Food Allergy Living Blog Tagged Results

In light of a recent New York Times article highlighting the link between artificial dyes and ADHD in children, we felt we should further explain how this debate originally started. A couple of days ago there was a spark in the news about the government reevaluating the safety of food dyes found in many everyday foods we all have in our pantries. The evaluation came when select studies were suggesting a link between food dyes and ADHD in children. In the end, the FDA did not find a link between food dyes and ADHD as the results of the studies were not substantial enough to make that claim.

Are elimination diets effective in helping with ADHD?

There is a recent article from February that confirmed an elimination diet that was made up of only rice, meat, vegetables, pears, and water was found to improve behavior in hyperactive children. As a caveat, 36% of the participants did not respond to the diet at all.

In the 1970’s, Dr. Benjamin Feingold, a pediatric allergist from California, had success treating the symptoms of hyperactivity in some children by prescribing an elimination diet. The doctor even came up with his own diet, The Feingold Diet or Program. The Feingold Program eliminates these additives from your diet:

• Artificial (synthetic) coloring
• Artificial (synthetic) flavoring
• Aspartame (NutraSweet, an artificial sweetener)
• Artificial (synthetic) preservatives BHA, BHT, TBHQ (these preservatives are found in most foods on the market)

So all-in-all, I would say strive to use foods that are low or contain no artificial color or dyes. It is already hard enough just restricting milk or soy from your child’s diet to have to worry about dyes as well! If you are concerned about the possibility that your child could have ADHD, speak to a Registered Dietitian about possibly starting an elimination diet. Remember, you must ensure your little one is still getting the nutrition he or she needs with these special diets. Another option you have is to use an allergen-free supplement, for example Neocate Junior Unflavored with Prebiotics (which is also free of food colorings and flavors) to help ensure that their individual nutrition needs are being met.

Have you looked into an elimination diet before? Do you know anyone who started one and has had success? We would like to hear about it. Please tell us your story in the comment section below.

-Christine

Eosinophilic Esophagitis (EoE) is a condition that is gaining more and more recognition. Unfortunately though, the treatment options for EoE are not black and white. EoE may be treated either with medication, which has known long term side effects, or nutrition therapy, which has been shown extremely effective, but may be hard to follow for some.

Medication treatment for EoE is the use of steroids. However, this is not a long term fix. As EoE is a chronic condition, treatment with nutrition therapy is often discussed. Here are nutritional therapy options for EoE:

• Elemental Diet – A diet consisting of solely an amino acid-based (or elemental) products
• Elimination Diets – The removal of allergens from the diet.
  1. Tailored Elimination – Elimination of specific allergens based on allergy testing
  2. Six Food Elimination – Elimination of 6 top allergens based on the most common allergens seen in EoE patients

The Six Food Elimination Diet

The 6 Food Elimination diet is interesting because it bypasses the need of extensive food allergen testing. As you may know, allergy testing (skin prick tests and blood tests) are not perfect. There are often false positives which can make the treatment plan more complicated and time consuming. So what the 6 Food Elimination diet proposes is that, off-the-bat, patients will eliminate the top 6 allergens seen in EoE patients. The top allergens are milk, soy, eggs, wheat, peanuts/tree nuts, and seafood. One study¹ confirms there is a 74% success rate when using this type of nutrition therapy for EoE. (As a point of reference, an Elemental Diet shows a 95-98% success rate based on multiple studies)

Advantages and Disadvantages to consider

The advantages of using this nutrition therapy are that the EoE patients may still eat solid foods. It also eliminates the need for extensive skin and blood tests to check for food allergies. Important disadvantages to this diet therapy are that it may unnecessarily remove foods from the diet. This could increase the risk of the patients’ nutritional status. As some of you may know, it is hard just to remove milk and soy from your diet. Try eliminating 6 different allergens while maintaining your nutritional status! One way to ensure there are no risks for nutritional deficiencies is to supplement the diet with a nutritionally dense, hypoallergenic elemental product, such as Neocate®. This will help ensure the patient is getting all the protein and nutrients they need per day while guaranteeing that no allergic reactions will occur upon starting the elemental products. It is vital that EoE patients are monitored by a dietitian. The dietitian will help calculate how much of the elemental product the patient will need per day and also make sure the nutritional status of the patient is maintained.

Again, since there is a 74% success rate, if any symptoms persist after starting the 6 Food Elimination diet, see your doctor, as you may need a more “allergen safe” diet therapy such as an Elemental diet.

I hope this helped to shed some light on this nutritional therapy option for EoE. Every person will have their own treatment plan that works for them. Is anyone doing an Elimination diet now? How is it going for you? Have any tips you can share that may help others manage an elimination diet?

-Christine

^{1 Kagawalla AF et al, Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006:4(9):363-8}

So, you find out your child has a milk protein allergy, and you think, “What am I going to feed him? Babies are supposed to drink milk!” I know it can be confusing, and a little overwhelming, at first. However, after taking a look at your options, you will be good to go!

If your child is formula fed, you won’t need to worry about eliminating anything from your diet. As we’ve talked about in previous entries, you can just switch your little one to an amino acid-based formula. However, if you choose to breastfeed, you will need to follow an elimination diet and remove all milk and soy protein from your diet.

For your reference, here is a list of the basic foods that may contain dairy or soy protein that you should avoid when on the elimination diet:

• All dairy and soy products
• Meat/processed meats
• Whey or Casein on the label
• Nutrition bars
• Glazes
• Lactose-free products
• Chocolate
• Fortified cereals
• Non-broth (cream) soup
• Cheese/Yogurt
• Salad dressing

Kids With Food Allergies also has another in-depth list you can take a look at. Click here to see the full list.

These are just some things to look out for when implementing an elimination diet. Of course, if you feel the need to supplement your baby’s diet or if the elimination diet is compromised, an amino acid-based formula is always a great option. And, as always, please speak with a registered dietitian or your pediatrician before starting the elimination diet.

- Christine

Some little ones, like Rachel’s son Baby E from our guest post last week, are allergic to the dairy proteins passed along in their mother’s breast milk.  This can often result in a cow’s milk allergy and a confused mom.  Fortunately this doesn’t mean the end of breastfeeding, but rather the start of an elimination diet.

When starting an elimination diet the breastfeeding mom removes all dairy including “hidden” dairy from her diet.  Because this can be such an adjustment, it’s important to make sure both mom and baby get the nutrition they need, so we recommend having the supervision of your doctor for this diet.

Keep in mind, children being not breastfed will also need to go on an elimination diet if diagnosed with a food allergy.  Any elimination diet will need to be supervised by a Registered Dietitian to ensure all the important nutrients are being met in the diet.  Studies show that children on elimination diets are often lacking in Protein, calories, Vit D, and Calcium.¹

In addition to our blog and cookbook, once you begin your elimination diet we recommend checking out these great websites for more information and recipes. 

• Kids With Food Allergies: In addition to helping families cope with dietary restrictions and lifestyle adjustments, they also host a breastfeeding with food allergies forum which provides support for mothers on allergy elimination diets.  
• Go Dairy Free: Is an informational website for dairy-free living and the goal is to provide honest, unbiased information about going dairy free. 
•  AllergyMoms: Provides support for parents of kids with food allergies.  They provide dairy-free allergy recipes as well as the latest news and research on breast-feeding, eczema, reflux and anaphylaxis.
• KellyMom: This site is run by an International Board Certified Lactation Consultant who provides lots of helpful information and articles on breastfeeding. 
• The Food Allergy & Anaphylaxis Network: Provides educational information, recipes and support for the many parents who need help managing food allergy.
• CoFAR(Consortium of Food Allergy Research): Provides a wealth of information for families and HealthCare professions.  This consortium was provided by a grant from the NIH.

Hopefully you’ll find these resources helpful and not just for eliminating dairy but also for eliminating the top eight allergens including egg, peanuts, tree nuts, fish, shellfish, soy and wheat.

If you’re already on an elimination diet what do you think of these websites?  Do you have any other websites you’d recommend?

- Christine

1. Henriksen C, Eggesbø M, Halvorsen R, Botten G. Nutrient intake among two-year-old children on cows’ milk-restricted diets. Acta Paediatr. 2000;89:272–278 

From time to time, parents of children with allergies, who use our products, ask me if I’ve ever tried the Neocate formulas. We here at Nutricia have certainly tasted them all, but tasting and consuming are two different things. After lots of questions from parents about what their little one is feeling and whether or not it’s normal, and given my indiscriminate palate, I decided it was time to really give Neocate a try.

My plan? To go on a nothing-but-Neocate diet for two days. What, exactly, would be allowed? Neocate: specifically any of the Neocate products, the flavor packets, and the flavors straws. What wasn’t allowed? Anything else. Well, almost anything else. I decided I would still be allowed tea (lack of caffeine could be a real problem!). I also decided that, given my usually high fiber intake, I would also be allowed to supplement my Neocate diet with fiber. I found an inulin fiber supplement: the same type of fiber that’s included in Neocate Junior with Prebiotics. Some folks might say this is cheating, but I took the advice that I (as a Registered Dietitian) would give anyone: to avoid a sudden and drastic change in fiber intake, up or down. 

With these rules in mind, I used my approximate calorie needs to design a “meal plan” and dove right in.

Day 1 Menu: 

• Morning Snack: Neocate Infant with DHA and ARA
• Breakfast: Neocate Infant with DHA and ARA
• Lunch: Neocate Infant with DHA and ARA + Lemon-Lime Flavor Packet
• Dessert: Neocate Nutra + Neocate Junior Chocolate (“Chocolate Pudding”)
• Afternoon Snack: E028 Splash Orange-Pineapple
• Appetizer: Neocate Junior with Prebiotics + Grapefruit Flavor Packet
• Dinner: E028 Splash Grape + Neocate Junior Chocolate (“Chocolate Covered Raisin”)
• Dessert: Neocate Junior with Prebiotics + Cookies ‘n Cream Flavor Straw

Day 1 Experience:

The day started with Neocate Infant with DHA and ARA. Does this taste like standard infant formula or milk? Nope. Because the Neocate products have amino acids instead of whole protein, Neocate Infant with DHA and ARA has a different taste and a thinner texture. To me it has a grassy undertone, which isn’t so bad, and is something most infants either don’t notice or get used to after a few days. Smaller amounts were fine, but a full 350 calories of plain Neocate Infant was a bit much, even for me: by my last “meal” of Neocate Infant at lunch I decided I could use the help of our Lemon-Lime Flavor Packet. So far, so good. I was surprised that I wasn’t ravenous as the day progressed – I had my doubts that an all-liquid diet would keep me satisfied, but it really did. I managed to go to bed without having any real cravings that day. No stomachaches and nothing out of the ordinary.

Day 2 Menu:

• Morning Snack: E028 Splash Tropical Fruit
• Breakfast: E028 Splash Orange-Pineapple + Neocate Junior + Strawberry & Banana Flavor Straws (“Fruit Salad”)
• Lunch: Neocate Junior Tropical
• Dessert: Neocate Nutra + Neocate Junior with Prebiotics + Cherry Vanilla Flavor Packet (“Chocolate-covered Cherry Pudding”)
• Snack: E028 Splash Tropical Fruit
• Appetizer: Neocate Junior with Prebiotics + Strawberry & Banana Flavor Straws
• Dinner: E028 Splash Orange-Pineapple + Strawberry Flavor Straw + Junior with Prebiotics
• Dessert: Neocate Nutra + Neocate Junior Chocolate + Strawberry Flavor Straw (“Chocolate-covered Strawberry Pudding”)

Day 2 Experience:

This day started with some definite hunger, but the morning snack took care of that. When I arrived at work I found a donut on my desk – so began the cravings for solid food. It was definitely difficult to avoid the snacks around the office that day, but I made it through. The toughest part was probably dinner time. I usually handle food preparation in our house, so having to cook dinner and not partake in enjoying it was difficult.

By the end of the day all of the different flavors began to taste pretty similar to me, probably because I tried to do too many flavor mash-ups. I will say that I definitely found the EO28 Splash an easy option. It seems silly, but it was so much nicer to grab a Splash instead of having to prepare a meal.

All things considered, the Neocate diet wasn’t nearly as difficult as I thought, and actually made life easier. I really appreciated having all of the different flavor options and the simplicity of Splash in a ready-to-go format. That said, a third day might have gotten a little routine, so I have a great deal of respect for the patients who have to stay on an elemental diet for an extended period of time, especially those children who have had “real” food, know what it tastes like, and have to give it up.

And the question many parents would like to ask: How did I feel after two days of Neocate? Pretty normal, actually. My stomach felt a bit more “active” at times, but I never felt queasy, had diarrhea or constipation, or really felt any different than I usually do. I didn’t experience any big swings in hunger or fullness, and it was nice not worrying about whether or not I was getting a balanced meal: Neocate took care of that for me. For parents of children who are going from a more typical diet to Neocate (such as those with EE who are starting an elimination diet) you may want to check with your child’s healthcare team about using Neocate Junior with Prebiotics, which has fiber to help maintain gut health. 

How about you: have you ever tried a full serving of Neocate? If so, what did you think? Feel free to share any questions you have about my experience!

- Rob

If you’ve ever tried to prepare a meal for a picky eater, you know that the process can be a handful. But what do you do when your little one has a very limited diet and they do not find the things they can eat appetizing? That’s just one of the many things we here at Nutricia have in mind, so we try to offer as many options to our customers as possible. Our goal is to make meal time as stress-free as possible for a diet that is difficult, but necessary. One of the easiest solutions we offer is our Flavor Packets.

What makes our Flavor Packets so great? They come in 3 flavors (cherry-vanilla, grapefruit and lemon-lime) that are different from the Neocate Junior and Splash flavors. Each packet adds only about 15 calories and contains no protein, making them perfect for an elemental diet. This gives more variety to a formula-based diet for children over one year.

The best feature of the Flavor Packets is that you can use as little or as much as needed to match your child’s flavor preference. For instance, some children who start using Neocate Infant at a young age and then transition to unflavored Neocate Junior make the switch with no problem. However, as they get older and experience new tastes (like fruit juice) they may not like the taste of an unflavored elemental formula as much. But it’s also possible to find one of our flavored formulas a bit overpowering. In this case, you can add just enough flavor to help mask the taste of the amino acids, but not so much that the flavor or sweetness is overwhelming.

Not sure how much of a flavor packet to use? Each flavor packet is designed to mix with about sixteen ounces (or two cups) of prepared formula. For a child who is accustomed to unflavored formula, a good suggestion might be to start out at half-strength and see what they think. If your child is old enough, you could set up a blind taste test “experiment” for them with a few different concentrations and flavors to see what they like best and make the experience more fun! Also, for children over a year old you can use Flavor Packets with Neocate Nutra. We suggest experimenting to see how much flavor is right and a good place to start might be ⅛ or ¼ teaspoon per serving of Nutra.

Have you found the Flavor Packets to be helpful with keeping your little one interested in their elemental formula? Let us know in the comments section below.

- Rob

We’re always keeping our eyes peeled and our ears tuned for new news on eosinophilic esophagitis (also EoE or EE). This matters to us because many children with EoE  use Neocate products, as part of their special, healthy diet.


The Study

Dr. Charles DeBrosse and Dr. James Franciosi at the Cincinnati Children’s Hospital, where there is a Center for Eosinophilic Disorders, recently published a new research study about the long-term effects of EoE.  If you’re interested in reading the study here are links to the study abstract as well as a great summary.


The Results

The research team looked at over 100 patients with esophagitis; some had EoE, while others had chronic esophagitis, and compared them to patients who had no esophagitis. On average, this was about 15 years after the patients developed esophagitis. EoE research was in its early stages back then, and many patients went undiagnosed or were misdiagnosed. The participants answered questions about their symptoms and quality of life. The researchers then compared the results of each of the groups to see what differences really stood out.

Patients with EoE reported a lower quality of life and experienced more trouble swallowing and had food become stuck in their esophagus more often. Those patients with higher eosinophil counts in childhood had more trouble swallowing as adults. Also, patients with a diagnosed food allergy were more likely to have trouble swallowing and to have food become stuck in their esophagus.


The Bottom Line

As the researchers concluded, EoE “is associated with reduced quality of life and persistent symptoms 15 years after presentation.” They also noted that both increased eosinophil counts and the presence of food allergy in childhood increase the rate of trouble swallowing in young adulthood. It doesn’t sound very positive, but it’s what many of us expected: there is a strong link between food allergies and symptoms among patients with EoE, and high eosinophil levels can have a lasting impact.


What Can We Take Away from This?

Sure, the results and conclusion don’t sound great at first, but there are a few things to keep in mind. For one, a HUGE amount of research has been conducted on EoE in the last 15 years, and we’ve learned a lot! Patients who had EoE 15 years ago had a much different experience than patients with EoE today have. For instance, the way that EoE is diagnosed and treated has improved in that time. Also, many more of today’s health care teams can recognize, diagnose, and treat EoE, which is more widely known. And many teams also include allergy testing as part of the care process for EoE.

There are also options for managing EoE that are now in wide use. For instance, elimination diets and elemental diets (which we’ll blog about in a few weeks – stay tuned) have come a long way. Elemental diets (or amino acid-based formulas) can be especially helpful in getting EoE under control and are useful in diagnostic phases. These formulas can help improve trouble swallowing when EoE isn’t under control, which can mean better outcomes. They can also provide key nutrients when added to a very limited diet.

Children on elemental diets have lots of options these days in the Neocate family of products. We have Neocate Junior, which is available in several flavors. We also have E028 Splash, which not only comes in multiple flavors, but is also in drink box form, so it’s just as ready-to-go as your child! And for children who miss solid textures on an elemental diet, Neocate Nutra can provide a change of scenery, especially prepared in one of our recipes.


What did you learn from the new research that was published in June?

- Rob 


[Photo: Microsoft Images]

Hi everyone! 

We get lots of questions from Moms (and Dads) about elimination diets.  This is why, in addition to the information we have here on our blog and website, our nutrition specialists and bloggers decided to address that very topic on our NeocateUS YouTube channel.  So if elimination diets seem a little confusing to you, check out our video for more answers!

Also, for more elimination diet information and resources check out some of our previous blog entries:

• Elimination Diet FYI
• Elimination Diet vs. Elemental Diet
• Resources for Your Elimination Diet
• A Mom’s Journey with TED (Total Elimination Diet)

Furthermore, if you enjoy receiving information from Neocate via video please let us know by posting a comment on our YouTube channel and liking our videos.  As we continue to work on more informative videos we would love to hear from you!  

So, what kind of other videos would you like to see our Nutrition specialists create? 

-Sarah 

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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