Allergies in children new recommendations you should know

Milk and Love Village

Allergies in western societies are on the rise, with the Australasian Society of Clinical Immunology and Allergy quoting that allergic diseases have approximately doubled in the last 25 years and that up to 40% of children in Australia and NZ will be affected by allergic disorders at some time during life.

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Allergies in Western societies are on the rise. The Australasian Society of Clinical Immunology and Allergy has quoted that allergic diseases have approximately doubled in the last 25 years and that up to 40% of children in Australia and New Zealand will be affected by allergic disorders at some time during life which is huge.

Corryn: Hello and welcome to the Milk and Love Village podcast. I m Corryn and today we re discussing the latest recommendations on allergy prevention for pregnant and new parents. With me I have the pleasure of the wonderful Jillian Dimock from BrisKidsNutrition. Jillian specialises in nutrition during pregnancy, early motherhood and also deals with children quite a lot; and is a fully qualified dietitian. She s passionate about applying evidence based guidelines for her patients.

Corryn: So hi Jillian, how are you?

Jillian: I m good Corryn. Thanks for having me.

Corryn: So let s start off. What is the difference between a food allergy and a food intolerance?

Jillian: That s a good question because they tend to blur. Intolerances are generally more common than allergies, but it s good to know that they are different. So an allergy is when the body actually has an immune response to a foreign object. So when we talk about food allergies when an individual consumes a food if they have an allergic reaction that will actually release chemicals in their body that will induce an allergic reaction. So we can actually measure allergies through blood tests and skin prick testing.

The difference is with intolerance, when the patient consumes the food allergen or the food that they re sensitive to, it doesn t actually induce any chemical change in the body but people will know that they have an unpleasant side effect. So the symptoms generally tend to be very similar to allergies. Someone with an intolerance may still get irritable bowel type symptoms or gastro symptoms or even hives, headaches, but we can t measure it; and there s also the tolerance effect with food intolerance that you can sometimes tolerate a fair amount of the food trigger, before you get a reaction.

The difference with an allergy is as soon as you consume that item, it doesn t matter how much or how little, an allergic reaction will start.

Corryn: Mmm so that makes food intolerances then very difficult to detect?

Jillian: It does, yeah, and that s why there s no simple quick blood test that you can have and unfortunately I ve seen quite a few patients recently who have been advised to have blood tests that really there is no reason, rhyme or reason for that because it doesn t prove anything to us, it just involves a lot of money output. The only way we can diagnose an intolerance is through a diet diagnosis where we remove all possible triggers and then one by one you reintroduce the food to see if there is a reaction and that s the way we diagnose food intolerances. With food allergies we have a few extra tricks up our sleeve where we can do skin prick testing from as early as 6 months in a baby. We can also do a type of blood testing that measures how the body reacts to a certain food or environmental allergen but we are finding in the allergy world that there are a sub-set of allergy kids and adults where we can t measure. There is no blood test or measure. So I can sometimes see a 9 month old baby who s had a horrendous first 9 months of gastro symptoms, prolonged effects, but the skin prick testing, blood tests, all come up negative.

Corryn: Wow.

Jillian: We do have a special name for that and that s non IGE mediated allergies but it s important for those parents to acknowledge that, yes the child does have an allergy but it s just that we can t actually test for that. They tend to be more of a delayed reaction versus a hive or a child who comes out in a rash straightaway.

Corryn: Mmm and I think it s also interesting that allergies can come and go. I know you can grow out of some allergies

Jillian: Yes.

Corryn: can you also acquire allergies?

Jillian: Yeah, so generally we have six main allergens that from birth a child is more likely to have an allergy to. So there s cow s milk, soya milk, wheat, egg, and nuts and shellfish and generally the only two that we know kids don t grow out of is the shellfish and the nuts, peanuts generally. There s lots of research though that is promising for those families who do have a peanut allergy child that potentially we are getting some really positive scientific studies showing that we can actually desensitise those kids, but it s a watch this space.

[Both laugh]

Jillian: But you know, it s really nice to know for those families that there is definitely a light at the end of the tunnel and I m sure in five to ten years time there will be some success with trying to reverse that allergy in those kids. And intolerance as well it generally comes it can come later in life, so I ll often see a lot of pre-menopausal women where suddenly they re having hives and reactions and generally that will be more of an intolerance than an allergy. But there is an increase in allergies in the adult population as well, yeah.

Corryn: Mmm and you also mentioned earlier that the recommendations for allergy prevention have changed since February 2013?

Jillian: Yeah. So with all the new allergy research that has come about, the Australian Dietary Guidelines did review their Infant Feeding Guidelines, so for pregnancy they recommend don t avoid anything. So where when I was pregnant I remember thinking maybe I shouldn t be eating peanuts, you know

Corryn: Mmm

Jillian: especially because I knew my sister s children had a peanut allergy. But even families where there is an allergy, the recommendation is to make sure that the pregnant mother doesn t avoid it and the reason for that, they suspect, is that a small amount of exposure when you re pregnant is better than sudden exposure to a baby.

Corryn: Mmm

Jillian: So during pregnancy not avoiding the same for during breastfeeding as well actually is it s actually allergies of even families where there is a child or an adult with a food allergy they will be they are currently recommending to continue to include all those foods in the diet unless there is a specific and notable reaction and then obviously we would stop. But the recommendation is to not have any restrictions during breastfeeding or in pregnancy.

Corryn: Mmm

Jillian: In terms of from when to start solids point of view there s changes with that as well , and I know when I had my children, my youngest is four, there was, you know, we had to start dairy at eight months and wheat wasn t until nine months and egg wasn t until ten months and so forth.

Corryn: Mmm

Jillian: That s all changed and that s all gone out the window! And purely from an allergy point of view the recommendations now start around six months, so it kind of gives us a bit of lee-way to start before and in fact ASCIA http://www.allergy.org.au/ who you mentioned earlier the Australasian body, really the governing body in Australia they recommend from four to six months.

Corryn: Wow.

Jillian: So the National Guidelines for Australians is around six months but ASCIA, the allergy body, they actually would like it introduced from four months. On my Facebook page I have a really great article that links to Professor Katie Allen in Melbourne and she has an article on basically why are food allergies on the increase and she has a hypothesis that it s the five Ds. So it s to do with delaying solids, it s to do with dirt, it s to do with vitamin D levels in our children and also to do with levels of probiotics in our diet as well. So if anyone s particularly interested, Professor Katie Allen is really leading research in Australia down in Melbourne and she s got some really interesting information that you can follow.

Corryn: Mmm

Jillian: So solids around six months. Don t delay anything

Corryn: Yep.

Jillian: they even recommend egg

Corryn: What about honey?

Jillian: OK, yes, so all foods whether they re an allergen food risk so the foods that we would potentially avoid like peanut butter or egg, they actually say introduce them.

Corryn: Yeah.

Jillian: There are still a couple of foods that we do recommend avoiding. Number one is not adding extra salt or sugar to baby s food. So that s not recommended. Preferably try to avoid that until after twelve months as well. Second thing is honey. So honey s still there and that s because of the botulism risk. So you know the heat treated Capilano that you buy at the supermarket that still poses a risk because there could still be some mould spores in the honey and that can the botulism can go to the brain in a young infant and cause damage. I remember working at intensive care in a children s hospital and we did have a case where there was a young infant who had resulting brain damage. So it s worth avoiding honey until after twelve months.

Corryn: Twelve months.

Jillian: So twelve months they say it s fine to start introducing and then the third thing is choking risk. So there s still the foods that we would avoid because the baby isn t developmentally ready to chew and masticate a food safely to swallow. So that s things like hard apple, hard carrot

Corryn: Grapes.

Jillian: Grapes. Whole grapes. Yeah, same. Cutting them up into small amounts is worthwhile and you know it s great, every mother will generally have a better idea of what their baby can and can t tolerate, generally those carrots and apples are the biggest, and popcorn are the biggest risk factors for choking.

Corryn: Mmm and I think it s also worth doing your, what do they call it, the first aid for children?

Jillian: Yeah.

Corryn: Before having a child.

Jillian: I did. That did cross my mind as well. My second boy gave me a complete breakdown when he choked on carrot

Corryn: Oh wow.

Jillian: because he was a baby that decided he was feeding himself and I was not feeding him anything!

[laughing]

Jillian: So, yeah, but he did choke on some carrot and it really was alarming; and I thought to myself, if I was just armed with that knowledge of what to do exactly.

Corryn: Yeah.

Jillian: You can prevent those things from happening.

Corryn: Cos I think, just quickly, the whacking on the back is the worst thing that you can do, which is one of the first things they tell you so it s but it s the most common thing that people do. I ve had people do that to my children and I said, no don t do that !

Jillian: Yeah.

Corryn: You can actually make it quite a lot worse so definitely always make sure that you re up to date with your first aid with kids, especially with choking because it s awful.

Jillian: Yeah.

Corryn: An awful thing to happen. And so with another common one that comes up baby led weaning what do you recommend around that? I know it s quite it can be quite a controversial topic.

Jillian: Yeah I think it is controversial but it really doesn t need to be. There s no specific recommendations either way. I think it just comes down to a mother s choice and , you know, I think if we always look at the child, some children do need that type of approach. So baby led weaning is when we allow the child to decide how much and what to eat, and generally it ll start by them being able to grab the food themselves and put it to their mouth. So it s a bit difficult in a six to seven month old they can t pick up a spoon and feed themselves puree!

Corryn: Yes [laughs]

Jillian: But they will start with things like cut up boiled egg or some, you know, I love those fishnets. You know the little nets you can buy where you put the soft fruit into like rock melon or watermelon and the baby can grab onto the ring and suck it themselves. So baby led weaning is all about the child feeding themselves and avoiding that puree stage. So Corryn I had mentioned earlier that it was the lazy approach and I took the lazy approach for baby number two because he wouldn t let me feed him! And I was petrified by nine months this child was still he was purely breastfeeding he would not eat anything

Corryn: Yeah.

Jillian: and it wasn t until he was able to get that pincer grip and grab the food himself. He just started feeding himself so I had to change all my ideas about purees and go, Oh OK this is good – embrace this – I don t have to puree and just give him finger food that was soft appropriate.

Corryn: Mmm

Jillian: And they do. It s amazing when you read it. Surely this baby s going to choke. But they do have the protective mechanism where they will tongue thrust and push it out if they can t masticate it enough to swallow.

Corryn: Mmm yeah it is amazing. Both of my kids didn t do the puree at all.

Jillian: It doesn t work for some people.

Corryn: No.

Jillian: You know every baby and mother is different so, I think, you know, you do what works for you.

Corryn: Mmm but interestingly I have had people comment on how good my kids fine motor skills are and I think it s from

Jillian: Ah OK, because it s utilised. ..

Corryn: Yeah, it s from the food and chasing little peas around their tray!

[both laugh]

Corryn: So I think there s lots of benefits as well.

Jillian: I d probably just add that when we do talk about introducing the solids, the main, from the main nutritionist point of view, the main reason is we need to get solids started around that sixth month, by six months is iron. So for the first six months of life the baby is using their in-utero iron store. They don t actually get any iron from formula or from breast milk and that s why we need to start solids. So the recommendations now are start on something that contains iron. So whether that be Farex or an iron containing rice cereal or starting with some pureed meat or chewing on Lando s . The most important thing is start with iron to get those iron stores developed in the baby. Yeah, so that would probably be the key thing. Generally we try to avoid starting meat and a lot of mothers are worried that that s a hard thing for a baby to digest but in fact it s not fibrous, it s very easy! [laughs]

Corryn: Yeah and good to chew on.

Jillian: Yeah that s right, yeah.

Corryn: And of course you ve got the beans. I know my kids loved canned beans, four bean mixes.

Jillian: Yeah for the legumes.

Corryn: Yeah, and the tofu if you re vegetarian and also introducing vegetables early I think. The leafy greens and stuff. Even if they don t eat them, just to play with them is a good way to do it because I see it as how many times do you have to introduce a food to .?

Jillian: It s a number that always changes but it really does depend on the child, but it can be anywhere from the first time for some through to about twelve times for another.

Corryn: Mmm

Jillian: So we often as mothers, we never get to twelve times. We wouldn t have the patience to cook something twelve times!

Corryn: Yes [laughs]

Jillian: But generally speaking with fussy eating and food for kids in general always remember it s up to you as the parent to provide the right food. It s up to the child to eat it. So you can t force them to eat it, but you can still put it on their plate! [laughs]

Corryn: And I do often find with my kids is as long as it s on their plate they will try it.

Jillian: Yeah OK, so yeah, some kids will. Other kids will completely freak out if it s on their plate. So for those kids you might want to put it on a separate plate in the middle of the table. But it s all just getting kids used to simply visualising it, being at the same table with it

Corryn: Mmm

Jillian: some of our kids will need that bit of a step up approach before they get it anywhere near their mouth!

Corryn: Yeah.

Jillian: And that s OK.

Corryn: I think the other big thing with my children, is because they re quite strong willed with the baby led weaning the benefit was that it was always what we were eating.

Jillian: Yes.

Corryn: So being able to take part in a family dinner and try lots of different foods.

Jillian: Exactly. The sooner you can get to eating normal food. What everyone else is eating, you develop healthier habits. Because we get a greater variety of foods, we start to introduce spice and flavour preferences and the sooner we can do that we know the less fussy a child will be.

Corryn: Mmm because they really do mimic what you do.

Jillian: They do! [laughs]

Corryn: a bit too much!

Jillian: Role-modelling is the key

Corryn: Yes!

Jillian: it doesn t matter what we say, you know, as parents we tend to need to say it. Simply sitting at the table and eating the food a child will learn that much more from.

Corryn: Mmm

Jillian: So I always use the example a lion cub will not eat meat until the mother has touched it and consumed it.

Corryn: Wow.

Jillian: As soon as the lioness has eaten it the lion cub thinks, OK this is safe, I ll go ahead . It s the same for adults and children you know the child needs to have faith in someone, that they feel safe with. If they consume it, OK it might be OK if I do it too . So sitting at the table is very powerful when a child s eating. Yeah.

Corryn: We ve actually also had to take condiments off the table, because my youngest, my two year old always wants to do whatever we re doing and yes the salt and the pepper and the sauces are yep.

[laughing]

Jillian: So we can use them to our abilities where needed but if it becomes suddenly a decorating competition then .

Corryn: It s not good!

Jillian: you do need to take them away!

Corryn: So we ve kind of moved away from allergies, so let s come back. What are the common symptoms of an allergy?

Jillian: That s a good question. It can be really broad and I m finding often babies go under our nose for a long time for that very reason. So even within the likes of cow s milk protein allergy, different babies can have different symptoms. Some babies will have blood in their stools or could have mucous in their stools. Whereas another baby s symptoms might just purely be extremely irritable so that night, overnight, they won t sleep and they ll be what we might call or misdiagnosed as colicky sometimes.

In the first two or three months of life if a baby has eczema that s a pretty good sign that the child does have a food allergy and generally that will often be a milk or an egg allergy that the child will have been exposed to, but generally it could be… It could also be vomiting.

Corryn: Mmm

Jillian: So I think in retrospect looking back at my first son we used to call him a happy chucker but and he thrived, so there was no problem with him doing that but maybe our first nine months of his life would have been easier if I possibly had removed cow s milk. So our common culprits are cow s milk or soya milk, egg, wheat and nuts. And for some women they can continue breastfeeding containing those foods in their diet.

Corryn: It is also in that order though isn t it, is that the most common down to the least common?

Jillian: Probably your top three are milk, egg and nuts.

Corryn: Yep.

Jillian: Yeah, so they re probably our most common and the children who are more H-type which means they re highly allergic generally they will have more than one allergen as well but the good news is, they will grow out of it.

Corryn: Mmm

Jillian: So with cow s milk protein which is probably actually our most common so down in Melbourne they recently discovered that one in ten children had a confirmed cow s milk allergy. So essentially

Corryn: Wow!

Jillian: it s a lot higher and we re finding that s why I just love Katie Allen s five Ds of food allergy. You know it s just simple things like if you live in the city you have a higher chance of having a child with food allergies than if you live in an urban and rural area.

Corryn: Wow.

Jillian: So a lot of it is to do with dirt. Are we too clean? [laughing]

Corryn: Hmm it s interesting isn t it?

Jillian: Are city dwellers a little bit too clean, whereas rural folk are a little bit more relaxed? And that goes in their favour!

Corryn: Mmm

Jillian: But where are we getting at Corryn? I ve lost track again!

Corryn: We were talking about the common symptoms of an allergy.

Jillian: Yeah so generally it will be skin related. It will be gastro related. It can be vomiting or diarrhoea. It can be eczema, hives. It can be a rash around the mouth so often kids will get a rash around the mouth. It can just be acid related so often kids will put oranges or strawberries and that actually can just be a contact issue not a food allergy. But generally in that first few months of life it s definitely not. It cannot always be colic. It can be a food allergen. The intolerances are less common. I suppose it depends on who you talk to really. It generally is more of a food allergen in the first twelve months of life. But we do have some kids where they also have that concurrent intolerance where it could be something like a salicylate or an MSG that starts to creep in and cause trouble and essentially family history is so important when we re talking and looking at these kids, if there is family history of intolerance, headaches, migraines, car sickness

Corryn: Mmm

Jillian: and those kids generally that does paint a picture for an increased risk, so seeing that I often find that with mums where do you go to. Because it is a really tricky area and I often find that they generally need to go to their pediatrician, that s a good step.

Corryn: Yep.

Jillian: If you re aware of in your community a good GP who is responsive to allergy needs that s always a good start as well. Finding a dietitian who specialises in allergies as well.

Corryn: Mmm Because it is, yeah with all the latest research

Jillian: It is common. There is an epidemic and it can really make the first six to twelve months of a mother and family, new baby s life really uncomfortable.

Corryn: Yeah and I think also going to see somebody like a pediatrician can help to identify all the possible avenues that they should explore

Jillian: Exactly. That s right. So, is it colic? Is it reflux?

Corryn: Yeah.

Jillian: We do know that with reflux there is a 30-40% chance of having a food allergy as well so

Corryn: Wow

Jillian: you know it s important to, if you do have these symptoms seek someone s advice like you said they can actually look at the picture and use that to brainstorm and to trouble shoot OK what could we be looking at here rather than starting to remove Brussel sprouts and caffeine and coffee .. and I saw one mum the other day and I don t know what she was eating. She d removed so much and was really keen to continue breastfeeding and she could. She just needed help.

Corryn: Yeah. I think that s also where seeing a professional comes in because there is a lot of stuff out there on the internet about how to do an elimination diet but I think it s best done with the help of a professional because it is so complicated and all the symptoms are

Jillian: Yeah, we can probably make it cheaper and quicker because we can do it in a shorter time. I do see some people who come to a clinic and they ve been following these crazy diets for two to three years because it wasn t done properly

Corryn: Wow

Jillian: and an elimination diet, I always say to be patients, are you ready to do it because it s full on…

Corryn: Huge

Jillian: It is not nutritionally complete, it s purely for the diagnosis, it s not for long term . We need to then start challenging some food chemicals to work out which is the culprit and then only remove that food rather than this array of foods that people have to live without which is really sad.

[laughing]

Corryn: Yes! And stressful.

Jillian: and particularly for a growing child. It is a concern for their growth and development.

Corryn: It s amazing. That s very interesting. So thank you very much. I think we re done.

Jillian: You re welcome. That was great.

Corryn: We ve been hearing all the latest recommendations on allergy prevention during pregnancy, breastfeeding and introducing solids with Jillian Dimock from BrisKidsNutrition. Make sure you check out her website at http://www.briskidsnutrition.com/ to find out more and also to read some of her lovely articles. I also recommend checking her out on Facebook at BrisKidsNutrition https://www.facebook.com/briskidsnutrition/ for more great information and inspiration.

You can also find all of the notes and links for this interview at www.milkandlovevillage.com.au

If you enjoyed listening to this interview then please do share it with your friends and make sure you check out our exclusive premium members area where we are putting together all of the essential information you need during your pregnancy, birth and early motherhood adventure with our trusted experts.

This is Corryn from the Milk and Love Village. I hope you have a fantastic week and thanks for listening!

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