Archive for November 2011

He will just grow out of it!

How many times have a heard this.  I have just seen a boy with severe eczema, food allergies, who is quite miserable.  His mother is doing the best that she can and each time she takes him to her doctors they say “he will just grow out of it”.  How irritating for the parents to hear this each time.  This means that his doctor does not know how to manage allergies and is just fobbing these parents off. 

The same doctor is unlikely to say “just get over it”  to an adult with Rheumatoid Arthritis or Heart Disease.  In my opinion, established disease which causes symptoms should be managed – not ignored!  Children with eczema and other allergies can very much be helped. Start to think about food allergy/ intolerance.

In our allergy clinic (the Childrens Clinic | Allergy centre, Christchurch), every day I see children who have been suffering with allergies for years but without anyone really getting to the bottom of the problem.  These children need investigation (usually skin tests or blood tests).  Their allergies need to be clearly documented and a management plan implemented.  This is what we do in The Children’s Clinic:  where we take allergies seriously.
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New to food allergy – what to do next?

When your child has just been diagnosed with food allergy, you probably will want some help as to what to next.

We interviewed a group of mothers who had recently attended their appointment at the Childrens Clinic | Allergy Centre. Their children had been diagnosed with food allergy. We asked them how we could help them more. They said that they would like to know:

  • What to do first, when feeling so overwhelmed.
  • How strict does an elimination diet have to be.
  • Advice on what children can eat once they have finished formula: a list of practical allergen free foods, especially breakfast and snacks.
  • A phone number of the support group: many mothers said that it would be good to talk with other mothers who have gone through similar experiences.
  • The shops in Christchurch that supply dairy- egg- free foods.
  • About egg replacer, where to get it and how to use it.
  • The alternative foods that supply calcium to their child’s diet.
  • When their child comes off the formula, how do they know that they are getting all the nutrients they need.
  • What are the alternative sources high nutrient foods that can replace dairy, egg and nuts.
  • Practical recipes that are egg-free, dairy-free and nut-free.
  • A detailed list of what foods their child can have, and must avoid (for example: soy sauce, sesame seeds, dressings, preservatives, colourings, gluten-free products).
  • More ideas of how to cook with Neocate/ Elecare / Pepti-Junior special infant formulas.
  • More information about anti-histamines, when they sould be used, as well as side effects.
  • More about the progression of food allergy, when might the child outgrow the problem.
  • When is it a good time to see a dietitian? Is their child is getting all the nutrients he needs.
  • Is it safe to completely eliminate all dairy and/or egg from the diet.
  • More help in reading food labels.

These are the questions that you are asking for more help.  So we have answered all of these in detail. We have also produced you a practical and easy-to-use set of recipes so that you can feel confident your giving your child a fully nutritious diet that avoids milk, egg and nuts.

We have also gathered a list of useful websites related to buying safe foods for your child (we have asked these firms to check through and make sure that this information is correct).

If we haven’t been able to answer your questions, please let us know and we will help you even more.

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Gluten test: not always accurate

Should everybody go gluten-free? 
Should everybody with undiagnosed symptoms go gluten-free? 

Emma can help you answer this question.

Emma is a 3-year-old and turns out to have gluten sensitivity.  She came to our clinic with severe recurrent abdominal pain. She had lots of investigations,  including x-rays and ultrasound which were normal.  Her celiac and gliadin antibodies blood tests were also normal.  She does not carry the celiac gene, she does not have celiac disease. Gastric reflux and constipation medications were of no benefit.

Most paediatricians would diagnose her as having “functional abdominal pain” and fit her into the “Rome criteria” (http://www.romecriteria.org), a system that has been developed to classify the functional gastrointestinal disorders (FGIDs) of the digestive system when: “symptoms cannot be explained by the presence of structural or tissue abnormality, based on clinical symptoms.”

However, it is my experience that many of these children do in fact have gluten sensitivity.  A gluten-free trial is not part of the “Rome” diagnostic work up to exclude disease! So, Emma went on a gluten-free diet for a 3-month trial. Success! Mum said:

“A great result. Emma has no more sore tummies, except when she has gluten.  She is now sleeping through the night, except when she has gluten.  Toilet training is at last going well (with normal poos), and she is generally happier, and she is eating a wide range of fruit and vegetables (before she was a much more picky eater).  Also we have noticed a huge benefit for her behavior, with her not being as grumpy or frustrated.”

“And she is so good about being on this gluten-free diet. She is always asking if a food might have gluten in it.  But if we make a mistake she says ‘my tummy hurts’ she feels sick and gets cranky again.”

For Emma’s sake I’m very pleased that we have now found the cause for her recurrent abdominal pain.  It is NOT a functional pain – she has a real disease.  All her tests were normal, including her gluten/celiac tests.  She has gluten syndrome.

I expect that Emma will remain gluten-free for the long-term, for a life-time.

Should everybody with undiagnosed symptoms go gluten-free? I say yes. So many people experience a dramatic response.

At the Childrens Clinic | Allergy Centre, Christchurch, we will test you for, and help you with, celiac, gluten sensitivity and gluten syndrome.

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Gluten: how much is okay?

My position is: gluten-free means ZERO gluten.

Yes, I’ve changed my mind.  When I wrote my first gluten book (“Are you gluten-sensitive? Your questions answered”) I thought that people who were gluten sensitive could eat gluten to as much as they can tolerate.  This is wrong.  Over the last 10 years I have done a lot more research – I realise that even a tiny amount of gluten is bad. Now I say “zero gluten for everyone”.

Let me tell you about Amelia.  She is 7-years-old, and came to our clinic when she was just 3. We diagnosed her as gluten sensitive, and she has been gluten-free for 4 years.

Bright red cheeks from gluten
She had bright red cheeks – it looked like they had been painted bright scarlet-red.  This worried her parents. She also had some eczema, and often got distressed at night with painful leg cramps.  Her blood tests showed high gluten antibodies, but no evidence of celiac disease.

My explanation of her bright-red-cheeks was that the gluten reaction was interfering with her autoimmune system that controls how your skin looks (pale, pasty, washed-out, blushed).  So she went on a 3-montdh trial of a gluten-free diet.  She responded very well!  Over the last 4 years gluten-free diet she has been usually been compliant. However, she says, “I get a sore tummy if I have too much.” She says that she gets a tummy pain the next morning.

How strict should she be?
She is tempted to sneak lollies now and then, which can be loaded with gluten.  She loves gluten-cookies and cakes. But she knows these make her tummy hurt.

Mum notices that she immediately gets “hyperactive, and extremely wound up and excitable” when she has even tiny amounts of gluten.  This in turn can upset her school work.  So mum is very strict with the gluten-free diet.

But dad is more relaxed about giving Amelia gluten.  Dad has the notion that he should keep on feeding her gluten, so that she will eventually develop tolerance.  In my experience this does not happen.  He is only making her unwell and putting her at risk for other gluten disease and maybe triggering auto-immune disease.

In my view Amelia should continue to have ZERO gluten.

 

At the Childrens Clinic | Allergy Centre, Christchurch, we can help you manage gluten problems and your gluten-free diet.

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Food allergies in 6% of young children

A research paper by Wang & Sampson declare food allergy as very common. http://www.ncbi.nlm.nih.gov/pubmed/21364287

They say: “Food allergies affect up to 6% of young children and 3%-4% of adults. They encompass a range of disorders that may be IgE and/or non-IgE mediated, including anaphylaxis, pollen food syndrome, food-protein-induced enterocolitis syndrome, food-induced proctocolitis, eosinophilic gastroenteropathies, and atopic dermatitis (eczema). Many complex host factors and properties of foods are involved in the development of food allergy.”

Every one with on-going symptoms needs to be assessed for food allergy.

 

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Mum makes plea: recognise allergy

Clair, a mum, writes this to me:

“Dr Ford, it frustrates me so much to see so many babies on Zantac and comfort formula and still suffering. My daughter was one of those babies until she was diagnosed by you as having a milk protein allergy.

I moved back to the UK and my son was born.  It took him to have 3 blue spells before the medics took me seriously: that it was allergy and after a serious A&E appearance it was finally acknowledged as anaphylaxis and his inhaler was replaced with an Epipen. I find it very hard to see so many kids suffering from obvious allergic symptoms that are ignored.

I just feel very privileged to have had the opportunity to see you all them years ago.  As without your knowledge and diagnosis, I dread to think where we’d be.

Time that modern medicine woke up [to allergy and reflux disease]!”

My comment:

Thanks for your kind words, Claire.  Good to hear from you. Yes sadly, every day we see babies, children & adults who have been miss-diagnosed (or their diagnosis missed).  Their allergies have gone unnoticed or ignored, or even worse, their allergy has been denied.  Yes, so many people have unrecognised food allergy, with years or decades of symptoms.  We work to uncover and manage these problems at the Childrens Clinic | Allergy Centre in Christchurch.

Worse, every day we see mothers who are working extremely hard to care for their children, only to be told that their “lack of good mothering skills” is the reason for their child’s problems. The mothers are blamed for causing their children harm, whilst the children are often labeled as spoilt or naughty.  

But the truth is that these babies and children are in pain or very uncomfortable. They might have untreated gastric reflux, or severe eczema that is caused by a food allergy, or behaviour disturbances that are triggered by food intolerances.

ALL OF THESE CHILDREN NEED FULL ALLERGY ASSESSMENT!

Again, thanks Claire for writing.

Cheers
Dr Rodney Ford   

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