n CME : Your SA Journal of CPD - The 'bite' in paediatric food allergy : main topic

Volume 21, Issue 11
  • ISSN : 0256-2170



'Allergic' disease in babies is triggered by foods, not by inhalants, and most manifest by 3 months. FA may affect up to 10% of children. <br>About 80% of all food allergic reactions in children are caused by legumes (peanuts, soyabeans), cow's milk and eggs. Most children (80%) will outgrow their hypersensitivity to milk and eggs at the end of their first decade. <br>Egg-specific IgE with a positive FH of atopy is a highly specific and predictive marker for sensitisation to inhalant allergens at 3 years of age. <br>CMA / CMI is the most frequent FA in infants (2 - 5%). The diagnosis should be made within the first year of life and 90% manifests within the first weeks of life. <br>Sensitisation to CMP can occur during pregnancy, breastfeeding and usually by being bottlefed. <br>CM formula feeds in the maternity ward should strictly be avoided in high-risk allergy infants and only glucose water or truly hypoallergenic formula should be given until breastmilk amounts are sufficient. <br>Sixty to seventy per cent of all adverse reactions to CMP are intolerant reactions and therefore no SPT or RAST will be positive. Generally, SPTs for foods in children are superior to RASTS. <br>The ear, nose and throat are the most common target organs for FA / FI. Recurrent otitis media affects two-thirds of all children by age 2 years. <br>SOM is the most common problem, occurring in 20% of children, and causes acquired hearing loss in children. FA / FI (especially CMP) may be the cause of many of these multiple episodes and should be considered. <br>A detailed clinical history and history of all foods/fluids ingested are essential for an accurate diagnosis and management of FA / FI. <br>All foods must be checked for 'hidden allergens'. Junk foods and incorrect soft drinks and volumes consumed must also be checked. No diet history is complete without a menu from the day mother / nursery school. <br>Calcium and iron supplements must be given to all children on a dairy-free diet and to those diagnosed with an iron deficiency. <br>The importance of a dietician in the management of FA, whenever possible, cannot be over-emphasised.

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