Dealing with Food Allergies in Babies and Children PDF
Preview Dealing with Food Allergies in Babies and Children
D F A EALING WITH OOD LLERGIES B C IN ABIES AND HILDREN Janice Vickerstaff Joneja, PhD, RD BULL PUBLISHING COMPANY BOULDER,COLORADO Copyright©2007BullPubishingCompany BullPublishingCompany P.O.Box1377 Boulder,CO80306 (800)676-2855 www.bullpub.com ISBN:978-1-933503-05-9 Allrightsreserved.Noportionof thisbookmaybereproducedinanyform orbyanymeanswithoutwrittenpermissionof thepublisher.Manufactured intheUnitedStatesof America. Publisher:JamesBull InteriorDesignandProduction:ShadowCanyonGraphics CoverDesign:LightbourneImages LibraryofCongressCataloging-in-PublicationData Joneja,JaniceM.Vickerstaff,1943- Dealingwithfoodallergiesinbabiesandchildren/JaniceVickerstaff Joneja. p.cm. Includesbibliographicalreferencesandindex. ISBN978-1-933503-05-9 1.Foodallergyinchildren—Popularworks.2.Foodallergyininfants— Popularworks.I.Title RJ386.5.J662007 618.92’975—dc22 2007023450 FIRSTEDITION 10987654321 CONTENTS Preface........................................................vii Introduction ...................................................xi CHAPTER1 WhatIsFoodAllergy? ............................................1 CHAPTER2 DealingwithFoodAllergyinBabiesandChildren ...................25 CHAPTER3 Preventionof FoodAllergy .......................................33 CHAPTER4 Symptomsof FoodSensitivityinBabiesandChildren ................57 CHAPTER5 Diagnosisof FoodAllergy........................................67 CHAPTER6 DetectingAllergenicFoods:EliminationandChallenge ...............89 CHAPTER7 MilkAllergy ..................................................125 CHAPTER8 LactoseIntolerance ............................................153 CHAPTER9 EggAllergy ...................................................177 iv CONTENTS CHAPTER10 PeanutAllergy ................................................195 CHAPTER11 SoyProteinAllergy ............................................215 CHAPTER12 AllergytoTreeNutsandSeeds ...................................225 CHAPTER13 WheatAllergy .................................................231 CHAPTER14 CornAllergy ..................................................243 CHAPTER15 SeafoodAllergy ...............................................253 CHAPTER16 TheTopTenAllergens:Avoidanceof Milk,Egg,Wheat, Corn,Peanuts,Soy,TreeNuts,Seeds,Shellfish,andFish .............261 CHAPTER17 FructoseIntolerance ...........................................269 CHAPTER18 AnaphylaxisandFoodAllergy ...................................277 CHAPTER19 HyperactivityandDiet .........................................289 CHAPTER20 AutismandDiet ...............................................305 CHAPTER21 OralAllergySyndrome .........................................315 CHAPTER22 EczemaandDiet ..............................................323 CONTENTS v CHAPTER23 AsthmaandFoodAllergy .......................................341 CHAPTER24 ImmunologicallyMediatedAdverseReactionstoFoodsin Childhood:FoodAllergy,FoodIntolerance,orSomethingElse? .......347 CHAPTER25 ProbioticsandAllergy ..........................................365 APPENDIXA DietaryConsiderationsfortheExpectantMother ...................381 APPENDIXB Gluten-andCasein-FreeDiet....................................411 APPENDIXC Gluten-FreeDietforManagementof CeliacDisease.................435 APPENDIXD ChallengePhase:EliminationandChallengeProtocolsfor DeterminingtheAllergenicFoods ................................445 APPENDIXE MaintenanceDiets .............................................477 APPENDIXF AUsefulToolintheDietaryManagementof FoodAllergies ..........495 APPENDIXG VitaminB12 ..................................................501 APPENDIXH SulfiteSensitivity ..............................................503 Glossary .....................................................511 Index ........................................................535 This page intentionally left blank PREFACE SomeyearsagoIwasinvitedtogivealectureataconferenceorganizedbya food allergy support group in Ontario,Canada.As I made my way to the lecturetheatre,Iwasconfrontedbyadistressinglymacabrescene:emergency health professionals in full uniform with ambulance stretchers and hospital gurneysanddisplaysofresuscitationequipmentcompletewithfacemasks,IV tubing,oxygen cylinders,and syringes ready for injections.Of course,such a scenario is not unusual when a patient is at risk of anaphylactic shock. However,as an exhibit,the message was too stark and frightening for a con- ferenceonfoodallergyinchildren. Unfortunately,theexhibitsetthetoneforthewholemeeting.Hair-raising stories of fatal and near-fatal anaphylactic reactions, frantic emergency calls, andterrifyingracestothehospitalbycarandambulancewererecountedwith relish.Theattendeeswere,forthemostpart,parentswhosechildrenhadbeen diagnosed with food allergy.Those new to the allergy scene were clearly dis- tressedandupset.Itisalwaysimportantforanyoneassociatedwithfoodaller- gy, especially parents and care-givers of atopic infants and children, to be aware of all the potential dangers. But, to present the rare threat of anaphy- laxisinsuchfrighteninganduncompromisingtermsamountstoquiteunnec- essary fear-mongering. Anaphylactic resuscitation is rarely required in the day-to-day management of food allergy.To generate such fear and anxiety at theoutsetof aconferencedesignedtoequipparentstohandlefoodallergyin their children has the potential to jeopardize the well-being of not only the atopic child but also the whole family and the family’s support network. A story from my years as head of the Allergy NutritionProgram at Vancouver HospitalandHealthSciencesCentreinBritishColumbiaillustratesthiswell. Jasona was a 14-year-old boy. He was referred to the Allergy Nutrition Clinic by his family doctor who was becoming concerned about his growth a Namehasbeenchanged vii viii DEALINGWITHFOODALLERGIESINBABIESANDCHILDREN and development.Jason was an only child and came into the Clinic with his mother and father. His mother was a nurse and his father worked in retail sales. Jason appeared much smaller than would be expected for his age even thoughbothparentswereofnormalheightandstature.Hewaspaleandfragile- lookingandworeabaseballcapthathidhisthin,sparsehair.Hismothertold hisstory. Jason had been a colicky baby and had developed eczema at about two monthsof age.Atsixmonthshismotherhadconsultedanallergistwhoper- formed skin tests for food allergy. The parents were informed that the skin tests were“positive to everything.”A list of foods that Jason must avoid was provided by the allergist. Faithfully, the mother had eliminated all of the “allergy foods,”and Jason had never eaten any of them.His diet consisted of about eight foods that were not on the allergist’s“avoid list.”Jason had con- sumed only these foods since the age of six months. He had been given no nutritional supplements because his mother did not think they were “safe.” Jason added his own story.He felt very unhappy in school.He was teased by the other children because of his sparse hair and his small size, which was more typical of a 9-year-old than a boy in his early teens. Jason’s father said littlethroughouttheinterviewbutmadeitclearthathefelthiswifewas“over- protective”of the child.Nevertheless,he thought that because his wife was a nurse she was entitled by her training to be in charge of Jason’s health. The fatherwasobviouslyunhappyabouthischild’ssituationbutfeltpowerlessto interveneinanyway. ItwascleartomethatJasonneededtostarteatingamuchwiderrangeof foodsthanhewaspresentlyconsuming.Hissmallsize,fragileappearance,and obvious lack of development were unmistakable indicators that multiple nutritional deficiencies were very real risk factors for his health and well- being. We arranged for Jason to undergo challenge tests, starting with small amountsof individualfoodsandmonitoringhisreactionsinasafeenviron- ment. I waited to hear the outcome, hoping for some encouraging news about his progress. Two weeks later, Jason and his mother came into the office; both were noticeably ill-at-ease. Apparently, the challenge test had been cancelled.No new foods had been introduced.Gradually,the sad story unfolded.Priortothedayscheduledforthefirsttrial,Jasonbecameextreme- ly anxious and upset.He had become nauseated,vomited continuously,and wasunabletosleep.Apparently,hewasconvincedthathewasgoingtodieas
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