Allergies & Intollerance
My baby has hives and a rash on his chest,
He has runny poos too- does he need a test?
There are so many symptoms that confuse you more,
But there’s much info & advice right behind this door.
Milk intolerances and allergies:
Acid-reflux is a simple backward flow of the stomach contents, but it can often be caused or exacerbated by food intolerances or allergies. A food ‘allergy’ is an abnormal response by the body’s immune system to a certain food. This is different from a food ‘intolerance’, which does not affect the immune system, although some of the same symptoms may be present. If a food allergy or intolerance is driving the acid-reflux, knowing this will help with managing the reflux bringing it under control.
Lactose intolerance: the basics
Lactose intolerance is the inability to digest significant amounts of lactose, which is a complex sugar found in milk. People sometimes confuse lactose intolerance with cow’s-milk-protein intolerance because the two conditions, while quite separate, can induce similar symptoms. A cow’s-milk intolerance, or allergy , is a reaction triggered by the immune system, whereas lactose intolerance is a problem caused by the digestive system.
Lactose intolerance or allergy is due to a shortage of the enzyme lactase, which is needed to break down the lactose in the milk. If the digestive system is deficient in lactase, the symptoms can include:
- excess bloating
- trapped wind
- stomach cramps
- explosive, green, loose and watery stools
A lactose intolerance can also occur after a gastro-intestinal infection or tummy bug, and can last for up to six weeks. Sometimes vaccines or ingesting certain medicines can also cause a temporary lactose intolerance.
Few toddlers actually have problems with lactose , though in some cases there can be more serious underlying cause, such as Crohn’s disease, coeliac disease or inflammatory bowel disease.
Cow’s-milk-protein intolerance: the basics
Cow’s-milk-protein allergy (CMPA) is the most common food allergy in babies and children. Although it is estimated to affect more than 2 per cent of children under the age of three, I believe there are many more children that are never actually diagnosed. It is also suggested that most children with the allergy will typically outgrow it by the age of five, but I have found this not always the case and have worked with many older children that have had longer-term problems due to a cow’s-milk allergy they have never grown out of.
CMPA occurs when the body’s immune system reacts abnormally to a protein in the milk of cows and some other animals. Normally, the immune system protects our bodies from harmful pathogens like bacteria and viruses. In CMPA, the immune system mistakes a protein in cow’s milk as a harmful substance and attacks it. This immune reaction can damage the baby or child’s stomach and intestines. Many will also be allergic to other types of milk protein, including that found in soy milk .
The allergic reaction to milk can begin within minutes of ingesting it or it can be delayed for several hours; sometimes it can be days or even weeks before a reaction is noticeable , especially if there is only an intolerance to the milk protein, and not a full-blown IgE, allergic reaction.
Symptoms may include:
- stomach pain
- erratic bowel movements
- skin rashes
- swelling of the lips or throat
- upper respiratory congestion
- trouble breathing
If you suspect your child has any form of lactose intolerance or cow’s-milk allergy , in my opinion it is best to completely remove all dairy and soy products from his diet for a short time and watch for any changes, reactions or improvements in symptoms. If there is a significant, positive change then you might assume that your child does some sort of issue with dairy products and it would be wise to keep the diet dairy-free for another few weeks before perhaps reintroducing some dairy very gradually, to see if there’s any further reaction. Often, just by giving the system a break he may well be able to go back to having dairy in his diet; this may need to remain at a restricted level or he may be able to tolerate a full dairy-inclusive diet once more.
However, if removing milk doesn’t seem to have improved his symptoms, before reintroducing the cow’s milk I would advise keeping his diet dairy-free for a while longer and removing gluten and wheat as well. It is sometimes necessary to remove all dairy, soya, wheat and gluten before there is an improvement in symptoms, and after this break from all major allergens it will become clearer which, if any – or even all – are causing the problems.
Gluten and wheat intolerance and allergy
Intolerance to gluten – a protein found in wheat, barley and rye – is a fairly common problem . The most severe form of gluten intolerance is coeliac disease, an autoimmune condition that affects about 1 per cent of the population and can lead to permanent damage to the digestive system. Meanwhile, up to 13 per cent of people may have non-coeliac gluten sensitivity, a milder form of gluten intolerance that can still cause problems.
Both forms of gluten intolerance can cause widespread symptoms, many of which have nothing to do with digestion, but these are the main signs and symptoms of gluten intolerance:
- bloating and excess bottom-wind, which can be very smelly
- diarrhoea or very wet, mushy and sometimes smelly stools
- constipation and often smelly stools
- abdominal pain, tummy aches and stomach cramps
- headaches and migraines
- fatigue and lack of energy
- skin problems such as psoriasis and alopecia
- mood swings, depression and anxiety
- unexpected weight loss
- iron-deficiency (anaemia)
- auto-immune disorders
- joint and muscle pain, or numbness and pins and needles in arms and legs
- ‘brain fog’ and inability to focus
In my opinion, gluten intolerance is much more prevalent than is generally understood, and often the medical problems it causes are diagnosed and treated only as individual conditions, without the root cause, of gluten allergy or intolerance, ever being realized.
Causes of food allergies and intolerances:
Nearly 5 per cent of children under the age of five years have food allergies . The prevalence of reported food allergies is definitely on the increase, and although most children ‘outgrow’ their allergies at some point, allergies to peanuts, tree nuts, fish and shellfish can be life-long.
To become allergic to a food, a sensitive child must have been exposed to the food at least once before her first reaction to it, even through breast milk after the mother has eaten the food . It is the second time the child eats the food that the allergic symptoms appear. This time, when IgE antibodies react with the food, histamines are released, which can cause the child to experience hives, asthma, itching in the mouth, trouble breathing, stomach pains, vomiting and/or diarrhoea. The symptoms can be merely uncomfortable or they can be life-threatening.
Approximately 90 per cent of all food allergies are caused by the following eight foods:
- tree nuts
Eggs, milk and peanuts are the most common causes of food allergies in children, with wheat, soy, and tree nuts also included , while peanuts, tree nuts, fish and shellfish tend to cause the most severe reactions.
The tendency to develop allergies is often hereditary, which means it can be passed down through the genes, from parents to their children. However, just because you, your partner or one of your children might have allergies, it doesn’t mean that all of your children will definitely get them (although the likelihood is higher), and some children have allergies even if no other family member is allergic. Unfortunately, those who are allergic to one thing are likely to be allergic to others. There are, of course, non-food allergies too, such as those to pollen, dust mites, pets and mould, plus insect bites, latex, certain chemicals, sulphites and medicines; even penicillin contains allergens that can cause a reaction.
Some children also have what are called ‘cross-reactions’ . For example, children who are allergic to birch pollen might have symptoms when they eat an apple, because that apple includes a protein similar to one in the pollen. There can also be a histamine intolerance , which has only recently started to be understood within the medical world.
On the one hand, it could be relatively easy to work out if a child has a dairy allergy , for example, and manage the condition by removing all milk products from his diet, but in other cases it can be far more complex, with several allergens causing issues, or even histamines exacerbating the child’s symptoms.
Diagnosing food intolerances and allergies
It is always advisable to seek medical help for suspected allergies or intolerances, and in the majority of cases a preliminary diagnosis can be made based on the symptoms your child is displaying. If there is any suspicion that he has some underlying digestive discomfort, it is easy enough to remove a particular type of food, or even all of them in turn, for a trial period to see if things improve or not. Removing food groups is also a useful first option to try before subjecting children to full-blown testing using needles and blood tests .
If you have unsuccessfully tried to reintroduce certain food groups, further medical help will be needed and your child may need some proper allergy tests carried out. There are a number of tests available, including the following :
- Hydrogen breath test Undigested lactose produces high levels of hydrogen gas in the breath. Doctors can diagnose lactose intolerance by measuring the hydrogen level after you drink a lactose-loaded beverage.
- Stool acidity test Undigested lactose increases the amount of acid in the stool. Doctors may test a sample to diagnose lactose intolerance in young children.
- Food-allergy testing If your doctor suspects a milk allergy, you may be sent to an allergist for skin-prick testing or have a blood sample taken for laboratory allergy testing.
Bear in mind that a mild intolerance to a particular allergen might not always show up in testing, even though it obviously causes a reaction in your child.
Sometimes there is no available test, such as with a histamine intolerance, and the only way to find a resolution is through removing certain foods and charting the reactions or changes.
Your doctor may refer you to an allergy specialist and a dietician, who can then advise you on how best to avoid a particular food allergen while still maintaining good nutrition for your child. You could also seek help from a nutritionist, who can advise on what foods to try or to eliminate and how to promote healthy gut flora , such as using probiotics to help repair a gut that has been damaged by a food allergy.
Managing CMPI and CMPA for babies
If you are breast feeding and your baby seems uncomfortable with lots of wind, has rashes or hives, produces explosive poos, green poos, orange poos, mucousy poos or poos that have traces of blood in them then it might indicate that he is not coping with certain things in your diet that are going into the breast milk. So one of the first things you can do is to try removing the main allergens from your diet to see if it helps. The 3 main allergens are:
And sometimes other foods such as eggs can cause problems for baby.
If this doesn’t seem to bring enough resolution then I also advise to exclude,
- Carbonated drinks
- Processed foods
- Refined sugar
Acidic foods such as tomatoes, peppers, chillis, onions etc and avoid too much fruit and fruit juice.
Of course you should discuss all this with your Doctor and-or Dietician for further advice.
If you’re bottle feeding baby then there are many different formulas available and some are designed specially for babies suffering with acid reflux, cow’s-milk protein and/or lactose intolerances or allergies. The type of formula that is best for your baby will depend on his individual symptoms and should always be discussed with your doctor. Always follow the manufacturers’ guidelines when using any formula for your baby.
As with introducing or changing any medications, it is important not to try too many new things at once as it is then difficult to tell what works and what doesn’t. When switching to a new or different formula, do make sure that enough time is allowed for the previous milk to leave the system completely and for the new one to be accepted before assessing whether the change has produced a positive response or not. Sometimes, if moving from a dairy formula on to a hydrolysed one, the baby may reject the new formula because of its taste. If this happens, then it may take time to wean the baby gradually on to the new milk by mixing this with the existing milk, increasing the strength ratio each day.
The quicker you can instigate the change on to the dairy/ lactose-free formula, the better. First try offering a full-strength bottle of the new, hydrolized formula. If your baby refuses, you could then try making the switch in just 3 days by using a stronger ratio each day.
The following list explains the different types of formulas most commonly advised or prescribed. Medical advice should always be sought when introuncing formula to your baby’s diet.
- An ordinary formula may be suitable if the baby has little or no cow’s milk protein/lactose intolerance or allergy. Infant Gaviscon can be added, which can help manage some reflux symptoms. Nearly all formula brands offer a ready-made version and a number of babies seem to be more comfortable on the ready-to-feed form than the powder form. The ready-to-feed milk is not only thicker and heavier so stays down better, but is slightly more easily digested as the treatment process to make it into ‘long-life’ milk breaks down some of the chains of the cow’s milk protein, which therefore makes it more easily digested. In fact, hundreds of parents have reported that their babies will actually refuse the powder formula in favour of the ready-made variety!
- Formulas like Easy Digest and Comfort are nearly always cow’s-milk- based but have a reduced lactose content and are usually of a thicker consistency when made up. They are designed to relieve mild reflux symptoms and may need to be fed through a faster-flow teat.
- Most formula brands have pre-thickened products within their range, such as Aptamil AR, SMA StayDown and HIPP Organic Anti- Reflux. Quite simply, the thicker the milk that goes down, the better it stays in the gut, not leaking back up quite so easily and therefore helping to reduce the backward flow of the stomach contents. However, be aware that the various brands use different thickeners and it may take time to understand which one best suits your baby. For example, Aptamil AR is thickened with carob bean gum, SMA StayDown with corn starch, and Enfamil AR with rice starch.
- Some brands of general formula offer lactose-free alternatives (e.g. SMA LF) designed for those babies who can tolerate cow’s-milk protein but have a lactose intolerance.
- Enfamil O-Lac is basically the same as Enfamil AR but has had the lactose removed, making it suitable for babies with reflux who also have a lactose intolerance.
- Nutramigen is a hypo-allergenic formula used for babies with either a cow’s-milk protein and/or lactose intolerance. The protein in it has been extensively broken down (hydrolysed) into tiny pieces that are not recognized by the immune system and will not trigger an allergic reaction in most babies. Nutramigen 1 is for babies up to six months and Nutramigen 2 for those six months and older.
- Some babies with a severe cow’s milk protein allergy or those who can’t seem to tolerate even an extensively hydrolysed formula need an amino-acid-based formula. There are a number of these on the market, such as Nutramigen Puramino, SMA Alfamino and Neocate LCP or Syneo. Elemental ingredients in these milks are broken down into the purest form for easy digestion; in fact these milks are almost ingested rather than digested.
- Pregestimil is a formula for babies who have a problem with digestion or absorption of routine formulas, or who are diagnosed with cow’s- milk protein allergy and fat malabsorption. It is lactose- and sucrose- free and the carbohydrate is readily digested and well tolerated as it contains a special fat called MCT (medium chain triglycerides) oil which is easily absorbed and shown to promote weight gain in babies with fat malabsorption and who may be failing to thrive.
Managing dietary changes for your child
It can be quite a daunting prospect to change your toddler’s diet, if that is what’s required to overcome digestive problems. That said, it is much easier today than it was ten or fifteen years ago, when you could only get gluten-free products on prescription. Today, all the supermarkets have a large ‘free-from’ range and a multitude of plant- and nut-based milks readily available, for example .
There is much more awareness surrounding food allergies and intolerances, and plethora of information available online about adopting a dairy-free, gluten-free or vegan diet. For instance, there are hundreds of social media groups can join that will give you information on the best alternative brands and allergen-free recipes, along with advice, help and support with whatever changes you are needing to make. Meanwhile, nearly all food outlets, restaurants, cafes, schools and nurseries now cater for food allergies, so thankfully it’s not quite the minefield it used to be. However, you will still need to read the labels on everything you buy, as there can be ‘hidden’ ingredients in some prepared foods and it’s sometimes easy to be confused by the wording.
For example, when needing to adopt a dairy-free diet, you’ll need to know that all of the following terms indicate that milk, or derivatives of milk, are present in the food:
- cow’s milk (fresh, UHT, malted, evaporated and condensed)
- dried milk, skimmed milk powder
- milk solids, non-fat milk solids, milk protein
- butter, butter oil, buttermilk, ghee
- cream, sour cream
- cheese, cream cheese, curd cheese, quark
- yoghurt, fromage frais, crème fraîche
- casein, casein concentrate, hydrolized casein, casein hydrolysate, sodium caseinate, ammonium caseinate or magnesium caseinate
- lactose, lactoglobulin, lactulose, lactalbumin, lactalbumin phosphate, lactoacidophilus
- whey, hydrolized whey, whey powder, whey syrup sweetener, whey protein hydrolysate, sweet whey, delactosed whey
What you can do
Having researched and read all the information about reflux and dietary related intolerances and food allergies that I give in both my books, through the podcasts I’ve recorded and scrolling though my Instagram, I would hope you now might have a clearer understanding of what could be exacerbating or causing your little one’s digestive issues
Often, all that is needed is to work out what is fueling the digestive discmofort, which then makes it easier to address the underlying problem and bring resolution to the condition.
It might be that you need to change your diet and remove all allergens if you’re breast feeding.
It could be you need switch your baby’s formula to one that has reduced or no lactose/cow’s milk protein.
You may well need some expert medical intervention to get a proper diagnosis and it would be useful to see a Pediatric gastroenterologist and a dietician.
It may be that probiotics would help to rebuild your baby’s gut health.
Whatever the problem, it can be changed, fixed, rectified and your baby will be able to feed comfortably and sleep more easily once all the symptoms are fully managed.
- You can read both my books.
- You can listen to the podcasts I have recorded on sleep, reflux and intolerances and food allergies.
- You can scrutinise my Instagram page and replay many of my ‘live’ posts and Q and A sessions.
- You can seek direct help from me through an online consultation.
There is definitely a light at the end of the tunnel and you, like thousands of parents before you, can and will learn how to manage your baby’s digestive issues and promote and establish positive feeding and sleeping habits for your baby, toddler or child. Good Luck!