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.”
To test their hypothesis that environmental influences experienced by the father can be passed down to the next generation in the form of changed epigenetic information, Rando and colleagues fed different diets to two groups of male mice. The first group received a standard diet, while the second received a low-protein diet. To control for maternal influences, all females were fed the same, standard diet. Rando and colleagues observed that offspring of the mice fed the low-protein diet exhibited a marked increase in the genes responsible for lipid and cholesterol synthesis in comparison to offspring of the control group fed the standard diet.
These observations are consistent with epidemiological data from two well-known human studies suggesting that parental diet has an effect on the health of offspring. One of these studies, called the Överkalix Cohort Study, conducted among residents of an isolated community in the far northeast of Sweden, found that poor diet during the paternal grandfather’s adolescence increased the risk of diabetes, obesity and cardiovascular disease in second-generation offspring. However, because these studies are retrospective and involve dynamic populations, they are unable to completely account for all social and economic variables. “Our study begins to rule out the possibility that social and economic factors, or differences in the DNA sequence, may be contributing to what we’re seeing,” said Rando. “It strongly implicates epigenetic inheritance as a contributing factor to changes in gene function.”
The results also have implications for our understanding of evolutionary processes, says Hans A. Hofmann, PhD, associate professor of integrative biology at the University of Texas at Austin and a co-author of the study. “It has increasingly become clear in recent years that mothers can endow their offspring with information about the environment, for instance via early experience and maternal factors, and thus make them possibly better adapted to environmental change. Our results show that offspring can inherit such acquired characters even from a parent they have never directly interacted with, which provides a novel mechanism through which natural selection could act in the course of evolution.” Such a process was first proposed by the early evolutionist Jean-Baptiste Lamarck, but then dismissed by 20th century biologists when genetic evidence seemed to provide a sufficient explanation.
Taken together, these studies suggest that a better understanding of the environment experienced by our parents, such as diet, may be a useful clinical tool for assessing disease risk for illnesses, such as diabetes or heart disease. “We often look at a patient’s behavior and their genes to assess risk,” said Rando. “If the patient smokes, they are going to be at an increased risk for cancer. If the family has a long history of heart disease, they might carry a gene that makes them more susceptible to heart disease. But we’re more than just our genes and our behavior. Knowing what environmental factors your parents experienced is also important.”
The next step for Rando and colleagues is to explore how and why this genetic reprogramming is being transmitted from generation to generation. “We don’t know why these genes are being reprogrammed or how, precisely, that information is being passed down to the next generation,” said Rando. “It’s consistent with the idea that when parents go hungry, it’s best for offspring to hoard calories, however, it’s not clear if these changes are advantageous in the context of a low-protein diet.”
Even young children appear to be consuming more caffeine, so much so that caffeine could be contributing to sleep problems in primary school children, researchers found. Three-quarters of children ages 5 to 12 consumed caffeine on an average day in a survey of parents at routine clinic visits by William J. Warzak, PhD, of the University of Nebraska Medical Center in Omaha, and colleagues. The more caffeine children consumed, the fewer hours they slept on average (P=0.02), the researchers reported online in the Journal of Pediatrics, although not drawing a causal link. The average intake was two or three times higher than the 22- to 23-mg daily average reported nearly a decade ago, they noted.
Eight- to 12-year-olds in Warzak's study averaged 109 mg of caffeine — the equivalent of nearly three 12-oz cans of soda each day. But even the 52 mg of caffeine consumed by 5- to 7-year-olds on an typical day was well above the level known to have a physiologic effect on adults, the researchers noted. “There's really no role for caffeine in kids,” Marcie Schneider, MD, of the Albert Einstein College of Medicine in New York City, emphasized in commenting on the study. “We know that caffeine raises your blood pressure, raises your heart rate, and can be addictive.” Unlike older teens who are likely drinking coffee to wake up in the mornings for school, the assumption is that younger kids are getting most of their caffeine from soda, noted Schneider, who serves as a member of the American Academy of Pediatrics Committee on Nutrition.
She urged pediatricians to raise parents' awareness of the issue, perhaps as part of the yearly checkup. “We routinely ask kids what they're eating and drinking,” “It may be something that is worth pediatricians pointing out to parents that this kid does not need caffeine in their life partially because it does some things that are negative.”
Warzak's group surveyed parents of 228 children seen at an urban outpatient pediatric clinic during routine visits about the children's average daily consumption of drinks and snacks with an emphasis on caffeine-containing items. None of the children had a known sleep disorder or medical condition that might cause bedwetting. Illustrated depictions were provided to help parents accurately estimate serving sizes.
Nearly all of the caffeine intake was consumed through beverages. Few children got a meaningful amount of caffeine from food. “Caffeine's diuretic properties have encouraged behavioral health practitioners to eliminate caffeine from the diet of children with enuresis,” the researchers noted. However, they found that intake didn't correlate with the number of nights a child wet the bed (P=0.49). Overall, enuresis was actually less likely in children who consumed caffeine.
The researchers cautioned that interpretation of these results may be complicated by cultural differences in reporting children's behavioral health concerns and that their study could not draw any causal conclusions. Schneider also noted the use of parental reports and the relatively small sample as limitations. Although the findings offered no support for removing caffeine from children's diets on the basis of bedwetting, Warzak's group concluded in the paper that “given the potential effects of caffeine on childhood behavior, a screen of caffeine consumption might be beneficial when evaluating childhood behavioral health concerns.”
Source: Warzak WJ, et al “Caffeine consumption in young children” J Pediatr 2011; DOI: 10.1016/j.jpeds.2010.11.022.
The authors used survey data from Project EAT (Eating Among Teens), in which two groups of adolescents (1608 middle school and 3074 high school students) completed surveys in 1999 and 2004 regarding eating habits, parental styles, and various socioeconomic variables.
Cross-sectional results for adolescent girls indicated a positive association between maternal and paternal authoritative parenting style and frequency of family meals. For adolescent boys, maternal authoritative parenting style was associated with more frequent family meals. Longitudinal results indicated that authoritative parenting style predicted higher frequency of family meals five years later, but only between mothers and sons or between fathers and daughters.
In the survey, commissioned by Act Against Allergy, further impact on family life was revealed. As a direct result of having a child with CMA, half (49%) the respondents have missed work, over a third (38%) have argued with their partner and 39% said the lives of other children in the family have also been disrupted.1
These findings were no surprise to Natalie Hammond, from Hertfordshire, UK, whose son Joe was diagnosed with CMA when he was six months old. Joe was initially misdiagnosed and even underwent surgery for a twisted bowel before doctors finally discovered that CMA was the cause of his illness. Mrs. Hammond said: “It was heartbreaking and frightening seeing Joe so sick – he would vomit and had blood in his stools. We felt utterly powerless, and couldn't believe a simple food like milk could do this. It took a long time to get over this terrifying and stressful experience.”
Cows' milk is one of the European Union's 'big eight' allergy-inducing foods alongside gluten, eggs, fish, peanuts, soya, treenuts and shellfish. More serious than lactose intolerance, a true milk allergy presents in one or more of three organ systems:
– Gastrointestinal (vomiting, diarrhoea, abdominal cramps, bloating) – affecting 50-60% of those with CMA
– Skin (rashes, including eczema and atopic dermatitis) – 50-70%
– Respiratory (wheeze, cough, runny nose) – 20-30%3
For further information on cows' milk allergy, see: www.actagainstallergy.com
The randomized, double-blind, placebo-controlled study, which was funded by The Dannon Company, Inc., involved 638 healthy children aged three to six, all of whom attended school five days a week. Parents were asked to give their child a strawberry yogurt-like drink every day. Some of the drinks contained the probiotic strain Lactobacillus casei (L. casei) and the others did not. Parents were also asked to record how many yogurt drinks their child consumed and to keep notes on their child's health.
At the end of the study, there was a 19 percent decrease in the number of common infections—e.g., ear infections, flu, diarrhea, sinusitis–among children who had consumed the yogurt drink with the probiotics than those who had the drink without the beneficial bacteria. When the researchers broke out the individual types of illness, they found that children who had the probiotic beverage had 24 percent fewer gastrointestinal infections (e.g., diarrhea, nausea, vomiting), and 18 percent fewer upper respiratory tract infections (e.g., ear, sinusitis, strep).
The reduction in infections did not, however, result in fewer days lost from school. Merenstein commented that “It is my hope that safe and tolerable ways to reduce illnesses could eventually result in fewer missed school days which means fewer work days missed by parents.”
The finding that the probiotic yogurt drink reduced infections in children, however, is significant. This joins results from other studies demonstrating benefits of probiotics in children, including one published in Pediatrics in which they reduced cold and flu symptoms, another in which they eased diarrhea, and one showing they helped prevent eczema in infants. Generally, probiotics have also been shown to benefit people who have celiac disease, irritable bowel, colitis, and possibly autism.
Georgetown University Medical Center
For many parents, dealing with an overweight child is a delicate issue. These four steps can put you and your child on the right path to a healthier lifestyle.
An important first step is to let your overweight child know she's OK, whatever her weight. A child's feelings about herself often reflect her parents' feelings about her. For example, if your child gets the message that you are unhappy with the way she looks, that impacts how she feels about herself. If you accept your child at any weight, and emphasize her strengths (e.g., good grades, musical talent, leadership skills), she learns how to feel good about herself. Let your child know she can talk openly with you and share her concerns about her weight. This issue may come up when she is shopping for clothes, participating in an athletic event or donning a bathing suit when it's time to hit the beach or pool. Your child probably knows better than anyone else that her weight is an issue. For that reason, she needs your support, acceptance and encouragement.
Focus On the Family.
Don't set your overweight child apart because of his weight or make a special issue out of it. Instead, make gradual, healthful changes in the whole family's physical activity and eating habits. Family involvement helps to teach everyone healthful habits and does not single out the overweight child as “being on a diet.” Changing the family environment provides your overweight child with the support he needs.
Increase Your Family's Physical Activity.
Regular physical activity, combined with good eating habits, is a must for promoting a healthy weight–and good health–among the whole family. Below are some simple ways to get the whole family moving:
- Be a role model for your children. If your children see you enjoying regular physical activity, they're more likely to get active and stay active for life.
- Plan family activities that are fun for everyone such as walking, dancing, biking or swimming. For example, schedule a walk with your family after dinner instead of watching TV. Make sure the activities you plan are done in a safe environment.
- Be sensitive to your child's needs. Overweight children may feel uncomfortable about participating in certain activities. Help your child find physical activities he enjoys and that aren't embarrassing or too difficult.
- Reduce the amount of time you and your family spend in sedentary activities such as watching TV or playing video games.
- Find ways for you and your family to be more active throughout the day. For example, walk up the stairs instead of taking the elevator, do some stretching during a work or school break, or encourage your child to walk to and from school, if possible.
- If your child likes structured sports activities or classes, sign him up and support his regular participation.
Teach Your Family Healthy Eating Habits Right from the Start.
Teaching good eating habits early and by example will help children develop a healthy attitude about food–that it's enjoyable, and required for energy to keep the body running right and to grow properly. Parents should provide children with the structure of regular meals and snacks, and choose the foods offered. Parents should allow children to choose what to eat from among the foods offered and how much.
To learn more about nutrition for children, make an appointment with Nastaran. See your doctor if you think your child has a serious weight problem.