5 commonly asked “Allergy” questions

Allergies truly are on the increase, including eczema, food allergies, and respiratory allergies like hayfever and asthma. There is evidence that countries such as South Africa are joining in this “allergy epidemic.” Allergies are a reality in most families or circles of friends nowadays, to the extent that public policies have been influenced; e.g. in certain schools and airlines the policy is now to be peanut-free.
We are not sure of the exact reasons behind this increase in allergies. We do know that it seems to have to do with the more westernised lifestyle, change in diet and “cleaner” environments. The variety and types of bugs in our guts (“microbiome”) seem to have changed over generations leading to less protection against allergies. This is a subject of much research internationally.

To a certain extent yes, but genetic tendencies are very strong in the allergy world (if a parent or sibling has an allergy, a child already automatically has a 50% or more chance of some kind of allergy in the future). However, we can influence our genes a little bit… During pregnancy, eating a healthy diet including oily fish may help, and certainly smoking is a big no-no. The use of probiotics and vitamin D for pregnant ladies is still under investigation. Babies should be breastfed where possible; the first 4-6 months are most beneficial. Excellent skin care and early treatment of dry skin and eczema is vital, especially in high risk families. Once again, Probiotics, vitamin D and omega 3 fatty acids may have a role but are still under investigation as to the correct type and dose. It seems the best environment to live in for allergy reduction is one rich in all sorts of bugs such as a farming environment!

Colic/discomfort are very common in the first few months of life, when babies’ tummies are still immature. The amount of milk they drink in proportion to their body weights is enormous! So for most babies, discomfort has nothing to do with an allergy but rather with an immature gut which gets better on its own by 3-4 months of age.

There are exceptions- those with early onset eczema, failure to grow, excessive reflux in addition to discomfort may need to be assessed for a cow’s milk allergy. Remember that small amounts of cow’s milk protein can be transmitted via breast milk, so in selected cases a trial of exclusion of cow’s milk from mom’s diet may be considered. However, the emphasis here is on selected cases after discussion with your healthcare practitioner.

Remember that lactose intolerance is very different to cow’s milk allergy- lactose is the SUGAR in both cow’s milk based products and breast milk….so reducing mum’s dairy intake will do nothing to treat “lactose intolerance” as mon’s milk is lactose-based anyway!

Food allergies can- and should- be tested for early as young as 4 months of age if there are any concerns or in children at high risk of allergies, such as those with eczema. Skin prick tests and blood tests can both be used from an early age. Babies with a strong family history of a food allergy and those with eczema should be advised to have food allergy testing early on to guide the introduction of solids.

Respiratory allergies (such as sensitivity to grass or dust mite) more commonly occur after the first year of life, so these tests tend to be more useful later down the line after a year or two of age.

Some babies who are very allergic such as those with eczema and food allergies may well have nasal allergies already in the first year of life.
However, by far the most common cause of recurrent snuffles in the first 2-3 years of life is recurrent colds/viruses. Each cold can cause a sniffle nose and even a cough for 3-4 weeks, and babies can get 5-10 colds a year, so it may be “normal” for young children to appear “sick all the time.” Of course, if a child has a high or prolonged fever, any signs of breathing distress, recurrent severe illnesses such as bronchitis, and a severe lack of appetite, they will need to seek medical attention.

Allergy prevention strategies

Allergies of all sorts (asthma, hay fever, eczema and more recently food allergy) have increased dramatically over the past few decades, and we find ourselves in the middle of a possible “allergy epidemic.” A child without any family history of allergies is now at approximately 15% risk of developing an allergic condition within the first few years; if one parent has an allergic condition, the child is at 40-50% risk of allergies, and if both parents are allergic, this increases to 60-80%. Having a sibling with allergies also carries an increased risk of allergic conditions developing.

There are many confusing messages on allergy prevention- the following are the ones with scientific backing that we currently recommend:

During pregnancy

  • Eat healthily; eating a wide variety of foods is beneficial
  • No need to cut out on any food groups for the sake of allergy prevention- it does not reduce allergy in the offspring
  • Try eat 2 or more portions of oily fish per week
  • Consider taking probiotics in the last trimester if your child is at risk of allergies (ie if there is a family history of allergy in parents or siblings). However, the best probiotic and optimal dose are still under investigation
  • Don’t smoke

Feeding the newborn baby

  • Breast milk is best and has allergy prevention properties- no formula milk is better than breast milk
  • The breast feeding mother does not have to eliminate any particular foods from her diet except if the child is already showing signs of allergies (e.g. eczema)- then discuss with your healthcare provider
  • Breastfeeding for the first 4-6 months has the most benefit
  • Continuing to breastfeed whilst the first solids are introduced seems to have some benefit too
  • Prolonged feeding over 6 months has no further allergy prevention properties (but of course has other benefits)
  • In high-risk families, only if the mother is unable to breast feed exclusively during the first 4 months, consider using a “hypoallergenic” formula milk. Studies have shown some benefit in allergy prevention. Please discuss the choice of formula milk with your healthcare provider
  • In high-risk babies consider giving a daily probiotic and prebiotic for the first 3-4 months (no absolute proof of this yet- but looks promising)
  • We do not yet have enough evidence for vitamin D and fish oils for allergy prevention

Solids introduction

  • Solids should be introduced when the child shows signs of readiness after 17 weeks of age (4 months)
  • There is no evidence that delaying solids beyond 4-6 months of age prevents allergies: in fact it may increase allergies
  • Start with reasonably low allergenic foods such as apple, pear, carrot, butternut, sweet potato for the first few weeks.
  • Thereafter you do not need to hold back on any particular food group- even highly allergenic foods such as egg and nuts- as there is no evidence that delaying their introduction reduces allergies. The recently published LEAP study, for example, showed that earlier introduction of peanut is probably better for allergy prevention.
  • HOWEVER, if the child is already showing signs of allergies- e.g. eczema, or if there is a strong family history of food allergy, then the child should ideally be assessed by an allergist between 4-6 months of age to check for evidence of food allergy and to guide the introduction of “high allergy” foods.

Other Strategies

  • There is now evidence that keeping your baby’s skin in good condition can help reduce eczema: this can be done by avoiding soap products and by applying daily emollients (a good bland moisturiser containing ingredients such as cetomacragol or emulsifying base.) We do not generally advise scented products or so-called aqueous creams as they may contain products that are too harsh for the sensitive skin.