Food Allergies

    Equip Parents with Allergy Knowledge.

    Infant Allergy Awareness Month is an ideal time to talk with parents about the rising rates of food allergies, and what that means for their infants.

    In the last 20 years, the rate of food allergies among U.S. children ages 0-4 has increased ~30%1. Researchers are working to discover the causes, but so far clear answers are elusive. Some hypothesize that epigenetic and environmental factors are at play2, while others suggest lack of early exposure to important microbes3. One thing we do know is that young children are the most commonly affected4.

    Help Parents Identify Their Infant’s Potential Allergies

    Download Symptoms Guide

    Food Allergy by the Numbers

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

    Infants with food allergies are up to 4x more likely to exhibit other allergies as they grow7.

    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 life8.

    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 age9-11. 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 tolerance12.

    Comprehensive CMA Management Supports Gut Development.

    An extensively hydrolyzed formula with the LGG probiotic may not only manage indications of CMA, but also result in fewer future allergic manifestations.

    Extensively hydrolyzed formula (eHF) with the probiotic LGG has been shown to reduce the likelihood of allergy progression13.

    Download MOA

    Classification of Adverse Reactions to Food.

    FODMAP: fermentable oligo-di-mono-saccharides and poly

    Management changes 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 a solution to support your patients with food allergies? Learn More About Mead Johnson’s CMA Options.

    See CMA Solution

    Teaching Parents About Identifying 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.

    GERO: gastroesophageal reflux disease.

    LGG is a registered trademark of Chr. Hansen A/S.
    * Published study showing fewer incidences of asthma, rhinoconjunctivitis, urticaria, and eczema at 3 years in infants with CMA compared to formula without LGG. Feeding began at 4 months of age or older in the study.
    Published study showing fewer incidences of asthma, rhinoconjunctivitis, urticaria and eczema at 3 years compared to Nutramigen® without LGG. Feeding began at 4 months of age or older in the study.

    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 AAP “Allergy and Anaphylaxis Emergency Plan” with parents of children with severe allergies.

    Anaphylaxis in infants

    Anaphylaxis is a severe, potentially fatal, allergic reaction involving multiple systems20. Infants with allergies are at risk for anaphylaxis, and the indicators of an anaphylactic reaction may be more difficult to recognize in these patients20.

    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 ones20.

    Common indications20:

    • 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 normal20:

    • 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 quickly21.

     

    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 response22-24.

    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 adults25. Ensuring these patients have an extra source of both DHA and ARA is important23.

    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 conditions26:

     

    Ineffective resolution with an EHF

    The degree of hydrolysis determines the allergenic response. ~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 higher26.

    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 formula27.

    Growth faltering

    Up to 24% of children with food allergies may have growth stunting26. When growth faltering does not resolve on an EHF, especially when multiple systems are involved and 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 anaphylaxis28.

    Consider an amino acid formula for these issues as well26:

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

    • Severe complex gastrointestinal issues with non-IgE-mediated food allergies26

    • Severe atopic dermatitis, growth faltering or ineffective resolution of CMA26

    • Short bowel syndrome29

    Mead Johnson offers a selection of amino acid formulas

    See Options

    References

    1. National Center for Health Statistics. Table 35. In: Health, United States, 2017: With special feature on mortality. Hyattsville, MD. 2018.
    2. Savage J et al. Immunol Allergy Clin North Am. 2015;35:45-59.
    3. Jones SM et al. N Engl J Med. 2017;377:1168-1176.
    4. Asthma and Allergy Foundation of America. Allergy Facts and Figures. Available at: https://www.aafa.org/allergy-facts/. Access on April 7, 2020.
    5. Fair Health. Food Allergy in the United States: Recent Trends and Costs. An Analysis of Private Claims Data. Available at: https://s3.amazonaws.com/media.2.fairhealth.org/whitepaper/asset/media2.fairhealth.org/whitepaper/asset/Food%20Allergy%20White%20Paper%20Final.compressed.pdf. Accessed on April 7, 2020.
    6. Gupta R et al. JAMA Pediatr. 2013;167(11):1026-1031.
    7. Branum AM et al. NCHS data brief, no 10. Hyattsville, MD: National Center for Health Statistics. 2008.
    8. Maciag MC, Phipatanakul W. Curr Opin Allergy Clin Immunol. 2019;19:161–168.
    9. Bishop JM et al. J Pediatr.1990;116:862-867.
    10. Wood RA. Pediatrics. 2003;111:1631-1637. 
    11. Host A et al. Allergy. 1990;45:587-596. 
    12. Canani RB et al. J Pediatr. 2013;163:771-777.
    13. Canani RB et al. J Allergy Clin Immunol. 2017;139:1906-1913.
    14. Burks AW et al. 2011;128(5):955-965.
    15. Burks AW et al. J Allergy Clin Immunol. 2012;129(4):906-920.
    16. Tuck CJ et al. Nutrients. 2019;11:1684.
    17. Walsh J et al. Br J Gen Pract. 2016;66(649):e609-e611.
    18. du Toit G et al. Arch Dis Child Educ Pract Ed. 2010;95:134-144.
    19. Dosanjh A. Infant Anaphylaxis: The Importance of Early Recognition. J Asthma Allergy. 2013;6:103-107.
    20. 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.
    21. 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.
    22. Hadley KB, Ryan AS, Forsyth S, et al. The Essentiality of Arachidonic Acid in Infant Development. Nutrients. 2016;8(4):216.
    23. 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.
    24. 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.
    25. 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.
    26. 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.
    27. 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.
    28. Abad-Sinden A, Sutphen J. Nutritional Management of Pediatric Short Bowel Syndrome. Pract Gastroenterol. 2003;27(12):28-48.