Sweet Christines gluten-free confections - Celiac Resource Library

Gluten Free Diet Not Just for Celiac Disease

Christine Ruggio — Fri, 24 Sep 2010 13:53:58 GMT

Gluten Free Diet Not Just for Celiac Disease

Used for Weight Loss, Autism, ADHD, Wheat Intolerance and More

Aug 21, 2009 Jennifer Harshman

Celiac disease diagnosis is one great reason to avoid gluten, but it’s certainly not the only reason to follow a gluten free diet. Gluten intolerance is increasing throughout the world, and millions are discovering that eating wheat and other foods that contain gluten is causing problems for them.Celiacs aren't the only ones who should go gluten free. The GF Diet, used for weight loss and part of treatment for many medical conditions, is getting easier to follow.

Reasons to Go Gluten Free

Gluten is a type of protein that Alessio Fasano, M.D., calls "useless" to the human body. At best, it is filler that is taking the place of nutritious food; at worst, it is a poison that is causing the body to self-destruct. Dr. Fasano is Director of the Mucosal Biology Research Center, University of Maryland School of Medicine.

A gluten free, casein free diet is often prescribed by Kenneth Bock, M. D., for patients who have Autism, ADHD, asthma or allergies. In his book, Healing the New Childhood Epidemics (Ballantine, 2007), he explains that gluten and casein are proteins that cause problems in the body, triggering the immune system.

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Gluten Free Diet May be Among Natural Cures for Diabetes and Other Medical Conditions

A gfcf diet can help improve symptoms associated with many medical conditions. Examples of conditions that might be helped by the diet are fibromyalgia and diabetes. A gluten free diet may make it easier to control blood sugar levels, according to Donna Korn in Living Gluten Free for Dummies (Wiley, 2006).

The desire to improve a chronic disease may prompt some to go gluten free. A gluten free diet might also help those who haven’t been diagnosed with a chronic disease, but are suffering from various symptoms such as headache, constipation, diarrhea, gas, bloating, or acid reflux.

Gluten Free Casein Free Diet Can be Healthy and Easy to Follow

Removing gluten from the diet may be enough for some people, but many people will need to remove both gluten and casein from their diet to see improvement in their symptoms. According to "Celiac Disease: Wheat Ails You?" on the American Diabetes Association website, many who have problems with gluten also need to avoid dairy products.

Read on

Following a gluten-free, casein-free diet (gfcf diet) can be complicated, but it does not have to be. Increasing numbers of food manufacturers such as Pamela's Products and even Betty Crocker are producing foods that are safe to eat. Substitute foods may be tasty, but are not necessary for a healthy diet.

A simple diet of unprocessed fruits, vegetables, and protein sources such as legumes, fish and meat is naturally gluten free and casein free. Eating nutritious whole foods is healthier than eating processed foods. If packaged foods are purchased, reading and knowing ingredients on food labels is a must. Milk ingredients and gluten ingredients are hidden in many foods.

Consult a Medical Professional Before Going Gluten Free

Only a medical professional can give medical advice, and it is always best to consult a medical practitioner such as a doctor prior to making any changes in diet or exercise. Suite101.com, while making every effort to present accurate information, is not a source of medical advice.

Going gluten free before consulting a doctor is not advisable for those who want a medical diagnosis. Some sources, such as the American Diabetes Association article mentioned above, say that trying a gluten free diet might help to convince a doctor (that a patient has celiac disease), but consulting a professional prior to making dietary changes is especially important if celiac disease, wheat allergy, gluten allergy, or gluten intolerance is suspected. Why? Staff at the Mayo Clinic say that cutting gluten and/or casein before being tested can invalidate the medical test results. Antibodies and intestinal damage can only be detected when a person has been eating the offending foods.

When gluten (and/or casein) is removed from the diet, the body will begin to heal, and will cease production of the substances for which the doctors will test. Conceivably, even confirmed celiacs could "pass" the typical screening tests after being on a gluten free diet. If a medical diagnosis is needed, patients should consult a doctor before making dietary changes in order to avoid interefering with an accurate diagnosis.

Healthy outlook for natural-food businesses

Christine Ruggio — Fri, 10 Sep 2010 15:03:32 GMT

By Michael Novinson

Times Herald-Record

Published: 2:00 AM - 09/07/10

When Richard Masterson opened a 5,000-square- foot natural-foods store 12 years ago, he had trouble filling the space and finding customers.

Now, Nature's Pantry in the Town of Newburgh is "bursting at the seams," according to Damian Masterson, store manager and Richard's son.

Damian added free-standing shelves and often lines items up sideways so he can squeeze more into the undersized store.

Farm-to-table options

Look for the opportunities to eat tasty, local food to increase in coming years, as direct food sales become more pervasive.

Six percent of organic food sales in 2009 occurred through farmers markets, co-ops, community-supported agriculture (CSAs) and the Internet, according to the Organic Trade Association.

The CSA at Rusty Plough Farm in Ellenville has grown from 20 members in 2007 to more than 80 today, while Pleasant Stone Farm is about to begin selling teas and spices from its website.

CSA members typically receive a prepackaged bundle of in-season edibles every week, but Rusty Plough owner Oleh Maczaj provides his customers with added options.

Members use a website to select products and quantities, and can even skip weeks if they're on vacation - or just too full to order more.

In response to exploding demand, the health-food retailer opened a second, 13,000-square-foot store in Fishkill three years ago.

Other health-food retailers in the region have grown, as well. Pleasant Stone Farm opened a store in Ellenville in June that's nearly twice the size of the original Middletown location.

Mother Earth's Storehouse just expanded its Kingston location to a massive 15,000 square feet.

A decade ago, organic food sales accounted for just 1.2 percent of total U.S. grocery food sales.

But sales quadrupled over the 2000s, reaching $24.8 billion in 2009. Organics now account for 3.7 percent of all grocery food sales, according to the Organic Trade Association.

"It's a growing trend, not a passing fad," said Lisa Protter, who began producing a natural sweetener six years ago in the Town of Saugerties.

'Natural' versus 'organic'

Health-food advocates tout the nutritional and environmental benefits of natural and organic foods. They're minimally processed and don't contain artificial preservatives, sweeteners or flavors.

But the U.S. government doesn't define "natural," meaning companies can slap a "natural" label onto any of their products without recourse.

Organic foods, on the other hand, can't be genetically modified and don't contain growth hormones or synthetic pesticides, according to SPINS, a natural products research firm.

Products must receive U.S. Department of Agriculture certification before they can bear the "organic" label.

Health foods are no longer the exclusive domain of specialty retailers. More than half of organic food sales in 2009 occurred in traditional grocery stores, according to the Organic Trade Association.

"When Walmart talks about organic food, you know it's going mainstream," Protter said.

Reasons for the switch

Why has natural eating caught on during the 2000s? Experts mostly cite health-related factors.

First, more people have diagnosed food allergies.

Masterson said doctors have become more adept at identifying allergies, while Benoit Turpin, owner of Pleasant Stone Farm, believes people have become more sensitive to substances such as lactose and gluten as their bodies have reached higher levels of toxicity.

Holly Shelowitz, a certified nutrition counselor based in Rosendale, believes the high concentration of hydrogenated oils in conventional foods has led to more heart disease and type 2 diabetes.

"When you eat the foods of your culture, you get the diseases of your culture," she said.

People have also become increasingly concerned about the side effects of medication, Protter said, and therefore prefer to resolve health problems through alternative diets.

High preservative use and rising prices for conventional foods have also caused more consumers to turn to local products.

About a quarter of the items sold at the High Falls Food Cooperative are produced within 100 miles of the store, said Ruth Molloy, co-manager, while about one-fifth of the items sold at Pleasant Stone Farm come from within a 30-minute driving distance.

"What's local in Ellenville isn't as local as I wish it to be in Middletown," said Pleasant Stone Farm owner Turpin.

More choices on the shelves

Some shoppers believe that natural and organic foods cost more and taste worse than their traditional counterparts.

"A lot of the food in the supermarket is inexpensive," Shelowitz said. "But there's a cost to it" in terms of health, she added.

Cooking meals is a great way to save cash and avoid unhealthy preservatives, Shelowitz said. And eating fatty foods will lead to more doctor appointments, surgeries and missed work down the road, she added.

People who struggle to process lactose or gluten no longer have to live in the monotonous world of soy milk and rice cakes.

They can now enjoy everything from almond milk to gluten-free Betty Crocker desserts and Chex Mix.

"People are getting kind of sick of soy and rice in milk," Masterson of Nature's Pantry said.

Coconut has become popular, appearing both in flavored water and as a nondairy substitute. Coconut yogurt and ice cream have been big sellers at Nature's Pantry.

Non-soy milk alternatives provide better taste and nutritional value than soy, Shelowitz said.

Eileen Kadet and Melissa Idelson have been diagnosed with celiac disease — caused by a reaction to the gluten protein found in wheat — and both frequent Nature's Pantry for its extensive gluten-free selection.

A decade ago, medical schools thought that celiac disease only affected 1 in 2,500 people, but more recent studies show it impacts 1 in 133 people, according to Flavours magazine.

Kadet drives to the Newburgh store from her home in Pine Bush about once a month to stock up on bagels, oatmeal and soups. Although the gluten-free selection has grown at conventional supermarkets, she still can't find breads closer to home.

Idelson received her celiac diagnosis a year ago, and a friend introduced her to Nature's Pantry. She relishes the gluten-free frozen and snack products.

"It's given me my life back," she said.

mnovinson@th-record.com

Health & Wellness TV

Christine Ruggio — Fri, 18 Jun 2010 17:20:55 GMT

NFCA Donation Video

Christine Ruggio — Tue, 15 Dec 2009 21:09:11 GMT

Range of Neurologic Disorders in Patients With Celiac Disease

Christine Ruggio — Fri, 02 Oct 2009 19:28:30 GMT

Nathanel Zelnik, MD, Avi Pacht, MD, Raid Obeid, MD and Aaron Lerner, MD

From the Department of Pediatrics, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Objective. During the past 2 decades, celiac disease (CD) hasbeen recognized as a multisystem autoimmune disorder. A growingbody of distinct neurologic conditions such as cerebellar ataxia,epilepsy, myoclonic ataxia, chronic neuropathies, and dementiahave been reported, mainly in middle-aged adults. There stillare insufficient data on the association of CD with variousneurologic disorders in children, adolescents, and young adults,including more common and "soft" neurologic conditions, suchas headache, learning disorders, attention-deficit/hyperactivitydisorder (ADHD), and tic disorders. The aim of the present studyis to look for a broader spectrum of neurologic disorders inCD patients, most of them children or young adults.

Methods. Patients with CD were asked to fill in a questionnaireregarding the presence of neurologic disorders or symptoms.Their medical charts were reviewed, and those who were reportedas having neurologic manifestations underwent neurologic examinationand brain imaging or electroencephalogram if required. Theirneurologic data were compared with that of a control group matchedfor age and gender.

Results. Patients with CD were more prone to develop neurologicdisorders (51.4%) in comparison with control subjects (19.9%).These disorders include hypotonia, developmental delay, learningdisorders and ADHD, headache, and cerebellar ataxia. Epilepticdisorders were only marginally more common in CD. In contrast,no difference was found in the prevalence of tic disorders inboth groups. Therapeutic benefit, with gluten-free diet, wasdemonstrated only in patients with transient infantile hypotoniaand migraine headache.

Conclusion. This study suggests that the variability of neurologicdisorders that occur in CD is broader than previously reportedand includes "softer" and more common neurologic disorders,such as chronic headache, developmental delay, hypotonia, andlearning disorders or ADHD. Future longitudinal prospectivestudies might better define the full range of these neurologicdisorders and their clinical response to a gluten-free diet.

Celiac Disease: A Diagnosis Often Missed

Christine Ruggio — Fri, 02 Oct 2009 19:15:06 GMT

(CBS) There's a disease that American doctors are absolutely terrible at diagnosing. It's estimated that three million Americans have celiac disease and only a small percentage of them know it. In celiac disease, a component of wheat, rye, and barley called gluten sets off an immune reaction that attacks the intestine and can affect the entire body.

Patients are unable to properly absorb essential nutrients because the absorptive fingers (villi) in the small intestine have been damaged or destroyed. Doctors usually miss the diagnosis because they don't realize how variable the disease can be. Here is a list of associated symptoms and problems:

Diarrhea, abdominal pain, bloating, gas, distention, weight loss, constipation, irritable bowel syndrome, failure to thrive in infancy, vomiting, short stature, iron deficiency with or without anemia, poor performance in school, delayed puberty, infertility, recurrent miscarriage, osteoporosis, vitamin deficiencies, fatigue, tooth discoloration and dental enamel defects, skin disorders, elevated liver enzymes, Down syndrome, Sjogren's syndrome, aphthous ulcers (canker sores), arthritis, depression, nerve and balance problems (peripheral neuropathy and cerebellar ataxia), irritability in children, seizures, and migraines. Patients with other autoimmune diseases such as type 1 diabetes and thyroiditis are at increased risk for celiac disease.

Click here for the National Institute of Health's information on celiac disease.

There appears to be a slight increase in the risk of lymphomas and gastrointestinal cancers that, in one study, returned to normal after five years of a gluten-free diet.

The diagnosis is usually missed because doctors don't think of it. I was taught in medical school thirty years ago that patients always have dramatic symptoms such as diarrhea and weight loss. Wrong. We now know that about half of patients have atypical symptoms that are included in the long laundry list above. Although doctors are becoming more aware of the illness, it takes an average of more than four years for the correct diagnosis to be made in the small percentage of patients in whom the diagnosis is not missed altogether.

New England Journal of Medicine on Celiac Disease.

There are simple blood tests that can detect celiac disease over 90 percent of the time and that only rarely give false positives. The diagnosis is then confirmed by an upper endoscopy. With the patient sedated, a small, flexible tube is slipped into the mouth, down the esophagus and stomach and into the first part of the small intestine (duodenum), where biopsies are taken and subsequently examined for changes seen in celiac disease.

Treatment is a gluten-free diet - easier said than done, especially for a child who wants to be like everybody else and eat pizza, cookies, and cake at birthday parties. Patients have to be extremely vigilant because gluten is in many unexpected foods, such as soy sauce, candy, and malt flavoring.

Consultation with an experienced dietitian is crucial because some older materials distributed by doctors, dietitians, and nutritionists are out of date and cause patients to avoid certain foods unnecessarily. There are many Web sites that provide excellent information about diet (see below). There's research into developing a pill that would help people with celiac disease, but it's not ready for prime time yet.

The key to improving our dismal rate of picking up celiac disease is to increase awareness both in physicians and patients. One study found that general practitioners actively looking for the disease increased their rate of diagnosis by 43 fold.

Anybody with any of the long list of symptoms or problems listed above should consult a doctor and discuss whether testing for celiac disease is appropriate.

There are many ways that celiac disease can disguise itself. Here are four to especially look out for:

• A child with behavior or learning problems

Celiac disease can cause cognitive difficulty that has been called "brain fog." The causes are unclear but may include nutritional problems, inflammation, or immunologic damage in the brain. It's well known that children with iron deficiency - with or without anemia - do worse in school. Researchers suspect celiac disease may be linked to developmental delay and ADHD.

• Irritable bowel syndrome

There is an increased risk of celiac disease in the 10-15 percent of adults who carry the diagnosis of "irritable bowel syndrome" (IBS). Many of the symptoms of IBS such as diarrhea, constipation, bloating, and abdominal pain also occur in celiac disease.

• Iron deficiency

A simple blood test will detect low iron, a relatively common condition that is usually not from celiac disease. However, low iron may be the only clue to celiac disease, so it's important to maintain a high index of suspicion. Remember that some patients can have both a relatively innocent cause of iron deficiency (such as poor dietary intake or menstrual blood loss) AND malabsorption of iron due to celiac disease.

• Osteoporosis

Untreated celiac disease - with its associated low vitamin D and decreased calcium absorption - increases the risk of osteoporosis. Although there is disagreement among experts, some researchers have advocated that all patients with osteoporosis be tested for celiac disease.

Others say to reserve routine testing for men and pre-menopausal women with osteoporosis because osteoporosis is less frequent in these groups compared to postmenopausal women and therefore it's important to look for unusual causes such as celiac disease. In any case, all patients with osteoporosis should be considered for celiac testing on an individual basis.

It is unacceptable that millions of people are suffering from a disease that can usually be easily treated with diet. Patient and physician education is crucial. If you send this blog to one hundred of your friends, the odds are that one of them will have celiac disease and not know it. You could change somebody's life.

For this week’s CBS Doc Dot Com, I discuss celiac disease with a world expert, Dr. Peter Green, Professor of Clinical Medicine and Director of the Celiac Disease Center at Columbia University Medical Center. To see the video, click below:

Celiac Disease and the Gluten Free Diet: From the Banana Diet to No Diet ?

Christine Ruggio — Tue, 18 Aug 2009 20:57:48 GMT

A faster test for the food protein that triggers celiac disease

Christine Ruggio — Wed, 01 Apr 2009 00:59:22 GMT

A faster test for the food protein that triggers celiac disease

November 17th, 2008 Researchers in Spain and the United Kingdom are reporting development of a faster test for identifying the food protein that triggers celiac disease, a difficult-to-diagnose digestive disease involving the inability to digest protein called gluten that occurs in wheat, oats, rye, and barley. The finding could help millions of people avoid diarrhea, bloating, and other symptoms that occur when they unknowingly eat foods containing gluten. The study is scheduled for the December 15 issue of Analytical Chemistry.

In the new report, Alex Fragoso, Ciara O'Sullivan and colleagues note that patients with celiac disease can avoid symptoms by avoiding foods that contain gluten. Doing so can be tricky, however, because gluten may be a hidden ingredient in unsuspected foods, such as soy sauce, canned soups, and licorice candy. Some prepared foods list gluten content on package labels, but identifying its presence remains difficult and time-consuming.

The scientists describe development of a new sensor that detects antibodies to the protein gliadin, a component of gluten. Laboratory tests showed that it is superior to the so-called enzyme-linked immunosorbent assay (ELISA), now the standard test for gliadin. It took the new test barely 90 minutes to detect gliadin in the parts per billion range, compared to 8 hours for the ELISA test. Although both tests were equally accurate, the new sensor would be easier to use at food manufacturing plants, the researchers note.

Citation: "Electrochemical Immunosensor for Detection of Celiac Disease Toxic Gliadin in Foodstuff" http://dx.doi.org/10.1021/ac801620j

Source: ACS

Understanding Food Allergies

Christine Ruggio — Wed, 01 Apr 2009 00:45:09 GMT

Understanding Food Allergy pdf

International Food Information Council Fo u n d a t i o n

1100 Connecticut Avenue, N.W., Suite 430

Washington, DC 2 0 0 3 6

h t t p : / / i f i c . o rg

Food Allergies II

Christine Ruggio — Wed, 01 Apr 2009 00:42:05 GMT

Food Allergy Symptoms

Approximately 8% of children and 2% of adults suffer from true food allergies. When the culprit food is eaten, most allergic reactions will occur within minutes. Skin symptoms (itching, urticaria, angioedema) are the most common, and occur during most food reactions. Other symptoms can include nasal (sneezing, runny nose, itchy nose and eyes), gastrointestinal (nausea, vomiting, cramping, diarrhea), lung (shortness of breath, wheezing, coughing, chest tightness), and vascular (low blood pressure, light-headedness, rapid heart beat) symptoms. When severe, this reaction is called anaphylaxis, and can be life threatening.

Allergy or Intolerance?

Most reactions to food are probably not allergic in nature, but rather intolerance. This means that there is no allergic antibody present against the food in the person. Intolerance can be classified as toxic and non-toxic. Toxic reactions would be expected to occur in most people if enough of the food was eaten, examples include alcohol, caffeine or in cases of food-poisoning. Non-toxic food intolerance occurs only in certain people, such as lactose intolerance, which is due to the deficiency of lactase, the enzyme which breaks down the sugar in milk and dairy foods. Patients with lactose intolerance experience bloating, cramping and diarrhea within minutes to hours after eating lactose-containing foods, but do not experience other symptoms of food allergies.

Non-allergic Immunologic Reactions

A less common form of non-allergic reactions to food involves the immune system, but there are no allergic antibodies present. This group includes celiac sprue and FPIES (food protein induced enteropathy syndromes). FPIES typically occurs in infants and young children, with gastrointestinal symptoms (vomiting, diarrhea, bloody stools, and weight loss) as the presenting signs. Milk, soy and cereal grains are the most common triggers in FPIES. Children typically outgrow FPIES by 2 to 3 years of age.

Common Childhood Food Allergies

Milk, soy, wheat, egg, peanut, tree nuts, fish and shellfish compromise more than 90 percent of food allergies in children. Allergy to milk and egg are by far the most common, and are usually outgrown by age 5 years. Peanut, tree nut, fish and shellfish allergies are typically the more severe and potentially life-threatening, and frequently persist into adulthood.

Cross-Reactivity and Cross-Contamination

Cross-reactivity refers to a person having allergies to similar foods within a food group. For example, all shellfish are closely related; if a person is allergic to one shellfish, there is a strong chance that person is allergic to other shellfish. The same holds true for tree-nuts, such as almonds, cashews and walnuts.

Cross-contamination refers to a food contaminating another, unrelated food leading to a "hidden allergy". For example, peanuts and tree nuts are not related foods. Peanuts are legumes, and related to the bean family, while tree nuts are true nuts. There is no cross-reactivity between the two, but both can be found in candy shops and in a can of mixed nuts, for instance.

Diagnosing Food Allergies

The diagnosis is made with an appropriate history of a reaction to a specific food, along with a positive test for the allergic antibody against that food. Testing for the allergic antibody is typically accomplished with skin testing, although can be done with a blood test as well.

The blood test, called a RAST test, is not quite as good of a test as skin testing, but can be helpful in predicting if a person has outgrown a food allergy. This is especially true since in many cases the skin test can still be positive in children who have actually outgrown the food allergy.

If the diagnosis of food allergy is in question despite testing, an allergist may decide to perform an oral food challenge for the patient. This involves having the person eat increasing amounts of food over many hours under medical supervision. Since the potential for life-threatening anaphylaxis exists, this procedure should only be performed by a physician experienced in the diagnosis and treatment of allergic diseases. An oral food challenge is the only way to truly remove a diagnosis of food allergy in a patient.

Food Allergies in Children

Christine Ruggio — Wed, 01 Apr 2009 00:40:30 GMT

Food Allergies and Baby

Many parents are concerned about food allergies in their children. About 4 out of 100 children have a food allergy. For most children with a food allergy, the best thing to do is avoid the food that causes the allergic reaction.

What Is a Food Allergy?
When a person has a food allergy, the body overreacts as if the food were harmful. The body fights the substance in the food that triggers the allergic reaction.

A person can be allergic to any food. Although some people are allergic to food additives (such as food dye and artificial sweeteners), natural foods cause the most food allergies. Almost all food allergies in children are caused by these foods:

Cow�s milk
Eggs
Peanuts
Soy
Wheat
Nuts from trees (such as almonds, walnuts and cashews)
Fish
Shellfish (such as lobster, shrimp and crab)

Sometimes a child is allergic to more than one food.

What Are the Symptoms?
Here are common signs of an allergic reaction to food:

Hives (itchy, red bumps on the skin)
Swelling of the face, legs or arms
Itchy skin
Coughing
Trouble breathing
Wheezing
Tightness in the throat
Runny or stuffy nose
Red rash around the mouth
Diarrhea
Pain in the belly
Nausea or vomiting
Fainting

Skin reactions are the most common signs of a food allergy.

Sometimes people with food allergies develop long-term health problems. The most common are:

Asthma
Eczema (itchy, scaly red skin)

Avoiding the Food That Causes the Problem
If your child has a food allergy, she should avoid the food. Read food labels carefully. For instance, some foods that you don�t expect contain peanuts or peanut oil. The label will tell you. At restaurants and at other people�s homes, ask if the dishes contain the food your child is allergic to.

Treatment
When children have food allergies, health care providers may recommend that they take certain medicines. Examples include inhalers and liquids or pills called �antihistamines.�

Danger Signs
Anaphylaxis is a serious allergic reaction. It can occur if a person has a severe food allergy.

Anaphylaxis comes on quickly and can be life threatening. The person has a hard time breathing. Her blood pressure may drop quickly, causing her to faint or go into shock. The person must be treated quickly.

Before anaphylaxis can occur, the person must have eaten the food that causes an allergic reaction at least once before. In other words, a child allergic to peanuts will not have anaphylaxis the first time he eats peanuts. But sometimes it�s hard to know if a child has already eaten the food.

If your child has a severe food allergy, his health care provider may give you special �pens.� If your child has an anaphylactic reaction, you can use a pen to quickly give him medicine. Baby sitters, child care workers, family members and others who spend a lot of time with your child will also need to know how to use the pens.

Do Children Outgrow Food Allergies?
Children usually outgrow allergies to cow�s milk, eggs, soy and wheat. But they do not usually outgrow allergies to peanuts, tree nuts, fish and shellfish.

Can Food Allergies Be Prevented?
Medical research on prevention of food allergies is limited and incomplete. After reviewing a wide range of medical research, the American Academy of Pediatrics has made these recommendations about food allergies in children:

Avoiding certain foods in pregnancy does not appear to prevent food allergies in children.
We don�t know for certain if breastfeeding can prevent or delay food allergies. For infants who have a parent, brother or sister with a food allergy, drinking only breastmilk for at least four months may reduce the risk of allergy to cow�s milk. Certain formulas that do not contain cow�s milk may also reduce the risk.
Soy-based infant formula does not appear to prevent food allergy.
Doctors recommend that most babies start eating solid foods between 4-6 months of age. Some people have thought that food allergies might be prevented if parents delayed giving their babies certain solid foods ((for instance, fish, eggs, peanut butter). But current medical research does not support this idea.

Medical research about food allergies is continuing. If you have any questions about food and your baby, ask your child�s health care provider.

Mach of Dimes - March 2008/October 2009

Food Allergies Guide

Christine Ruggio — Wed, 01 Apr 2009 00:37:59 GMT

Up to 25% of the population report having had adverse food reactions. The true prevalence of food allergy is lower and seems to range from 1% to 4% of the general population and about 6% of the paediatric population, but does occur in as much as 25% of children with eczema. Consequently the general public perceive that food-related allergy is under-diagnosed, whilst most doctors feel that it is over-diagnosed. Many individuals have themselves noted that they are prone to develop adverse reactions to a specific food. They have then dealt with the problem by simply avoiding that food without ever seeking the advice of a doctor.
Four types of Adverse reactions to food occur:

*Food Reactions modulated by the Immune System, these involve immediate hypersensitivity (IgE) and delayed T-cell mediated responses (non-IgE). These reactions may occur to minute amounts of the offending food in the diet. They depend on the bowel surface integrity and the individual’s ability to mount an abnormal immune response. This is true FOOD ALLERGY and accounts for 20% of all adverse reactions to food.

*Non-Immune mediated reactions may involve food malabsorption due to intestinal enzyme deficiencies (lactose intolerance), adverse reactions to naturally occurring chemicals in food (salicylates, histamine, serotonin and tyramine), as well as reactions to food containing preservatives (sodium benzoate and sulphites), flavourants (monosodium glutamate, aspartame) and colourants (tartrazine). These reactions usually related to the amount of offending additive or chemical in the food and are commonly referred to as FOOD INTOLERANCE

Toxins and poison may naturally occur in food such as glyco-alkaloids (in potato), cyanogenic glycosides (in beans) and bacterial contaminants. Free histamine resulting from bacterial degradation of the flesh in scombroid fish results in scrombotoxicity - a pseudo allergic reaction typified by intense itching, rapid pulse and skin flushing. This reaction is due to the direct toxic effect of the spoiled food and is called FOOD TOXICITY.

Finally, some people are psychologically convinced that certain foods disagree with them, however, but when tested fail to react to that food. This occurs quite commonly and is referred to as FOOD AVERSION.

Mechanism of "true" food allergy

Allergic sensitization to food will occur in infants if there is a breach in the bowel surface integrity followed by an adverse immune response to a foreign food protein penetrating the intestinal surface. Certain foods seem to be more allergenic than others (Table 1). Fortunately enzymatic degradation of food in the intestinal tract tends to reduce this allergenicity. Secretory IgA, an antibody, also plays a protective role by combining with the allergens on the intestinal epithelial surfaces, further reducing allergen penetration. Mast cells, which release allergy mediators such as histamine, are present in the gastrointestinal surface and are found in increased numbers in allergic individuals. If intestinal barriers are weakened by inflammatory disease or IgA deficiency, allergen sensitization and allergic disease is more likely to occur. In infancy, reduced digestive capability and increased intestinal surface permeability are factors that enhance allergic sensitization to foods. As the gastrointestinal surface barrier naturally improves with age, so the incidence of food allergy tends to decrease with age. Food is most allergenic in the fresh form and cooking reduces or eliminates this allergenicity (with the exception of nuts and peanuts).

Mechanism of food intolerance

Additives such as Sulphur dioxide or sulphites affect up to 40% of children with asthma, they are commonly ingested in dried fruit, soft drinks and sprayed onto fresh produce. It is the Sulphur dioxide gas, which is eructed from the stomach that results in throat irritation and wheezing. Allergic individuals also seem to have low levels of sulphite oxidase, the enzyme that normally metabolises sulphites in the diet. Sensitivity to Tartrazine the yellow food colorant is, despite it’s media publicity, quite a rare cause of food intolerance, it affects only 0.1% of the population. This colorant seems to act by causing histamine release via non-immune mechanisms and so exacerbates the symptoms of allergy. Certain allergic individuals with reduced levels of the histamine degrading enzyme Diamine Oxidase develop sneezing, flushing, runny nose, headaches and wheezing after ingesting foods rich in histamine. This reaction seems to be quite common and is often confused with food allergy. Histamine and Tyramine occur naturally in fish, certain cheeses, cured meats, some alcoholic beverages and Marmite.

How does food allergy manifest

Allergic reactions to food may manifest in the form of nausea, vomiting, flatulence, abdominal pain, cramping, diarrhoea and with non gastrointestinal illnesses such as rashes, eczema, swelling, nasal allergy, wheeze, angioedema and in some cases, even life threatening anaphylaxis.

Fresh fruit, nuts, vegetables and spices may cause local tissue reactions on the lips, in the mouth and in the throat - this is the so-called Oral Allergy Syndrome (OAS). Oral allergy tends to occur more commonly in individuals who are allergic to Birch and Grass pollen. Some food allergic people may also develop flushing, shortness of breath, hives and fainting following strenuous exercise. This condition is known as food related Exercise-induced Anaphylaxis. It can occur for up to 12 hours after ingesting offending food such as shellfish, celery and wheat. Evidence now suggests that Coeliac Disease may be due to delayed T cell-mediated allergy to dietary gliadin found in wheat, rye barley and oats. Preservatives and other additives tend to predominantly induce reactions outside the intestine such as rashes, wheezing and exacerbate eczema. There is still considerable controversy as to whether the hyper-activity syndrome and migraine are allergic in nature - so far scientific evidence is in conflict, but so-called Myalgic Encephalomyelitis (M.E.) and the Chronic Systemic Candidiasis syndrome do not appear to have any food allergy basis.

The common offenders

Only when the adverse reaction occurs immediately after eating the causative food may the diagnosis of food allergy be easy to make. Otherwise with delayed reactions to food, such as when cell mediated and immune complex mediated mechanisms are involved, the offending food is very difficult to isolate.

Infants tend more commonly to develop allergies to Hen egg white, Cows milk protein, Wheat, Peanuts, Bony Fish, Citrus and even Soya protein, whilst adults tend to be allergic to foods such as Bony Fish, Shellfish, Peanuts, Tree-nuts, Tomatoes and Kiwi. Although these foods are more commonly implicated in food allergy, almost any food can be a potential allergen.

Potentially allergenic foods in children

Cows Milk Protein, Hens Egg White, Soya Milk,

Codfish, Wheat and Peanut

Potentially allergenic foods in adults

Tree Nuts (Brazilnut, Hazelnut, Almond, Walnut, Cashew, Pistachia)

Fruit (Peach, Apple, Strawberry, Citrus fruit)

Vegetables (Tomato, Celery, Onion, Potato, Parsley)

Meats (Pork, Beef)

Shellfish (Mussels, Crab, Shrimp, Squid)

Seeds (Sesame and Poppy seeds)

How to diagnose food allergy

Food allergy usually manifests in babies with feeding problems and a strong family background of allergy. The high-risk infant is the one who has one or both parents with allergic disease. Those with a single affected parent have about a 37% risk of developing some form of allergy while those with both parents affected have about a 62% risk. The diagnosis is dependent on a clinical history suggestive of food allergy, with symptom improvement on withdrawing the offending food from the diet. The physical examination is often not particularly informative. There are a number of Diagnostic tests, which determine IgE mediated allergy by means of skin or blood testing. Skin Scratch Test solutions are commercially available from ALK Abello and Diagenics (UK) Ltd for most foods, but fresh extracts are preferable and should be used to test for fruit allergy. Phadia Diagnostics market a number of food allergy screening tests such as Total IgE and the CAP RAST fx5 Paediatric Food Mix which tests for 6 common paediatric food allergens (Milk, Egg, Wheat, Peanut, Soya and Peanut). In adults the CAP RAST fx1, fx2 and fx3 are additional screening tests for nuts, seafood and cereals respectively. There are also up to 160 individual CAP RAST tests available for different foods.

Neither skin tests nor CAP RASTs alone can absolutely exclude or confirm the possibility of a food allergy. For example, Prof. Bahna (USA) has shown that in Cow’s Milk allergy confirmed by double-blind challenge testing, both skin testing and RAST showed similar although sub-optimal degrees of reliability. The sensitivity (true positive test) was 44% for skin testing and 56% for RAST, and the specificity (true negative test) was 67% for both. Therefore provocation challenge testing is the best way of confirming a suspected food allergy.

The diagnostic gold standard.

The diagnostic "gold standard" in food allergy is the double blind placebo controlled food challenge test (DBPCFC). In reality it is very difficult to perform this challenge outside the orderly environment of an academic inpatient hospital. In the Primary Care setting, if a specific food is implicated, a trial exclusion diet is implemented, followed by the diagnostic re-introduction of the offending food.

____Elimination Diets for children___

0-6 months of age

Nutramigen, Pregestimil or Alfare

Comminuted chicken

6-24 months

Nutramigen, Pregestimil or Alfare

Rice cereal and rice cakes

Lamb or chicken meat

Cooked pears or bananas

2 years or older

Herb or Rooibos Tea (only sugar may be added)

Rice cereals, "Rice Krispies" and rice bread

Lamb and chicken meat

Cooked or canned pears, apricots, prunes or their juices

Sunflower or olive oil, non-dairy margarine

Cooked beetroot, sweet-potato, carrots, parsnips

Lettuce

If no obvious food is suspected, then a simple elimination diet for two to four weeks is suggested. It should consist of either a extensively hydrolysed infant formula or only hypo-allergenic foods such as: lamb meat or chicken, polished rice, rice cakes, pears, bananas, water and sunflower or olive oil. In children, if despite the elimination diet, the symptoms persist, an elemental diet such as Neocate, a hypoallergenic amino acid based formula, should be considered. If Neocate is unavailable then Comminuted chicken or lamb meat may be used as a "homemade" hypoallergenic formula. The elimination diet for children is very limited and obviously not well adhered to by adults. In adults a greater number of foods may rather be used in a "few food" elimination diet.

The "few food" diet for adults - if offending food is not apparent

The following foods are considered to have a low potential for causing allergies

Meat: Lamb, chicken

Vegetables: Rice, sweet-potato, carrots, rhubarb, asparagus.

Fruit: Pears, banana, apricots, apple, pineapple (All peeled)

Fat: Non-dairy margarine, sunflower and olive oil

Other: Herb or Rooibos tea, water, honey, sugar, sago

Supplement: Calcium 400 - 800mg/day and added vitamin B

Provocation testing

Once the allergy has settled after 4 weeks on the elimination diet, other foods are slowly re-introduced one at a time at weekly intervals. Each new food may be tried in small test quantities and then given in normal amounts every day for a week until the allergy provoking food is identified. Most foods can then slowly be re-introduced during the provocation testing period. Adults are tested by slowly re-introducing fish and shellfish, pork and beef, nuts, chocolate, legumes, white potatoes, tomatoes, oranges, strawberries, cows milk, wheat, eggs, pizza, fresh fruit and finally hens eggs. Provocation testing should not be performed if there is a history of anaphylaxis to a particular food (such as peanuts).

Food allergy prevention

Food allergy prevention measures should only be considered in babies with one or both parents manifesting definite allergic disease. Maternal diet in early pregnancy seems to play little or no role in the infant becoming food allergic, so dietary manipulation is not recommended at this stage. However, in the last 3 months of pregnancy and during breastfeeding, cigarette smoking should be strongly discouraged and milk, egg and peanuts avoided. The most effective form of food allergy prevention in the "at risk" infant is unsupplemented breast-feeding for at least the first four to six months of age. Breast-feeding should be encouraged as it reduces exposure to foreign proteins, helps to mature the gut barrier early, has anti-inflammatory properties and reduces the risk of infections, which can act as allergy triggers. The breastfeeding mother must be careful to avoid eating common allergenic foods such as eggs, cow’s milk and peanuts, as traces can pass into the breast milk and sensitize the infant.

Which hypoallergenic milk formula?

If exclusive breast-feeding cannot be established or maintained then a partially hydrolysed infant milk formula or an extensively hydrolysed formula such as Nutramigen, Pregestimil or Pepti should be used. These hydrolysed formulae are produced by heat or enzymatic hydrolysis of cows milk casein or whey, rendering them hypoallergenic. The more complete the hydrolysis process the less allergenic the milk. Cow’s milk free formulas are expensive (£8 to £20 per 400g ). Amino acid based formulas (Neocate, Pepdite) are best as they are completely free of cows milk protein but are more expensive than extensively hydrolysed formulas (Nutramigen, Pregestimil, Pepti) which are the current preferred cows milk free formulas. However exquisitely sensitive infants may react to traces of cows milk protein even in extensively hydrolysed formulae. An amino acid based formula provides a good therapeutic trial for initial diagnosis of cow’s milk allergy, after which it would be more economic to switch to an extensively hydrolysed formula (if this is tolerated).

Although soy milk is the cheapest alternative formula available (£4 per 400g), 20% of cow’s milk allergic infants will develop a concomitant soy allergy. Goat’s milk is inappropriate as it contains many allergenic proteins found in cows milk, so should not be recommended. Comminuted chicken meat suspensions are another alternative particularly if there is associated carbohydrate intolerance.

Avoid certain foods

Delay the introduction of solids until 6 months of age, initially introducing only rice, lamb meat, non-citrus fruit and non-legume vegetables. Potential food allergens in the diet, such as cows milk, soya, citrus and wheat, should be avoided for the first year of life, with eggs, peanuts and bony fish being introduced only after 2-3 years of age. Factors that promote allergic sensitization such as maternal cigarette smoking should be avoided whenever possible. Avoidance is easy to prescribe but in reality is very difficult to implement. Therefore the strictness of the diet often depends on the severity of the food allergy symptoms. Most food allergic children eventually tolerate milk, eggs and vegetables but usually remain allergic to fish and nuts.

Pitfalls in food allergy treatment

Food allergy is most prevalent in the paediatric age group. Eggs and cows milk seem to be the commonest causes of food allergy followed by peanut and wheat. Often infants will also develop an allergy to their soya milk and may even have an adverse reaction to "hypoallergenic" formulas. Once the food allergy is diagnosed, an exclusion diet is instituted. Calcium (400-800mg/day) needs to be supplemented in cows milk-free diets, and Vitamin B in wheat free diets. A certain amount of cross-reactivity occurs between foods of similar classes and this should be borne in mind if symptoms recur on specific food avoidance. For example if allergic to peanuts, then there is a high risk of being allergic to beans, peas, lentils, carob, senna and liquorice (all members of the legume family). But foods from divergent food families may cross react such as "celery-spice-carrot-mugwort syndrome". This may be due to the presence of similar pan-allergens called Profilin and Lipid Transfer Protein (LTP) common to fruit, grass and vegetables and which accounts for the cross-reactivity we see between unrelated foods. It would appear that allergic reactions to fruit and vegetables, which often coexist with pollen allergy, are on the increase. These pan-allergens seem to play a protective role in plants and are induced by environmental stress such as plant infections, soil conditions, changes in weather and storage conditions. Birch pollen allergic people can have cross-reactions to apples and other fruit, grass pollen allergic people may react to melon, cereals and tomatoes, while those allergic to latex, react to avocado, chestnut, banana and kiwi-fruit. For two foods to cross react, the allergenic protein has to have at least 35% similar amino-acid homology. Profilin generally causes milder reactions and is destroyed by heat and cooking. Lipid transfer Protein (LTP) is heat and digestion resistant and can cause more severe systemic allergic reactions. Hidden allergen sources also need to be identified as processed foods are notoriously inadequately labelled.

Sometimes the apparent allergy provoking food is not the cause but another co-existent allergy, such as allergy to the Cod Worm parasite (Anasakis simplex) in fish mimicking a typical fish allergy, or allergy to the red spider mite on tomatoes or grapes being the allergen and not that food.

Food Families

Legumes

: Peanut, Pea, Lentil, Bean, Senna, Liquorice, Soya.

Milk:

Butter, Cheese, Cream, Milk & Formula, Yoghurt.

Fish:

Plaice, Tuna, Salmon, Mackerel, Sardine.

Citrus:

Orange, Grapefruit, Lemon, Lime, Tangerine.

Nightshade:

Peppers, Eggplant, Potato, Tobacco, Tomato.

Crustacean:

Lobster, Prawn, Crab, Shrimp.

Grain:

Wheat, Barley, Oats, Rye, Rice, Millet.

Tree Nut:

Brazil, Hazelnut, Almond, Walnut.

Mollusc:

Oyster, Mussel, Snail, Squid, Octopus, Clam.

Enlist the help of a dietician.

If an essential foodstuff needs to be excluded from the diet, a dietician should be consulted for advice so as to ensure the diet is nutritionally adequate. Restrictive diets run the risk of inducing malnutrition, are costly to implement, cause anxiety in the family, result in the child being over protected and socially isolated. If the diet does not work, then great disappointment and anger may ensue, affecting the whole family.

All hidden sources of the allergen should be excluded.

If milk is implicated, then all sources of milk such as butter, cheese, buttermilk, chocolate, cream, ice cream, yoghurt and casein should be avoided and the diet supplemented with calcium and vitamin D. In wheat allergy avoid wheat cereals, crackers, pasta, snacks, bread, malt, sweets and supplement Vitamin B and Iron. Wheat allergic children can usually tolerate oats, rye, barley and corn. In egg allergy avoid egg white, albumen, egg lecithin, mayonnaise and other hidden sources of egg such as processed foods and batter. In severe hen egg allergy, children are sometimes skin tested with dilute (1:10) MMR vaccine although in reality the vaccine is extremely unlikely to contain egg protein. Peanuts may be hidden in soups, Chinese foods, marzipan and used as a bulking agent in many processed foods, they can even cross react with peas and beans. Soya protein found in infant milk formulas, baked foods, canned tuna, soups and sauces, is another allergen encountered. Peanut and soya oils are generally non-allergenic and safe to use in the diet.

Allergen avoidance.

The main thrust in food allergy treatment is specific allergen avoidance. Medical treatment may sometimes need to be instituted if symptoms are severe and includes; antihistamine, adrenaline and corticosteroid medication. All people with documented food anaphylaxis should wear a Medic Alert bracelet and carry an adrenaline injection (Epipen) for self-administration. Allergy prevention medication such as cetirizine (Zirtek) should be recommended in the paediatric age group. This may reduce food allergen reactivity and slow the so-called "Allergy March" onto Eczema, Asthma and Nasal Allergy which are common sequels to food allergy. At present studies are being undertaken in Europe to assess how effective preventer-medicines are in stopping the "allergic march"- this is the so-called Early Treatment of the Allergic Child (ETAC) concept. The role of oral desensitization vaccines need to be further evaluated, but they may be a future therapeutic option for severe reactions to unavoidable food allergens.

Finally, cautious re-introduction of a "prohibited" food can be attempted after 6-12 months as the natural history of food allergy is for gradual improvement. Foods implicated with anaphylaxis should not be re-introduced outside a controlled hospital environment.

A controversial allergic condition.

Most clinical food allergic reactions are immediate and IgE mediated. A non-IgE or T-cell mediated allergic reaction might be considered when an allergic basis is still suspected despite conventional skin prick and CAP RAST tests being negative.

When evaluating food allergy one must also be wary of unproven diagnostic and therapeutic regimes. Chiropractors have popularised "food allergy" using dubious diagnostic tests such as Applied Kinesiology and Vega testing - these tests are of no value and are not reproducible. Practitioners should be aware of the fact that the publicity and "popularity" surrounding food allergy has spawned a new form of "Munchausen by proxy" - where the parent, convinced that their child’s symptoms are secondary to food allergy, institutes bizarre and nutritionally deficient diets.

All exclusion diets must include adequate amounts of protein, carbohydrate, essential fats, vitamins and minerals otherwise malnutrition will occur. The advice of a qualified dietician should be sought if foods are excluded from the diet for any length of time.

by Dr Adrian Morris

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