Children Food Sensitivities – Confusing Gluten

There’s so much about gluten-free these days – it’s an industry in itself and marketing ‘Gluten-Free’ is seen in menus and food packaging. We hear of sports celebrities performing better after cutting gluten and we hear of celebrity moms choosing gluten-free diets for their children. But what is gluten and what happens when you eat it? As the 4th part of this series, today’s post explores the different types of gluten sensitivities.

TOP 5 Facts You Need to Know to Differentiate Your “Gluten Sensitivity Type”!

Gluten refers to the proteins found in wheat, barley, rye and triticale (a cross between wheat and rye). Gluten gives elasticity/stickiness to the dough.

GLUTEN SENSITIVITY

GLUTEN SENSITIVITY TYPE #1 – CELIAC DISEASE (CD)

CD Fact #1: Involves immune system, BUT not IgE-mediated reaction to the gluten.

CD Fact #2: Immune system attacks the villi in the esophagus when exposed to gluten protein gliadin, found in wheat, barley, rye, and sometimes oats. This lead to intestinal inflammation, flattening of the villi and long-term damage to the small intestine. Associated with high intestinal permeability whereby bacteria, antigens and undigested food ‘leaked’ through the gastrointestinal barrier.

CD Fact #3: Symptoms include diarrhea, abdominal bloating/pain/cramps, bone/joint pain, bruises, constipation, depression, failure to thrive for children, mouth sores, infertility/miscarriage, malnutrition, weight loss, chronic fatigue, anemia, blood or fats in stool, nausea, joint pain, tingling on hands/feet, Dermatitis Herpetiformis or no symptom. Related to malabsorption of nutrients due to the intestinal villi being compromised.

CD Fact #4: Diagnosis is straightforward with tests to detect AGA (Antigliadin) and EmA (Andomysium Antibodies). Cutting gluten before testing will affect results. Small intestinal biopsy is an accurate test for celiac disease.

CD Fact #5: Treatment is strict avoidance of gluten in order for the villi to heal. Note that oats can be tainted with gluten and some common medications, vitamin supplements and cosmetic products also contain gluten. Untreated gluten has been linked to intestinal cancer, liver disease, small bowel ulcers and other inflammation-related diseases of the digestive tract, heart, joint and even brain.

GLUTEN SENSITIVITY TYPE #2 – NON-CELIAC GLUTEN SENSITIVITY (NCGS) or GLUTEN INTOLERANCE

NCGS Fact #1: Does not involve immune system and is not celiac disease. However, patients clearly experience discomfort and symptoms after ingesting gluten.

NCGS Fact #2: No intestinal inflammation and not associated with high intestinal permeability, unlike celiac disease.

NCGS Fact #3: Symptoms are gastrointestinal symptoms like abdominal bloating, diarrhea, gas, cramps, headaches and fatigue.

NCGS Fact #4: Diagnosis is not straightforward with no proven medical test. It is typically diagnosed after elimination of other similar conditions (for instance, wheat allergy, Irritable Bowel Syndrome) and after observation and further consultations.

NCGS Fact #5: Treatment is avoidance of gluten ONLY after confirmation of this course of action by doctors. Doctors will eliminate the possibility of celiac disease, wheat allergy or other diseases before advising on treatment for NCGS.

GLUTEN SENSITIVITY TYPE #3 – WHEAT ALLERGY (WA)

WA Fact #1 : Involves an immune Ig-E mediated reaction to the wheat protein

WA Fact #2: The increase in IgE antibodies trigger chemical release that lead to allergic reactions, that can either be manifested via the skin, respiratory or gastrointestinal systems and other behavioral issues.

WA Fact #3: Wheat is one of the common food allergens in children and symptoms include eczema, rhinitis, asthma, urticaria, conjunctivitis, abdominal pain, diarrhea and angiodema. These symptoms could be immediate (swelling or hives) or be delayed, including low weight gain in children. There’s also exercise-induced anaphylaxis to wheat.

WA Fact #4 Diagnosis is via allergy testing.

WA Fact #5: Treatment is avoidance of wheat. There is no need to avoid barley and rye which contains gluten but not wheat.

There is recently studied that people with non-celia gluten sensitivity may actually not be sensitive to gluten, but instead to FODMAPs. FODMAPs stand for fermentable oligo-, di-, and mono-saccharides and polyols, which are sugars, carbohydrates that tend to be poorly digested, e.g. frutose. It could be that gluten-containing grains are high in FODMAPs and thus avoiding gluten makes one who is sensitive to FODMAPs feel better. (see this study conducted as double-blind cross-over trial).

Hope this 4-part series clarify! it did for me and I have a clearer picture and better appreciation of the complexities involved in understanding and diagnosing one’s gluten-related (or suspected!) condition.

For other posts in this series, do check out

Allergic, Intolerant or Hyper?

Top 10 Kids’ Food Sensitivities Myths

Outgrowing Food Allergy

Sources:

MedicineNetFODMAP studyMayo ClinicWebMd

Mom E-votional : Each Child has a Gift

Child's Multiple Intelligence

Each child has his/her own gift – there are 8 multiple intelligences from this interview with Dr Thomas Armstrong and it’s amazing how each of us learn and can be ‘gifted’ in different way! I wonder too if having eczema helps or impedes our child in the way they learn and see the world – many children with eczema develop interpersonal and intrapersonal skills, to make friends and to explain the skin condition. What about your child?

The bible asks us to use our gifts too and I pray all the time that whatever I’m doing at this blog is using some of that gifts and helping someone!

Bible verse:

1 Peter 4:10 As each has received a gift, use it to serve one another, as good stewards of God’s varied grace:

God, help us and our children to discover our gifts and use it purposefully in this life! It would be such a waste if we never discover and use that something special we’re gifted with!

Your Child has a Gift

Eczema Camp for Singapore Kids on 28 Nov!

Eczema Camp Singapore

Come join as a family on 28 November 2014 – a camp for your eczema kids!

A reminder for signing up for eczema kids’ camp on 28 Nov (Friday)! Fun programmes are lined up with dermatologist’s talk.

Eczema Camp Program SIngaporeRegistration Fees: $10.00 per pax (including activities, transport and lunch). Registrations are confirmed upon receipt of payment, please call 6350 8560 or email [email protected] – it’s a wonderful opportunity for your primary school kids and pre-teens to make friends, who can support them in their eczema journey!

Children Food Sensitivities – Outgrowing Food Allergy

This blog has always been focused on eczema, rather than allergy. However, I came across a very good book by Dr Wayne Shreffler and Dr Qian Yuan on ‘Understanding your food allergies and intolerances‘ and found that it clarified many food allergy concepts. Thus, this 4-part series is to share that knowledge with you!

For the past 2 weeks, we’ve covered

This week, I’m doing something totally unscientific – I’m compiling all statistics I find online on outgrowing allergies to lay out in a graphical representation of  WHAT AGE will a CHILD (likely!) OUTGROW FOOD ALLERGY! It’s definitely not scientific because each study/report has a different focus but just to save time for you (paranoid moms and dads who would try to do the same), I figure I might as well make an attempt!

Age your Child will Outgrow Food Allergies

While reading up on outgrowing food allergies, I’ve found some interesting food allergy facts!

Fact #1 Shellfish allergy onset later in life (6 years and older) and usually lifelong. Same for fish allergy.

Fact #2 Shellfish allergy IS NOT THE SAME as fish allergy.

Fact #3: Shrimp, lobsters and crabs are more allergic than mollusks such as scallops, oysters, clams and mussels.

Fact #4: Allergy to one type of (fin)fish does not mean allergic to another BUT study in 2004’s Journal of Allergy and Clinical Immunology found that 30% of children and approximately 66% of adults reacted to multiple types of fin fish.

Fact #5: More women than men are allergic to fish (0.6% vs. 0.2%).

Fact #6: Egg allergy is most closely associated with eczema, among the other food allergens. (Does not mean that egg allergy is most likely the trigger for your child’s eczema, as house dust mite is the more likely suspect for older children)

Fact #7: You can be allergic to either egg white or yolk or both but avoid the whole egg as it’s not possible to ensure clean separation.

Fact #8: Eggs and Milk cooked under intense heat (say baking cakes) seem to be more well-tolerated but don’t experiment without doctor’s advice (study here).

Fact #9: Soy allergy tend to be mild

Fact #10: Highly refined soybean oil (not cold pressed, expeller pressed, or extruded oil) and soy lecithin is usually tolerated by people with soy allergy.

Fact #11: Food allergies developed from young (except peanuts, tree nuts, shellfish and fish) are more likely to be outgrown versus food allergies developed as a teenager or adult, which tend to be lifelong.

Fact #12: 26.6% of children outgrew their allergies by age 5.4.

Fact #13: The more severe the allergic reaction, the less likely to be outgrown.

Fact #14: Mean age of tolerance for egg allergy was age of 7.2; Milk 6 years; Tree Nut 9.6; Shellfish 11.6; Soy 7; Fin fish 9.3; Peanuts 8.4

Fact #15: Boys are more likely to outgrow allergies than girls.

When researching for this post, I actually found quite a number of websites carrying misinformation or unclear information where it’s either proven wrong in later studies (for instance, to delay introduction of foods) or information relating to intolerance being grouped as food allergy information (such as only larger amounts of food trigger a reaction).

Another ‘sad’ news is that there is a study that children can develop a second (different) reaction to foods that they have outgrown. This is a study on Eosinophilic Esophagitis or EoE where it was found that 17 out of 1,025 patients in the study had initially outgrown IgE-mediated reaction to the foods but now suffer from EoE reaction (see AllergicLiving.com for their interview with the researchers of the study). EoE is an inflammation at the esophagus due to increase of eosinophil cells, leading to narrowing of the esophagus.

Hope whatever age your child is, your family is managing the food allergies well. Share your outgrowing age below!

Sources:

  1. ACAAI
  2. RaiseHealthyEaters (post by Dr Joneja)
  3. FARE
  4. Mayo Clinic
  5. Medscape
  6. Studies (egg) here and here

Mom E-votional : WHOLE-Hearted Love

Love Wholehearted Mom Parents Kids GodIt’s almost impossible to give something our undivided attention these days – our many commitments, responsibilities, roles and our devices seem to pull us in all direction. What about undivided love? Sometimes I find it a mystery for those who have more than one child, is it possible to give undivided love to both? Even between an eczema child and a spouse, can love be undivided?

Yet, as a Christian, I am to love God wholeheartedly. I find it hard as well – in theory, loving God will translate to loving everyone, one another. IRL (in real life), I’m not sure how ti works – for me, I have lists of to-dos which I strike off to make sure I’ve somehow loved everyone I care about in my life, but that’s an effort in itself!

Bible verse:

Jeremiah 29: 13 You will seek me and find me, when you seek me with all your heart.

Lord, help me to be wholehearted in loving the people around me.

How do I love everyone I care about? How do I love without selfishness?

How do I love without resentment and balancing scales?

Help us parents of eczema kids to love, it’s So Important to get this right in life!

Love Wholeheartedly

Children Food Sensitivities – Top 10 Kid’s Food Sensitivity Myths

Top 10 ids food sensitivity mythsThis blog has always been focused on eczema, rather than allergy. However, I came across a very good book by Dr Wayne Shreffler and Dr Qian Yuan on ‘Understanding your food allergies and intolerances‘ and found that it clarified many food allergy concepts. Thus, this 4-part series is to share that knowledge with you!

Last week, we clarified Food Allergy vs Food Intolerance which gave an overview of the differences between the two. Today we can put this to test by tackling these Kids’ Food Sensitivity Myths!

Myth #1: This Food Doesn’t Agree with Me, I’m Allergic to It!

This actually reminds me of my hubby (lol), most times we don’t agree (that is when we actually talk!) but no, I’m not allergic to him (hopefully he thinks the same!). As explained in last week’s post, food sensitivity can be either in the form of allergy or intolerance. Some doctors also allow for a 3rd category of food sensitivity, when they can’t classify it as either an allergic reaction or find the chemical the body is intolerant to.

However, these days, there’s almost a ‘cool’ factor to say you’re allergic to something. So while it is possible that more people think or say they have an allergy than they really have, food intolerance/sensitivity may also be underestimated as they are hard to diagnose. Do note too that adults can also have an onset of allergy at an older age, esp for certain allergy like shellfish.

Myth #2: Food intolerances can be tested using IgG antibodies test

There are many IgG tests available online and generally the medical community is against this test for identifying food sensitivity. The main reason is that elevated IgE implies an exposure to the food rather than an allergy to the food. Also while 80% of the foods are the common suspects in allergy, IgG test may test hundreds of foods and with false positives, lead to harmful elimination diet.

Myth #3: You are either Allergic or Intolerant

For some individuals the same foods can trigger both food allergy and intolerance. For instance, there can be an allergy to the milk protein while also lacking lactase digestive enzyme to break down lactose. This is why it is important to consult a specialist as it is not easy to figure it out on your own.

Myth #4: You can eat JUST A LITTLE of the sensitive food

This falls back to last week’s explanation of food allergy and intolerance. For severe food allergy, smelling the food can trigger a reaction, and it can be fatal one like anaphylactic reaction (that’s why there is so much debate about peanuts on plane!). However, for food intolerance, some people can eat certain amounts or in certain forms, e.g. food cooked with milk (I tried this fish recipe before, tasted horrible!) may give a different reaction to drinking milk.

Myth #5: I feel Bloated, I’m Allergic!

Bloating is more closely related to food intolerance but eating gassy foods cause bloating too. Pregnant women suffer more from bloating and constipation due to pregnancy hormones leading to relaxation of gastrointestinal wall muscles, thus foods stay in the tract longer.

Myth #6: I didn’t eat the food, how can I be allergic to it?

Food sensitization is when the body first comes into contact with the food protein and the body then ‘tag’ it as an enemy. The next time even small amounts of the food (in some cases, touched or smelled) can trigger an allergic reaction. So smelling peanuts on plane, touching or shaking hands with another child with peanut butter trace on hands can lead to an allergic reaction.

Myth #7: Delaying food introduction to a child can prevent the food allergy

Based on updated studies, the recommendation to delay introduction of common food allergens (usually peanuts, tree nuts, shellfish) is now revoked. The studies were contradictory – some showed late introduction helped as the child’s immune system is stronger while others showed early introduction helped as the child builds an immunity to it earlier. Thus the current recommendation is Just Eat (Whatever) a Balanced Diet.

Myth #8: Allergy testing is 100% accurate

Allergy testing (skin prick and IgE) is fairly accurate but not 100%. The only gold standard in food allergy testing is the oral food challenge. However due to the difficulty of conducting the oral food challenge (involves hospital stay), doctors form a diagnosis based on corroborated ‘evidence’, for instance the test results, parents’ observations and doctor’s knowledge of food allergens, family history.

Myth #9: Organic Foods are Safer

Organic foods (only the properly certified ones) may be safer in terms of free from pesticides but not safer in terms of allergic reaction to the food protein. Organic or not, the food protein is still present. For some people, peeling the fruit’s skin or cooking in a different way may help.

Myth #10: Allergy test can tell how Allergic you are

Allergy testing only tells you if you have an allergy, but it cannot predict the severity of the reaction. For instance, (see this previous post), the size of the wheal from skin prick test does not correlate with the reaction you will have.                                                                                                   

Living with Eczema Book Launch

Book launch eczemaIt was very nice meeting many moms at last Saturday’s Living with Eczema book launch. Both Professor Hugo and I shared, and in case you’re worried you missed something important from Prof Hugo’s talk, here are the salient points!

1. As the child ages, the type of eczema may change (for instance, from atopic dermatitis to contact dermatitis – saliva, ingredients in skincare products) and the triggers change too (an older child is more likely to be allergic to house dust mites).

2. Avoid antibiotic cream as it is more likely to destroy weaker strains of bacteria but stronger strains prevails (oral antibiotic is also not advised)

3. Psoriasis n pigmentation are possible to be present at birth, but not eczema (thus indicating that an environmental element is present in this skin condition) > further reinforced by studies that show moisturizing a newborn baby at high risk of eczema reduces risk of AD by 50%

4. Reduce contact with allergens in the air, including eggs which are present in food court and non-circulating air. Egg protein is airborne, small and light – can even be in our dust and our mattress.

5. Recommendation to adopt an outdoor lifestyle to reduce contact with indoor allergen.

6. Untreated eczema  can lead to infection, particularly with scratching. Infected eczema after healing leads to dark scars which are permanent. Scratch lesions which persist will also reduce pigment cells, thus leading to skin discoloration. (See also eczema complications series, where many complications arise due to scratching/infection).

7. Eczema has a genetic component – 25% if both parents don’t have eczema, 60% if mom has eczema, 50% if dad has eczema.

8. In terms of food allergens in Singapore, egg is the most common, followed by milk, soy and wheat.

There is much more that is shared in the book Living with Eczema: Mom Asks, Doc Answers, watch this video to see what it covers. Furthermore, from now till 8 May 2015, Prof Hugo and I will answer any question you have from reading the book on GooglePlus, read here to find out how!

Mom NeedyZz Cartoon – Ashton Kutcher’s Dry Run

Mom Sleep Cartoon5Do let me know if you have any funny story on how your pregnancy! For all the cartoon in this series, look up this ‘Mom Sleep Cartoon‘ Category.

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