They are bacteria that can lead to benefits to the large bowels when taken in an appropriate amount.
❓But are all Probiotics good?
📝For me to have a better idea about that, I went to find the evidence behind it.
✴There are over 2.5k articles focusing on 22 different probiotics.
✴From those articles, I found 249 RCTs (𝘳𝘢𝘯𝘥𝘰𝘮𝘪𝘻𝘦𝘥 𝘤𝘰𝘯𝘵𝘳𝘰𝘭𝘭𝘦𝘥 𝘵𝘳𝘪𝘢𝘭𝘴), with most of them being sponsored by the company selling them.
✔So take their conclusions with a pinch of salt…
✅The most effective use for them is diarrhoea, IBD (𝘐𝘯𝘧𝘭𝘢𝘮𝘮𝘢𝘵𝘰𝘳𝘺 𝘉𝘰𝘸𝘦𝘭 𝘋𝘪𝘴𝘦𝘢𝘴𝘦) and IBS (𝘐𝘳𝘳𝘪𝘵𝘢𝘣𝘭𝘦 𝘉𝘰𝘸𝘦𝘭 𝘚𝘺𝘯𝘥𝘳𝘰𝘮𝘦).
⚠️This image shows the conditions for which probiotics are helpful and the evidence's strength.
(𝘊𝘩𝘰𝘰𝘴𝘪𝘯𝘨 𝘢𝘯 𝘢𝘱𝘱𝘳𝘰𝘱𝘳𝘪𝘢𝘵𝘦 𝘱𝘳𝘰𝘣𝘪𝘰𝘵𝘪𝘤 𝘱𝘳𝘰𝘥𝘶𝘤𝘵 𝘧𝘰𝘳 𝘺𝘰𝘶𝘳 𝘱𝘢𝘵𝘪𝘦𝘯𝘵: 𝘈𝘯 𝘦𝘷𝘪𝘥𝘦𝘯𝘤𝘦-𝘣𝘢𝘴𝘦𝘥 𝘱𝘳𝘢𝘤𝘵𝘪𝘤𝘢𝘭 𝘨𝘶𝘪𝘥𝘦. 𝘩𝘵𝘵𝘱𝘴://𝘥𝘰𝘪.𝘰𝘳𝘨/𝟷𝟶.𝟷𝟹𝟽𝟷/𝘫𝘰𝘶𝘳𝘯𝘢𝘭.𝘱𝘰𝘯𝘦.𝟶𝟸𝟶𝟿𝟸𝟶𝟻 𝘋𝘦𝘤𝘦𝘮𝘣𝘦𝘳 𝟸𝟼, 𝟸𝟶𝟷𝟾)
❇This means, not all probiotics have any evidence based effect on your health.
➡️And the helpful ones are disease specific.
❗At least, from all of them, we know there are no absolute contraindications to their use.
✅Other benefits found are that they:
▶️Stimulate the immune system
▶️Can decrease the inflammatory response
▶️Can improve vaccine response
✅Where are they found:
▶️Fermented milk drinks
▶️Examples: kefir, kombucha, sauerkraut, pickles, miso, tempeh, kimchi, sourdough bread, some cheeses (Cheddar, Parmesan, and Swiss cheeses are soft cheeses that contain a decent amount of probiotics. Gouda is the soft cheese that delivers the most probiotics of all)
✅How to take them:
▶️There is scant evidence comparing which type of formulation may be more effective.
▶️The choice of formulation may be based on shelf-life, in that lyophilized capsules maintain high concentrations longer than probiotics in dairy products and enteric-coated capsules show higher survival rates than non-enteric coated capsules.
▶️Probiotic capsules requiring refrigeration are heat-dried (not lyophilized) and thus not stable at room temperature, limiting their portability.
▶️Besides, if the patient is lactose-intolerant, yoghurts or other types of fermented dairy products may not be advisable.
‼️Careful with quality control, some will have less than stated.
⚠️Sometimes, when having an 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐜 𝐫𝐞𝐚𝐜𝐭𝐢𝐨𝐧, it can become a more severe reaction.
✳The most severe allergic reactions are called 𝐀𝐧𝐚𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬.
📝The definition of 𝐀𝐧𝐚𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬 is not uniform worldwide.
For you to have an idea, the WAO (𝘞𝘰𝘳𝘭𝘥 𝘈𝘭𝘭𝘦𝘳𝘨𝘺 𝘖𝘳𝘨𝘢𝘯𝘪𝘻𝘢𝘵𝘪𝘰𝘯), the WHO (𝘞𝘰𝘳𝘭𝘥 𝘏𝘦𝘢𝘭𝘵𝘩 𝘖𝘳𝘨𝘢𝘯𝘪𝘻𝘢𝘵𝘪𝘰𝘯), the AAAAI (𝘈𝘮𝘦𝘳𝘪𝘤𝘢𝘯 𝘈𝘤𝘢𝘥𝘦𝘮𝘺 𝘰𝘧 𝘈𝘭𝘭𝘦𝘳𝘨𝘺, 𝘈𝘴𝘵𝘩𝘮𝘢 𝘢𝘯𝘥 𝘐𝘮𝘮𝘶𝘯𝘰𝘭𝘰𝘨𝘺), the EAACI (𝘌𝘶𝘳𝘰𝘱𝘦𝘢𝘯 𝘈𝘤𝘢𝘥𝘦𝘮𝘺 𝘰𝘧 𝘈𝘭𝘭𝘦𝘳𝘨𝘺 𝘢𝘯𝘥 𝘊𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘐𝘮𝘮𝘶𝘯𝘰𝘭𝘰𝘨𝘺) and the ASCIA (𝘈𝘶𝘴𝘵𝘳𝘢𝘭𝘢𝘴𝘪𝘢𝘯 𝘚𝘰𝘤𝘪𝘦𝘵𝘺 𝘰𝘧 𝘊𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘐𝘮𝘮𝘶𝘯𝘰𝘭𝘰𝘨𝘺 𝘢𝘯𝘥 𝘈𝘭𝘭𝘦𝘳𝘨𝘺), all have slightly different definitions.
✴The one I like the most is actually the ASCIA one:
"𝘈 𝘳𝘢𝘱𝘪𝘥𝘭𝘺 𝘦𝘷𝘰𝘭𝘷𝘪𝘯𝘨, 𝘨𝘦𝘯𝘦𝘳𝘢𝘭𝘪𝘴𝘦𝘥 𝘮𝘶𝘭𝘵𝘪-𝘴𝘺𝘴𝘵𝘦𝘮 𝘳𝘦𝘢𝘤𝘵𝘪𝘰𝘯 𝘤𝘩𝘢𝘳𝘢𝘤𝘵𝘦𝘳𝘪𝘴𝘦𝘥 𝘣𝘺 𝘰𝘯𝘦 𝘰𝘳 𝘮𝘰𝘳𝘦 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴 𝘰𝘳 𝘴𝘪𝘨𝘯𝘴 𝘰𝘧 𝘳𝘦𝘴𝘱𝘪𝘳𝘢𝘵𝘰𝘳𝘺, 𝘤𝘢𝘳𝘥𝘪𝘰𝘷𝘢𝘴𝘤𝘶𝘭𝘢𝘳 𝘢𝘯𝘥 𝘰𝘵𝘩𝘦𝘳 𝘴𝘺𝘴𝘵𝘦𝘮𝘴 𝘴𝘶𝘤𝘩 𝘢𝘴 𝘵𝘩𝘦 𝘴𝘬𝘪𝘯 𝘢𝘯𝘥/𝘰𝘳 𝘎𝘐 𝘵𝘳𝘢𝘤𝘵."
Given this, how do we know it is 𝐀𝐧𝐚𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬 or not
⬆️Have a look at the image above.
❓What to do if you think you, or your child, are having an anaphylactic reaction?
▶️If you are sure it is, give 𝐀𝐝𝐫𝐞𝐧𝐚𝐥𝐢𝐧𝐞.
▶️If you are unsure it is, STILL GIVE 𝐀𝐝𝐫𝐞𝐧𝐚𝐥𝐢𝐧𝐞.
▶️If you are sure it is not, ONLY in this case, give 𝐀𝐧𝐭𝐢𝐡𝐢𝐬𝐭𝐚𝐦𝐢𝐧𝐞𝐬.
‼️In ALL circumstances (or if you don't have an Adrenaline AutoInjector), 𝐜𝐚𝐥𝐥 𝟗𝟗𝟗 and ALWAYS ask for 𝐡𝐞𝐥𝐩.
✅(𝘵𝘩𝘦 𝘢𝘭𝘨𝘰𝘳𝘪𝘵𝘩𝘮 𝘐 𝘩𝘢𝘷𝘦 𝘶𝘴𝘦𝘥 𝘰𝘯 𝘮𝘺 𝘪𝘮𝘢𝘨𝘦𝘴 𝘪𝘴 𝘵𝘩𝘦 𝘯𝘦𝘸 𝘥𝘳𝘢𝘧𝘵 𝘰𝘯𝘦, 𝘸𝘢𝘪𝘵𝘪𝘯𝘨 𝘵𝘰 𝘣𝘦 𝘱𝘶𝘣𝘭𝘪𝘴𝘩𝘦𝘥)
🔶️It is important to know that 𝐀𝐧𝐚𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬 is a 𝐫𝐚𝐫𝐞 𝐞𝐯𝐞𝐧𝐭, and most times, it 𝐃𝐎𝐄𝐒 𝐍𝐎𝐓 𝐥𝐞𝐚𝐝 𝐭𝐨 𝐝𝐞𝐚𝐭𝐡.
🆕️In fact, recently published research said there had been a significant increase in hospital admissions with Anaphylaxis, but a decrease in deaths.
This seems like a contradiction, but it is not.
⁉️Why is that?
✅On the one hand, we know there is a significant increase in the incidence of allergies, so naturally, the number of Anaphylactic cases will increase.
✅But on the other hand, the health care professionals awareness has increased, leading to better recognition and prescription of appropriate medication.
I will put my hands down, and agree with whoever tells me what is done, is still not enough.
The bottom line is:
➡ ️𝐑𝐞𝐜𝐨𝐠𝐧𝐢𝐬𝐞 it Fast.
➡️Have your 𝐦𝐞𝐝𝐢𝐜𝐚𝐭𝐢𝐨𝐧 with you AT ALL TIMES!
🆘️Ask for 𝐇𝐄𝐋𝐏!
⚠️Recently publication showed there are significant 🥜peanut proteins in 🏡household dust.
But what is the relevance of this study, and how does it apply to the development of 🤧allergies?
🔸️It is known that during the 👶first year of life, exposure to allergens will lead to the development of either tolerance or allergy.
🔸️With the loss of the natural skin barrier, the presence of eczema increases the risk of developing sensitization to the allergen that gets in contact with the skin.
The best course of action to deal with eczema, and potentially prevent the development of 🤧allergies, should be:
➡️Apply moisturizers as often as you feel the skin is dry to touch.
➡️If that is not solving the problem, speak to your doctor as the child might need topical steroids as well.
➡️Consider the possibility of an allergy leading to eczema and consider an exclusion diet. That should be guided by a paediatric allergist and a paediatric allergy dietitian.
🔜(In due course, I will publish more information regarding eczema and the best way to take care of it.)
(Main article – “Mass spectrometry confirmation that clinically important peanut protein allergens are in household dust”; Helen A. Brough, Elizabeth Naomi Clare Mills, Kerry Richards, Gideon Lack, Philip E. Johnson; 04 October 2019)
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:
🔹️Enquire if the staff at the summer camp is trained to deal with allergic conditions, mainly anaphylaxis.
🔹️See what policies and emergency measures they have in place, e.g. contacts for local ambulance service, GP or Hospital.
🔹️Provide action plans specifically for your child. If you don’t have one, ask your Paediatric Allergist to provide a BSACI action plan.
🔹️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.
🔹️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)
🤧 It is a reaction from our immune system to something we got in contact with that the immune system did not recognize as "safe".
This can happen to a multitude of substances, with the best known being 🥘foods, 🐈pet dander, pollen, house dust mites, 🐝bee or wasp venom. But chemicals can also lead to those reactions.
The substance that causes such a reaction is called an "allergen".
Allergens can be found all around us.
In 🥘food, 🍵drinks, environment, being them airborne (which can be either 💦droplets or minuscule solids) or solids we get in contact with.
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?
🔸️ Tree nuts
How does it affect 👶children:
🔸️Increased risk of developing allergies if one/both 👫parents are atopic
🔸️33% with moderate/severe eczema may present with a food allergy
🔸️There is a close relationship between asthma, 👃allergic rhinitis and food allergy in school-age
🔸️Food allergy is associated with severe asthma
The outcome of the allergies depends on the food the child is allergic to.
🔸️ Milk and egg - usually resolved by teenage years
🔸️ Wheat and soy - those are transient allergies of childhood
🔸️ Peanut and tree nut - typically starts in childhood and only 20% resolve
🔸️ Fish - it is often lifelong
Milk, soy, egg and wheat - are the most common foods involved in non-IgE mediated food allergy.
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?
▶️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
✅Acute life-threatening events
✅Oesophagitis (endoscopy needed to make a diagnosis)
✅Haematemesis (vomiting blood)
𝐈𝐧𝐯𝐞𝐬𝐭𝐢𝐠𝐚𝐭𝐢𝐨𝐧𝐬 𝐟𝐨𝐫 GER
▶️Oesophageal pH study and/or impedance study
▶️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.
⚠️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:
▶️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:
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).
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…
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.
❓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.
Dr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health.