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Allergy Articles & Updates

incidence of food allery in the middle east

5/23/2022

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Incidence of food allergy
I was recently invited to write an article for Arab News, focusing on the increased incidence of allergies in the 𝐌𝐢𝐝𝐝𝐥𝐞 𝐄𝐚𝐬𝐭.⁣

This included the significant growth of 𝘩𝘢𝘺𝘧𝘦𝘷𝘦𝘳 and 𝘢𝘭𝘭𝘦𝘳𝘨𝘪𝘤 𝘢𝘴𝘵𝘩𝘮𝘢 and its 𝘴𝘰𝘤𝘪𝘰𝘦𝘤𝘰𝘯𝘰𝘮𝘪𝘤 𝘪𝘮𝘱𝘢𝘤𝘵.⁣

It was published on the 14th of May under the name “𝐌𝐢𝐝𝐝𝐥𝐞 𝐄𝐚𝐬𝐭 𝐦𝐮𝐬𝐭 𝐚𝐝𝐝𝐫𝐞𝐬𝐬 𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞 𝐨𝐟 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐞𝐬”.⁣

If you want to read it, please go to

arab.news/mvdh4

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food allergy labelling

1/13/2022

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Food allergy labelling
Also known as⁣

𝐏𝐫𝐞𝐜𝐚𝐮𝐭𝐢𝐨𝐧𝐚𝐫𝐲 𝐀𝐥𝐥𝐞𝐫𝐠𝐲 𝐋𝐚𝐛𝐞𝐥𝐥𝐢𝐧𝐠 (𝘗𝘈𝘓)⁣

This is of extreme importance to improve the quality of life of allergy sufferers.⁣ ⁣
Despite its existence, often, there are still episodes of allergic reactions.⁣

Almost half of adult patients have suffered moderate to severe allergic reactions to pre-packed food.⁣

Recent research has shown both allergic and non-allergic sufferers struggle to understand what the different 𝘗𝘈𝘓 mean.⁣
In fact, they incorrectly associate different wording to different risk levels.⁣

The higher the health education of people in the study, the more they would give different risk levels to various food labels.
Interestingly, non-allergy sufferers give a higher risk to food labels than allergy sufferers.

According to the research, consumers felt “𝐏𝐫𝐨𝐝𝐮𝐜𝐞𝐝 𝐢𝐧 𝐚 𝐟𝐚𝐜𝐭𝐨𝐫𝐲” was associated with less risk than “𝐌𝐚𝐲 𝐜𝐨𝐧𝐭𝐚𝐢𝐧” or “𝐓𝐫𝐚𝐜𝐞𝐬 𝐨𝐟”.⁣

To make matters worse, a high proportion of allergy sufferers do not read 𝘗𝘈𝘓 and rely on their own previous experience.⁣

The problem is that there are 𝐧𝐨 𝐠𝐮𝐢𝐝𝐞𝐥𝐢𝐧𝐞𝐬 on 𝘗𝘈𝘓 wording or when they should be used.⁣
It is also not compulsory in the 𝐄𝐔, being of voluntary use by producers.⁣
In the 𝐔𝐊, it became compulsory due to 𝘕𝘢𝘵𝘢𝘴𝘩𝘢’𝘴 𝘓𝘢𝘸.⁣

There is an urgent need to enforce legislation, making the wording better and clearer.⁣

It would start with the sole use of “𝐌𝐚𝐲 𝐜𝐨𝐧𝐭𝐚𝐢𝐧” in 𝘗𝘈𝘓, this way levelling the information, potentially decreasing the risk for all allergy sufferers.

www.facebook.com/permalink.php?story_fbid=336565208470697&id=100063516604410

14 main allergens
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shellfish allergy

12/15/2021

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Shellfish Allergy
Shellfish Allergens
Often 𝐬𝐞𝐚𝐟𝐨𝐨𝐝 is what is named to anything coming from the sea.⁣⁣

But this name seems to be mixed or interchanged with 𝐬𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡.⁣⁣

Let’s clarify this.⁣⁣

𝐒𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡 is made of 𝘴𝘦𝘢 𝘮𝘰𝘭𝘭𝘶𝘴𝘤𝘴 and 𝘤𝘳𝘶𝘴𝘵𝘢𝘤𝘦𝘢𝘯𝘴⁣⁣

Both groups are very different.⁣⁣
  • 𝐂𝐫𝐮𝐬𝐭𝐚𝐜𝐞𝐚𝐧𝐬 are from 𝘗𝘩𝘺𝘭𝘶𝘮 𝘈𝘳𝘵𝘩𝘳𝘰𝘱𝘰𝘥𝘢⁣⁣
  • All others are from 𝘗𝘩𝘺𝘭𝘶𝘮 𝘔𝘰𝘭𝘭𝘶𝘴𝘤𝘢⁣⁣

The most important allergen is a protein called 𝐭𝐫𝐨𝐩𝐨𝐦𝐲𝐨𝐬𝐢𝐧, and it can be found in the muscle of any of those species.⁣⁣
This is the main reason for cross-reactivity between them.⁣⁣

















The incidence of 𝐒𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡 allergy depends on diet habits:⁣⁣
  1. 𝘈𝘴𝘪𝘢𝘯 𝘤𝘰𝘶𝘯𝘵𝘳𝘪𝘦𝘴 have the highest⁣⁣
  2. In 𝘗𝘰𝘳𝘵𝘶𝘨𝘢𝘭, it represents 35% of food allergy⁣⁣
  3. In 𝘚𝘱𝘢𝘪𝘯 is on the rise⁣⁣
  4. It is roughly 5 times higher in adults⁣⁣

Cross-reactivity:⁣⁣
  1. 𝐕𝐞𝐫𝐲 𝐬𝐦𝐚𝐥𝐥 𝐛𝐞𝐭𝐰𝐞𝐞𝐧 𝐟𝐢𝐬𝐡 𝐚𝐧𝐝 𝐬𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡⁣⁣
  2. 𝐌𝐨𝐫𝐞 𝐥𝐢𝐤𝐞𝐥𝐲 𝐭𝐨 𝐛𝐞 𝐟𝐨𝐮𝐧𝐝 𝐰𝐢𝐭𝐡𝐢𝐧 𝐭𝐡𝐞 𝐬𝐚𝐦𝐞 𝐠𝐫𝐨𝐮𝐩𝐬⁣⁣
  3. Often found between 𝘤𝘳𝘶𝘴𝘵𝘢𝘤𝘦𝘢𝘯 and 𝘮𝘰𝘭𝘭𝘶𝘴𝘤𝘴⁣⁣
  4. Common between 𝘤𝘳𝘶𝘴𝘵𝘢𝘤𝘦𝘢𝘯𝘴 and 𝘩𝘰𝘶𝘴𝘦 𝘥𝘶𝘴𝘵 𝘮𝘪𝘵𝘦𝘴, 𝘤𝘰𝘤𝘬𝘳𝘰𝘢𝘤𝘩𝘦𝘴, and 𝘱𝘢𝘳𝘢𝘴𝘪𝘵𝘦𝘴⁣⁣
  5. Possible between 𝘴𝘯𝘢𝘪𝘭𝘴 and 𝘩𝘰𝘶𝘴𝘦 𝘥𝘶𝘴𝘵 𝘮𝘪𝘵𝘦𝘴⁣⁣

Important notes:⁣⁣
  • 𝐒𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡 can cause 𝘧𝘰𝘰𝘥-𝘥𝘦𝘱𝘦𝘯𝘥𝘦𝘯𝘵 𝘦𝘹𝘦𝘳𝘤𝘪𝘴𝘦-𝘪𝘯𝘥𝘶𝘤𝘦𝘥 𝘢𝘯𝘢𝘱𝘩𝘺𝘭𝘢𝘹𝘪𝘴⁣⁣
  • 𝐒𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡 can lead to 𝘰𝘳𝘢𝘭 𝘢𝘭𝘭𝘦𝘳𝘨𝘺 𝘴𝘺𝘯𝘥𝘳𝘰𝘮𝘦 (𝐎𝐀𝐒)⁣⁣
  • 𝘍𝘪𝘴𝘩𝘦𝘳𝘮𝘦𝘯, 𝘳𝘦𝘴𝘵𝘢𝘶𝘳𝘢𝘯𝘵 𝘸𝘰𝘳𝘬𝘦𝘳𝘴 and 𝘧𝘢𝘤𝘵𝘰𝘳𝘺 𝘸𝘰𝘳𝘬𝘦𝘳𝘴 can develop 𝘰𝘤𝘤𝘶𝘱𝘢𝘵𝘪𝘰𝘯𝘢𝘭 𝘥𝘦𝘳𝘮𝘢𝘵𝘪𝘵𝘪𝘴, 𝘳𝘩𝘪𝘯𝘪𝘵𝘪𝘴 and 𝘤𝘰𝘯𝘫𝘶𝘯𝘤𝘵𝘪𝘷𝘪𝘵𝘪𝘴 induced by 𝐜𝐫𝐮𝐬𝐭𝐚𝐜𝐞𝐚𝐧𝐬⁣⁣
  • 𝘖𝘤𝘤𝘶𝘱𝘢𝘵𝘪𝘰𝘯𝘢𝘭 𝘢𝘴𝘵𝘩𝘮𝘢 can happen to workers in 𝐬𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡 𝐟𝐚𝐜𝐭𝐨𝐫𝐢𝐞𝐬⁣⁣

As with fish, if you have reacted, but the tests are negative, think of 𝐀𝐧𝐢𝐬𝐚𝐤𝐢𝐬 allergy.⁣⁣

Remember, if you have reacted to 𝐜𝐫𝐮𝐬𝐭𝐚𝐜𝐞𝐚𝐧𝐬, you need to be tested for 𝐡𝐨𝐮𝐬𝐞 𝐝𝐮𝐬𝐭 𝐦𝐢𝐭𝐞𝐬!⁣⁣

www.facebook.com/permalink.php?story_fbid=319900496803835&id=100063516604410


Prawn and Shrimp differences
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fish allergy

12/15/2021

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Fish Allergy
Fish allergens
Although 𝐟𝐢𝐬𝐡 𝐚𝐥𝐥𝐞𝐫𝐠𝐲 is common, fortunately, it is not as common as other allergies.⁣

Its incidence varies from country to country, and around 40% of people with fish allergy had their first reaction when they were adults.⁣

In 𝘌𝘶𝘳𝘰𝘱𝘦, less than 0.1% of children have a fish allergy.⁣


  • The protein causing most of the allergic reactions is called 𝐏𝐚𝐫𝐯𝐚𝐥𝐛𝐮𝐦𝐢𝐧, and it exists in the fish’s muscle.⁣
  • Some species will have other allergens, which might also lead to allergic reactions.⁣

















𝐂𝐨𝐝 has been the primary source of studies and information regarding fish allergy.⁣

Though most fishes contain this protein, this 𝐃𝐎𝐄𝐒 𝐍𝐎𝐓 mean that an allergy to a fish will lead to an allergy to all fish.⁣
  • Expect to have cross-reactions between fish in the same family (see the tables I made) but to a lesser extent between fish from different groups.⁣
  • Studies show that, in this case, the cross-reactivity is moderate or small.⁣

If there were no specific allergens on the table I made, it is because none has been identified yet, though some proteins have been.⁣

Some main aspects to note are the following:⁣
  1. 𝐄𝐞𝐥 and 𝐜𝐨𝐝 likely cross-react⁣
  2. 𝐀𝐧𝐜𝐡𝐨𝐯𝐲 and 𝐜𝐨𝐝 cross-sensitivity is found in nearly 35% of children⁣
  3. 𝐀𝐧𝐜𝐡𝐨𝐯𝐲 has a high content of 𝘩𝘪𝘴𝘵𝘢𝘮𝘪𝘯𝘦, so some reactions might not be allergic⁣
  4. 𝐅𝐢𝐬𝐡 𝐠𝐞𝐥𝐚𝐭𝐢𝐧𝐞 is used in medication, like in 𝘷𝘢𝘤𝘤𝘪𝘯𝘦𝘴, but generally do not lead to a reaction in people who are allergic to fish⁣
  5. Fish allergies typically are 𝐥𝐢𝐟𝐞𝐥𝐨𝐧𝐠⁣

There are cases in which an apparent allergic reaction to fish has normal investigations.⁣
  • In some cases, this might be due to the presence of a parasite called 𝐀𝐧𝐢𝐬𝐚𝐤𝐢𝐬.⁣
  • Investigation for this parasite should be done through blood tests.⁣

Final note:⁣
Think of the fish in a 𝘧𝘪𝘴𝘩 𝘵𝘢𝘯𝘬!


www.facebook.com/permalink.php?story_fbid=319899903470561&id=100063516604410

Frog legs allergy
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neuritin

9/15/2021

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Neuritin
What is Neuritin
In March this year, researchers from the 𝘈𝘶𝘴𝘵𝘳𝘢𝘭𝘪𝘢𝘯 𝘕𝘢𝘵𝘪𝘰𝘯𝘢𝘭 𝘜𝘯𝘪𝘷𝘦𝘳𝘴𝘪𝘵𝘺 made a fantastic discovery.⁣

They realised that a protein we produce in our bodies significantly influences our immune system’s reaction to allergens.⁣

People who produce less amount of Neuritin have a higher risk of dying of 𝐀𝐧𝐚𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬 and developing 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐞𝐬.⁣

Studies in mice showed some key components that mediate allergic reactions were substantially raised in mice lacking Neuritin.⁣
They proceeded to give Neuritin to those mice, and it managed to restore the lost function, decreasing the production of 𝐈𝐠𝐄 and other 𝐚𝐧𝐭𝐢𝐛𝐨𝐝𝐢𝐞𝐬.⁣

To make matters more important, it was also found that Neuritin also plays a vital role in decreasing 𝐚𝐮𝐭𝐨-𝐢𝐦𝐦𝐮𝐧𝐞 𝐝𝐢𝐬𝐞𝐚𝐬𝐞, 𝐚𝐬𝐭𝐡𝐦𝐚 and the control of 𝐜𝐚𝐧𝐜𝐞𝐫 cells.⁣




















This means we might have a chance to introduce a protein our body produces and give it to patients who are deficient in it, helping them either outgrow their 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐞𝐬 and 𝐚𝐬𝐭𝐡𝐦𝐚 or decrease the severity of the symptoms.


www.facebook.com/permalink.php?story_fbid=253986310061921&id=100063516604410

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food industry and allergies

7/27/2021

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Food Industry and Allergies
Eliciting Dose for 14 major Allergens
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?⁣
⁣⁣
  • In a study done many years ago, the researchers found over 20 different ways of writing an allergy warning in food.⁣
  • They asked people how they would act, depending on what was written, and the variability was incredible.⁣
⁣
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 products with a warning, 6.5 to 93% contained an allergen.⁣
  • In products without a warning, 11 to 53% contained an allergen.⁣
⁣
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".⁣
  • This is the most powerful lobby within the 𝘌𝘜 – the 𝐟𝐨𝐨𝐝 𝐢𝐧𝐝𝐮𝐬𝐭𝐫𝐲 𝐥𝐨𝐛𝐛𝐲.⁣
  • They have offices inside the 𝘌𝘶𝘳𝘰𝘱𝘦𝘢𝘯 𝘗𝘢𝘳𝘭𝘪𝘢𝘮𝘦𝘯𝘵 and manage to block all resolutions that can lead to improvement of food quality when this affects the profit the food industry has.⁣
  • It is easy to see what they have done so far, as most are widely published. (the list is far too long for me to place it here).⁣
⁣
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.⁣⁣
⁣⁣
www.facebook.com/permalink.php?story_fbid=218423533618199&id=100063516604410
​

Exercise and lack of sleep can lead to increased allergic reactions
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summer camps and allergies

3/7/2021

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Summer Caps and Allergies
A US study suggests that, though camps will accept children with allergies, most are not prepared to act if something happens as often they don’t have or request individualized action plans.
  • It seemed camps that had faced anaphylactic events in previous years were better trained and able to recognize it than others who didn’t.
  • Despite that, one-third of camp leaders did not think most staff would be able to act appropriately.

Though this study was not done in the UK, I would suggest parents need to be aware of the possibility of the same happening in summer camps here or any other country where they might send their children to.

The main lessons to take from this study are:
  1. Enquire if the staff at the summer camp is trained to deal with allergic conditions, mainly anaphylaxis.
  2. See what policies and emergency measures they have in place, e.g. contacts for local ambulance service, GP or Hospital.
  3. Provide action plans specifically for your child. If you don’t have one, ask your Paediatric Allergist to provide a BSACI action plan.
  4. See if your child’s medication did not expire and take them to the camp, in a clearly marked container, potentially with a photo of your child outside it.
  5. You don’t stand to lose anything by asking if the food your child is allergic to is excluded from the camp, and other children cannot bring it with them there.

As more and more nurseries/schools are becoming nuts free, it would not be a bad idea for summer camps to follow suit.

(Many Summer Camps Unprepared for Allergic Campers - Medscape - Dec 10, 2019)

www.facebook.com/permalink.php?story_fbid=257470342749873&id=109164090913833
Picture
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Chicken Allergy

2/14/2021

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Chicken Allergy
Primary Chicken Allergy
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.

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Bird Egg Syndrome
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Breast milk and Allergens

2/11/2021

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Breast Milk and Allergens
Breast milk production
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:⁣⁣
  1. Start a food and symptoms diary.⁣⁣
  2. Speak to your GP.⁣⁣
  3. Potential referral to a Paediatric Allergy Dietitian and/or Paediatric Allergist⁣⁣.
  4. Do not start a food exclusion on your own, especially extensive food exclusions.⁣
⁣
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Allergens in breast milk
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Cow's Milk Protein Allergy or Lactose Intolerance?

1/8/2021

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IgE or non-IgE mediated
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:
  1. Primary (the most common form in which our bodies decrease the production of lactase from 5 years of age)
  2. Secondary (after a gut injury, illness or surgery our bodies produce less lactase)
  3. Developmental (mostly affecting preterms and resolving soon after birth)
  4. Congenital (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.


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    Dr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health.

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