Tammy Hua Dietitian

How to combat the common child allergies

It is just heart-breaking to see your little one suffer from allergies – whether it’s food allergies, asthma, allergic rhinitis (hay fever), or atopic dermatitis (eczema).

Food allergy

A food allergy reaction occurs when a person’s immune system overreacts to a food (or a substance in a food) and triggers a protective response. Allergies tend to run in families; errors in a gene that helps regulate the immune system are associated with higher rates of allergies, but it’s difficult to predict whether a child will inherit a parent’s food allergy.
While any food can cause the allergic reaction, there are some common food allergens amongst children: eggs, milk, peanuts, tree nuts, fish, shellfish, wheat and soy.
If your baby is already diagnosed to be allergic to one of the above, here are some tips:

Allergen Management
Milk Use breast milk, soy milk or H.A formula
Egg Avoid egg and egg products and food items that may contain eggs.
Read the food labels and avoid contamination.
Use alternatives to eggs in recipes.
Anyone diagnosed with an allergy to either egg whites or egg yolks should avoid eggs altogether; it is not possible to completely separate the white from the yolk
Fish Avoid fish products and food items that may contain fish (ie. Worcestershire sauce and Caesar dressing).
Read the food labels and avoid contamination.
shellfish Avoid shellfish (ie. shrimp, lobster and crab).
Read the food labels and avoid contamination.
Peanuts Avoid peanuts and peanut products.
Avoid foods that may contain peanuts.
Be extra careful when eating Asian and Mexican food and other cuisines in which peanuts are commonly used.
Read the food labels and avoid contamination.
Avoid “arachis oil” (which is another term for peanut oil)
Some food (ie Chia seeds) may cause the same allergic reaction.
Tree nuts Avoid tree nuts and tree nut products.
Avoid foods that may contain nuts.
Read the food labels and avoid contamination.
Tree nut oils, which may contain nut protein, can be found in lotions, hair care products and soaps; those allergic to tree nuts should avoid using these products.
Soy Avoid soy, soy products and food items that may contain soy.
Avoid foods that may contain nuts.
Read the food labels and avoid contamination.
Wheat Avoid grains that contain wheat such as cereals, pastas, crackers, and food items that may contain wheat like some hot dogs, sauces and ice cream.
Read the food labels carefully to avoid cross-contamination during manufacturing process.
Choose wheat free products such as corn, rice, quinoa, oats, rye and barley.

Breastfeeding, complementary food and allergy

Breastfeeding can certainly help to decrease the risk of infection and allergy, but it is also important to know when to introduce the complementary food. WHO recommends to exclusive breastfeed up to 6 months, which is crucial in developing countries to eliminate the risk of infection. But with access to clean food and careful feeding practices, studies (1, 2) have shown that starting on solids during 4-6 months did not increase their risk of hospitalization for diarrhoea or risk of infection.
If the baby’s digestive system is ready for solid food, parents can start complementary food from 4-6 months if they desire. It’s recommended to introduce a variety of pureed natural foods in a small quantity, with no additional flavouring and seasoning. Studies have found that introducing wheat and eggs between 4 and 6 months had a decreased risk of allergy, compared to introducing them after 6 or 10 months. A study also showed a lower risk of type 1 diabetes when cereals were introduced between 4 and 6 months.

Probiotics and allergy

The occurrence of allergy is also associated with the presence of probiotics in the intestine. Lactobacillus can reduce the body’s allergic reaction by activating T cells and regulating the balance of Th1 / Th2. If pregnant women or both husband and wife have a family history of allergies, the chance of giving birth to children with allergies is higher. Many studies have found that, instead of supplementing the infants with probiotics, mothers who took probiotics during the trimester and continued to breastfeeding had a lower chance of giving birth to children with an allergy.

There are thousands of different types of probiotics and some of them have been proven to lower the risk of certain allergies. But there are so many probiotics products on the market, which one should you choose?
By taking Lactobacillus rhamnosus (LGG, LC705, F19, LPR and HN001), Lactobacillus acidophilus La-5, B. bifidum BGN4, B. lactis AD011, Bifidobacterium animalis subsp. lactis Bb-12 and/or B. longum BL999 from the trimester, it can help reduce the incidence of eczema in children by 20-50%.

It’s also shown that supplementation of synbiotics (a mixture of prebiotics and probiotics) with young children (over 1 year old) can reduce the incidence of atopic dermatitis. The probiotics in the studies included Lactobacillus fermentum LF-PCC, Lactobacillus acidophilus DDS-1, Bifidobacterium lactis UABLA-12, Lactobacillus salivarius, Lactobacillus rhamnosus LCS-742, and Bifidobacterium infantis M63.

L. paracasei LP33 was confirmed to be effective in improving allergic rhinitis, but in 2011, Dr. Xu Qingxiang discovered the probiotic Lactobacillus paracasei LP BRAP-01, which is not only more effective, but also able to improve the symptoms of asthma, atopic dermatitis, IBS, drug allergy, food intolerance. Moreover, a study done in 2012 showed that Lactobacillus lactis LJ EM1 can effectively improve the symptoms of seasonal rhinitis.
Although probiotics have a lot of advantages to us, it must be taken cautiously by people who have a low immunity, and also need to follow the recommended amount on the food label.

References
1. Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial. J Allergy Clin Immunol 2007; 119:184–191.
2. Prescott SL, Wiltschut J, Taylor A, et al. Early markers of allergic disease in a primary prevention study using probiotics: 2.5-year follow-up phase. Allergy 2008; 63:1481–1490.
3. Jensen MP, Meldrum S, Taylor AL, et al. Early probiotic supplementation for allergy prevention: long-term outcomes. J Allergy Clin Immunol 2012; 130:1209–1211; e5.
* A large randomized controlled trial (RCT) from Australia using postanatal-only probiotic supplementation showing no effect on eczema prevention in 5-year follow-up.
4. Kalliomaki M, Salminen S, Poussa T, Isolauri E. Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol 2007; 119:1019–1021.{22}
5. Kukkonen K, Savilahti E, Haahtela T, et al. Probiotics and prebiotic galactooligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol 2007; 119:192–198. {25}
6. Wickens K, Black PN, Stanley TV, et al. A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol 2008; 122:788–794. {32}
7. West CE, Hammarstrom ML, Hernell O. Probiotics during weaning reduce the incidence of eczema. Pediatr Allergy Immunol 2009; 20:430–437 {36}
8. Dotterud CK, Storro O, Johnsen R, Oien T. Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial. Br J Dermatol 2010; 163:616–623. {38}
9. Kim JY, Kwon JH, Ahn SH, et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial. Pediatr Allergy Immunol 2010; 21 (2 Pt 2):e386–e393. {39}
10. Rautava S, Kainonen E, Salminen S, Isolauri E. Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant. J Allergy Clin Immunol 2012; 130:1355–1360. {41}
11. Chang YS, Trivedi MK, Jha A, et al. Synbiotics for Prevention and Treatment of Atopic Dermatitis. JAMA Pediatr. 2016;170(3):236-242.
12. Simpson MR, Dotterud CK, Storro O, et al. Perinatal Probiotic Supplementation in the Prevention of Allergy Related Disease: 6 Year Follow Up of a Randomised Controlled Trial. BMC Dermatol. 2015;15(13).
13. Costa DJ, Marteau P, Amouyal M, et al. Efficacy and safety of the probiotic Lactobacillus paracasei LP-33 in allergic rhinitis: a double-blind, randomized, placebo-controlled trial (GA2LEN Study). Eur J Clin Nutr. 2014 May;68(5):602-7.
14. Prescott SL, Dunstan JA, Hale J, Breckler L, Lehmann H, Weston S, Richmond P. Clinical effects of probiotics are associated with increased interferon-gamma responses in very young children with atopic dermatitis. Clin Exp Allergy. 2005 Dec;35(12):1557-64.
15. Lue KH, Sun HL, Lu KH, Ku MS, Sheu JN, Chan CH, Wang YH. A trial of adding Lactobacillus johnsonii EM1 to levocetirizine for treatment of perennial allergic rhinitis in children aged 7-12 years. Int J Pediatr Otorhinolaryngol. 2012 Jul;76(7):994-1001.

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