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.
There are two primary sources of 𝐕𝐢𝐭𝐚𝐦𝐢𝐧 𝐀.
𝐏𝐥𝐚𝐧𝐭 𝐬𝐨𝐮𝐫𝐜𝐞, or 𝘱𝘳𝘰𝘷𝘪𝘵𝘢𝘮𝘪𝘯 𝘈:
𝐀𝐧𝐢𝐦𝐚𝐥 𝐬𝐨𝐮𝐫𝐜𝐞, or 𝘱𝘳𝘦𝘧𝘰𝘳𝘮𝘦𝘥 𝘝𝘪𝘵 𝘈:
Examples of low concentration of Vit A (𝘪𝘯 𝘮𝘪𝘤𝘳𝘰𝘨𝘳𝘢𝘮𝘴 𝘢𝘯𝘥 % 𝘰𝘧 𝘥𝘢𝘪𝘭𝘺 𝘷𝘢𝘭𝘶𝘦).
Though most get their Vit A from plant sources, in reality, its absorption is not great.
To make the matter a bit more complicated, 𝘥𝘦𝘧𝘪𝘤𝘪𝘦𝘯𝘤𝘺 𝘪𝘯 𝘻𝘪𝘯𝘤, 𝘱𝘳𝘰𝘵𝘦𝘪𝘯 𝘢𝘯𝘥 𝘧𝘢𝘵 𝘢𝘣𝘴𝘰𝘳𝘱𝘵𝘪𝘰𝘯 (conditions like abetalipoproteinemia) affect carotenoid absorption.
𝐂𝐚𝐫𝐨𝐭𝐞𝐧𝐨𝐢𝐝𝐬 are 𝘱𝘪𝘨𝘮𝘦𝘯𝘵𝘴 𝘧𝘰𝘶𝘯𝘥 𝘪𝘯 𝘱𝘭𝘢𝘯𝘵𝘴.
You can take supplements, if you can't eat any of the above.
As we spoke before, 𝐕𝐢𝐭𝐚𝐦𝐢𝐧 𝐀 is 𝘧𝘢𝘵-𝘴𝘰𝘭𝘶𝘣𝘭𝘦.
We don’t eat Vit A, even in supplements.
When we consume fruits, vegetables or supplements, in reality, we are taking something called “𝘳𝘦𝘵𝘪𝘯𝘺𝘭 𝘦𝘴𝘵𝘦𝘳𝘴” (also known as preformed Vit A) or 𝘱𝘳𝘰𝘷𝘪𝘵𝘢𝘮𝘪𝘯 𝘈.
One way or another, they suffer alterations to become 𝘳𝘦𝘵𝘪𝘯𝘰𝘭𝘴. This is simply because those are easier absorbed in the small bowel.
Those tissues are mainly:
Another group of molecules called 𝐋𝐃𝐋 (𝘓𝘰𝘸-𝘋𝘦𝘯𝘴𝘪𝘵𝘺 𝘓𝘪𝘱𝘰𝘱𝘳𝘰𝘵𝘦𝘪𝘯𝘴) might also do that transport.
𝐕𝐞𝐫𝐲 𝐢𝐦𝐩𝐨𝐫𝐭𝐚𝐧𝐭 𝐭𝐨 𝐤𝐧𝐨𝐰:
Bear in mind any disease affecting the bowels (and I am referring to the 𝘴𝘮𝘢𝘭𝘭 𝘣𝘰𝘸𝘦𝘭) will affect fat absorption capacity. In turn, this will affect Vitamin A absorption as well.
Remember we spoke about Vit A being fat soluble?
Conditions that affect Vit A absorption:
People with any of these conditions should take 𝐕𝐢𝐭 𝐀 𝐬𝐮𝐩𝐩𝐥𝐞𝐦𝐞𝐧𝐭𝐬.
When Vit A is not absorbed, it will be excreted in stools.
The one that becomes inactivated in the bloodstream will be excreted in the urine.
The big problem is that our body absorbs Vit A better than it destroys it.
This can lead to excessive accumulation and 𝐕𝐢𝐭 𝐀 𝐭𝐨𝐱𝐢𝐜𝐢𝐭𝐲.
Also known as Retinol or Retinoic Acid.
It was the first 𝘧𝘢𝘵-𝘴𝘰𝘭𝘶𝘣𝘭𝘦 but not the first Vitamin to be discovered.
It all started with the 𝘌𝘨𝘺𝘱𝘵𝘪𝘢𝘯𝘴, as they found that some types of 𝘣𝘭𝘪𝘯𝘥𝘯𝘦𝘴𝘴 could be cured by 𝘦𝘢𝘵𝘪𝘯𝘨 𝘭𝘪𝘷𝘦𝘳.
This Vitamin plays a vital role in 𝘷𝘪𝘴𝘪𝘰𝘯, 𝘨𝘳𝘰𝘸𝘵𝘩, 𝘤𝘦𝘭𝘭 𝘥𝘪𝘷𝘪𝘴𝘪𝘰𝘯 and 𝘪𝘯𝘵𝘦𝘨𝘳𝘪𝘵𝘺 (mainly 𝘢𝘪𝘳𝘸𝘢𝘺𝘴, 𝘶𝘳𝘪𝘯𝘢𝘳𝘺 𝘵𝘳𝘢𝘤𝘵 and 𝘨𝘶𝘵), 𝘳𝘦𝘱𝘳𝘰𝘥𝘶𝘤𝘵𝘪𝘰𝘯 and 𝘪𝘮𝘮𝘶𝘯𝘪𝘵𝘺.
We cannot forget how important it is for foetal development.
But beware, pregnant women DO NOT need a Vitamin A dose higher than the daily recommended dose.
Due to this, many believe it is 𝐭𝐡𝐞 𝐦𝐨𝐬𝐭 𝐞𝐬𝐬𝐞𝐧𝐭𝐢𝐚𝐥 𝐕𝐢𝐭𝐚𝐦𝐢𝐧 in animal life (not just humans).
When there is a deficiency, it can lead to:
𝐍𝐨𝐭𝐞 𝐨𝐟 𝐜𝐚𝐮𝐭𝐢𝐨𝐧:
𝗪𝐡𝐚𝐭 𝐭𝐨 𝐝𝐨?
Use it after sun and/or at nighttime.
Is there a connection between Vitamin A and allergies?
Too much Vitamin A can also lead to problems. Such as:
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.
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)
Other benefits found are that they:
Where are they found:
How to take them:
Careful with quality control, some will have less than stated.
Sometimes, when having an 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐜 𝐫𝐞𝐚𝐜𝐭𝐢𝐨𝐧, it can become a more severe reaction.
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?
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?
I will put my hands down, and agree with whoever tells me what is done, is still not enough.
The bottom line is:
Recent 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?
The best course of action to deal with eczema, and potentially prevent the development of allergies, should be:
(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.
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)
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.
It 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?
Do all need investigation and/or treatment?
When GER becomes severe (leading to GERD - GastroEsophageal Reflux Disease), there are several aspects we need to worry about, and appropriate action is required.
𝐈𝐧𝐯𝐞𝐬𝐭𝐢𝐠𝐚𝐭𝐢𝐨𝐧𝐬 𝐟𝐨𝐫 GER
Do bear in mind that a significant proportion of GER in infants might be associated with a milk allergy:
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.
Dr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health.