Food Allergy Living Blog

Many Neocate parents know that using allergy testing to determine food allergies can be tricky, because many children experience what may be considered a food intolerance or sensitivity, versus a true food allergy. 

Generally, a food allergy is considered to be an immunoglobulin E (IgE) mediated immune response.  (1) In a previous blog, we have outlined the standard tests that may be done to determine whether your child has an Ig-E mediated food allergy, such as a skin prick test or a RAST.

However, you or your child may have a negative IgE test, but still appear to have symptoms that are typical of a food intolerance or sensitivity.  Several tests are now marketed as tools for determining these types of non-IgE mediated food reactions.  While more research is needed to determine the accuracy of these tests, they may provide helpful clues as to which foods to consider eliminating from the diet. Some of these tests include:

Enzyme Linked Immunosorbent Assay (ELISA): A blood test that is intended to measure levels of immunoglubulin G (IgG) in response to different foods.  However, elevated IgG does not always indicate an adverse food reaction.  In fact, sometimes elevated IgG is an indicator that an IgE response, or a true allergy, has been successfully treated.  This test may be helpful in providing clues as to which foods to consider eliminating, but remember that elevated IgG does not always mean that there is a negative reaction to the food.  (2, 3)

Mediator Release Testing (MRT): A blood test that in intended to measure many types of non-Ig-E mediated food intolerances or sensitivities, including IgG response.  Proponents of MRT believe that because it assesses multiple immune pathways it provides a more complete picture of which foods are causing symptoms compared to IgG testing.  (3)

Atopy Patch Testing (APT): A skin test used to determine delayed food reactions.  A preparation of the food is placed in an aluminum chamber on the skin for 48 hours. Twenty four hours after removal the skin is inspected for a reaction; a positive reaction is determined based on the level of redness and swelling.  (1) Some practitioners find that APT is a great tool to use along side IgE testing in order to a get a more complete picture of all the foods that may be causing symptoms for you or your little one.

Have you tried any of these tests?  We would love to hear about your experience! 

References:

1. Carney, Liesje Nieman. (2009, July). Pediatric Food Allergies. Today’s Dietitian, 11, 48.

2. Joneja, Janice Vickerstaff. (2008, January). Food Allergies: Type II, III, and IV Hypersensitivities. Today’s Dietitian, 10, 10.

3. Keller, Maura. (2010, August). Get Certified- Provide a Valuable Service By Adding Allergy Testing to Your Practice. Today’s Dietitian, 12, 18. 

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In the next part of our Neocate Product Series, we will take a look at Neocate Nutra.  As you saw in our previous blog about Neocate Infant DHA ARA, we take a look at the description of the product, preparation instructions as well as the nutrient and ingredient profile.

Neocate Nutra is a one-of-a-kind hypoallergenic, elemental semi-solid food for infants and children over 6 months of age. It is for the dietary management of cow milk allergy, multiple food protein intolerance (MFPI) and food-allergy-associated conditions such as gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), short bowel syndrome (SBS), malabsorption and other GI disorders.

As seen on the Neocate Nutra label, Neocate Nutra is:

·         Hypoallergenic – based on 100% non-allergenic amino acids

·         High in Calcium, and a good source of vitamin D and iron

·         Milk protein- and gluten-free

·         Free from artificial flavors, colors, or preservatives

How to prepare Neocate Nutra

 Click here to find watch our video on how to mix Neocate Nutra.

Click here for recipes using Neocate Nutra

· Fill the scoop provided with Neocate Nutra and level off with a clean, dry, flat utensil. Do not press the powder into the scoop. Only use the scoop provided in the can

· Add the recommended number of scoops** of Neocate Nutra into a clean bowl.

· Gradually add the required amount of water while stirring with a clean spoon. Mix until thickened and evenly blended. To alter the consistency, add more or less water as needed.

** The suggested serving size for children (1yr +) is 8 scoops + 2 fl oz of water.  For infants (6-12 months) use 4 scoops + 1 fl oz of water.

Neocate Nutra should be prepared immediately prior to feeding. Any prepared product remaining should be discarded if not used within 1 hour. Neocate Nutra can be added to cooked dishes. Do not add to very hot foods. Store unopened cans in a cool dry place. Once opened, reseal can. Store in a cool dry place and use within one month.

Nutrient and Ingredients profile

Ingredients:

Corn Syrup Solids (42%), Cornstarch (19%), Refined Vegetable Oil (18%) (Non-Hydrogenated Coconut (6%), High Oleic Sunflower (6%), Canola (3%), Sunflower (3%)), Sugar (9%), Calcium Phosphate Tribasic (2%), Contains 2% Or Less Than Each Of The Following: L-Arginine L-Aspartate, L-Leucine, L-Lysine Acetate, CAEM (An Emulsifier), L-Glutamine, L-Proline, L-Valine, Glycine, L-Isoleucine, L-Threonine, L-Phenylalanine, L-Tyrosine, L-Serine, L-Histidine, L-Alanine, L-Cystine, L-Tryptophan, L-Methionine, Choline Bitartrate, Magnesium L-Aspartate, Magnesium Acetate, M-Inositol, L-Ascorbic Acid, Ferrous Sulfate, Taurine, Zinc Sulfate, L-Carnitine, DL-Alpha Tocopheryl Acetate, Calcium D-Pantothenate, Niacinamide, Manganese Sulfate, Cupric Sulfate, Thiamine Chloride Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Vitamin A Acetate, Potassium Iodide, Chromium Chloride, Folic Acid, Sodium Selenite, Sodium Molybdate, Phylloquinone, D-Biotin, Vitamin D3, Cyanocobalamin.

*Important: Neocate Nutra is intended as a supplement to the child’s diet. Neocate Nutra is not nutritionally complete and should not be used as a sole source of nutrition. Neocate Nutra is not for bottle or tube feed use.

Spring is in the air, which means a few holidays are coming up. This year Passover will begin on Saturday, April 7th (observed at sunset on April 6^th) and go through Friday April 13^th and Easter is being celebrated on Sunday, April 8^th.

As these holidays approach, families with food allergies may have more stress than others in planning for these social events. Through the years, we have written often about this time of the year and how to best manage it when you have children with food allergies. Below are a variety of blog posts we have written focused on food allergies and Easter and Passover celebrations. Hope you and your family find them helpful.

Easter and Passover Allergy Friendly Recipes

http://www.neocate.com/blog/celebrate-easter-and-passover-with-recipes-for-kids-food-allergies/

Have a Happy Allergy Free Easter!

http://www.neocate.com/blog/have-a-happy-allergy-free-easter/

Dealing with Easter goodies with Food Allergies

http://www.neocate.com/blog/no-chocolate-bunny-for-easter/

Time for an Allergen Free Passover

http://www.neocate.com/blog/its-time-for-an-allergy-free-passover/

Kosher Foods and Milk Allergies – Kosher for Passover

http://www.neocate.com/blog/kosher-foods-and-milk-allergies/

Have an allergen free and enjoyable springtime season,

Christine

The most common questions we get have to do with product details so, we decided to start a product series that will hopefully answer a lot of your questions.

Today we are going to start with our Neocate Infant product.  Neocate Infant is a special formula designed for the specific nutrient needs of infants with milk protein allergy, multiple food protein intolerance (e.g. allergies to soy protein, hydrolyzed protein in other infant formulas) and food allergy associated conditions such as gastroesophageal reflux disease, atopic dermatitis (a type of skin rash), eosinophilic esophagitis, short bowel syndrome and other GI disorders.

Neocate is described on the label as:

• Hypoallergenic: The formula is less likely to cause an allergic response.
• Nutritionally Complete: All of the essential nutrients needed to grow and develop are supplied by the formula when consumed in adequate amounts.
• Elemental: Ingredients are broken down to their simplest and purest form so they are easier for the body to process and digest.
• Amino Acid-based: Amino acids are the non-allergenic building blocks for all protein.

With over 50 published studies (an going), we are proud to say that Neocate is the most studied amino acid-based formula available.  In clinical studies an elimination diet using Neocate has been shown to improve gastrointestinal symptoms of cow milk allergy such as diarrhea, blood in the stools and vomiting associated with milk protein allergies in just 3 days and improving gastroesophageal reflux and skin irritations, such as eczema and atopic dermatitis in just 14 days.

To see how Neocate Infant has helped other families cope with the challenges of food allergies and GI issues we recommend reading RJ, Olivia and Luke's testimonials.

Below you will find the Neocate Infant mixing instructions, nutrient profile and ingredients.  Additional information and frequently asked questions can be found in our Neocate Parent Guide.

Easy Preparation

(click here to watch our Neocate Infant mixing video):

Neocate Infant may be mixed with warm or cool sterile water.*  Do not boil formula or use a microwave to prepare or warm formula.  For standard dilution, use enclosed scoop (4.75 g) to mix one level scoop per fluid ounce of prepared formula.

How to make a 5 fluid ounce bottle:

1. Add 5 scoops of Neocate Infant to a clean, sterile container.
2. Fill up to the 5 fluid ounce line with warm or cool sterile water.
3. Shake for 15-20 seconds or until the powder dissolves.  Add additional water if necessary to make final volume and shake again.

*Boiling is the preferred method for sterilizing water, bottles, nipples and mixing utensils.

Freshly mixed formula is best.  Refrigerate pre-mixed formula immediately and use within 24 hours of mixing.  Shake immediately before use.  Throw away formula left in the bottle one hour after feeding.  Tube feeding hang time should not exceed 4 hours.

Nutrient Profile:

Ingredients:

Corn Syrup Solids (57%), Refined Vegetable Oil (Medium Chain Triglycerides (Palm Kernel and/or Coconut Oil) (7%), High Oleic Sunflower (7%), Soy (6%)), Calcium Phosphate Dibasic (2.5%), and less than 2% of each of the following: L-Arginine L-Aspartate, Tripotassium Citrate, L-Leucine, L-Lysine Acetate, L-Glutamine, L-Proline, L-Valine, Glycine, L-Isoleucine, CAEM (an Emulsifier), L-Threonine, L-Penylalanine, L-Tyrosine, L-Serine, L-Histidine, L-Alanine, Sodium Chloride, L-Cystine, L-Tryptophan, L-Methionine, Magnesium Acetate, Magnesium L-Aspartate, Potassium Chloride, M. Alpina Oil*, Choline Bitartrate, M-Inositol, C. Cohnii Oil**, L-Ascorbic Acid, Ferrous Sulfate, Zinc Sulfate, Taurine, L-Carnitine, Sunflower Oil, Niacinamide, DL-Alpha Tocopheryl Acetate, Calcium D-Pantothenate, Cupric Sulfate, Manganese Sulfate, Pyridoxine Hydrochloride, Riboflavin, Vitamin A Acetate, Thiamine Chloride Hydrochloride, Ascorbyl Palmitate, Potassium Iodide, Chromium Sulfate,Mixed Tocopherols, DL-Alpha Tocopherol, Phylloquinone, Sodium Molybdate, Folic Acid, Sodium Hydrogen Selenite, D-Biotin, Vitamin D3,Cyanocobalamin.

*A Source of Arachidonic Acid (ARA)

**A Source of Docosahexaenoic Acid (DHA)

We get questions related to starting solid foods from parents pretty often, and have blogged on topics such as how to start and some specific tips for infants with allergies. Most questions about starting solids are best answered by your little one’s health care team, since there isn’t always consensus in the medical community. Today we want to share an interesting study that was published recently in the Journal of the Academy of Nutrition and Dietetics that may be helpful.


The Article and the Study

The title of the article is “Associations of Infant Feeding Practices and Picky Eating Behaviors of Preschool Children.” We can simplify it to “how feeding infants might add to picky eating later on.” The authors looked into the way that feeding patterns in infancy, when eating patterns start to develop, affect picky eating behavior later in life. We know that every child will exhibit picky eating at some point; what we don’t know is how picky they will be and how long it will last. We don’t know any parent who wouldn’t do whatever they could to lower the risk of picky eating!

The authors of the study looked at data from 129 mothers of preschool children. The focus was on how early the moms started solid foods. They compared this with how willing the children were later in life to try new foods and how much variety their diets had.


The Results

The authors found that children in the study who were exclusively breastfed for the first 6 months of life were less likely to be picky about how their food was prepared, less likely to reject food, and less likely to be afraid of new foods. By waiting until 6 months to introduce solid foods, their children were less likely to be picky eaters later in childhood.


What the Results Mean

While it’s tempting to take the results of this study at face value, waiting until 6 months to introduce solids will not guarantee no picky eating. For starters, the authors admit that picky eating is hard to define, and each parent sees picky eating differently. This study also relied on parents’ memories about feeding their infants, and the small study group may not represent the whole population.

What we should take away from this study is that infant feeding practices, particularly the age when solids are started, can have an impact on picky eating behavior later in childhood. This study presents evidence that waiting until 6 months may be a good start, and that further studies could be useful. Introducing solids at 6 months is in line with the recommendations of the Academy of Nutrition and Dietetics (AND) and the American Academy of Pediatrics (AAP). For infants with documented allergy or risk of allergy, an expert panel has also suggested that it’s best to wait until 6 months to introduce solids. This is part of the reasoning behind why we suggest waiting until 6 months to introduce Neocate Nutra, the only hypoallergenic, amino acid-based semi-solid designed specifically for infants and children with allergies.

Would you change the age that you introduce solids based on the results of this study?

- Rob

[Image Source– http://www.babybites.info/2012/03/08/forgo-the-food-fight/]

Ingredients:

• 8 scoops Neocate Nutra
• 2 fl oz of Neocate Junior with Prebiotics, Vanilla (at standard dilution)
• ¼ teaspoon of cinnamon

Directions:

Add Neocate Nutra powder to a bowl. Add 2 fl oz of Neocate Jr, Vanilla. Blend till evenly distributed. Add cinnamon and stir. Using a small spoon, place 5 cookie sized dollops onto a flat plate or tray. Place tray in freezer for over 3 hours. Use spatula to remove patties from tray. Serve right away as they may defrost quickly.

*Leave out the cinnamon if desired for a different taste experience.

Serving size: makes about 6 patties

Nutrition Information per serving:

Calories: 236 Pro: 5g CHO: 32g Fat: 9.6g Fiber: 0.7g

Neocate Junior with Prebiotics, Vanilla is an aspartame-free, hypoallergenic and nutritionally complete medical food for children over the age of one.  And as a reminder, be sure to consult your healthcare professional to determine if this recipe, ingredients and consistencies are appropriate for your child.

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We often hear about Neocate families who in addition to following a dairy and soy free diet, also need to follow a gluten free diet as treatment for Celiac Disease.

Celiac Disease is an autoimmune condition that results in damage to the small intestine when gluten, a protein in wheat, barley, and rye, is consumed.

Currently, the only treatment for Celiac Disease is strict adherence to a gluten free diet.  In recent years more and more delicious gluten free versions of your favorite foods, such as breads, cereals, and crackers, have become available; however the cost of these specialty foods can add up quickly.  Fortunately, some of the cost of these gluten free foods may be tax deductible as a medical expense.

In order to take this deduction you must have a diagnosis of Celiac Disease, and you must also itemize your deductions.  The Celiac Disease Foundation does a wonderful job of summarizing the ins and outs of how this deduction works.  Check out their website for more information.   

We hope this tip will help you save some cents this tax season!

-Irene

We get a lot of questions from food allergy families about how to get insurance to cover elemental formula like Neocate.  While some insurance companies do reimburse families for these formulas, many do not.

At Nutricia, we feel strongly that reimbursement for formulas that are medically necessary is something insurance companies should do.  Getting help with the costs of feeding a child with cow milk, soy or protein allergies, or severe GI issues, can go a long way to helping the whole family feel better.  

On the Neocate website we have lots of resources and information that can help you find reimbursement for the medical foods and exempt infant formulas your child needs to thrive. You may be eligible for private insurance coverage, government support and even assistance from us.

We are especially proud of our Nutricia Product Coverage Navigator program! The program assists patients living in Arizona, Connecticut, Illinois, Massachusetts, New Jersey, New York or Texas obtain insurance coverage for Nutricia products, including Neocate.

So, if you are a resident of Arizona, Connecticut, Illinois, Massachusetts, New Jersey, New York or Texas please call 1-800-365-7354 for help with:

• Obtaining prior authorization for any and all Nutricia products, including Neocate Infant, Neocate Junior and E028 Splash;
• Answering questions regarding claims submissions;
• Drafting letters of medical necessity;
• Providing instructions on how to correct billing errors;
• Interceding with the insurance company on complex reimbursement matters; and
• Appealing a denied claim.

But, if you don’t live in one of these states, please visit the Neocate website where you will find tips for obtaining coverage and details about reimbursement legislation.

Immediately following his birth, Blaise suffered from a severe skin rash that developed once his mother began feeding him regular infant formula.

Unable to tolerate the formula, Blaise experienced persistent vomiting and diarrhea, accompanied with sleepless nights.  Blaise’s symptoms caused him to constantly be fussy and lethargic despite his mother’s countless attempts to console him.

“The longer we fed him the formula, the worse his rash, vomiting and diarrhea got,” says Danielle Phillips, Blaise’s mother.  “No matter what I did to soothe him, it was useless, and as his mother, that was hard to handle.”

Becoming concerned with Blaise’s skin rash, Danielle mentioned the issue to his doctor, who dismissed it as baby acne. As time passed, his related symptoms did not improve. In search of a solution, Blaise’s mother tried soy and hydrolyzed formulas, which unfortunately made him worse.

As Blaise’s symptoms began to get worse, his mother readdressed the symptoms with his doctor, who asserted that Blaise did in fact suffer from atopic dermatitis; a chronic skin disorder where the skin becomes extremely itchy and inflamed, causing redness, swelling, cracking and scaling. He concluded that the dermatitis was fueled by milk allergies.  However, the doctor insisted that she continue using the hydrolyzed formula, as it was too early to confirm its effectiveness. A week passed and Blaise was still in pain, suffering from atopic dermatitis, vomiting and diarrhea.

With a little research on Danielle’s part and advice from her mother, who works at a hospital, she turned to Neocate with hopes that it would help her baby lead a healthy and happy life.

“I found it amazingly effective almost immediately,” says Danielle. “It was like I had a new baby. His dermatitis cleared up, he started sleeping through the nights and his vomiting and diarrhea stopped immediately.”

At 10 weeks old, Blaise is responding great to Neocate, it has made him an active and responsive baby. His parents are thankful for the Neocate product and their commitment to improving the quality of life for babies suffering from milk allergies.

“It was quite the trip to get here, but he’s developing at an amazing rate,” says Danielle.  “Neocate is a great product and has made my son the baby he always should have been.”

We receive a fair amount of questions from parents and healthcare professionals on how to mix our Neocate products at specific concentrations and volumes. Our Nutrition Specialists can help with any Neocate mixing concentration you want and on whatever size serving Neocate needed based on your doctor’s or dietitian’s recommendations. At times, we will be asked to give mixing instructions for larger serving sizes of Neocate*. In these cases we may typically use household measurements (HHM) as requested by the healthcare professional or parent.

By far, the best way to measure the amount of Neocate powder needed is to use the enclosed scoop provided in each can or to use a gram scale. This will ensure the most accurate amount of powder is used for you or your child. 

Household measurements may be used to mix Neocate in large quantities but we would encourage that this be the last resort. The amount of Neocate powder in a ½ cup, for example, could vary based on the individual, if there were any air pockets in the powder when measuring, if the HHM is US standard or European based, and even on the brand of the measuring cups. There may be a wide discrepancy in the weight of the powder with using HHM. So with that in mind, we would highly encourage that you either use a gram scale to weigh the Neocate powder, or use the enclosed validated scoops in the cans of Neocate to provide the most accurate serving of powder.  If you and your healthcare team decide mixing Neocate will be most useful for you using household measurements, we will be happy to help.

Here are a few tips for you when using household measurements with Neocate powder:

• Use standard US, dry household measurements (240mL). Some HHM may say 250mL which would not be appropriate to use. Do not use liquid measuring cups.
• Household measurements are to be leveled and unpacked. Do not pack powder into cups. You may tap the side of the HHM to eliminate air pockets. Level with a clean flat utensil.

For questions and instructions on how to mix Neocate, please call us at 1-800-Neocate!

- Christine

*Including Neocate Infant DHA ARA, Neocate Jr, Unflavored, Neocate Jr Tropical or Chocolate flavored, Neocate Jr with Prebiotics, Unflavored or Vanilla flavored