How Our Formulas Help Those with Common Sensitivities and Digestive Conditions

What are the symptoms of a food allergy?

Symptoms can include any of the following:

• Skin: redness, itchy hives, rashes, or eczema
• Respiratory: nasal congestions, runny nose, sneezing, dry cough, wheezing, asthma or shortness of breath, turning blue
• Gastrointestinal (GI): nausea, vomiting, stomach cramping or diarrhea
• Cardiovascular: drop in blood pressure, feeling faint, confused, weak or passing out, chest pain, weak pulse
• Nervous systems: itchy mouth or ear canal, trouble swallowing, swelling of the lips, tongue and/or throat that blocks breathing

Reactions can occur immediately, or within a few minutes to hours. The scariest of these reactions is called Anaphylaxis which can be life threatening if not treated immediately with epinephrine.

How are food allergies diagnosed?

Tests should be conducted by a board certified allergist who will take into account your detailed history. Your primary care physician can provide you with a referral if needed. An allergist may use a combination of testing methods to confirm results.

If food allergy testing is negative, this is definitive. However, positive results are wrong 50% of the time. This is why it is ideal to only test the suspected food rather than a panel. An oral challenge is the gold standard of food allergy testing but are time consuming and place the patient at risk of having a reaction.

Skin Prick Test (SPT)

Procedure

• Tiny needles puncture the skin and a small amount of the food protein is applied
• The wheels around the reaction sites are then measured to identify a food allergy

Time for Test

• Results available in about 30 minutes

Limitations

• Can lead to over diagnosis because of high number of false positives
• Does not measure severity of reaction
• Not diagnostic alone
• Best used together with blood test

Serum IgE Test

Procedure

• Allergen specific blood test
• Must be drawn by or sent to lab for analysis
• Higher numbers = more accurate

Time for Test

• Results make take several days to a week

Limitations

• Can lead to over diagnosis because of frequent false positives
• Measurements vary by laboratory
• Not diagnostic on their own
• Best used together with skin test

Oral Food Challenge

Procedure

• Eliminate possible allergen for at least 2 weeks prior to test
• A very small measured dose of the suspected food is eaten and every 30 minutes the portion is gradually increased
• The patient will be supervised in the clinic for at least 2 hours or longer based on history after the last dose is finished

Time for Test

• Can take 4 to 8 hours per food

Limitations

• Must be conducted in a medical office with careful medical supervision and emergency medication/ crash cart ready
• Poses risk of reaction
• Increased cost of supplies needed
• Time needed to allow for possible reaction
• Fear of reaction by child or caregiver

What is the treatment for food allergies?

At this time the primary treatment for food allergies is complete avoidance of the allergen. This requires careful label reading to check for hidden allergens. The Food Allergy Labeling and Consumer Protection Act of 2004 (FALCPA) requires manufacturers to list the top 8 allergens even if it is only a trace amount.

For those with multiple allergens food avoidance can lead to a nutritionally incomplete diet. Essential Care Jr. or EquaCare Jr. can be utilized to give additional calories and needed protein for growth as well as needed vitamins and minerals.

Will I ever be cured of my food allergy?

Unfortunately, there is no definitive answer. For those with allergies to eggs, milk, soy or wheat, these may eventually disappear over time. If you are allergic to peanuts, tree nuts, fish and shellfish, these tend to be a lifelong restriction.

Where can I learn more about food allergies?

The following sites have accurate information about the treatment of food allergies. They can also provide a information on where to find a board certified allergist near you.

• American Academy of Allergy, Asthma, & Immunology: https://www.aaaai.org/
• American College of Allergy, Asthma & Immunology: https://acaai.org/
• Food Allergy Research & Education: https://www.foodallergy.org/
• Kids with Food Allergies: https://www.kidswithfoodallergies.org/

Non-IgE Mediated Food Allergy

• A food protein intolerance is also known as a non-IgE mediated food allergy.
• Immunoglobulin E (IgE) are a form of specialized proteins called antibodies produced by the immune system.
• A non-IgE mediated response to a food protein is related to a different immunologic mechanism that remains unknown.
• Non-IgE mediated food allergic disorders are a well-established clinical category of food allergy, and they mostly affect the gastrointestinal tract.
• Diagnosis of a non-IgE mediated food allergy relies on oral food challenges as there are no skin or blood tests for diagnosis.
• These allergies are managed experimentally with food avoidance.
• An Amino Acid formula, like Essential Care Jr. or EquaCare Jr., may provide support with the restrictive diets needed for these disorders if they continue into childhood.

Food Protein–Induced Allergic Proctocolitis (FPIAP)

A benign condition in which about 60% of cases occur in breast-fed babies, and may resolve by mother eliminating milk and soy from her diet. The remainder occurs in infants who are fed cow’s milk or soy protein-based formulas.

• Symptoms: bloody stools in well-appearing infants that begins between 1 and 4 weeks of age
• Common foods to avoid: milk and soy
• Diagnosis: because it is a non-IgE mediated allergy, there is no blood or skin testing available for diagnosis
• Treatment: strict avoidance of milk and soy
  • Most formula fed infants are changed to an amino acid formula designed for infants
• Resolution: a majority have resolution of symptoms by 12 months of age and can then consume milk and soy without problems

Milk Soy Protein Intolerance (MSPI)

MSPI is a temporary reaction to the proteins found in cow’s milk and soy products. You may also see it referred to as food protein-induced colitis or cow’s milk protein intolerance (CMPI). Symptoms can appear as early as 2-3 weeks after birth.

• Symptoms: colic, irritability/fussiness, weight loss, congestion, repeated vomiting, reflux and sometimes skin rashes or blood or mucus in the stools
• Common foods to avoid: milk and soy
• Diagnosis: because it is a non-IgE mediated allergy, there is no blood or skin testing available for diagnosis
• Treatment: strict avoidance of milk and soy
  • If mother is breast feeding – she should avoid milk and soy in her diet
  • Most formula fed infants are changed to an amino acid formula designed for infants
• Resolution: a majority have resolution of symptoms by 12 months of age and can then consume milk and soy without problems

Food Protein–induced Enteropathy (FPE)

• Symptoms: intermittent vomiting or diarrhea following consumption of the food protein trigger, bloody stools are rare
• Common foods to avoid: milk and soy
• Diagnosis: because it is a non-IgE mediated allergy, there is no blood or skin testing available for diagnosis
• Treatment: strict avoidance of the triggering food. If symptoms remain after the first year of life, supplementation with an amino acid formula, like Essential Care Jr. or EquaCare Jr., may help.
• Resolution: Most cases resolve in 24-36 months

Food Protein–Induced Enterocolitis Syndrome (FPIES)

FPIES is often misdiagnosed early on as a potential severe blood infection or repeated infections of a gastrointestinal virus.

• Symptoms: decrease in energy, change in body temperature, severe vomiting, diarrhea, dehydration or low blood pressure leading to
  hospitalization
• Common foods to avoid: cow milk, soy and grains like rice, barley, and oats
• Diagnosis: because it is a non-IgE mediated allergy, there is no blood or skin testing available for diagnosis
• Treatment: strict avoidance of the triggering food and possible supplementation with an amino acid formula, like Essential Care Jr. or EquaCare Jr.
• Resolution: Most children outgrow FPIES by 3 or 4 years of age

Where can I learn more about Non-IgE Food Intolerances?

The following sites have accurate information about the treatment of the Non-IgE food intolerances reviewed above. They can also provide information on where to find a board certified allergist near you that specializes in treatment of these conditions.

MSPI: Complete Children’s Health https://www.completechildrenshealth.com/what-is-mspi/

FPIES: The FPIES Foundation http://fpiesfoundation.org/about-fpies-3/

Kids with Food Allergies https://www.kidswithfoodallergies.org/food-protein-induced-enterocolitis-syndrome-fpies.aspx

FPIES is a type of non-IgE mediated food allergy that can present with severe vomiting, diarrhea and dehydration. Reactions are triggered by eating a certain food protein. The most common food triggers are cow milk, soy and grains. Of the grains, rice, barley, and oats are most likely to cause a reaction. A severe case of FPIES can result in an energy decrease, change in body temperature and low blood pressure leading to hospitalization. FPIES is often misdiagnosed early on as a potential severe blood infection or repeated infections of a gastrointestinal virus.

Symptoms

FPIES symptoms are most likely to start after the introduction of milk or soy-based formulas. Older infants can have a reaction with the first introduction of solid foods around 4 months of age. This usually occurs when the infant is introduced to rice, oats, barley and other similar foods.

FPIES reactions involve the gastrointestinal tract. Vomiting and diarrhea may not occur until several hours after the food protein is consumed and it may be difficult to evaluate the trigger food due to the delayed reaction.

Diagnosis

When a child with FPIES is taken to a hospital, it is often misdiagnosed as a bacterial infection (sepsis) or gastrointestinal viral illness. Because FPIES is a non-IgE mediated allergy, it cannot be diagnosed with a skin or blood test. FPIES is typically diagnosed using the child’s clinical history and symptoms.

In some cases, a clinically supervised oral food challenge is needed to confirm FPIES. It may be necessary to find a solid food that a child can tolerate to ensure he or she is developing with oral feeding skills. An oral food challenge may also be helpful in determining whether a child has outgrown FPIES.

Management and Treatment

• Management of FPIES requires the removal of the trigger food from the diet.
• If the FPIES reaction is to milk/soy formula, a hypoallergenic formula may be necessary. If the FPIES reaction is to solid foods, the allergist may suggest introducing low risk fruits and vegetables rather than cereals and grains.
• In the most extreme cases, children with FPIES can require hospitalization for IV hydrations and possibly treatment with anti-vomiting medication.

Protein is known to be the part of food that the body reacts to with a food allergy. Although the refinement of the corn starch removes a majority of the protein, a product cannot be guaranteed free of the protein unless it has been tested for that particular protein. It has been noted by some medical providers that there are reports from patients and families of reactions to the corn syrup despite reported protein removal through refinement. This may be due to the undetectable amounts of corn protein that may be found in the highly refined corn syrup or it may be related to a sensitivity to the carbohydrate. Because Essential Care Jr. uses tapioca as its carbohydrate source it may be a good alternative to other amino acid-based formulas that use corn syrup solids as the primary carbohydrate source.