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Breastfeeding and food allergies

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The most common food allergens in the UK

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Egg allergy

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Managing my child’s food allergy

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Are allergies genetic?

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Tips and ideas for getting started with baby led weaning

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The benefits of breastfeeding

There are a number of reasons to breastfeed and this is widely accepted as the best thing you can do for your baby if you are able to. The first milk your breasts produce is called Colostrum, which is rich in antibodies and can help protect against the bacteria and viruses encountered outside the womb. At birth, a baby’s immune system is still immature and not developed fully so Colostrum helps to provide a barrier inside your baby’s intestine to protect it. Babies also depend heavily on antibodies obtained from their mothers while in the womb and their digestive systems are not quite ready for substances other than their mothers’ milk.

Breastfeeding can also help to reduce the risk of allergies as breastfed babies are exposed to fewer allergens in the first months of life as they are only experiencing the foods their mother eats, available via her milk.

The incidence of cow’s milk allergies appears to be higher in babies who are fed formula milk based on cow’s milk or soya instead of breast milk. Every family is different but those with a history of food allergy, hay fever, eczema or asthma, are at higher risk and should try to exclusively breastfeed for the first six months.

Your diet when breastfeeding

Although it has hugely important nutritional benefits, exclusively breastfeeding does not mean that your child will have no risk of developing allergies. Babies can develop allergies to during the early part of infancy and the baby having eczema seems to increase this risk significantly. If one or both parents have an allergies, it makes it more likely that your baby will too.

If your baby is allergic to certain foods such as soy, milk, wheat or egg, these may pass from your diet into the breastmilk and cause symptoms in the baby. If your baby has an allergy to a certain food, it might not always present an immediate or obvious reaction and there can instead be a more delayed reaction, such as eczema worsening or tummy symptoms such as reflux, colic or diarrhoea, for example.  Some breastfeeding mothers will notice an obvious difference in their baby’s behaviour and/or health when they eat certain foods making it more clear that your baby is showing allergic tendencies. Cow’s milk is the most common problem food but some babies will react to other foods.

The good news is that there isn’t a list of ‘high risk’ foods to avoid if you are breastfeeding. There is no evidence that avoiding specific foods during either pregnancy or breastfeeding has any effect on the chance of your baby having food allergies so there is no need to exclude anything. Previous advice to avoid peanuts was withdrawn in 2009. If you are concerned your baby may be reacting to something you are eating, then it would be worth discussing this with your GP or health visitor before removing it from your diet. Any changes in diet or food restrictions are only recommended for breastfed babies who have developed symptoms.

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Food Intolerance

Food intolerance is much more common than food allergy. Symptoms are often slower and may be delayed by many hours after eating the offending food and can even last until the next day. Fatigue, bloating, irritable bowel, joint pains, rashes, nettle rash, eczema and migraine are some of the symptoms caused by a food intolerance.

The most accurate way of identifying whether food intolerance is the cause of these symptoms is an Elimination and Challenge Diet. If your symptoms diminish or disappear with the removal of certain food items, and then reappear with the reintroduction of the food, then you have proved the cause is dietary. Elimination diets must be followed strictly and for the correct period of time to be effective.

Having performed an elimination diet and found the cause of your symptoms, the only treatment is to avoid the offending food(s). Avoiding a large number of foods is not sensible, as good nutrition is vitally important, and because repeatedly eating a small number of foods tends to make intolerances worse. A dietitian will be able to ensure that your diet is not excessively limited, and that it contains all the necessary vitamins and minerals you need.

Food Allergy

A food allergy is caused when the body mistakenly makes an antibody (IgE) which ‘fights off’ the food when it is eaten (or sometimes is just in contact with the skin). The symptoms are usually those of ‘classic’ allergy such as a red raised, itchy rash (Urticaria), wheezing, vomiting, severe gut symptoms or (very rarely) sudden collapse. Most people will therefore already recognize that the food causes them a problem. There are reliable blood tests and skin tests, available through the NHS, that can be used to quite accurately confirm the presence or absence of food allergy.

Although some tests for food intolerance may be scientifically reliable, their relevance to food related symptoms is scientifically unproven. The Gold Standard, and only way, to ascertain which foods cause adverse reactions, is by accurately recording the times and duration of all symptoms, illness or stress, as well as everything you eat and drink. This includes all prescribed medicines and other supplements, all sweets, nibbles and even licking out the mixing bowl when cooking!

This record should be continued for two weeks and should be representative of your normal diet. Use a new page each day. Ideally, it should be analysed by a registered dietitian or nurse with nutritional training. It is also helpful to keep food packaging which lists ingredients for reference by the health care professional.

 For more information and advice contact the Allergy UK Helpline on 01322 619898, Monday – Friday, 9am – 5pm or visit the Allergy UK website www.allergyuk.org and use the ‘live chat’ feature.

Click here to view a useful video on Allergise, hosted by Annabel Karmel with Professor Adam Fox

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Cow’s milk allergy is one of the most common food allergies to affect babies and young children in the United Kingdom. It affects around 3-6% of infants and young children and often is not diagnosed or takes many months to be diagnosed. Symptoms can be immediate or delayed and occur after being exposed to cow’s milk. Usually, a child will react to cow’s milk protein when introduced to a formula or weaning food. However, a child may react after breastfeeding if they are very sensitive to traces of cow’s milk protein found in the breastmilk.

Allergic Symptoms

Allergic symptoms can affect one or more of the body’s systems, including the skin, tummy and, less commonly, breathing or blood circulation.

There are two types of symptoms:

 Immediate symptoms occur quickly after consuming cow’s milk. They are most likely to be seen when weaning starts from breastfeeding or when a change is made from breastfeeding to formula feeding. The symptoms will usually be mild-to-moderate and often only affect a baby’s skin. It is very rare to see severe symptoms that can affect a baby’s breathing or how alert they appear.

 Delayed symptoms appear much more slowly and are more likely to be mild-to-moderate. They are more difficult to relate to being caused by cow’s milk as they happen several hours after cow’s milk is consumed. However, it is important to remember that many of the symptoms of delayed allergies, such as eczema, colic, reflux, and diarrhoea are common in infants and milk allergy is only one of a number of possible causes. In most cases of cow’s milk allergy, a baby will show several symptoms in a pattern that will suggest either the delayed or immediate type of food allergy.

If you suspect your child is showing symptoms of Cow’s Milk Allergy, do not delay. Seek advice from your GP or Health Visitor as they will be able to assess whether the symptoms may be due to milk allergy or there is another cause. They will listen to your concerns and take an allergy-focused clinical history (a series of questions to help decide if an allergy is a possible cause of the symptoms). It may be necessary for the doctor to carry out a physical examination. In addition, if you think your child may be showing delayed symptoms, consider keeping a food and symptom diary of all the food eaten and symptoms seen. Listing medications and taking photos or videos of rashes, swelling, etc. may also be helpful.

For more information and advice contact the Allergy UK Helpline on 01322 619898, Monday – Friday, 9 am – 5 pm or visit the Allergy UK website www.allergyuk.org and use our ‘live chat’ feature.

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Eczema, also known as ‘atopic eczema’ or ‘atopic dermatitis’, is a skin condition causing inflammation and intense irritation. Eczema symptoms tend to be caused by dry skin. Scratching is hard to avoid since the main distressing symptom of eczema is unbearable itching but once the skin gets broken and cracked, infections can set in, causing even more discomfort.

This skin condition can affect any age range and it is thought to be caused by a defect in the skin barrier that makes it more susceptible to inflammation and allows allergens and bacteria to make contact with the immune system. Eczema can affect quality of life significantly and may also affect sleep patterns. Whilst this can make you irritable and frustrated, good management can help alleviate these problems. This skin condition is well understood and dermatologists (skin doctors) have developed effective skin treatment regimens to control and manage the symptoms. It can take some time to find the most suitable therapy for each individual, often causing embarrassment and daily frustration with the symptoms in the meantime. Many people do not understand that eczema is neither infectious nor contagious.

Generally, GPs can diagnose eczema and differentiate whether it is eczema or another skin condition. Seasons of the year (for example, in winter), or even emotional responses (such as stress), may cause eczema to worsen. However, a large number of eczema sufferers are not able to link a cause to their symptoms. It is essential that any known triggers are avoided and sometimes keeping a ‘trigger symptom’ diary at home may help you to realise what might be causing flares.

Treatments

Eczema can be treated in a number of ways, emollients, wet wraps, topical steroid creams and calcineurin inhibitors can all be used.

Emollient Lotions

Emollient lotions and creams are prescribed for eczema and dry skin, and are, in their simplest form, mixtures of oil and water. Some emollients may also contain slight amounts of antibacterial chemicals (to avoid infection in broken skin), or steroids (to reduce inflammation). Emollient products range in their consistency, from being runny lotions to thick creams, and while they can be a very cooling and soothing treatment for eczema, the stickiness of the thicker products can sometimes make them a source of annoyance. It is important to find a product that is suitable for you.

Corticosteroids

It is sometimes necessary to apply topical corticosteroids (e.g. hydrocortisone), as these reduce inflammation in the skin. Many people worry when steroids are mentioned as a treatment option because of stories they may have heard in the media, particularly related to anabolic steroid abuse in sports. These, however, are not the same steroids that are used as medical treatments and, when used as directed by a physician, steroids have an important role to play in treating a range of ailments, including eczema. Topical steroids are safe to use but it is important to always follow the instructions provided, making sure you understand which areas you apply the cream to and exactly how much. If you have any questions, then ask your doctor or nurse for further advice and information.

Wet Wraps

Sometimes, special pyjama-like garments (known as ‘wet wraps’) that are used for children, may also help certain areas of the  body that have not responded to the usual topical application of emollients and steroids. Wet wraps can also be useful if you suffer from itch at night and cannot sleep, allowing you to have a better quality of sleep during times when the eczema is particularly bad. There are various ways of applying these garments and your nurse or doctor will be able to demonstrate the best way of application.

If you would like further information on managing eczema symptoms call the Allergy UK Helpline on 01322 619 898, we are open Monday – Friday, 9am – 5pm or go to www.allergyuk.com

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Here is your guide to the allergens to watch out for, and some examples of where they can be found.

For more information, visit:
www.allergyuk.org
www.nhs.uk/conditions/allergies
Find out more about food allergies in babies here.

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Entering into the wonderful world of weaning can be daunting at the best of times, let alone when you’re also worried about your baby’s food allergies. Here Consultant Paediatric Allergist Professor Adam Fox shares his expert advice to help get you started; from how to safely go about introducing new foods, to highlighting those which most commonly cause an allergy – he’s got it covered.

Before you get started

The actual incidence of food allergy in babies is small – about 5-6% with many babies growing out of allergies like cow’s milk or egg allergy by the age of 2 or 3.

Food allergies are more common among babies and children from families with a history of allergy and babies who suffer from eczema are at a particularly high risk of suffering from food allergies. Babies who develop severe eczema before the age of three months are at very high risk, so you need to be particularly cautious and should discuss this with your doctor.

Avoiding particular foods during pregnancy or breastfeeding does not seem to make any difference in the changes of your baby having allergies. The best thing you can do is aim to breastfeed, exclusively for 4-6 months.

If your baby is at high risk e.g. has bad eczema, then it would be sensible to get allergy testing done just before weaning to help guide the safe introduction of common allergenic foods such as milk, egg and peanut.

Foods to consider

The most common cause of the immediate type of food allergy is egg, milk, nuts, fish, sesame and shellfish. Wheat, kiwi and soy are also important allergens. With delayed allergies, milk and soy are the most common causes. It is worth being aware of these common top allergic foods when you are weaning your baby and introducing them to new foods.

 

Introducing new foods

First foods should be simple, easy to digest, and unlikely to provoke an allergic reaction.

Start with a single ingredient, ideally a fruit or vegetable. Fruits such as apple, banana and avocado are a good place to start. Root vegetables like carrots, butternut squash and sweet potato and are very popular first foods; they have a naturally sweet flavour and can easily be puréed to a smooth texture. As a tip, try mixing them with a little breast or formula milk to ease the transition.

The new advice is not to withhold foods like eggs, milk and peanut from six months as giving these foods can actually help to reduce the risk of allergy developing in babies. The best thing you can do is to introduce new foods one by one. As reactions usually happen very soon after exposure, you don’t need to wait a huge amount of time between trying new food, just go at your baby’s own pace.

It is important not to delay the introduction of allergenic foods as this may increase the chance of allergy developing. In fact, there is now excellent evidence to suggest that early introduction of egg and peanut, from 17 weeks can reduce the risk of allergy.

This was initially based on an observation that in some countries such as Israel, for example, where peanut is used in a snack called Bamba given to infants. This early weaning with peanut seemed to relate to the level of peanut allergy being very low, even among high-risk children.  In 2015, doctors at St Thomas’ Hospital in London were able to show that children at high risk of peanut allergy (they had eczema or egg allergy) who ate products containing peanuts between the ages of 4 and 11 months, and regularly thereafter, had a 70% reduced risk of developing an allergy to peanuts compared with children who ate them for the first time when they were older. This research has even led to a change in weaning guidance in the USA.

Allergy – immediate and delayed

There are two sorts of allergy:

Immediate allergies can cause a rash, swelling and hives within minutes of the food being eaten, usually around the mouth.

Delayed allergies can cause your baby to have eczema, reflux, colic or diarrhoea.

If you are concerned about either of these, you should always consult your GP.

Testing for allergies

Introducing foods one by one is the best way to get started with weaning, however, if there is a high risk of allergy e.g. eczema, then it may make sense to get your baby allergy tested before you do this but do not allow this to delay weaning progressing. This could involve either a skin prick test or a blood test.

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Even with an egg allergy, many people can eat baked food containing well-cooked eggs without a problem. Research has shown 70-80% of children with an egg allergy can eat plain cakes and biscuits containing egg. But it is important to always get advice from a health care professional before consuming allergenic foods in any form. It is essential that any child with an egg allergy is first tested under specialist medical supervision (for example, in a hospital allergy clinic) before foods (such as cakes and biscuits) containing egg are given to them.

Vaccinations

Vaccinations are an important area to consider for parents of a child with an egg allergy. Inactivated influenza vaccines, given by injection, that are egg-free or have a very low ovalbumin content are safe for individuals with egg allergy (des Roches et al., 2012). The BSACI (British Society for Allergy and Clinical Immunology) have advised that children with egg allergy can safely be vaccinated with the nasal influenza vaccine in any setting, including a GP surgery and school. However, facilities should be available and staff trained to recognise and treat anaphylaxis.

The exception is for children who have previously required admission to an intensive care unit for severe anaphylaxis to egg; these children should be referred to a specialist for immunisation in hospital.

The yellow fever vaccine may contain traces of egg and should be avoided by anyone allergic to egg. The vaccines against yellow fever and typhus are produced in a similar way to influenza. However, this vaccine is not a routine part of the UK immunisation schedule and are usually only given to people travelling abroad to high-risk destinations.

All available information about immunisation and allergy points to the fact that immunisation in children who are at high risk of developing allergy is safe and not a factor in their future allergic conditions.

Many people ask if the MMR (measles, mumps and rubella) vaccine should be given to those with egg allergy. The MMR vaccine does not contain any egg protein and is considered to be safe but any concerns should always be discussed with your GP.

For more information and advice contact the Allergy UK Helpline on 01322 619898, Monday – Friday, 9am – 5pm or visit the Allergy UK website www.allergyuk.org and use our ‘live chat’ feature.

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Usually the level of impact an allergic reaction brings is similar each time it occurs, whether it be a mild, moderate or severe. However there is no guarantee a moderate reaction may not be severe in the future so it is important allergies are diagnosed, treated and controlled.

Symptoms to look out for:

Eyes – Itchy, watery, prickly, red, swollen and dark areas under the eyes

Nose, Throat and Ears – Runny nose, blocked nose, itchy nose, sneezing, pain in sinuses, headaches, post-nasal drip (mucus drips down the throat from behind the nose) loss of smell and taste, sore throat, swollen larynx (voice box) itchy mouth and/or throat, blocked ear and glue ear.

Airways – Wheezy breathing, difficulty in breathing, coughing (especially at night time), shortness of breath.

Digestion – Swollen lips/tongue, itchy lips/tongue, stomach ache, feeling sick, vomiting, constipation, diarrhoea, bleeding from the bottom, reflux, poor growth.

Skin –     Urticaria – Wheals or hives, bumpy, itchy raised areas, rashes.

Eczema – cracked, dry, or weepy, broken skin.

Angiodema – swelling of the deep layers of the skin

Many of these symptoms can develop as a result of other common childhood illnesses. However, with allergy, symptoms may appear suddenly, even dramatically; they can be persistent, and can appear without an obvious cause. If you have any concerns about your child’s health and wellbeing, you should visit your GP.

When an allergy is triggered, the body’s immune system has an inappropriate reaction to what, for most people, is an entirely harmless substance. The cells which react are found in those areas of the body that come into contact with the outside environment, or external substances that are passing through the body; that is, the skin, lining of the throat, airways, eyes and digestive tract.

This is why these areas of the body are most affected by allergy and show most allergy symptoms. However, an allergic reaction that starts in these places can set off effects in other parts of the body, which is why allergy sufferers may experience more than one symptom for a single allergy.

Food allergy symptoms affect many children on a daily basis, but it is not always easy to recognise how much the symptoms affect a child’s general health and well-being. For example, a child with eczema will have chronic itchy, sore, skin, while an asthma sufferer may not be able to run around with their friends, and the coughing and wheezing can affect their sleep. Rhinitis sufferers can struggle to avoid the allergens they react to, while children with a food allergy may have to worry about anaphylaxis if they have a severe reaction.

Suffering from any of these symptoms can have a massive impact on a child’s life. Some symptoms can be seen to lead to more severe conditions. For example, itchy rashes can lead to skin infections; and chronic diarrhoea can lead to weight loss. However, there are many more minor symptoms, such as constant runny or blocked noses that may affect the quality of a child’s life because, for example, they then suffer from headaches, lack of sleep, and lack of concentration at school. Tiredness can lead to irritability and bad moods, and this can affect both the child and whole family.

However, once understood, the effects of allergy can be reduced, and treatments can bring relief to a child, making their childhood a much happier experience.

For further information and advice contact the Allergy UK Helpline on 01322 619898, Monday – Friday, 9am – 5pm or visit the Allergy UK website www.allergyuk.org and use our ‘live chat’ feature.

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If your baby has a food allergy, he is likely to show symptoms just a few minutes after having the food.

Food allergies are common in babies and young children, and your child is more likely to have a food allergy if you have a family history of them, or of other allergic conditions, such as asthma, hayfever or eczema.  The link between food allergies and eczema is the strongest.

Consultant Paediatric Allergist Professor Adam Fox explores the top food allergies in babies.

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