FOOD ALLERGY
A food allergy is an immunological reaction to one or more proteins. Egg, Cow's milk and
peanuts are the three most common food allergens. The offending proteins enter the
bloodstream, and the immature immune system treats it like a foreign object or antigen
(i.e. virus), and reacts to it forming an IgE antibody. This antibody then joins with histamine
in the body resulting in an allergic reaction, which can include a range of symptoms from
rashes and swelling through to difficulty in breathing.
Most food allergies begin in infancy. With food allergic children usually having a history
of eczema or food intolerant symptoms including reflux and colic. Allergic reactions to
food are usually quite immediate although can be delayed, with blood and skin tests also
being used to identify problem foods. However intolerances can also show up as allergies
in infancy skin tests, so are used in young children as a guide only.

FOOD INTOLERANCE
Food intolerance is the term used for non-immune reactions to food; however they do
involve the immune system. The offending food (generally protein) enters the bloodstream,
and the immature immune system treats it like a foreign object or antigen (i.e. virus), and
reacts to it forming a non IgE antibody. This antibody then can cause a host of digestive
system symptoms ranging from occasional intestinal spasms and wind, colic like symptoms,
through to gastro esophageal reflux or eczema.

The effects of food intolerance can be dose related, and may build up over days from eating
a range of foods containing the same problem substance. Therefore the symptoms displayed
can vary in severity from hour to hour, day to day even week to week. Due to the large
variance between cases with each child differing from the next, we are only just beginning to
get an understanding of this condition and how it relates to infant distress.

Research is indicating that food intolerance, more specifically protein intolerance, plays a major
role in infant distress. Please note that we at DISA have yet to find a child that exhibits all of
the symptoms below. In the infants we at DISA have come into contact with, generally only
on or two symptoms where displayed. Generally the infant presents as simply fussy, colicky
or symptomatic of reflux.

Symptoms of food intolerance may include:
Aggravation of reflux
Wind
Reflux
Vomiting
Colic
Discomfort
Irritability
Obstructive nasal symptoms / blocked nose
Loose stools, mucus in stools
Constipation, or struggling to pass bowel motions.
Disturbance of sleep due to discomfort
Distress
Rashes

The research we have found states that the onset of symptoms after eating a problem food
can vary from almost immediate to delayed (up to 24 - 48 hours). However we at DISA
have found that some of these infants show symptoms in relation to having distressed or
fussy episodes within a day or two of birth, others slowly worsen in the weeks following the
birth, and others are fine even up to ten to twelve weeks before the food intolerance
symptoms or distress presents, thus adding to the confusion surrounding this condition.
Basically if in doubt, rule it out.

Food intolerances are both easy and hard to rule out. As food intolerance isn't an IgE
immunological reaction to food, although it is an immunological reaction, blood and
skin tests are not helpful, as they don’t always show up on these tests. So what do
you do?

Basically there are two methods which regardless of whether the infant is breast or bottle
fed, revolves around removing the protein from the diet, then reintroducing the protein.
Some parents chose not to do the second part of this process once they’ve seen their
child improve to the change in diet; this of course is up to you.

The elimination diet involves removing most problem proteins such as milk and soy protein
from the diet, in either yourself if you are breastfeeding or simply doing a trial of a
hydrolyzed formula. There are many hydrolyzed formulas available and generally parents
find they are put on soy then a partially hydrolyzed formula, and if they don’t work then
the infant are placed on Neocate formula. Please note that DISA has come across many
infants that did not respond until they got to Neocate. Failure to respond to soy or
hydrolyzed formula or the elimination diet does not rule out his condition. Only a Neocate
trial can be used to rule out food intolerance completely.

At DISA we have found that a 3 month old food intolerant infant generally takes two to
three weeks to respond to a Neocate trial, a 6 month old infant four weeks and a twelve
month old four to six weeks. This is longer if the child is ill or teething within this time.

In Australia Neocate is available from any G.P. who are authorized to give three month trials,
however then in Australia you are required to see a Paediatric allergenist/gastroenterologist,
for ongoing authority scripts, which brings the price down to around $20 per 8cans.

Some researchers are now theorizing that untreated food (protein) intolerance may sensitize
the immune system, making the infants more prone to allergies. This is because the incidence
of allergies later in life appears to be higher in children who had symptoms of protein intolerance
as infants. This is still only a theory and there has been no research done yet into this area that
we are aware of.

Please note that infants with food intolerance will have their symptoms such as
reflux return when they are sick, immunized or teething, this is suspected to be due to their
involvement with the immune system.

MILK INTOLERANCE
Milk intolerance is a different problem from cow's milk allergy. It may be an isolated problem
or part of a broader range of food intolerances. This is an intolerance to the protein in dairy
foods, and gets worse as the amount of cow's milk in the diet is increased.

An intolerance is the term used for non-immune reactions to food, and initial research indicated
that milk protein intolerance fell into this category. It was suggested that the infant was born
without enough enzymes to break down all the protein in the feed, resulting in undigested protein
building up in the large intestine creating gas and gastrointestinal symptoms. However this didn't
explain why it was worse when these babies had a virus, were teething or had just been
immunised, or why some parents reported rashes that coincided with the gastrointestinal
symptoms. It is now believed by specialists working in this area that milk protein intolerance is
more complex, and does involve the immune system, and that protein intolerance occurs when
the infant is born with an immature immune system that is unable to distinguish what should and
shouldn't be in the blood.

In Infants with protein intolerance it is now theorized that two things are happening

The first is that the infant because of an immature digestive system does not have enough
enzymes to break down all the protein in the feed, allowing undigested protein to enter
- the large intestine creating gas
- the bloodstream

The second is that when the undigested protein enters the bloodstream, the immature
immune system treats it like a foreign object or antigen (i.e. virus), and reacts to it forming
an non IgE antibody. This antibody then causes an array of reactions in the body ranging from
reflux and intestinal spasming, through to rashes and irritable behaviour.
Pliease note, the antibodies formed in intolerances are different to the IgE antibodies formed in
allergies. This is why intolerances are referred to as non-IgE mediated allergy.

This would explain why the symptoms reappear when the immune system is
compromised and why many parents of known milk protein intolerant children say
there is unsettled behaviour associated with the gastrointestinal symptoms as well as
coinciding rashes.

As a number of milk protein intolerant infants in the past responded to a soy formula, it
was wrongly confused with lactose intolerance for some time.

As many milk protein intolerant infants will be sensitive to soy protein as well, a soy
formula cannot be used for this condition. The two conditions are not related. Lactose
intolerance is an inability to break down large amounts of lactose, a sugar in milk,
resulting in undigested lactase building up in the large intestine creating gas, whilst milk
protein intolerance is a reaction to protein as a result of an immature immune system.
The resulting symptoms are similar, causing confusion even for medical professionals.

Milk protein intolerance we now know is the more common type of food intolerance in
infants. Occurring both in breastfed and bottle fed babies as protein is passed through
breast milk, research is indicating that at least 8% of all infants born will present with
this condition. Some specialists believe this figure is understated. This is an immaturity
that the infant will grow out of eventually, although it is thought now that if it is left
unaddressed, and the infant continues to have the offending protein, they may become
sensitised to the protein increasing the risk of allergies.

Symptoms
Symptoms of milk intolerance in babies may include one or more of the following:

Aggravation of reflux
Wind
Reflux
Vomiting
Colic
Discomfort
Irritability
Obstructive nasal symptoms / blocked nose
Loose stools, mucus in stools
Constipation
Disturbance of sleep due to discomfort
Distress
Rashes, recurrent hives
Leg cramps
Apparent difficulty w3ith passing bowel motions

Diagnosis
Infants presenting with this condition may exhibit one or more of the above
symptoms, with the range of symptoms differing among different infants For
example, one may be distressed with infrequent bouts of diarrhoea and
constipation, while another infant may simply be distressed. This makes it a
difficult condition for medical practitioners to diagnose.

A diagnosis is hence made by removing all milk and other diary products from
either the infant's or, if breastfeeding, the mother's diet. As 50% of these infants
are also intolerant to soy protein, soymilk or soy formulas are to be eliminated
as well. Goat's milk formulas are not a viable alternative. Often babies are put
on a formula such as Peptic Junior which has the protein component already
broken down into its subunits. However as this is based on cow's milk this only
works in some instances (around 15% of cases).

Milk protein intolerance is most successfully treated by the introduction of
Neocate, which is a totally non-allergenic extensively hydrolyzed formula that is
completely broken down into amino acids and is not based on cow's milk. It is
the only available formula that can be used to identify and treat milk protein
intolerance. Although your GP can prescribe it, you will need to see a specialist
paediatrician (paediatric gastroenterologist/allerginist) for repeats.

In breastfed infants the lactating mother is required to eliminate all diary and soy
products from her diet for at least two weeks. To compensate for the loss of
protein, carbohydrates, vitamins and minerals, she should eat an additional meal,
as well as take a calcium supplement of at least 1200gms each day. It is also
recommended that she try this diet only under medical supervision so as to monitor
her nutritional needs.

Most parents report an improvement within a couple of days, yet it may
take up to four weeks before any change is noted, longer if the infant is
teething, immunized or has a virus. Generally the older the infant, the
longer the response time.

Reflux and Milk Protein Intolerance
We've known for some time that a baby with reflux is likely to be milk protein
intolerant as well. What we've learned since then is that in some infants the reflux
is a symptom of the milk protein intolerance, that the intolerance is causing the
reflux and that once the milk protein intolerance is treated the reflux improves.

This has important ramifications in the treatment of reflux, as the only sign exhibited
by some infants that they have milk protein intolerance caused reflux, is that they
have reflux. So we are now seeing specialists in the field treating diagnosed reflux
with dietary changes as a first step in the treatment of reflux.

Some parents become confused when their baby, on medication for reflux, find on
going to a specialist that they are advised to stop all medications and instructed to
avoid diary and soy foods if breastfeeding, or switch to Neocate if bottle feeding.
They become more confused as Neocate is a watery solution that is refluxed more
easily, so can appear to make the reflux worse! However, as we are learning more
about milk protein intolerance this is becoming a necessary step in the
treatment of reflux.

MULTIPLE PROTEIN INTOLERANCE
Please note that it is now being theorized that if you are protein intolerant
and it is not addressed, this may compromise your immune system so that
it becomes more sensitive, and more likely to form an allergy later in life to
the offending protein.

A small percentage of babies have been found to be multiple protein intolerant, which
simply means they are sensitive to more than one protein. These may include eggs, fish,
peanut, soy, meat or gluten, however all foods are a potential problem.

All foods contain protein, with each type of food having different proteins, so apple has different
proteins to pear, etc. Some foods have higher levels of protein than others, with meat, fish, poultry,
milk, eggs, cheese and other foods from animals, generally having high amounts of protein, whilst
plant foods usually have small amounts of protein in comparison. Animal proteins generally are
referred to as complete proteins because they contain all the essential amino acids that are needed
by our bodies. Plant food proteins do not contain all the necessary amino acids, so are referred to
as incomplete proteins except for Soya beans protein which is a complete protein

Proteins are made up of amino acids, with there being about twenty two amino acids that occur
naturally in foods. It is the number of, types of and different combinations of amino acids that
determine the type of protein it is, whether it is milk or a carrot protein.

Now some of these amino acids are made by our bodies and others we gain from food. Our bodies
need protein to function. When we ingest protein, enzymes break the protein down, allowing the
amino acids to be absorbed into our bloodstream; we then use these amino acids to form and grow
body tissue, produce antibodies, enzymes, and hormones as well as store oxygen, assist in blood
clotting and provide energy. So protein is essential to life

Multiple Protein Intolerant Infants are identified and treated in much the same way as milk protein
intolerant infants, although obviously this has ramifications for a breastfeeding mother. As breast
milk helps develop both the digestive and immune system, and is the most nutritious form of food
available for an infant, treatment is dependant on a number of factors and is tailored to each
individual situation. Neocate on the other hand is already broken down into amino acids, so when
it is absorbed into the bloodstream, the immune system is unable to react to it.

LACTOSE INTOLERANCE
Lactose intolerance exists when there is difficulty in digesting lactose. It is caused by a
deficiency of the enzyme lactase in the baby's intestines. This enzyme breaks down the
amount of lactose in the feed, so the result is that undigested lactose builds up in the
intestines, causing pain.

Symptoms of lactose intolerance include:
- Abdominal discomfort
- Bloating and excessive wind
- Diarrhea

People with lactose intolerance can usually still digest some lactose without adverse
reactions. However more severe symptoms may develop in infants for whom milk is
the staple food. Lactose intolerance may also occur temporarily after gastroenteritis
in infants and children. It is important to understand the lactose content of various
foods. Milk, ice cream and yogurt have significant amounts, but other dairy products
have significantly less. Yogurt is less likely to cause symptoms because the enzymes
present may break down some of the lactose.

Diagnostic tests are possible if confirmation of lactose intolerance is required, although
they are usually reserved for severe cases. Please note that the faeces test only
indicates intolerance and does not confirm lactose intolerance. (If an infant is intolerant,
the intolerance generally results in spasms of the small and large intestine, resulting in
the lactose not being digested properly resulting in undigested lactose in the faeces)

Milk Protein Intolerance and Food Chemical Intolerance

Food chemical intolerance is thought to occur when the infant's body reacts to chemicals,
- Salicylates
- Amines
- Glutamate
- Food Additives (colors & preservatives)

In the bloodstream, causing a similar range of symptoms to intolerances. However it is
generally, but not always classified by behavior, ranging from sullen, withdrawn behavior
through to irritable, hyperactive, angry behavior such as is found with ADD. Food
chemical diets are achieving a lot of success and awareness in children who are having
behavioral issues or alternatively not doing well at school. However it can in infants
present as colicky behavior.

It is theorized that in food chemical intolerance the following is happening. Firstly, the
food chemicals such as amines, salicylates, glutamate or food additives are absorbed
into the bloodstream, where they begin to rise slowly over time. When they reach a
certain level in the blood stream, a threshold, the chemicals stimulate or aggravate the
nerve endings of the body resulting in a host of symptoms.

Salicylates Amines and Glutamate are naturally occurring chemicals that are found in
foods, in plants they act as a natural pesticide or deterrent to pests. They also act as
a natural preservative in plants. Generally the tastier the food the higher the level of
chemicals, and they tend to be concentrated near the surface of foods. The level of
Salicylates tends to decrease with the ripening of foods, where as Amine levels
increase with ripening or aging. High protein foods tend to be low in food chemicals
and vica versa. Children that are sensitive to food chemicals are often found to be
sensitive to colors and preservatives as well, so information on them is often grouped
together.

Food Additives comprise a range of both natural and artificial chemicals that we use to
color, preserve or enhance the flavor of foods the most likely problems are:
102,107,110,122,123,124,125,126,127,128,129,,132,133,142,151 ,155,160b,210,
211,212,213,214,215,216,217,218,219,200,201,202,203,220,221, 222,,223,224,225,
226,227,228,249,250,251,252,280,281,282,283,310,311,312,319, 320,321,621,622,
623,624,625,& products labeled "Natural flavors' or HVP TVP

Although protein intolerance generally occurs at birth and is common in infants, food chemical Intolerance is quite rare in infants, in comparison. With chemical intolerance becoming more common or identified as the child moves onto solids or in the toddler years. Both are identified in the same way with the introduction of Neocate, then trials of the suspected trouble foods; or with breastfed infants, an elimination diet of the suspected problem foods.

Please note, it is now being theorized that if you are protein intolerant, and you are eating the offending protein, this may compromise your immune system so that it becomes more sensitive, causing it to start reacting to food chemicals or preservatives on entering the bloodstream as well, leaving you with a multiple food sensitive infant who reacts to everything.

This is important because it means that although your child may appear to be food chemical intolerant and even though they may react to food chemicals, as one specialist told me it may not be the food chemicals that is the problem

Also some researchers are now theorizing that untreated protein intolerance may sensitize the immune system to other chemical substances such as amines and salicitates later in the child's life. This is because the incidence of food chemical intolerance appears to be higher in children who had symptoms of protein intolerance as infants. This is still only a theory and there has been no research done yet into this area that we are aware of.

Colitis
In some infants untreated food intolerance may result in inflammation of the colonic mucosa or the lining of the large intestine, which becomes red and sore, and may even form lesions that bleed resulting in bloody diarrhea.

Until this heals, it can cause the peristaltic action of the bowel to spasm, cramp and, in general, not work as it should. It can also cause pressure receptors in the bowel which stimulate the passing of bowel movements in infants to not work as they should. This is why constipation, apparent bowel pain, or difficulty in passing bowel movements, diarrhea and bloody faeces are all indicators of colitis. Like food intolerance, this is a transition condition, which responds well to eliminating the offending foods so will get better with time.

If milk protein intolerance is suspected and the child fails to respond to the introduction of Neocate or changes in the maternal diet, a colonoscopy may be necessary to identify the problem. Although the treatment is the same, a baby with colitis will take longer to respond to the dietary changes. This is a transient disorder, which responds well to eliminating the offending foods.

Once you've got a good idea what your child is or isn't reacting to, it’s worthwhile contacting the following
Department of Immunology
Royal Prince Alfred Hospital
Camperdown, N.S.W. 2050

AESSRA
P.O. Box 298 Ringwood VIC 3134
Ph 03) 888 1382

Dept of Allergy
Royal Childrens Hospital
151 Flemington Rd
North Melbourne 3051

DISA Guidelines on introducing foods to food intolerant infants.

1. Basically if your baby is on something like Neocate you are dealing with a baby that is likely to be sensitive to protein and possibly food chemicals, so playing it safe is the key.

2. You will need help don't start foods until given the all clear and then in the order as advised by your specialist. Discuss with your specialists guidelines for doing so

3. Don't use commercial products as there is always more than one factor, IE Even the plainest rice cereal has rosemary in it, so that in order to know what is the problem

- You buy fresh,
- You cook it,
- You prepare it
- And you don't add anything
- Besides boiled water,
- Or water if you know waters okay!

4. If introducing a food for the first time and your baby has had severe or allergic reactions, try the food first on their finger, wait a while (I.e. a couple of hours), their cheek, and then their lip. If no sign of a reaction, you can try giving the child a quarter of a teaspoon.

5. You may have thought a food diary was for Neurotics but not any more. Use a calendar, a scrap of paper, but you write down every time you introduce a food and watch for any reaction.

6. Any change is a reaction, miserable behavior, distress, constipation, diarrhea, and pain, rash swelling etc Rashes, swelling or any reaction involving breathing needs to be reported to your specialist immediately.

7. Start small and introduce the one food for a week, starting of with a quarter of a teaspoon and doubling the amount once a day over the week. If at the end of the week it's okay it can be included in the Childs diet if not, mark it according.

1 for not to bad
2 for bad reaction
3 for absolute hell!
This will help you later on!

8. Introduce foods in the following order

1. Rice
2. Fruit (Excluding citrus/berry & kiwi fruits) & Vegetables(excluding onions, tomatoes, mushrooms)
3. Cereals(one at a time I.e. wheat/oats/rye
4. Meats(starting of with white meat excluding fish)
5. Other (sees your specialist in regards to soy/ milk/ nut/ fish and egg products).

9. Generally with soy milk nut and eggs you introduce them in things first like milk in baking etc once well established and generally not within the first year and certainly not until your specialist tells you to.

10. Once you feel your Childs reacting you stop the food, if unsure you keep going and if still unsure cease it and see if there's an improvement on ceasing the food. You then mark the food according and give the child a break before trialing the next food.

11. A break between trials of different food ranges from a week or more, depending on the child and the reaction.

12. Once you've gone through a variety of foods you can go back and try foods that scored low on the initial trial. We've found 2 months at least for foods rating 1, 4 months for foods rating 2 and 6 months for foods rating 3, was a good guide for our children. If your child rates higher on retrial we found it best not to retry that food within 6 months.

13. We found it impossible to determine everything on labels due to all the names given to soy, milk nut and egg products I.e. Vegetable oil has soy in it as soy's a vegetable, Lecithin and Emulsifier is often soy, also we found numerous cases of cross contamination, I.e. a child had a reaction to nuts from rice bubbles because of cross contamination, the company used the same machinery to make a cereal with nuts as they did the rice bubbles, so found it best if you stick
to the general rule that you don't buy commercial or manufactured products in sensitive infants until that infant is well
established on foods..

14. We also found all takeaway and deli foods, especially hot chips to be a problem because of the above! It's not only what they've used in the cooking process but what they've cooked before, i.e. fish in the oil, before cooking your chips in it! So again we found it best to go by the general rule of no take away until the infant is well established on foods.

15. Many mums where told if their child couldn't have one food that means they couldn't have another, I.e. pear then they couldn't have apple, we have found this not to be the case, it is much of a much ness and unless you are talking dairy foods which all have milk in them, then we found no rhyme or reason to the foods.

16. We found that the following where best avoided until the child was over twelve months and well established on foods

1. Spices, herbs, sauces, stock
2. Fizzy, alcoholic drinks and commercial cordials
3. Commercial and Manufactured Foods
4. Deli and all Take Away/Restaurant Food
5. High Protein Foods (dairy, soy, nut, egg, fish)

TIPS
The more a food is cooked or prepared the more protein your child will ingest, so try steaming the food so they just lose their crispness instead of boiling it and offering as a finger food instead of pureeing it when introducing for a trial. Fruit is often best offered as a finger food for the same reason when introducing it.

Sandwich bags are invaluable for these children

If you weren't organized before now you will need to be, try not to leave the house without a meal packed for emergencies, including a treat bag, it will stop you from being tempted to take a risk on foods whilst you're out.

Don't trial foods if there teething or sick

We found they recover quicker from a reaction on straight Neocate, even if for just 24 hours.

Don't have untolerated food out unless necessary, as they will find it.

Explain to visitors the situation before they come or on arrival, as being a good host may cost you three days of their life

A badge that clearly states NO FOOD PLEASE can stop many frustrating situations for both you and your infant when out.

DISA, its members and volunteers are unable to accept any liability for any advice or information given.
Professionally qualified advice should always be obtained if required