𝐨𝐮 𝐤𝐧𝐨𝐰, 𝐚𝐥𝐥 𝐯𝐚𝐫𝐢𝐚𝐭𝐢𝐨𝐧𝐬 𝐦𝐞𝐚𝐧 𝐞𝐱𝐚𝐜𝐭𝐥𝐲 𝐭𝐡𝐞 𝐬𝐚𝐦𝐞.
Several other studies went to see what was the actual variation of allergen concentration.
What did they find?
In reality, there is still a significant risk of a not labelled food, to contain a substantial amount of allergens.
But why is it that the food industry has this massive variability in warnings they use and still have so much potential cross-contamination of allergens?
The problem tracks back to political parties, the way they are funded or the individual politician's financial interest.
What I am saying might be controversial, but let's look at what is known.
Most of you have never heard of the "𝘌𝘶𝘳𝘰𝘱𝘦𝘢𝘯 𝘍𝘰𝘰𝘥 𝘍𝘰𝘳𝘶𝘮".
In the 𝘜𝘚𝘈 alone, in the 2014 elections, the food industry donated $𝟏𝟕𝐌, in total, to both parties.
This comes to the 𝐏'𝐬 I have spoken about before.
Those, also called 𝐄𝐃'𝐬 (𝘌𝘭𝘪𝘤𝘪𝘵𝘪𝘯𝘨 𝘋𝘰𝘴𝘦), look into the dose needed to cause an allergic reaction and the percentage of allergic people who will react.
So a 𝐏𝟏 or 𝐄𝐃𝟏 means that the potential cross-contamination in a particular food will lead to 1% or fewer allergic people reacting to that food.
The best collaboration done so far is the one between the food industry in Australia, the Government and Allergy Organizations.
(see the attached table to see the ED for the 14 main allergens)
Such an agreement does not exist in the 𝘌𝘜 at present.
The hope for the 𝘜𝘒, at the moment, is that the so called "𝐍𝐚𝐭𝐚𝐬𝐡𝐚'𝐬 𝐋𝐚𝐰" will lead to a change in this practice.
But we need to go deeper than simple labelling, look into manufacturing practices, and avoid allergens altogether.
It is a reaction from our immune system to something we got in contact with that the immune system did not recognize as "safe".
The substance that causes such a reaction is called an "allergen".
Allergens can be found all around us.
The primary reaction that will happen is the immune system trying to destroy that "invader" (allergen), and for that, it uses a significant amount of the immune mediators.
The outcome is an allergic reaction that can come in all sorts of presentations and severity.
Saying that not all allergens we get in contact with will make our immune system react.
Some are relatively harmless, depending on each individual's immune system and, often, prior exposure to that substance.
What are the most common allergens in children?
How does it affect children:
The outcome of the allergies depends on the food the child is allergic to.
Milk, soy, egg and wheat - are the most common foods involved in non-IgE mediated food allergy.
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:
Dr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health.