Children who are allergic to food are found to be suffering from anxiety and are increasingly more lonely; One allergic child out of five never attends peers’ parties, while one in four always brings along “safe” food. The burden of food allergies and the risk they can escalate to life-threatening diseases is particularly heavy on children, whose normally active and sociable lifestyle can be severely limited and frustrated by the effort to keep them away from potentially dangerous food.
According to a study presented at the 2011 Food Allergy and Anaphylaxis Meeting by the European Academy of Allergy and Clinical Immunology (EAACI), held Feb 17-19 in Venice, Italy, 23 percent of allergic children are no longer curious to try new food to vary their diet, considered too monotonous by most of them. A child out of ten also gives up crucial physical activity for fear of anaphylactic shock triggered by exercise.
“About 17 percent of allergic children, regardless of their age, never go to a party or a picnic with friends, while 24 percent are forced to bring along something to eat,” says Prof. Maria Antonella Muraro, Chair of the EAACI Meeting. The study, headed by Prof. Muraro, was carried out by the Center for the study and treatment of allergies and food intolerances at the hospital of the University of Padua, Italy on 107 young patients and their mothers.
“Also, 5 to 15 per cent of cases of anaphylactic shock can be triggered by physical activity following the consumption of small amounts of allergenic food that would otherwise be harmless, so one allergic child out of ten also stops every kind of exercise,” Prof. Muraro added. “Allergies are often downplayed as a minor problem, but the life of an allergic person can be hell. Allergic children show to be more afraid of being sick and a higher level of anxiety about food than children with diabetes. The constant alarm surrounding them is taking a toll on their development and well-being.”
Another worrisome problem adding to the poor quality of life of allergic patients, especially the younger ones, is the need to carry life-saving devices at all times, such as epinephrine auto-injectors, “loaded” with enough drug to prevent death in case of severe anaphylactic shock. They are easy to use, light to carry and discreet, but one out of three patients still leaves home without them.
“Within 8 or 10 minutes the shot reverses the symptoms, ranging from urticaria to respiratory distress, cardiovascular collapse and gastrointestinal problems including vomiting and diarrhoea,” explains Prof. Muraro. “It can cause minor side effects, such as irritability or tremors that end as soon as the adrenaline is processed by the body, generally within a couple of hours. Patients should not be scared, even those who have a heart disease: the possible side effects are negligible in comparison to the opportunity to save your life.”
There is no scientific evidence that complementary therapies or kits sold through websites can identify allergies, the UK NHS watchdog NICE says. It says sites for services such as hair analysis use plausible stories but are not backed up by scientific evidence. It is publishing new guidance to help doctors in England and Wales identify when a child may have allergy problems. NICE says some parents end up turning to alternative therapies after a perceived lack of help from their GPs.
It is estimated that one in 20 young children has a food allergy. Dr Adam Fox, an allergy specialist based at the Evelina Children's Hospital in London, says not all children suffer immediate and obvious symptoms. “Food allergies can actually be extremely subtle. Lots of children have eczema, colic or spit up more food than usual. For some of those children the underlying problem is an allergy to something within their diet.”
The guidelines include detailed advice about how to recognise symptoms and when to refer to specialists. Dr Fox, who helped write the guidelines for National Institute for Health and Clinical Excellence (NICE), says he often sees parents in his specialist clinic who have wasted money on complementary or alternative tests.
The review by NICE looked for any scientific research of the usefulness of approaches including hair analysis and Vega testing, which uses mild electric currents, or kinesiology, in diagnosing allergies in children. “The websites are very well put together, the stories behind them are plausible, but we were unable to find any evidence to support them,” says Dr Fox. He says there are two types of testing used in NHS clinics – skin prick and blood sample – which are backed by scientific research. NICE is warning that parents sometimes turn to alternative tests when they have failed to convince their family doctor to listen to their concerns.
It took Alison Berthelson more than two years to get an allergy diagnosis for her first son Harris. She had been to the local surgery several times when he suffered rashes and stomach upsets without any particular cause being identified. After Harris ate a small piece of chocolate containing nuts he suffered a more extreme reaction, becoming agitated, with an extreme rash covering his entire body. The out-of-hours GP gave her son a medicine to reduce swelling, but did not send him on to hospital as an emergency. “It was really very terrifying, terrifying at the time because we didn't know what was happening, and terrifying later when we did know what had happened and how lucky we were.” A new GP correctly diagnosed possible food allergies, and sent Harris for testing at a specialist NHS clinic. He now has to avoid nuts, sesame and some other ingredients used in prepared foods.
Allergies on rise The number of children suffering from food allergies appears to be increasing, although experts are at a loss to understand exactly why. Family doctors are now more likely to see very young children suffering allergic reactions. Dr Joanne Walsh, a GP involved in drafting the advice, says she now sees several children a week with suspected allergic reactions. Some are babies just a couple of weeks old. By gradually eliminating, and reintroducing different foods, she can help parents manage the allergy without the need for hospital visits. “There's nothing more rewarding than a parent coming back and saying it's like having a different child.”
Researchers have a new theory on why some kids get unexplained tummy aches.
In some people, the small intestine is unable to efficiently break down fructose (and sometimes other forms of sugar). This problem is sometimes referred to as fructose intolerance. The undigested fructose passes into the large intestine, where it is broken down by bacteria. A by-product of this process is the creation of carbon dioxide and hydrogen. These two gases build up in the intestine, causing bloating, gas, pain and diarrhea. In some cases, the problem can affect absorption of important nutrients, like calcium and iron.
Researchers estimate about 33 percent of Americans have some level of sensitivity to sugar, most commonly to fructose, but the symptoms are often vague. Some people with fructose intolerance can eat small amounts of the sugar and not have any problems, making diagnosis even trickier.
Daniel Lustig, M.D., Pediatric Gastroenterologist at Mary Bridge Children’s Health Center in Tacoma, WA, says patients with chronic digestive problems should have a physician’s evaluation to rule out other possible causes of the symptoms, like Celiac disease or Crohn’s disease. Once those conditions have been ruled out, he recommends a diagnostic tool called the breath hydrogen test.
A patient is given a dose of fructose. Then, periodically, he/she breathes into an air collection bag. The gases from the bag are retrieved and analyzed for the presence of hydrogen (one of the gases given off when fructose is broken down in the large intestine). Patients whose hydrogen levels exceed 20 points beyond a baseline reading are likely to be fructose intolerant.
Lustig explains the main treatment of fructose intolerance is avoidance of foods containing fructose. That includes fruits, fruit juices, sodas and processed foods and drinks with high fructose corn syrup. Since fructose is in so many foods, it can be tricky to find and hard to avoid.
Lustig recently performed a study to look at possible fructose intolerance in 245 children and adolescents (ages 2 to 18) with unexplained chronic abdominal pain, gas or bloating. The breath hydrogen test found that nearly 54 percent of the participants tested positive for fructose intolerance. Lustig says the problem appeared to be especially high among teen girls.
Those who were judged to be fructose intolerant were given advice on using a low-fructose diet. The investigators found that nearly 68 percent of those who followed the recommended diet had an improvement or resolution in their symptoms.
A study led by Brian Moss of Wayne State University’s School of Social Work reveals that one third of infants in the U.S. are obese or at risk of obesity. In addition, of the 8,000 infants studied, those found to be obese at 9 months had a higher risk of being obese at 2 years. Other studies have revealed that Infant obesity increases the risk for later childhood obesity and could lead to other obesity-related health problems like heart disease, asthma, high blood pressure and cancer. According to the U.S. Centers for Disease Control and Prevention, childhood and infant obesity has more than tripled in the past 30 years.
Moss, in collaboration with William H. Yeaton from the Institute for Social Research at the University of Michigan in Ann Arbor, published their analysis, “Young Children’s Weight Trajectories and Associated Risk Factors: Results from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B),” in the January/February 2011 issue of the American Journal of Health Promotion. The ECLS-B draws from a representative sample of American children born in 2001 with diverse socioeconomic and racial/ethnic backgrounds. It is one of the first studies to monitor weight status changes of a nationally representative sample of very young children.
For their study, Moss and Yeaton used results from ECLS-B to follow the trajectory of the infants’ weight status at 9 months and 2 years, then performed statistical analyses to examine whether weight persistence, loss or gain was linked to demographic characteristics such as sex, race/ethnicity, geographic region or socioeconomic status. Children above the 95th percentile on standard growth charts were considered to have infant obesity, children in the 85th to 95th percentile were considered at risk for obesity.
Some of their results show that:
• 31.9 percent of 9-month-olds were at risk or obese;
• 34.3 percent of 2-year-olds were obese or at risk for obesity;
• 17 percent of the infants were obese at 9 months, rising to 20 percent at 2 years;
• 44 percent of the infants who were obese at 9 months remained obese at 2 years;
• Hispanic and low-income children were at greater risk for weight status gain;
• Females and Asian/Pacific Islanders were at lower risk for undesirable weight changes;
• 40 percent of 2-year-olds from the lowest income homes were at risk or obese compared to 27 percent of those from the highest income homes.
“This study shows that a significant proportion of very young children in the United States is at risk or is obese,” said Moss. The team notes a consistent pattern of obesity starting early in life. “As obesity becomes an increasing public health concern, these findings will help guide health practitioners by targeting high risk populations and foster culturally sensitive interventions aimed at prevention and treatment of obesity,” Moss said.
“We are not saying that overweight babies are doomed to be obese adults. However, we have found evidence that being overweight at 9 months puts you on track for being overweight or obese later in childhood.”
In the past, positive blood and skin tests would often be mistaken for a food allergy because they would indicate the presence of immunoglobulin E antibodies, but it is important to remember that these are typically higher in patients with atopic dermatitis, according to a speaker at the 69th Annual American Academy of Dermatology Meeting conducted in New Orleans this week. “Those antibodies are not diagnostic, and the only way to diagnose food allergy is with a strong history of reactions or a challenge,” Jon M. Hanifin, MD, of Oregon Health & Science University, said in a press release. “This is done in a doctor’s office, using small increments of the food in question and increasing the amount until an allergic reaction occurs or does not occur. Usually a parent can pinpoint if a child has a true food allergy because the allergic reaction will appear so quickly with lip swelling or hives, quite distinct from simply food intolerance.”
Between 6% and 10% of children have atopic dermatitis, and about one-third of these children have food allergy. Recent research examining the genetic basis of atopic dermatitis has shown that this chronic skin condition is likely related to a defect in the epidermal barrier, which allows irritants, microbes and allergens (such as food) to penetrate the skin and cause adverse reactions. Because the skin barrier in patients with atopic dermatitis is compromised and open to absorb proteins, it allows sensitization to certain foods, leading to a positive skin or blood test.
New guidelines recently issued by the National Institute of Allergy and Infectious Diseases established a protocol for the proper evaluation and management of food allergy. The guidelines recommend that children who are younger than aged 5 years with moderate to severe atopic dermatitis be considered for food allergy evaluation if they have persistent atopic dermatitis despite optimized management or if the child has a reliable history of an immediate reaction after eating a specific food.
Hanifin said research is also ongoing into whether withholding foods is leading to more allergies than an unrestricted diet in young children. This may provide future insight in potential ways to prevent food allergies. He said children in Israel seldom get peanut allergy, which may potentially be attributed to the use of peanut proteins in pacifiers in that country. In the United States and Europe, where peanut allergies are more common, infants are not usually exposed to this food until they are toddlers – the time when most peanut allergies are noticed.
“There is some thinking that withholding foods might actually be causing more allergies, and that an unrestricted diet may help tolerize babies to foods that could potentially cause a problem later in life,” Hanifin said. “Ongoing studies in this country using oral immunotherapy appear promising, and physicians hope that we may discover how to prevent food allergies in the future while continuing to provide successful treatment for children with atopic dermatitis.”
Source: Hanifin J. Food allergy and dermatology. Presented at: The American Academy of Dermatology 69th Annual Meeting; Feb. 4-8, 2011; New Orleans
Eating more fruits and vegetables may not protect children from developing allergies, according to a large Swedish study that questions earlier hints of benefit. Fruits and vegetables are rich in antioxidants, which are thought to reduce airway inflammation. So recent studies reporting less asthma, wheezing and hay fever among children who consumed more produce appeared to make sense.
But not all research has found that link, and the studies that did may have had a surprising flaw, said Helen Rosenlund of Karolinska Institutet in Stockholm, who led the new study. She said some proteins in fruits like apples and pears resemble the pollen parts that trigger hay fever, meaning that kids might react to both. In other words, existing allergies may have caused them to eat around the produce, rather than the other way around. “This could confuse research findings,” explained Rosenlund, “falsely suggesting that diets with fewer fruits and vegetables result in more allergic disease.”
To find out if this was the case, Rosenlund and her colleagues looked at data on nearly 2,500 eight-year-olds who had participated since birth in a larger Swedish study. Based on blood tests and questionnaires filled out by parents, the researchers found that seven percent of the children had asthma. The rates of hay fever and skin rashes were more than twice as high. The average child ate between one and two servings of fruit, and between two and three servings of vegetables each day.
At first glance, some produce did seem helpful: Kids with the biggest appetite for fruit had less than two-thirds the odds of developing hay fever than those who ate the least amount. Apples, pears and carrots appeared to be particularly helpful, the researchers report in the Journal of Allergy and Clinical Immunology, but there was no such link for vegetables overall. However, it turned out that half the children with hay fever were sensitive to birch tree pollen, one of the pollens known to resemble the proteins in apples and carrots. And sure enough, after the team repeated their analysis excluding the 122 kids with food-related allergy symptoms, the hay fever link disappeared as well. “Fruits do not seem to offer protection against allergic if diet modifications are considered,” say Rosenlund.
The researchers say more studies are needed, particularly in other parts of the world that may have a different variety of allergy triggers, or allergens. And they advise those studies should not forget to look at how allergies might influence what participants eat. “Studying diet it is not so easy when it comes to the relation with allergic disease,” Rosenlund said, “because it is such a complex disease pattern.”
SOURCE: bit.ly/g3DpI7 The Journal of Allergy and Clinical Immunology, online January 10, 2011.
A controversial new Dutch study may have found a link between food allergies and ADHD. However, many experts are dismissing the findings. The study found that in children with ADHD, putting them on a restrictive diet to eliminate possible, previously unknown food allergies or sensitivities decreased hyperactivity for 64% of them. “There is a longstanding, somewhat inconsistent story about diet and ADHD,” said Jan Buitelaar, the lead author of the Dutch study and a psychiatrist at the Radboud University Nijmegen Medical Centre. “On the one hand, people think it’s sugar that’s the trigger, others think that food coloring could be causing ADHD. Our approach was quite different. We went [with] the idea that food may give some kind of allergic or hyperactivity reaction to the brain.”
There have been previous studies in this field, but they were limited. “This has long been viewed as a kind of a controversial approach,” Buitelaar said. “When we started the research, I was skeptical, but the results convinced me.”
In the study, of the 41 kids who completed the elimination diet, 32 saw decreased symptoms. When certain foods thought to be “triggers” for each child were reintroduced, most of the children relapsed. Among 50 kids given a “control” diet that was just a standard, healthy diet for children, no significant changes were noted. Given these findings, Buitelaar recommended that the elimination diet become part of standard of care for children with ADHD. However, while pediatricians acknowledge some effectiveness, they were against the elimination diet as part of the care for children with ADHD.
“People seem to think that dietary modification is essentially ‘free,’ but it is difficult, socially disruptive, and presents the risk for nutritional deficiency,” said Dr. Michael Daines, a pediatric allergist-immunologist at the University of Arizona. Though Daines is willing to work with families who want to try an elimination diet for treating ADHD, he feels it will only have an effect if the child is having a true food allergy or intolerance.
Consumption of Vitamin B during pregnancy does not increase the risk of allergy in the infants, says a new study from Japan that challenges previous findings. Maternal consumption of folate and vitamins B2, B6, and B12 during pregnancy was not associated with the risk of the infant developing asthma or eczema, according to findings from 763 infants published in Pediatric Allergy and Immunology.
The link between folate and folic acid, the synthetic form of the vitamin, and respiratory health is not clear cut, with contradictory results reported in the literature. A study from Johns Hopkins Children’s Center found that higher levels of folate were associated with a 16 per cent reduction of asthma in (Journal of Allergy & Clinical Immunology, June 2009, Vol. 123, pp. 1253-1259.e2). However, a Norwegian study reported that folic acid supplements during the first trimester were associated with a 6 per cent increase in wheezing, a 9 per cent increase in infections of the lower respiratory tract, and a 24 per cent increase in hospitalisations for such infections, (Archives of Diseases in Childhood, doi:10.1136/adc.2008.142448). In addition, researchers from the University of Adelaide in Australia reported that folic acid supplements in late pregnancy may increase the risk of asthma by about 25 per cent in children aged between 3 and 5 years (American Journal of Epidemiology, 2010, doi:10.1093/aje/kwp315).
Illumination from the Land of the Rising Sun?
The new study, performed by researchers from Fukuoka University, the University of Tokyo, and Osaka City University, goes beyond folate and folic acid, and reports no link between Vitamin B intake and the risk of asthma or eczema in children. “To the best of our knowledge, there has been no birth cohort study on the relationship between maternal consumption of Vitamin B during pregnancy and the risk of allergic disorders in the offspring,” wrote the researchers. The findings were based on data from 763 pairs of Japanese mother and child. A diet history questionnaire was used to assess maternal intakes of the various B vitamins during pregnancy, and the infants were followed until the age of 16 to 24 months. Japan has no mandatory fortification of flour with folic acid.
Results showed that, according to criteria from the International Study of Asthma and Allergies in Childhood, 22 and 19 percent of the children had symptoms of wheeze and eczema, respectively, but there was no association between these children and the dietary intakes of the various B vitamins by their mothers. “Our results suggest that maternal intake of folate, vitamin B12, vitamin B6, and vitamin B2 during pregnancy was not measurably associated with the risk of wheeze or eczema in the offspring,” said the researchers. “Further investigation is warranted to draw conclusions as to the question of whether maternal Vitamin B intake during pregnancy is related to the risk of childhood allergic,” they concluded.
According to the European Federation of Allergy and Airway Diseases Patients Association (EFA), over 30m Europeans suffer from asthma, costing Europe €17.7bn every year. The cost due to lost productivity is estimated to be around €9.8bn. The condition is on the rise in the Western world and the most common long-term condition in the UK today. According to the American Lung Association, almost 20m Americans suffer from asthma. The condition is reported to be responsible for over 14m lost school days in children, while the annual economic cost of asthma is said to be over $16.1bn.
Source: Pediatric Allergy and Immunology. Volume 22, Issue 1-Part-I, February 2011, Pages: 69–74 DOI: 10.1111/j.1399-3038.2010.01081.x
“Maternal B vitamin intake during pregnancy and wheeze and eczema in Japanese infants aged 16–24 months: The Osaka Maternal and Child Health Study”. Authors: Y. Miyake, S. Sasaki, K. Tanaka, Y. Hirota
With eating disorders on the rise among boys, minorities and younger children, doctors need to keep an eye out for unexpected cases, according to the author of a new report. The stereotype that eating disorders affect only affluent, white teenage girls no longer applies, said David S. Rosen, MD, MPH, who wrote a clinical report on the topic that was published in the December issue of Pediatrics. “It’s also happening to boys, young children, people of color and middle-aged women. It’s more of an equal opportunity disorder,” said Dr. Rosen, a professor of pediatrics, internal medicine and psychiatry at the University of Michigan.
Males, for example, now represent up to 10% of all cases of eating disorders. The number of children younger than 12 who are hospitalized for eating disorders increased 119% from 1999 to 2006, according to an analysis by the Agency for Healthcare Research and Quality cited in the report (www.ncbi.nlm.nih.gov/pubmed/21115584/). Young children who develop eating disorders are more susceptible to serious medical consequences such as stunted growth and organ damage, Dr. Rosen said.
Early intervention recommended
He urges physicians, nurses, parents, school social workers and others to intervene early. Health care professionals should take note when patients, particularly young ones, make derogatory comments about their appearance or talk about going on a diet. The report said screening questions about eating patterns and body image should be asked of all preteens and adolescents.
Fewer than 1% of adolescent girls in the U.S. have anorexia, and 1% to 2% percent have bulimia. Experts estimate that between 1% and 14% of Americans exhibit some physical and psychological symptoms of an eating disorder. Male and female athletes, including gymnasts, runners and wrestlers, and performers, such as dancers and models, may be more at risk.
The report said eating disorders may have more of a genetic link, similar to alcoholism and depression, than previously thought. The discovery that some children may be genetically predisposed to the condition may “help to take away some of the blame or stigma,” Dr. Rosen said. With more children obese, physicians should choose their words carefully when counseling a child about his or her weight, Dr. Rosen said. He sees young patients with eating disorders who claim their problems with food began when their doctor told them to lose weight.
Dr. Rosen recommends that physicians discuss healthy eating practices, not dieting, with patients and focus on a healthy lifestyle, not losing weight. “There’s a perception that, like alcoholism, [an eating disorder] never goes away and that the best you can do is keep it under control,” he said. But if caught early, “most children and teens can expect to recover completely.”
Primary school children who don't like eating fruit and vegetables are 13 times more likely to develop functional constipation than children who do, according to a study in the December issue of the Journal of Clinical Nursing. Drinking less than 400ml of fluid a day also significantly increases the risk. Dr Moon Fai Chan, assistant professor at the National University of Singapore, teamed up with Yuk Ling Chan, from the Hong Kong Polytechnic University, to study the diet and toileting habits of 383 children aged from eight to ten from a school in Hong Kong. Fifty-one per cent were boys and children who were on regular medication or who paid regular hospital or clinic visits were excluded. Seventy per cent of the children who took part in the study were ten-years-old, 22 per cent were nine and eight per cent were eight.
“A number of studies have suggested that functional constipation – which is due to dietary habits, environmental habits and psychosocial factors rather than a particular health problem – is getting worse among school-age children” says Dr Moon Fai Chan from the Alice Lee Centre for Nursing Study at the University. “It is estimated that functional constipation accounts for 95 per cent of cases of constipation affecting children once they pass infancy. The condition has serious consequences, as it can cause a wide range of distressing emotional and physical problems such as stress, soiling, problems at school, damaged self-confidence and reduced social interaction.”
Key findings of the study included:
- Seven per cent of the children who took part suffered from functional constipation and there were clear dietary differences between the children who did and did not have problems.
- Girls were more likely to have functional constipation than boys (8.2 per cent versus 6.6 per cent) and nine-year-olds were more likely to report problems (13.3 per cent) than eight-year-olds (10 per cent) and ten-year-olds (5.2 per cent).
- Children who only drank 200ml to 400ml of fluid a day were eight times more likely to experience problems than children who drank 600ml to 800ml and 14 times more likely than children who drank a litre or more.
- Children who said they did not like fruit or vegetables were 13 times more likely to suffer from functional constipation than children who did.
- Nine out of ten children refused to use the school toilets for bowel movements and the figure was the same for children with and without constipation.
The biggest problems with school toilets were that children preferred to go at home. They also cited lack of toilet paper and dirty toilets. “When we compared our findings with previous studies we found that the levels of functional constipation among Hong Kong school children was higher than those in the USA and UK, but similar to Italy” says Dr Chan. The authors have made a number of recommendations that they feel would help to tackle the problem. They suggest that:
- Primary schools should work with healthcare professionals to make children more aware of the problem, with regular healthcare education sessions in classrooms and at assemblies.
- Parents need to be educated about functional constipation so that they can spot problems in their children and make sure that their diet provides sufficient fluid, vegetables and fruit. They should also remind their children to pay regular toilet visits at school.
- School tuck-shops should stock high-fibre snacks such as popcorn, fresh food and dried fruit, instead of crisps and sweets.
- Children should be encouraged to drink plain water during lessons and drinking fountains should be installed.
- School toilets should be more user-friendly, private and well stocked with paper so that children feel more comfortable using them.
“We hope that this study will help to raise awareness of functional constipation, which can cause children real physical and emotional distress and seriously affect their quality of life” says Dr Chan.
Source: Investigating factors associated with functional constipation of primary school children in Hong Kong. Chan MF and Chan YL. Journal of Clinical Nursing. 19, pp3390-3400. (December 2010). DOI: 10.1111/j.1365-2702.2010.03366.x