 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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 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    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.
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:
Cross-reactivity:
Important notes:
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    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.
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.
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:
There are cases in which an apparent allergic reaction to fish has normal investigations.
Final note: Think of the fish in a 𝘧𝘪𝘴𝘩 𝘵𝘢𝘯𝘬! www.facebook.com/permalink.php?story_fbid=319899903470561&id=100063516604410    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   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. www.facebook.com/permalink.php?story_fbid=218423533618199&id=100063516604410   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.
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:
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    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:
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:
www.facebook.com/permalink.php?story_fbid=241380731025501&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.
Lactose intolerance has 4 types:
The tests for both are different.
Obviously, the symptoms are also different.
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. Categories
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Email address: officedrcosta@gmail.com
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Email address: officedrcosta@gmail.com
Contact number: 07949990798
Website design & content by LIT Communication: www.litcommunication.com
