Ask #SkinishMom – Why Can’t the Doc Just Give Me the Allergy Test?

#SkinishMom Parenting Skin Expert

Ask #SkinishMom any question – parenting, skin, eczema or plain venting!

My kid has eczema and we haven’t figured out what is the trigger. I’ve been asking the doc about taking an allergy test but the doctor either say that my kid’s eczema is only at a certain area, so no testing is needed or say that it’s those common allergens that affect almost every child, so again no testing is needed. But there’s no CONCRETE EVIDENCE of WHAT’S TRIGGERING MY CHILD’S ECZEMA – why can’t the doc just give me the test?

Frustrated Mom

I totally understand, many moms feedback the same and many docs replied the same. The short reply is if taking an allergy test is on your mind 24/7, just demand it. If the dermatologist that you’re seeing refuses to prescribe one, go to another doctor. After all, eczema is a long-term situation that requires much working and communication with your doc; if you can’t even agree on something as basic as whether or not to allergy test, it’s unlikely that this is a doctor that you can work with.

Allergy test for eczema child

On presenting both sides of the story:

From the parents’ view:

  1. You’re tearing your hair out figuring out the triggers, you need an allergy test to get some answers.
  2. You’re growing day by day fearful of applying corticosteroid cream on your child, figuring out the trigger means less flare-ups and less need for the steroid.
  3. You’re breastfeeding still and you seriously are going nuts on what you can or cannot eat.

From the doctors’ view:

  1. Your child’s eczema is localized, say on the face, thus likely due to saliva or food residue irritating the child’s skin. 
  2. Allergy testing is unlikely to be accurate for a baby (less than 6 months) and therefore, testing and working on the inaccurate results may turn out to be even more confusing for the parents.
  3. It is true that most of the children are affected by the common allergens of cow’s milk, egg, soy, wheat, seafood, dust mite, pet dander and pollen. Younger children are more affected by food while older children are commonly affected by dust mite. It is therefore a waste of money to be testing for something when you’d already know the test results.

SkinishMom’s view:

  1. Go for allergy testing, even if it’s going to turn out results you’d expect (so you know for sure).
  2. Go for allergy testing at the clinic/hospital where you’d want to see the doctor, because the results have to be interpreted and collaborated, with future action plan for eczema care
  3. Don’t go for allergy testing online or some ‘innovative’ allergy tests – skin prick, blood IgE and skin patch are the standard tests

Do what you (as a mom/dad) think it’d give you peace,

SkinishMom

Toddler Nutrition series with Natalia Stasenko – What NOT to Eat

Toddler Nutrition on Eczema Blues with nutritonist Natalia Stasensko

Don’t forget to get 30% off Natalia’s toddler nutrition class with code EcBlues30

This is a 3-topic series focused on nutrition for toddlers, in particular dealing with picky eaters or children who cannot eat certain foods. I’m glad to know a friend, Natalia Stasenko, a registered dietitian, whose passion is pediatric nutrition and shares nutrition tips on her website, online classes and of course, with all of us here in this series!

More on Natalia, RD – Natalia has a Master of Science in Nutrition Education from Columbia University. She founded her private practice Tribeca Nutrition and online nutrition class for parents of babies and young children at Feeding Bytes.
For further information on her latest online course on feeding toddlers, do check out this link. Natalia is also offering 30% to readers of Eczema Blues with the code EcBlues30.

My Child Can’t Eat That!
This final part of the Toddler Nutrition series with Natalia is going to be fun. If you missed the first two parts on How Much to Eat and What to Eat, do click on the links and catch up!

Today we will explore two scenarios:
i. What a Child Cannot Eat due to Allergy, Food Sensitivity or Intolerance, and
ii. What a Child Cannot Eat because he/she just shouldn’t!

MarcieMom: Hi Natalia, so good to have you back! Let’s go straight into the situation when a child cannot eat certain foods. Instead of focusing on each condition, could you offer quick insights into
i. When a parent should suspect there’s a problem with the child after eating the food?
ii. When should a parent bring a child in for test/ examination?

Natalia:In case with allergic reactions, the typical symptoms to look out for are hives, swelling of the face and mucous membranes found in the nose, ears, lungs and throat, nasal congestion and sneezing, intestinal cramps, vomiting and diarrhea. With smaller kids who cannot talk yet, general discomfort and crying after eating a specific food may also indicate an allergic reaction to food. If your child has any of these symptoms after trying a certain food for the first time, food allergy may be suspected. It is a good idea to call your doctor who will probably refer you to an allergist for a testing.

Food allergy is often diagnosed by one of the widely available tests: skin prick test and blood test for antibodies, neither of which gives a 100% guarantee of true clinical reactivity. These tests may be helpful to assist in diagnosing food allergy when the patient history indicates that a specific food may be a problem. A double blind placebo controlled food challenge is considered by this and other reports as a diagnostic “gold standard”. This basically means that a person is given the suspected food once and a placebo another time, without knowing what is what.
The challenges are provided in gradually increasing doses and neither the patient nor the practitioner knows in which order they follow, thus patient and clinician biases are removed.

Once the offering food is identified, the doctor will likely recommend to remove it from a diet.Children with food allergies may be at a high risk for nutritional deficiencies if important foods like dairy, eggs, or wheat are not replaced by nutritionally optimal alternatives. For example: calorie, protein and fat contents of cow’s milk are much higher than those in most milk substitutes, including almond and rice milk. A child who drinks rice milk instead of cow’s milk may not be growing properly because he or she will not be getting enough nutrients in the diet. Soy milk, on the other hand, is closer in calories, fat and protein to cow’s milk and could be considered a good alternative. The US Food Allergy guidelines recommend nutrition counseling and close growth monitoring for all children with food allergies in order to ensure proper growth and development.

MarcieMom: We know that there are certain foods that are the more common food allergens of children, while others are likely to cause intolerance. Given that a food (say fish) has more than one nutrients, how should a parent know what is a suitable replacement food i.e. as long as replacing the main nutrition, say is a protein or replacing the more beneficial nutrients, the omega-3 or finding a food that is as close to fish as possible (but that may trigger the same allergy?).

Natalia: It is a great question and I would like to provide some background information. Food allergy is an adverse reaction to protein in food. So every time the allergen is eaten, the immune system starts fighting it using the whole arsenal of chemicals causing the potentially life-threatening symptoms. Food allergy is often confused with food intolerance, which is caused by lack of digestive enzymes, such as lactase in case with milk intolerance. However, food intolerance does not involve immune system.

Food allergy can be IgE-mediated and/or non-IgE mediated. IgE-mediated basically means that when the allergen is ingested, the body produces Immunoglobulin E antibodies, which attack the allergen causing the release of histamine and other potent mediators that cause the symptoms of a food allergic reaction. Non-IgE mediated reactions primarily affects the gastrointestinal tract lining and causes allergic disorders such as protocolitis and
entrocolitis. To complicate matters further, a bunch of adverse food reactions can be both IgE and non-IgE mediated.

As you see, there are many different ways we can react to certain foods. To answer your questions, in the case with fish allergy it is more likely to the protein the child is reacting to so the health care provider will probably recommend stay away from all fish and seafood and take a DHA supplement instead.

In case of milk intolerance, switching to lactose-free milk will help to avoid the symptoms but if your child. has food allergy to milk i.e. reacting to milk protein, all dairy products lactose free or not, should be avoided. In my private practice I worked with many kids with food allergies who needed a safe and balanced diet to meet their nutrient needs after removing the allergens. In most cases I needed to collaborate with their allergists and pediatricians to create a plan that works for a specific family.

Thanks so much Natalia, we are taking a pause till next week where I’d publish Natalia’s reply to part (ii) of this post on what foods kids simply should not be eating. This is to give some time for parents to digest the tips from Natalia – as you can see, she is thorough in her explanation, so imagine how much more you’d learn from her online class. Do sign up and don’t forget to use EcBlues30 for that 30% off.

(Video) Quick Guide on Allergy Test for Kids

This is the fifth of baby skincare series, focusing on Allergy Testing. The previous four videos were on Common Baby Rash I Sun Protection for Kids I How to Shower Baby I How to Moisturize. I NEED YOUR SUPPORT, do subscribe to my EczemaBlues channel here. As I’m just starting out, and camera-shy, the video is my voice over slides that I prepared. Do share your comments pleeease on how I can improve them.

Firstly, understand that eczema is also known as atopic dermatitis, inferring that there is an atopy ie hypersensitivity to allergen involved. However, not all eczema children will have an allergy, for instance, my child is tested negative to the common allergens.

For most parents then, it makes sense to find out the allergens involved in your child’s eczema, eliminate/avoid these triggers, so that your child’s skin can heal (versus constantly being provoked to skin inflammation). There are two common allergy tests,

1. Skin Prick Test – this is recommended as it is fast, accurate and low cost, it’s not scary and my daughter didn’t cry at all when she had it at 7 month old. Many parents are worried about how many allergens the child has to be pricked with, but this worry is undue as there are few common food, environment allergens that most kids react to and thus only these need to be tested. Read more on SPT here.

2. Blood IgE test – this is usually recommended for babies without clear patch of skin or unable to go without antihistamine (which is necessary to abstain for a week before the SPT). Read more on allergy test here.

The allergy test is done during consultation and parents should not be afraid to ask your doctor the next course of action and how you’d expect your child’s skin to be within the next few weeks of prescription and allergen avoidance. Don’t be shy!

Do watch the video for more details and as always, appreciate you sharing your experience. Also what other videos would you like to see, do leave me a comment!

Parent (Patient) Eczema Consultation Tips with Dr Susan J. Huang – Before Consultation

Dermatologist Susan Huang interview with EczemaBlues Eczema

Dr Susan Huang interview with MarcieMom, EczemaBlues.com

It’s fairly common to hear eczema patients lamenting that their doctors seem to be just prescribing creams and not listening enough. It can be even more difficult for parents, particularly as we are not the one ‘experiencing’ the eczema but we’ve got the responsibility to learn as much from the doctor (while keeping our toddler quiet)! MarcieMom is privileged to know Dr Susan J. Huang, the chief resident at the Harvard Dermatology Residency Program, who works at multiple prestigious hospitals in the United States.

More on Dr Susan J. Huang – Dr Huang is the chief resident of Harvard Dermatology Residency Program, and works at many hospitals including the Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Childrens’ Hospital of Boston, Boston VA Medical Centers, and the Lahey Clinic. She is also the author of DermBytes.com, an online resource and blog on dermatology. Dr. Huang has written book chapters, published peer-reviewed articles, and presented at multiple national conferences on issues and topics in dermatology.

Marcie Mom: Thank you Dr Huang for taking your time to offer tips to our parents on what they can do before, during and after consultation, as well as what they need to consider if changing their doctor. Let’s start right away with preparing for a doctor consultation.

MarcieMom: I’m assuming that the child has already been diagnosed with eczema and the parent is looking for a suitable doctor. In Singapore, there are many good doctors, some of whom listed here. I note that each doctor has their own specialty/ interest apart from being a pediatrician – immunology, allergy, asthma and/or dermatology. Must a parent specifically ask for a doctor in a particular specialty?

Dr Susan Huang: When looking for a doctor for your child with eczema, it is important that the physician has taken care of many children with eczema and thus has sufficient experience and knowledge about eczema.  In the U.S., physicians who routinely take care of children with eczema consist primarily of dermatologists, allergists/immunologists, and pediatricians.  The relationship between the physician and the parent(s) and child is also very important.  Treatment of eczema involves many behavioral components and these take time to review and demonstrate at the visit.  You will likely be seeing this physician many times over years (unless you don’t like him/her!), so it’s important to have a good patient-physician relationship.

MarcieMom: One of the key reasons why I brought my baby to see a specialist in a children hospital was because allergy tests are not available at a general practitioner or even pediatric clinic. Read here for preparation before a skin prick test. Apart from physical preparation (no antihistamine, good health), how can a parent help the doctor who is seeing the child for the first time to learn as much about the eczema/skin condition? Keep a food diary versus skin condition? If yes, for how long? Write down suspected triggers? Write down how the parent has been managing the skin, for instance, already using hypoallergenic detergent or vacuuming weekly?

Dr Susan Huang: Your physician will ask you questions to get your child’s eczema history. You will likely review whether there are any exacerbating or ameliorating factors to your child’s eczema.  These may include ingested foods or contact allergens.  Having details such as the temporal relationship between the trigger and effect on eczema is helpful. Note that the role of food allergy and food allergy testing in eczema is still a debated one (http://www.nationaleczema.org/blog/allergy-tests-eczema-complex-controversial-topic).

We do know that there is a tendency for allergy, asthma and eczema run together.  Many patients will also recall a clear history of a certain food triggering eczema. In this case, it is important to confirm this potential trigger through allergy testing.  Keep in mind that food allergy testing is not perfect (as is the case for any testing) and can lead to what we call “false positives.” So although it may be tempting to test to all allergens and via skin prick, RAST or oral challenge, it is important to discuss with your physician to come up with the appropriate testing for your child. Our National Institute of Allergy and Infectious Diseases (NIAID) has put out guidelines for food allergy testing (http://www.niaid.nih.gov/topics/foodallergy/clinical/Pages/default.aspx).

Regarding whether food allergy testing should be performed, the guidelines state that testing for milk, egg, peanut, wheat and soy allergy should be considered in “a child younger than 5 years old, and has eczema that does not go away with treatment, or has eczema and a history of allergic reactions to a specific food. Children with moderate to severe eczema are at risk for developing food allergy, especially allergy to mild, egg, and peanut. These children may benefit from a food allergy evaluation.”  If testing is performed, it is important to review with your physician what the plan of action will be.  It is a matter of figuring out which tested allergens are affecting your child’s eczema, and your child’s nutrition should be taken into account as well.

Also have a list of prior treatments on hand. These include medical and non-medical treatments.  In terms of medical treatments, make note of what medication was used, for how long, where it was used (for topical medications), how frequently and how much was used, and the effect the medication had.  Remember to also tell your provider about other treatments such as bleach baths, wet wraps, etc.

MacieMom: Thank you Dr Huang, you raised some points that I didn’t think of such as bleach bath, wet wrap, treatments that the parent may have implemented prior to seeing the doctor. Excited to read your tips for during consultation next week.

SOMEONE Manages Allergy Testing for Child

Kristin on Allergy Testing on Eczema Blues

Kristin shares on managing allergy tests for child with multiple severe allergies

This is a 2013 series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Kristin Beltaos, whose son has severe food allergies and shares how she manages his allergies via allergy testing. Kristin is a member of the Anaphylaxis & Food Allergy Association of Minnesota’s Speakers’ Bureau and a consultant/licensed trainer and owner of A Gift of Miles.

Marcie Mom: Hi Kristin, thanks for taking time to share with us about allergy testing. Let’s start with you sharing your son’s allergy history – when did he have them and did it show up as rashes on the skin?

Kristin: Hi Marcie, thanks for asking me to participate. My son’s allergies exhibited themselves prior to us leaving the hospital from his birth. He vomited and scream-cried after breastfeeding multiple times a day; physicians and nurses attributed the vomiting to a baby’s underdeveloped digestive tract. At six weeks, his pediatrician decided to have an Upper GI Series to rule out pyloric stenosis, a narrowing of the pylorus, the opening from the stomach into the small intestine that causes severe projectile non-bilious vomiting in the first few months of life. This test came back negative. It was decided that he had severe acid reflux and prescribed Zantac and later Prevacid in order to control his condition.

For the next seven months his vomiting continued, he also had eczema, unexplained hives, did not transition to baby food or table food and was labeled borderline failure to thrive for 18-months.

Two particular instances made us think something more was happening than acid reflux. The first was that I tried to wean a breastfeeding and provided him with a milk-based formula. He literally had one drop on his lips; his head looked like a red, cherry tomato and he scream-cried for over an hour. At first I thought, ok, ok, you’re a breast man and you don’t want a bottle. Then connecting the dots had us questioning…is this a clue for something else?

The second was the straw for my husband and I. I’d describe my son as a happy, but fussy baby. I know that sounds contrary, but he really was happy. One morning, he was fussy and I picked him up and kissed him all over his head to make him laugh. For every kiss that I gave him he had a nickel size hive, there were eight hives for eight kisses. I had cereal that morning, and while my lips weren’t wet with milk, there was residue. Later we found he was allergic to milk by touch and ingestion, along with other allergens.

Lastly, because of missing the window between four and nine months when oral motor skills are developed, he served 18-months in the Children’s Hospitals and Clinics Feeding Clinic to learn how to orally manipulate his food, i.e., chew, transition food from side-to-side, learn how much to chew prior to attempt swallowing and work on food texture issues. Even after he was diagnosed with his food allergies at 11-months, his food challenges haunted him until he was just shy of his fourth birthday.

I have to say all the while this was going on, I always knew something was wrong. I knew the doctors were missing something. So I tell parents, especially mothers, know that you aren’t going crazy and to seek opinions until you find an answer.

Marcie Mom: When was your child’s first allergy test and how did the physician help you to interpret his test results? 

Kristin: At 11 months, my son had a Radioallergosorbent Test, commonly known as RAST Test, which is a blood test used to determine to what substances a person is allergic. Our pediatrician broke the news to us that he was allergic to Cow’s Milk (including by touch due to the cereal and kiss episode), Eggs, Peanuts and Tree Nuts. In the summer of 2011 we added Sesame to his list.

After his diagnosis, we moved to a board certified allergist for care.

Marcie Mom: How often is a repeat allergy test required? And did it benefit your family to learn of new/ outgrown allergies?

Kristin: Obviously allergy testing is recommended whenever you have a new and/or unexplained reaction of course. For management of already diagnosed food allergies, the recommendation may vary from allergist to allergist and based upon each patient’s individual allergies and needs. Personally, I have my son’s allergies reviewed on an annual basis.

Coincidentally, we just had his allergen review within the past week. We received good and bad news. His Cow’s Milk numbers have been on the rise in the past two years, very disappointing as you can imagine. In this last test, his numbers more than doubled, placing him in the next Class level, Class 4 that is labeled as a Strong Positive. Our allergist continues to encourage us to stay hopeful, that the big reveal would be closer to when he enters high school as to whether this may be a lifelong allergy. He’s only seven, soon to be eight, so we have some time yet.

His Egg numbers have stayed the same; however, we are able to do a Baked Egg Challenge to see if he might be able to consume Egg in a baked good, i.e., muffins, cupcakes, cake, bread, etc. This is a test done in a supervised medical environment, clinic or hospital, with your board certified allergist or other medical representative present. I should add that this type of Challenge is not something done at home in your own experimentation.

We’re also investigating, via another blood test, whether he might be a candidate for a Baked Milk Challenge. The results remain to be seen on this front.

Peanut is no longer tested for because his numbers are too high. It is believed that peanuts will be a lifelong allergy.

Interestingly enough, his Tree Nut results have come back negative, pointing to outgrowing this allergy. We will investigate with a skin test to confirm and of course orally test him by having him consume Tree Nut(s) that are processed on dedicated lines with no risk of cross contamination with peanuts.

Lastly, his Sesame results came back very low, which may point to him outgrowing this allergy as well. We will pursue a skin test, should he pass, a Sesame Oral Food Challenge would be in the cards for him.

As you can see, testing regularly not only allows you to know the status of a person’s allergies. Moreover, if a child outgrows an allergy or allergens, it permits the reintroduction of food items permitting an expansion in diet. An expanding diet is ALWAYS a good thing. : )

Marcie Mom: One final question – for a mom who has difficultly with figuring out false positives in test results, what would you recommend to do?

Kristin: I honestly do not have any recommendations regarding false positives. What I do recommend is finding and partnering with a board certified allergist that you truly trust. In doing so, you’ll feel confident in the recommendations provided and can go about living life to the fullest with food allergies.

Marcie Mom: Thank you so much for sharing your journey on managing allergies and allergy testing – many eczema families are also ‘figuring’ this out and your sharing will be useful for them!

About Kristin Beltaos, M.A. – Kristin is the owner of A Gift of Miles, offers food allergy one-on-one consulting, national and local trainings, school consulting, and parent/school advocacy; and serves the markets of stress, with subspecialties, and reproductive challenges. She is a Licensed Trainer with the Minnesota Center for Professional Development, teaching food allergy continuing education to early childhood and school age providers and educators, a member of the Anaphylaxis and Food Allergy Association of Minnesota’s (AFAA) Speaker’s Bureau and a former board member. Kristin wrote and drove the implementation of the first food allergy 504 Plan in her child’s school, was influential in creating a new school food policy which eliminated food celebrations (both in classroom and school wide) – a policy that other schools are interested in emulating. Kristin was named a Top 25 Food Allergy Mom, 2012 by Circle of Moms. Stay happy and informed by following Kristin on her Facebook, Twitter and Pinterest.

SOMEONE Managed Allergic March for Son with Eczema

Sarah, with her 3 children, shares on managing allergic march

Sarah, with her 3 children, shares on managing allergic march

This is a 2013 series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Sarah Chapman, whose third son has eczema since three-month old. Today, she shares how she managed her son’s Allergic March. Sarah is a volunteer with AllergyUK and had shared her allergy knowledge nationwide.

Marcie Mom: Hi Sarah thanks so much for taking part in my Friday blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your family’s eczema and allergy history, and when did eczema or allergy start and what’s the severity?

Sarah: I had eczema soon after birth, and throughout my childhood. I still get it every now and then. My maternal grandfather had it all his life. I can remember him scratching! My mother and her brothers had eczema as well. There is also a lot of asthma in my family and nickel allergies.

My husband has asthma with links to environmental allergies.

Marcie Mom: I understand that your son, now 17 year old, experienced the Allergic March, progressing from eczema to allergies.  What was his condition from birth to a young child?

Sarah: Our 3rd son had eczema day 10 after birth, and as time went by he had a poor sleep pattern (by that I mean an  inability to sleep for longer than 2 separate hours a night, and 20 min cat naps a day) He also had very slow and poor weight gain, even though breastfeeding was going well. These are the early signs of food allergy in a breast fed infant before three months old.

As he grew his eczema was very hard to control, his daily treatment was 5- 8 all body emollients and twice daily low dose steroid cream. Just before we were about to start wet wrapping treatment we discovered that he had an egg allergy and then peanut at 13 months old. I had also started to suspect that environmental allergies, like pollen, dog and cat were a problem.  At 18 months old immunologist confirmed allergies to, dust mite, cat, dog, tree pollen, hay fever, egg, tree nut, peanut.

As we paid a great deal to lessen dust mite exposure and pollen in our home, and controlled diet and his skin improved. When I stopped breastfeeding him, his skin got instantly better, but he began to catch every infection going, and skin became infected and so on.

Treatment added to original eczema plan, change of emollients, eye drops, nasal sprays, antihistamine during hay fever and tree pollen season.   Age 2 epi pens, and emergency plan for anaphylaxis.

Like many allergic children he physically shows signs of being an allergic child. He has a ‘captains salute’ a small dry crease on top of nose from rhinitis, from using hand to push up nose from constant nose drip. He is a mouth breather child, again a sign of poorly controlled rhinitis.

He has dark rings, and an extra dry crease under his eyes. He also has derma- graphism (am not sure about the spelling of that btw!) which means that if he is slightly scratched a wheal will form within minutes. He also snored as a child which isn’t normal and is a sign of rhinitis.

Rhinitis has a major impact on sleep quality, and babies and young children require sleep to grow. Concentration at school when you have a totally blocked nose 24/7 is very difficult and so has impact on education.

Marcie Mom: How did the eczema progress when he started elementary school?

Sarah: As he neared 5 his eczema improved, this is typical of an allergic march child, and at the same time his rhinitis and environmental allergies were making more of an impact. We had discovered more food allergies to add to list.  Eczema treatment 3 full body emollient a day, and no steroid cream required. Except after food reaction in which eczema would appear as hives and other IgE response symptoms disappeared.

Age 5   allergies, Dust mite, Tree Pollen, hay fever, dog , cat , egg, peanut, legumes, tree nut, kiwi fruit.

Age 7   Dog allergy considered life threatening, change to emergency treatment plan, oral steroids and asthma inhaler (has asthma response during allergic reaction, but not asthmatic) yeast extract new food allergy.

Food challenge in allergy clinic confirmed outgrown cooked egg allergy = increase in  food  choice with higher calories.(still underweight.)

Age 10 Outgrown raw egg allergy in food challenge. Dog allergy lessened and quality of life improved, for instance sleep overs with friends who have dog, controlled with antihistamine.

Eczema,dry skin only.

Marcie Mom: What was his condition as a preteen and teenager? Did puberty change his condition? And how is your son now, as a young adult?

Sarah: By 12 redeveloped raw egg allergy, and by 13 possibly cooked egg, now at 17 prefers to avoid himself.  Food allergies: Egg, Peanut, some Legumes, Brazil nut, Yeast Extract, Kiwi Fruit, Hay Fever, Mold, Tree Pollen, Dust Mite.

Skin very dry, but otherwise OK!

We have used epi pen 3 times so far, but despite this is gaining confidence in his ability to buy food independently and going out with his friends.

Marcie Mom: Thanks Sarah for taking time to share your son’s allergic march, it is useful for parents to know but hopefully, won’t go through the full allergic march!

Eczema Kids Nutrition with Judy Converse: Newborn – Just Milk but Complicated (Part 2)

Judy Converse, founder of Nutrition Care for Children LLC, is a licensed nutritionist and a registered dietitian.

Judy Converse, founder of Nutrition Care for Children LLC, is a licensed nutritionist and a registered dietitian.

This is a 4-topic series focused on nutrition for babies and toddlers with eczema. I’m passionate about nutrition and believe that it’s of utmost importance to our health – after all, it’s one of the daily survival activities of breathe, drink, eat and sleep! I’m honored to have Judy Converse, founder of Nutrition Care for Children LLC, to help out in this series. Judy is a licensed nutritionist, a registered dietitian for more than 20 years and authored the first web-interface accredited learning module for health care providers on nutrition and autism.

More on Judy Converse, MPH RD LD – Judy has a master’s degree in public health nutrition and a bachelor’s degree in food science and human nutrition. She authored 3 books including Special Needs Kids Go Pharm-Free and Special Needs Kids Eat Right: Strategies to Help Kids on the Autism Spectrum Focus, Learn and Thrive. She has also testified for safer vaccines and consulted with industry partners on specialized formulas for infants and children with inflammatory conditions. Judy is available for nutrition consultation at http://www.NutritionCare.net

Newborn – Just Milk but Complicated

Last week, we’ve learnt lots from Judy on hydrolyzed milk formula and she has provided a systematic analysis of alternatives.

MarcieMom: Let’s talk about the scenario where the child has no cow’s milk allergy and parents can decide among the many brands of formula cow milk. I’ve read about the toxins in formula milk – the antibiotics given to the cows and the cows eating a diet of genetically modified corn. I’ve also seen babies who drank lots of formula milk growing very big, exceeding far more than 100% on the growth chart. Is there (i) any conclusive study done on formula milk and its impact on the child’s health, (ii) does formula milk contain toxins and is it inflammatory? (if yes, which ingredient makes it so?) and (iii) how soon should parents attempt to replace formula milk with solid food that are rich in protein, calcium, vitamins and other minerals?

Judy: Breast milk is best, hands down. We’ve all heard that, and it is still true. There are so many immune modulating components in human milk that formula will never be able to emulate. It is so powerful in this regard, that it may outperform vaccinations in protecting the baby (see my blog post on this topic). Its impact on gut biome and long term immune function is just emerging in the literature. Unfortunately there are toxins in breast milk too, simply because we now live in a toxin filled world. These concentrate in breast milk. Rather than not breast feed, I would like to see women become conscious prior to pregnancy about eliminating toxins from their diets. Begin early to eat very healthfully, avoid pesticides, poor air quality, heavy metals, and other toxins. Consider working with providers who can help you detoxify prior to conception.

Meanwhile, yes, it is often easier for babies to gain and grow on commercial formula, as long as they are not allergic/sensitive to it. Bottle-feeding can offer faster delivery, so more is taken per feeding. But “more and faster” is not necessarily better. The carbohydrate source is often corn syrup, which is troubling for weight gain in older children. And yes all these ingredients – unless you have an organic formula – may come from genetically modified sources. I think there are enough data implying that GMO foods may be more allergenic to consider avoiding these entirely for a newborn, or during pregnancy. This is a big debate. For more info, parents can visit ResponsibleTechnology.org. Click on the link for health professionals, then on the “state of the science” link.

Solids can be introduced once your baby is able to sit well unassisted, can hold his head up, and is able to move soft foods to back of tongue and swallow them safely with a little practice. This can be around six months, but later is okay too. This might also depend on your baby’s growth pattern. Some will want solids sooner than others.

MarcieMom: Let’s talk about the scenario where the child has cow’s milk allergy. What would be the cow’s milk alternative? Fully hydrolyzed formula or goat’s milk (which I understand to be similar to cow’s protein, so may not help cow milk allergy?) or soy milk or rice milk?

Judy: We covered that in the previous section, except for rice milk. Rice milk should not be used for infant formula, period. It is devoid of protein and healthy fats that are essential for brain development. Please do not use rice milk! Same goes for oat milk, hemp milk, or almond milk. None of these are safe or appropriate for babies as a substitute for breast milk or formula.

Goat milk has casein, as does cow or human milk. But it is in a gentler configuration, slightly different than the cow casein, and is often quite tolerable for babies who can’t take cow’s milk. Again think in terms of two parts to this puzzle – the protein source, and the baby’s gut biome. Both may need changing to successfully arrest inflammation.

MarcieMom: I remembered the first six months when my baby was too young to take allergy test, we were advised to switch to partially hydrolyzed milk (our girl turned out not to have any allergy). When her rashes didn’t go away with the partially hydrolyzed milk, we switched to goat’s milk then soy milk (her rashes were still there all the time). It was a stressful experience copying all the ingredients across formula brands and different types of milk, and comparing which brand had higher carbohydrates, protein, calcium, DHA and more than 20 nutrition elements listed. What would be your advice when choosing formula milk – I assume first decide on the type of milk and once that’s decided, how to see which brand is better formulated?

Judy: This is too much stress for a new mom! I went through that and then some myself. This is how I became so interested in this niche of practice. I could not fathom that my pediatricians didn’t have good answers for me, or why it was so hard. I would have added an elemental option to those you were told to try, plus probiotics. As I mentioned earlier, this is commonly overlooked. I would also want to know what set your daughter’s gut up to be inflamed. Did she need antibiotics, C-section delivery (another early antibiotic exposure), time in NICU? All these things disrupt optimal colonization of the newborn gut with healthy bacteria. If this is found to have been the case, sometimes babies need herbs or medications to treat fungal species dominating the gut biome. I give this topic a lot of ink in both my books.

Your daughter may have had a milk protein sensitivity and a soy protein sensitivity, without allergic to either. These are mediated by different classes of immunoglobulins, one is IgE (allergy) and the other is IgG (sensitivity). Both can cause skin changes, feeding problems, and eczema.
A negative IgE test does not mean that a food protein is safe. Most allergists do not test for IgG reactions, because they think the testing is unreliable. This is not my experience in practice. The tests are not perfect, but they are useful, when interpreted in the context of food intake, signs, and symptoms.

MarcieMom: Thanks so much Judy, honestly, I feel like bursting into tears now, just thinking how difficult the first 9 months are, sorting through the milk formula, breast feeding, solid feeding – if only I’ve known you earlier! I’m sure many parents reading this will feel the same, and start to ask their docs of other alternatives.

Friday Dr Q&A with Dr Liew – Vaccines and Cross-Reaction

Dr Liew Woei Kang

Marcie, who inspired MarcieMom to start this blog, doesn’t have any allergy and thus, this blog has been focused on eczema. Recognizing that there are many parents whose child also have allergy, MarcieMom invites Dr Liew Woei Kang, Paediatrician with special interest in Allergy, Immunology & Rheumatology to share more about managing allergy for eczema children.

More about Dr Liew: Dr. Liew practices at the SBCC Baby & Child Clinic and is also a visiting consultant to KK Hospital. He was also awarded several research grants from the National Medical Research Council, Singhealth Foundation and KKH Research centre to pursue clinical research in paediatric anaphylaxis, drug allergy, primary immunodeficiencies and Kawasaki disease. He is also the President of Singapore’s Asthma & Allergy Association which is currently administering the very first eczema fund (initiated by MarcieMom’s donation) for low income patients in Singapore.

MarcieMom: On vaccines, there is so much discussion out there where even doctors are coming out to say that vaccines are unnecessary and pharmaceutical companies are coming up with more and more vaccines that are unnecessary and even harmful for our children. Some parents may be opting their child out of vaccines due to egg protein included in some of the vaccines. What’s your recommendation on this and when should a parent seriously questions a vaccine before letting his/her child have it?

Dr Liew: Vaccines are the one of the proven public health measures to reduce mortality from infectious diseases. Vaccines are produced for significant infectious diseases. There is no link between vaccination and allergies. Traces of egg proteins can be found in influenza vaccines and specialised vaccines like yellow fever. Egg allergic patients should discuss the risk benefit ratios of receiving these vaccines. MMR vaccines are safe for egg allergic patients.

MarcieMom: On antibiotics, I’ve read online that antibiotics are mostly unnecessary since they are only effective against bacteria yet it is so common for general practitioners to prescribe antibiotics! (in fact, I always have to refuse the prescription because it’s just a common flu!) Antibiotics are also known to cause allergic reaction, what would be your recommendation?

Dr Liew: Antibiotics should only be prescribed for bacterial infections.

MarcieMom: On cross-reaction, it’s commonly heard of when a child is allergic to birch pollen, he/she is also allergic to apple. Or a child who is allergic to latex is also allergic to kiwi. Can such allergy be identified by allergy tests? Also, what are some of the common allergies that you can point our parents to, so that they are aware if their child is allergic to one thing, they should probably avoid something else.

Dr Liew: Cross-reactive allergens occur due to the similarity of one protein to another, usually within the same botany taxonomy. They can be easily tested by skin prick test or blood IgE testing. A good example would be most cow’s milk allergic patients are allergic to goat’s milk as there is an approximately 95% similarity between the two.

MarcieMom: Thank you Dr Liew, it’s such a great pleasure to have you explaining all these allergy questions that many parents have, we are all so grateful!

Friday Dr Q&A with Dr Liew – Common Allergens in Children

Dr Liew Woei Kang

Marcie, who inspired MarcieMom to start this blog, doesn’t have any allergy and thus, this blog has been focused on eczema. Recognizing that there are many parents whose child also have allergy, MarcieMom invites Dr Liew Woei Kang, Paediatrician with special interest in Allergy, Immunology & Rheumatology to share more about managing allergy for eczema children.

More about Dr Liew: Dr. Liew practices at the SBCC Baby & Child Clinic and is also a visiting consultant to KK Hospital. He was also awarded several research grants from the National Medical Research Council, Singhealth Foundation and KKH Research centre to pursue clinical research in paediatric anaphylaxis, drug allergy, primary immunodeficiencies and Kawasaki disease. He is also the President of Singapore’s Asthma & Allergy Association which is currently administering the very first eczema fund (initiated by MarcieMom’s donation) for low income patients in Singapore.

MarcieMom: Based on your experience and knowledge of research studies, what are the common allergens in children? Also, we’ve been using an allergic reaction to food interchangeably with eczema, is it possible to have an allergy that’s not manifested on the skin? (We know the vice versa is possible, i.e. a child can have eczema without an allergy).

Dr Liew: The most common allergens depend on the allergic conditions. For eczema, older patients tend to be sensitised to house dust mites, but not food allergens. Some young infants with eczema has food sensitisation and trigger. The most common food allergens in eczema children include egg, cow’s milk, wheat, peanuts and soy. Some forms of food allergy eg, allergic enteropathy presents with isolated intestinal symptoms without skin involvement.

MarcieMom: If a parent suspect a food is causing an allergy, should the parent insist on it being an item to be included in allergy test?  As a pediatrician, would you test the child on what the parent suspect?

Dr Liew: A detailed history would be obtained prior to allergy testing. If there is a suspected food trigger, I would usually test it. I would usually encourage targeted testing, whereby only the relevant food items are tested. For eg, should the child be tolerating cow’s milk formula for the past 3 years, and eczema commenced after 3 years old, cow’s milk protein is unlikely to be a food trigger, and should not be tested.

MarcieMom: Gluten has been gaining more awareness and with many food packaging labeling gluten-free, some parents may think it’s gluten that’s causing the eczema. Again, how can a parent identify if it’s gluten (is it even a common trigger?) that’s triggering the eczema? How can this be differentiated from celiac disease?

Dr Liew: There should be a close temporal relationship between food ingestion and eczema flare. If there is inconsistent relationship, it is unlikely a food allergy. Celiac disease is an immune-mediated reaction to glutens, resulting in malabsorption in the gut, and resultant bloatedness, diarrhea and weight loss.

MarcieMom: Thank you Dr Liew, for our next DR Q&A series in July, we’ll learn some practical insight into how to manage our child’s allergy and eczema if our child is taken care by another care-giver.

Friday Dr Q&A with Dr Liew – Elimination Diet and Allergy Test

Dr Liew Woei Kang

Marcie, who inspired MarcieMom to start this blog, doesn’t have any allergy and thus, this blog has been focused on eczema. Recognizing that there are many parents whose child also have allergy, MarcieMom invites Dr Liew Woei Kang, Paediatrician with special interest in Allergy, Immunology & Rheumatology to share more about managing allergy for eczema children.

More about Dr Liew: Dr. Liew practices at the SBCC Baby & Child Clinic and is also a visiting consultant to KK Hospital. He was also awarded several research grants from the National Medical Research Council, Singhealth Foundation and KKH Research centre to pursue clinical research in paediatric anaphylaxis, drug allergy, primary immunodeficiencies and Kawasaki disease. He is also the President of Singapore’s Asthma & Allergy Association which is currently administering the very first eczema fund (initiated by MarcieMom’s donation) for low income patients in Singapore.

MarcieMom: Last week we talked about allergy testing and today’s questions are follow-up on what parents can do as a follow-up to the tests. Given that allergy tests are not 100% accurate, parents may start to rely on an elimination diet strategy. Can you explain how much you would rely on each allergy test and whether they serve a different purpose in your diagnosis?

Dr Liew: Standard allergy tests are accurate, but as mentioned last week, have their limitations. Unvalidated tests for food allergy include blood IgG testing, intradermal skin testing, applied kinesiology, electrodermal testing, hair mineral testing, and iridology, and should not be performed. Eczema is a chronic medical condition with no curative treatment currently, and some patient would undertake extreme measures to look for the “elusive trigger”. I would remind your readers that eczema is a skin disease, and not an allergic disease. Removing triggers can reduce the eczema, but will not cure it.

Empiric food elimination may be considered for 2-3 weeks if a consistent food trigger is suspected. An objective assessment should be made if food elimination has resulted in any change. Food triggered eczema would improve significantly with elimination. If there is no improvement, as in the majority of cases, the food should be introduced and assessment made if there is a change. I would caution regarding multiple food elimination as I have seen really malnourished and stressed out patient and families.

MarcieMom: I understand that it’s good to send the child for a re-test, to check if he or she has outgrown any allergy or developed new ones. What’s the reason for the change in the allergy profile of the child? Also, how often do you recommend a re-test and would your recommendation differ for a child who has different type of allergies and/or differ for a child who has different level of severity in eczema?

Dr Liew: Retesting is sometimes required in food allergies, but generally not necessary for eczema. The allergic profile of an individual changes according to his/her immunity and exposure to environmental proteins. We often see food allergens being “outgrown”, but a gain of house dust mite sensitisation with time. Retesting is usually considered if there is a new allergic disease eg. Allergic rhinitis, rather than based on fluctuation in eczema severity.

MarcieMom: Thank you Dr Liew; the advice you just shared is so useful as many parents, like myself, while struggling and managing with eczema in our children would have wondered if we ought to eliminate certain foods or bring our child for another test!

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