Food Allergy and Intolerance: Nestle

Speaker: Dr. Pankaj Vohra, Diplomate American Board of Pediatric Gastroenterology, Pediatric Gastroenterology, Hepatology and Nutrition, Max Hospitals, New Delhi Presented at:  Nestlé Nutrition Institute, Delhi

Summary

In this webinar, Dr. Vohra talks about increasing allergy rates all over the world. He says that 54 percent of Americans are allergic to atleast one substance and 10 percent Australian children have challenge proven IgE mediated food allergy. He stated that the causes behind the rapidly rising rates of food allergy are not known – various theories have attributed it to vaccines, reduced worm infestation, over use of Paracetamol, hygiene hypothesis, longer pollen season and pollution. Milk is the most common cause of food allergy in infants. Known as cow milk protein allergy, it is a cause for diarrhoea too. Different formulations of milk are available in the market now. Dr. Vohra also talks about wheat allergy and FPIES.

Allergy rates are rapidly increasing all over the world 54% of Americans have allergy to at least one substance and 10% of Australian children have challenge proven IgE mediated food allergy. Food allergy rates in India are increasing. Traditional or alternate medicines like Ayurveda/ Unani were used for these while food restriction was very common. Theories like vaccines/lesser infection, reduced worm infestation, paracetamol, hygiene hypothesis and longer pollen seasons/pollutions have come up to explain as to the increase of allergy.

Milk allergy is an adverse reaction to cows’ milk resulting from an immunologic hypersensitivity to one or more milk proteins. Lactose intolerance is the lack of lactase enzyme; it is far more common and can be overcome by consuming milk in a form where the lactose is removed. More than 70% Indian adults are lactose intolerant. There is lots of confusion in minds of doctors. Poor reporting from parents about this allergy is a problem. Parents force children to drink milk especially in North India so they may complain but will have ice cream willingly. Senior practioners would often stop milk for chronic abdominal pain or diarrhoea or even constipation.

Type of wheat being consumed has changed from ancient or diploid wheat Triticum monococcum to modern or hexaploid wheat Triticum aestivum. The age for introducing wheat into the infants diet is increasing. Epidemiology studies from Sweden/Scandinavia have showed that delayed introduction prevents CD but more recently delay probably delays appearance of classical CD. This allergy is less in South India because of less wheat intake or later wheat intake but lower rates of DQ2/DQ8 HLA haplotypes.

Diagnosis for allergy is to suspect it. IgE specific IgE levels, Skin Prick tests are done to check sensitivity though very sensitive sensitization has occurred but it necessarily does not mean that child is allergic. Non IgE are more difficult but GI related can find biopsies useful.

There is no good evidence that avoiding particular food item during pregnancy or delaying its introduction will avoid allergy. Exclusive breast feeding for 4-6 months is most effective dietary to prevent allergy in high risk infants. Probably the best time to introduce solid food is under the cover of breast feeding and as many foods as possible; 2-3 days apart between 17-26 weeks.