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Allergy is an overreaction of the body's natural immune system towards substances that are otherwise harmless.

The human body has its own independent defence mechanism—the immune system—to protect itself against potentially harmful substances. A healthy immune system only reacts when it identifies harmful or foreign substances, such as bacteria or other microbes. Sometimes, the immune system mistakenly identifies substances that are usually harmless, such as pollen, dust, mould or certain foods, to be harmful and then triggers a series of reactions, leading to various symptoms of allergy.

While many allergic triggers come from the environment, the likelihood of allergic response is often genetically determined. Family history is the most important factor; children from allergic families have a higher likelihood of developing allergy, particularly if the parents and siblings have experienced some forms of allergy, such as food allergy, asthma, atopic eczema and hay fever.

References:
1. Hamburger RN. Nutr Res 1992;12:101-107.
2. Kjellman N-I M. Allergy 1982;37:463-473.

A child has a 70% chance of developing allergy if both parents have the same symptoms of allergy!

Allergic reactions can manifest on the skin, in the air passages or in the digestive system, where immune system cells are located to fight off invaders that come in contact with the skin, are inhaled or are swallowed.

Common allergic symptoms include:

• • Skin – rash, eczema, hives (red itchy bumps)
• • Air passages – wheezing, difficulty in breathing, rhinitis (inflammation of the nasal passages)
• • Digestive system – abdominal cramp, diarrhoea, vomiting, colic

Many factors in the environment may give a wrong message to the immune system and subsequently trigger allergic reactions. Common types of allergens include:

• • Food
• • Pollen
• • Mould
• • Household dust, dust-mites and their waste
• • Pet fur, animal dander

Food allergy occurs when the immune system misidentifies foods eaten as potentially harmful substances.

What are the reactions of food allergy?
Common symptoms of food allergy include:

• • Eczema, hives (red itchy bumps)
• • Itching or swelling of the lips, tongue or mouth
• • Nausea, vomiting
• • Abdominal pain, diarrhoea
• • Itching or tightness in the throat
• • Wheezing, difficulty in breathing
• • Chronic rhinorrhoea (runny nose)

Sometimes, but rarely, an allergic reaction can be very serious and can affect the whole body, including the heart, lungs and blood vessels. This condition is called anaphylaxis, which is life threatening. If medical treatment is not given immediately, anaphylaxis can progress to death.

What are the foods more likely for a child to develop allergies to?
A child can become allergic to any food, but the eight most common foods that cause allergy amongst atopic families (high risk groups) are:

• • Milk (e.g., cow's, goat's)
• • Eggs
• • Peanuts
• • Soy
• • Tree nuts
• • Fish
• • Shellfish (e.g., shrimp)
• • Wheat

The foods listed above account for most food allergies in children. Other foods that can also cause allergy include rice, fruits (e.g., strawberries, pineapples, bananas), tomatoes and some food additives. Fortunately, most children outgrow many acquired food allergies by age 5.

What should I do if I suspect my child has a food allergy?
If you suspect your child has a food allergy, the best person to consult is your child's doctor or an allergist. Do not put your child on a restrictive diet without first discussing this with the doctor, to ensure that you do not, by this action, unintentionally deprive him of some necessary nutrient not easily found in other parts of his diet.

First of all, your doctor may recommend you to seek medical advice from an allergist/ immunologist. The allergist/ immunologist will first rule out other possible causes of your child's symptoms by reviewing your child's medical history, performing a physical examination, and asking questions about his/her symptoms and the diet. Once it is confirmed that the symptoms are not due to other conditions, the allergist/ immunologist may perform some tests to diagnose the type of food allergy your child is experiencing.

Tests for diagnosing food allergy include:
• Elimination diet
This is helpful in identifying specific foods that may be causing the allergy. Your child will be told to avoid eating a certain food that is suspected to be the culprit. If symptoms disappear, the food will be reintroduced into your child's diet to see if the symptoms reappear. Reintroduction of that food must be done only under strict medical supervision as this may provoke an unexpectedly severe reaction.

• Skin test
With this test, your doctor first pricks or scratches on your child's skin, then applies a small amount of the suspected allergic substance onto their skin. If an itchy red bump develops after the skin prick, then your child is considered allergic to that substance.

• Radioallergosorbent test (RAST)
This blood test is used if your child tends to develop extreme allergic reactions that may even be life threatening. A sample of your child's blood is examined to see if it contains antibodies to a specific allergen.

Consult your healthcare provider or allergist to learn more about these tests. Please remember that these tests should be performed under professional supervision because life-threatening anaphylactic reactions, though rare, may occur.

Cow's milk is a common source of nutrients for growing children. However, its constituent proteins, whey and casein, may trigger allergic reactions in infants. This type of allergy is cow's milk protein allergy (CMPA). It is one of the most common allergies in infants—5 out of 100 infants and children suffer from CMPA in the first 3 years of life.

Allergic reactions may occur immediately or start several hours or even days (up to one month) after the intake of cow's milk.³

• Immediate onset
Reactions occur within less than 45 minutes after the ingestion of milk protein. Symptoms include colic, diarrhoea, vomiting, eczema (itchy skin sometimes even with red blisters) and hives (red swelling of the skin); occasionally a runny nose or wheezing may follow.

• Delayed onset
Symptoms, such as vomiting and diarrhoea, usually develop 2 hours or even days (up to one month) after the ingestion of milk protein.

Reference: 3. Vila Sexto L, et al. J Investig Allergol Clin Immunol 1998;8(4):249-252

Is there any difference between CMPA and lactose intolerance/ maldigestion?
It is important to note that CMPA is different from lactose intolerance/ maldigestion. CMPA is an overreaction of the body's immune system towards cow's milk proteins and has the highest prevalence in infants and lowest in adults. Apart from the common food allergy symptoms (e.g. abdominal pain, diarrhoea), CMPA may also produce mild to severe reactions in the respiratory system (e.g., wheezing, difficulty in breathing) and skin (e.g., rashes). In severe cases, anaphylaxis can occur.

In contrast, lactose intolerance/ maldigestion is non-immunological. It is the inability of the body to fully digest and thus absorb lactose — a consequence of lactase deficiency. The body cannot produce or produces insufficient lactase, the enzyme that aids lactose digestion by breaking down the lactose ingested (from milk). It is more common during late childhood or adulthood and is generally a benign condition. Symptoms that may occur in more serious cases of maldigestion are mainly limited to the gastrointestinal tract, such as abdominal pain, colic, flatulence and watery diarrhoea.

*Lactose intolerance/maldigestion usually does not cause much morbidity, unless it occurs in infants after an episode of infection, such as gastroenteritis, and if serious or prolonged can cause malnutrition and significant morbidity.

More and more children are showing signs and symptoms of allergic diseases. The pattern and severity, as well as the causes and symptoms of the allergy may change over the years following a predictable route—from food allergy that shows up as gastrointestinal and skin symptoms to asthma and other respiratory symptoms. This phenomenon is called "Atopic March". Therefore, early preventive measures to decrease the risk of developing allergy will benefit children in later life.

References:
4. Barnetson R, Rogers M. BMJ 2002;324(7350):1376-1379.
5. Tay YK, et al. Br J Dermatol 2002;146(1):101-106.
6. Wong GW, et al. Clin Exp Allergy 2001;31(8):1225-1231.

There is no medication to cure allergy, though the symptoms may be well controlled with modern medicines. However, avoiding the offending substances can significantly reduce the occurrence of symptoms.

If your child has or is at risk of developing an allergy, giving your child the appropriate diet and creating a clean and hygienic living environment can help prevent allergic reactions from happening.

If your child is at risk of or has food allergy...

• • Exclusive breastfeeding for the first 4-6 months is recommended.
• • If your child is at risk of food allergy (based on your family history) and you are breastfeeding him, you should also avoid allergenic food in your diet. Allergens from food may be passed through breast milk to your child.
• • If your breastfed child experiences an allergic reaction despite modification of your own diet by avoiding food allergens, consult a doctor. Switching your child to an alternative milk with partially-hydrolysed proteins may help reduce the likelihood of sensitization to cow-milk protein and its consequent allergic reactions. Alternatively, a milk with extensively hydrolysed proteins might be a rational option. ⁷
• • Introducing solid food to your child too early may also increase the risk of developing allergy. Solid foods should not be introduced before 4 months of age.
• • Once you start introducing solid food to your child, do it gradually by adding one new food at a time per week.
• • It is best to avoid giving potentially allergenic foods, such as eggs, before 12 months of age, but make sure you consult your healthcare provider first before doing this.
• • Do not introduce milk products containing whole cow-proteins without the advice of your doctor or dietician. A product containing hydrolysed proteins is a better option.⁸
   

References:
7. American Academy of Pediatrics. Committee on Nutrition. Pediatrics 2000;106(2):346-349.
8. Ovid Osborn. The Cochrane Library, Volume (2) 2004.

If your child is allergic to environmental triggers…

• • Create a clean and dust-free environment
• • Air and vacuum your child's mattress regularly
• • Choose washable bedding for your child, avoiding wool and feathers. Cotton would be a more suitable material to use
• • Wash sheets, curtains and furnishings regularly, especially in your child's bedroom
• • Do not put cut flowers in your child's bedroom
• • Avoid smoking inside the house
• • Avoid your child coming into contact with pets

What is hydrolysed protein?
Hydrolysed protein is protein that has been broken down into its smaller fragments—peptides and free amino acids. Hydrolysed milk contains these very small protein fragments. Different forms of hydrolysed milks differ in the extent to which protein hydrolysis has taken place and this affects its abilities to protect the sensitive child from allergic reactions, or in preventing the currently normal but at-risk child from developing allergy.

Completely hydrolysed protein has protein fragments that are so small that they are unlikely to be recognised by the immune system, and therefore significantly reduces both the risk of allergic reactions in the sensitized child, and the development of milk allergy in the currently normal, but high-risk child. On the other hand, partially hydrolysed proteins contain larger protein fragments. It is therefore suitable only for helping to prevent sensitization to cow's milk protein, and cannot be used once a child is sensitized (or known to be allergic). ⁹

Reference:
9. Oldaeus G, Anjou K, Bjorksten B, et al. Arch Dis Child 1997;77(1):4-10.

Childhood allergy can be prevented, and the best way to avoid milk or other food allergies from developing, especially when allergies run in the family, is to breastfeed your infant exclusively for the first 6 months of life. This will allow your child's immune system to develop and prevent him or her from being exposed to allergens early in life.

This short questionnaire will help you determine the number of family members (parents and siblings) who have an allergic history. Please complete it with your healthcare provider who is the best person to diagnose allergy and advise you on managing allergy and allergic risk in your family. The more members of your family are "allergic" in different ways, the more at risk your child is of developing allergies.

Although there is no cure for allergy, carefully managing your child's diet and living environment, as well as working hand in hand with your healthcare provider, can help to minimise your child's risk of developing allergy or prevent allergic reactions from happening.

Please consult your healthcare provider for more information on childhood allergy and ways to manage it.

Breast-feeding is universally accepted as the best method of feeding babies. Over the last decade there has been a plethora of scientific evidence and data supporting the supremacy of breastmilk and the health benefit derived from it.

Breast-feeding bonds mother and child
During breast-feeding, a mother's smell, feel and visual image are imprinted on an infant while the baby's are imprinted on the mother – a process called BONDING that will have a lifelong positive effect on the relationship between mother and child.

Breastmilk is the perfect food for infants
Mother's milk is the best food for infants and it contains all the nutrients required for the growing and developing baby in the right proportions. Mothers should be instructed on how to prepare for and maintain lactation and about the importance of good maternal nutrition. Breast-feeding should be initiated immediately after birth or within one hour after delivery.

Breast-feeding is a baby's first immunisation
Breastmilk and especially colostrum is rich with antibodies and live cells that protect infants from bacteria and viral pathogens.

Breast-feeding saves lives
Overall it is estimated that if more mothers were to breastfeed optimally, an additional 2 million infants' lives can be saved each year.

Breast-feeding saves money
It is one of the most cost-effective child health survival measures. Breast-feeding is an economic plus for families, hospitals, communities and nations. Working mothers should also be encouraged to continue breast-feeding even after they resume their full-time jobs.

Important Notice: Pregnant women and new mothers should be informed on the benefits and superiority of breast-feeding. Mothers should receive guidance for proper maternal nutrition and that the decision to avoid or discontinue breast-feeding may be hard to reverse. The introduction of partial bottle-feeding may have a negative effect on breast-feeding. Inappropriate infant feeding practices should be avoided so breast-feeding is not discouraged. Mothers should be advised of the social and financial implications of the decision to formula feed and the importance to the health of the infant to use infant formula properly. It is recommended to seek professional advice when mothers are unable to breast-feed.

Content developed by: CMPMedica Medical Education

With editorial advice from: Associate Professor Christopher Boey Chiong Meng, Department of Paediatrics, University Malaya Medical Centre

A health educational service sponsored and brought to you by:

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This article is compiled by CMPMedica Medical Education for your general knowledge and benefit and is not intended as a substitute for professional medical care and advice. Only your doctor can diagnose and treat a medical problem. Please consult your doctor on your/your child's specific medical condition. The views and opinion expressed by the author of the article above do not represent the views and opinion of Mead Johnson Nutrition (M) Sdn Bhd or CMPMedica and should not be relied on as such. Mead Johnson Nutrition(M) Sdn Bhd and CMPMedica Medical Education shall not be liable for any loss or damage howsoever arising, including from reliance on any information provided in this article. Editorial development by CMPMedica Medical Education. ©2004 CMPMedica. All rights reserved. No parts of this article may be reproduced by any process in any language without the written permission of the publisher.

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