Food Allergies

    Equip Parents with Allergy Knowledge

    Help parents and caregivers stay educated on the rising rates of food allergies and what that means for their infants.

    Since the late 1990s, the rate of food allergies among children (under 18 years of age) has nearly doubled, and food allergy-related hospitalizations have tripled1-3. Researchers are working to discover the causes, but so far clear answers are elusive. Some hypothesize that epigenetic environmental factors and lack of early exposure to important microbes are at play4,5. One thing we do know is that young children are the most commonly affected6.

    Help parents identify their infant’s potential allergies:

    Download Indications Guide

    Food Allergy by the Numbers

    Raising awareness for food allergies, especially early in childhood, is important.

    Infants with food allergies are up to four times more likely to exhibit other allergies as they grow2.

    Infants with certain food allergies, including egg, fish and cow’s milk allergy (CMA), often present other allergic manifestations later in life. This association, known as the “Allergic March,” refers to the progression of the allergic response. It typically begins with atopic dermatitis and food allergy in infancy, progresses to aeroallergen sensitization in pre-elementary ages, and culminates in allergic rhinitis and/or chronic asthma later in life9.

    Clinical Study

    Allergic Manifestation in Children with CMA:

    Download Study

    Supporting oral tolerance and gut development can help infants overcome food allergies and reduce the likelihood of the Allergic March.

    Most infants who have CMA build tolerance to cow’s milk protein by 3–5 years of age10-12. Extensively hydrolyzed protein formula is the first-line recommendation for CMA over soy or amino acid formulas, and has been shown to support the development of oral tolerance13.

    Comprehensive CMA management supports gut development.

    Extensively hydrolyzed formula (eHF) has been shown to reduce the likelihood of other allergies15,*.

    * Asthma, rhinoconjunctivitis, urticaria and eczema at 3 years vs. Nutramigen® without LGG®. Feeding began at 4 months of age or older in the study.

    Classification of Adverse Reactions to Food

    FODMAP: fermentable oligo-, di-, mono-saccharides and polyols

    Management impacts outcomes for infants with CMA.

    Watch Dr. Christina Valentine review background significance and key highlights from recent studies on early relief and long-term outcomes for infants with CMA.

    Looking for an option to support your patients with food allergies? Learn more about Mead Johnson’s CMA options:

    See CMA Options

    Teaching Parents About the Indications: Allergy vs. Intolerance

    Explaining allergic response to parents can be challenging because of the complex nature of the disease process. Plus, as you know, not all children who react to a certain food have an allergy. Instead, they may have a food intolerance to components such as lactose or gluten.

    GERD: gastroesophageal reflux disease

    Addressing Infant Allergy Prevention and Updated Clinical Guidelines

    Until recently, it was generally accepted that avoiding or delaying infant introduction to common allergenic foods was the most effective way of avoiding food allergies.

    However, newer studies suggest that introducing certain foods into an infant’s diet between the ages of 4-6 months (and regular exposure thereafter) can actually help build and maintain tolerance5,22.

    More specifically, a groundbreaking study of 640 allergy-prone children ages 4-11 months found that early introduction of peanuts significantly decreased the chances of developing peanut allergy compared to complete avoidance23.

    See Global Guidelines

    Early Recognition of an Allergy is Important for More Effective Management

    Identifying allergic patients

    Identifying patients with food allergies can be challenging. Issues may vary and can often seem disconnected, and, in the case of infants and young children, your patients may not be able to verbalize exactly what they are experiencing.

    The difference between moderate and severe food allergies can also present challenges. The subtle indications of a food allergy in infants, like drooling or spit-up, may be misinterpreted as a normal issue, but can be related to a severe allergic reaction.

    Share the American Academy of Pediatrics “Allergy and Anaphylaxis Emergency Plan” with parents of children with severe allergies:
    Download AAP Plan

    Anaphylaxis in infants

    Anaphylaxis is a severe, potentially fatal, allergic reaction involving multiple systems24. Infants with allergies are at risk for anaphylaxis, and the indicators of an anaphylactic reaction may be more difficult to recognize in these patients24.

    Subtle signs of anaphylaxis

    Indicators of anaphylaxis can present as normal issues in infants. Look for these common indications as well as these often-misinterpreted ones24.

    Common indications24:

    • Pruritus (skin and nasal)

    • Flushed appearance

    • Tingling mouth

    • Chest tightness

    • Shortness of breath

    • Nausea

    • Abdominal pain

    • Trouble swallowing

    • Blurred vision

    • Feeling of faintness

    • Vertigo

    • Headache

    Indicators misinterpreted as normal24:

    • Itching

    • Sneezing

    • Rubbing nose

    • Clear rhinitis

    • Drooling

    • Leaning forward

    • Occasional dry cough

    • Spit-up

    • Diarrhea

    • Low-grade fever with rapid heart rate

    • Drowsiness

    It is important that healthcare providers and caregivers alike recognize the indicators of anaphylaxis in infants, as even mild indications can progress quickly25.

     

    Severe allergies and inflammation

    Severe allergies create an excessive and ongoing inflammatory immune response. DHA, an omega-3 fatty acid, may help modulate the immune response in infants with severe allergies. The ratio of DHA and ARA, an omega-6 fatty acid, is important for developing an appropriate immune response26-28.

    Alpha-linolenic acid (ALA) and linoleic acid (LA), precursors of DHA and ARA, are commonly found in food sources such as oils, nuts, seeds and eggs. However, infants may not be able to efficiently convert dietary ALA and LA into DHA and ARA compared to adults29. Ensuring these patients have an extra source of both DHA and ARA is important27.

    Download this clinical correspondence to learn about the mechanism of action of DHA and ARA to support the immune response:

    Download MOA

    When should you consider recommending an amino acid formula?

    A review of peer-reviewed, published articles found an amino acid-based formula may be used for the following conditions30:

     

    Ineffective resolution with an EHF

    The degree of hydrolysis determines the allergenic response. Approximately 10% of patients with IgE-mediated CMA may not see resolution with an extensively hydrolyzed formula; for non-IgE-mediated gastrointestinal CMA, the percent of patients may be higher30.

    Eosinophilic esophagitis (EoE)

    The American Academy of Allergy, Asthma & Immunology currently suggests using an amino acid formula as first-line management for EoE. Successful management has been reported for 90% of patients with EoE using an amino acid formula31.

    Growth faltering

    Up to 24% of children with food allergies may have growth stunting30. When growth faltering does not resolve on an EHF, especially when multiple systems are involved and with multiple food eliminations, an amino acid formula should be considered.

    Anaphylaxis

    Milk-induced anaphylaxis may affect up to 9% of patients with CMA. Amino acid formula is the first-line recommendation for patients with milk-induced anaphylaxis32.

    Consider an amino acid formula for these issues as well30:

    • Ineffective response to multiple food eliminations, including cow’s milk

    • Severe complex gastrointestinal issues with non-IgE-mediated food allergies30

    • Severe atopic dermatitis, growth faltering or ineffective resolution of CMA30

    • Short bowel syndrome33

    Mead Johnson offers a selection of amino acid formulas:

    LGG® is a registered trademark of Chr. Hansen A/S.

    References

    1. Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997-2011. NCHS data brief, no 121. Hyattsville, MD: National Center for Health Statistics. 2013. Retrieved from http://www.cdc.gov/nchs/products/databriefs/db121.html. doi:10.1503/cmaj.150364
    2. Branum A, Lukacs S. Food allergy among U.S. children: Trends in prevalence and hospitalizations. NCHS data brief, no 10. Hyattsville, MD: National Center for Health Statistics. 2008. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db10.pdf on August 15, 2019.
    3. National Center for Health Statistics. Summary Health Statistics: National Health Interview Survey, 2018. Table C-2b. Available at: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2018_SHS_Table_C-2.pdf. Accessed October 7, 2020.
    4. Savage J, Johns CB. Food Allergy: Epidemiology and Natural History. Immunol Allergy Clin North AM. 2015;35(1):45-59.
    5. Jones SM, Burks AW. Food Allergy. N Engl J Med. 2017;377:1168-1176.
    6. Asthma and Allergy Foundation of America. Allergy Facts and Figures. https://www.aafa.org/allergy-facts/. Accessed April 7, 2020.
    7. Fair Health. Food Allergy in the United States: Recent Trends and Costs. An Analysis of Private Claims Data. https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/Food%20Allergy%20White%20Paper%20Final.compressed.pdf. Accessed April 7, 2020.
    8. Gupta R, Holdford D, Bilaver L, et al. The Economic Impact of Childhood Food Allergy in the United States. JAMA Pediatr. 2013;167(11):1026-1031.
    9. Maciag MC, Phipatanakul W. Preventing the Development of Asthma: Stopping the Allergic March. Curr Opin Allergy Clin Immunol. 2019;19(2):161–168.
    10. Bishop JM, Hill DJ, Hosking CS. Natural History of Cow Milk Allergy: Clinical Outcome. J Pediatr. 1990;116(6):862-867.
    11. Wood RA. The Natural History of Food Allergy. Pediatrics. 2003;111:1631-1637.
    12. Høst A, Halken S. A Prospective Study of Cow Milk Allergy in Danish Infants During the First 3 Years of Life. Clinical Course in Relation to Clinical and Immunological Type of Hypersensitivity Reaction. Allergy. 1990;45(8):587-596.
    13. Canani RB, Nocerino R, Terrin G, et al. Formula Selection for Management of Children with Cow’s Milk Allergy Influences the Rate of Acquisition of Tolerance: A Prospective Multicenter Study. J Pediatr. 2013;163(3):771-777.
    14. Allen CW, Campbell DE, Kemp AS. Food Allergy: Is Strict Avoidance the Only Answer? Pediatr Allergy Immunol. 2009;20:415-422.
    15. Canani RB, Di Costanzo M, Bedogni G, et al. Extensively Hydrolyzed Casein Formula Containing Lactobacillus Rhamnosus GG Reduces the Occurrence of Other Allergic Manifestations in Children with Cow’s Milk Allergy: 3-Year Randomized Controlled Trial. J Allergy Clin Immunol. 2017;139(6):1906-1913.e4. doi:10.1016/j.jaci.2016.10.050
    16. Majamaa H, Isolauri E. Probiotics: A Novel Approach in the Management of Food Allergy. J Allergy Clin Immunol. 1997;99:179-185.
    17. Petschow BW, Figueroa R, Harris CL, et al. Effects of Feeding an Infant Formula Containing Lactobacillus GG on the Colonization of the Intestine: A Dose-Response Study in Healthy Infants. J Clin Gastroenterol. 2005;39:786-790.
    18. Burks AW, Tang M, Sicherer S, et al. ICON: Food Allergy. J Allergy Clin Immunol. 2012;129(4):906-920.
    19. Tuck CJ, Biesiekierski, Schmid-Grendelmeier P, et al. Food Intolerances. Nutrients. 2019;11:1684.
    20. Walsh J, Meyer R, Shah N, et al. Differentiating Milk Allergy (IgE and Non-IgE Mediated) from Lactose Intolerance: Understanding the Underlying Mechanisms and Presentations. Br J Gen Pract. 2016;66(649):e609-e611.
    21. Du Toit G, Meyer R, Shah N, et al. Identifying and Managing Cow’s Milk Protein Allergy. Arch Dis Child Educ Pract Ed. 2010;95(5):134-144.
    22. Abrams EM, Becker AB. Food Introduction and Allergy Prevention in Infants. CMAJ. 2015;187(17):1297-1301. doi:10.1503/cmaj.150364
    23. Du Toit G, Katz Y, Sasieni P, et al. Early Consumption of Peanuts in Infancy is Associated with a Low Prevalence of Peanut Allergy. J Allergy Clin Immunol. 2008;122:984-91.
    24. Dosanjh A. Infant Anaphylaxis: The Importance of Early Recognition. J Asthma Allergy. 2013;6:103-107.
    25. Rudders SA, Banerji A, Clark S, et al. Age-Related Differences in the Clinical Presentation of Food-Induced Anaphylaxis. J Pediatr. 2011;158(2):326-328.
    26. Calder PC, Krauss-Etschmann S, de Jong EC, et al. Early Nutrition and Immunity – Progress and Perspectives. Br J Nutr. 2006;96(4):774-790.
    27. Hadley KB, Ryan AS, Forsyth S, et al. The Essentiality of Arachidonic Acid in Infant Development. Nutrients. 2016;8(4):216.
    28. Hageman JHJ, Hooyenga P, Diersen-Schade DA, et al. The Impact of Dietary Long-Chain Polyunsaturated Fatty Acids on Respiratory Illness in Infants and Children. Curr Allergy Asthma Rep. 2012;12:564-573.
    29. Shek LP, Chong MFF, Lim JY, et al. Role of Dietary Long-Chain Polyunsaturated Fatty Acids in Infant Allergies and Respiratory Diseases. Clin Dev Immunol. 2012;730568.
    30. Meyer R, Groetch M, Venter C. When Should Infants with Cow’s Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide. J Allergy Clin Immunol Pract. 2018;6:383-399. doi:10.1016/j.jaip.2017.09.003
    31. Groetch M, Venter C, Skypala I, et al. Dietary Therapy and Nutrition Management of Eosinophilic Esophagitis: A Work Group Report of the American Academy of Allergy, Asthma, and Immunology. J Allergy Clin Immunol Pract. 2017;5:312-324.e29.
    32. Fiocchi A, Brozek J, Schünemann H, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines. Pediatr Allergy Immunol. 2010;21:1-125.
    33. Abad-Sinden A, Sutphen J. Nutritional Management of Pediatric Short Bowel Syndrome. Pract Gastroenterol. 2003;27(12):28-48.