I have a friend whose daughter has severe gluten allergies. We often have long conversations about what it’s like to live with a child who has severe allergies, but one story she shared with me stands out. Her daughter was starting to get a horrible rash on her feet, and my friend could not understand what was causing it. After some investigative work, it turns out it was her daughter’s new flip flops! The sandals had gluten on them. She had found out by calling the manufacturer and was able to locate the culprit.

I was truly stunned by this! My friend works so hard at avoiding gluten by looking over all food labels and yet, there it was, in her daughters’ flip flops. This got me thinking; what other things are gluten and other allergens hiding in?

Here is a list of some surprising hidden allergens in products other than food:

Gluten

• Adhesives on envelopes and stamps
• Self-stick labels and stickers
• Latex or rubber gloves for house cleaning
• Art supplies like play dough, clay, glue
• Hand lotion
• Shampoos

Dairy

• Chewing gum
• Toothpaste
• Sunscreen
• Clothing

Soy

• Adhesives
• Body lotions and creams
• Fabrics
• Paper
• Printing Inks
• Soaps

What are some weird and unusual places you have found an allergen? It always helps to discuss your findings with other families to help them in avoiding accidental exposure and frustrations! We’d also love to hear about any “safe” products you are using.

-Christine

Sources: http://www.celiacsolution.com/hidden-gluten.html

http://www.celiac.com/articles/183/1/Additional-Things-to-Beware-of-to-Maintain-a-100-Gluten-Free-Diet/Page1.html

Question:

My daughter just turned a year old, and I was wondering when I should transition her from Neocate Infant to Neocate Junior? Do I need to introduce it slowly, or can I just make the switch 100%?

Answer:

Since your little one is now one, her vitamin and mineral requirements have changed. That’s why Neocate Junior is formulated a bit differently than Neocate Infant to meet her new needs. Neocate Junior also contains more calories (30 calories/ounce) than Neocate Infant (20 calories/ounce).

Before making any switch, be sure to get the go-ahead from your doctor. If your child is doing well on Neocate Infant, the transition should go smoothly. Some children are able to make the switch “cold turkey”, while others are more sensitive to changes in texture and taste and may need to be weaned onto it slowly. You can start with 25% Junior and 75% Infant, slowly working up to 100% Junior.

Another thing you can consider is using flavor packets (available in cherry-vanilla, grapefruit and lemon-lime), flavor straws or the chocolate and tropical versions of Neocate Junior to add some variety into your daughter’s diet.

In a very recent study looking at the prevalence, diagnosis, and management of food allergies, it found that “the evidence for the prevalence and management of food allergy is greatly limited by a lack of uniformity for criteria for making a diagnosis.”¹ Interestingly, the study also stated that there is not a universally accepted definition of food allergy!¹

There are several food allergy tests out there to make a diagnosis of a food allergy.  It can be difficult sometimes to determine which one will help get the most accurate diagnosis for you or your little one. Today we will cover what the most common tests are and how they work.

The most common allergy diagnosis tests are skin prick testing, total serum (blood) IgE testing, and atopic patch testing. An oral food challenge is also an effective test for food allergy diagnosis, but it has its limitations.

Here is a list of how each test works and some of the advantages and disadvantages of each one. Some of these tests can be less accurate in young children, so remember to talk with your doctor about which option(s) is best for your child.

Skin Prick Tests (SPT) – Direct challenge of allergen on skin with a needle prick. Most commonly used method.

Advantages: Rapid results, may apply many allergens, easy to perform.²

Disadvantages: Affected by use of antihistamines, false positives are noted, potential risk of anaphylactic reactions, not ideal for those with extensive eczema, trained professional must administer.²

Total Serum IgE (RAST or ELISA) – Sample of blood is taken to measure IgE amounts.

Advantages: More comfortable than skin tests, no risk of anaphylaxis, unaffected by medication use.

Disadvantages: Tests results delayed, requires large volume of blood for multiple tests which may be harder for younger children, high cost, fewer allergens tested.

Atopic Patch Test (APT) – Skin exposure to allergen over long period of time (24 – 72 hours). Used to assess non-IgE food allergy responses.

Advantages: Assesses late onset of symptoms, can help to identify allergens for patients with Eosinophilic Esophagitis or Atopic Dermatitis.

Disadvantages: Highly variable in testing method, preparations and results.

Oral Food Challenge – Specific foods are introduced to patient and symptoms are assessed. Must be a double blind placebo controlled food challenge.

Advantages: The most accurate testing method for food allergies, criterion standard.

Disadvantages: Risk of anaphylactic reactions, significant amount of time and man power needed, cost, facility must have proper tools and equipment to perform this test.

At times, some physicians may perform more than one type of test to ensure the most accurate results.

Have you had experience with any of these tests? Which did you find to be most accurate for your little ones?

- Christine

1.  Schneider Chafen, J et al. Diagnosing and Managing Common Food Allergies: A Systematic Review. JAMA 2010;303(18):1848-1856

2.  Huang, Shih-Wen, Allergy Testing in Children; Which Test When?. Consultant for Pediatricians 2010;9(3);93-100

To follow up on Mallory’s post on Dysphagia, GERD, and Silent Aspiration in children, I wanted to discuss the use of thickeners to help with the treatment of GERD/GER, dysphagia and aspiration.

If your little one is showing signs of GERD/GER, dysphagia or aspiration, you should always see a doctor to determine exactly what condition needs to be treated. One thing to remember is that children with Eosinophilic Esophagitis (EoE) can also have symptoms of dysphagia and often have symptoms very similar to that of GERD.  EoE is caused by food allergies and can be treated effectively by eliminating the allergens in your child’s diet.  Thickening their food or formula may not be needed once the allergens are removed.  Be sure to check with your doctor or speech pathologist to see if a food thickener is appropriate for your little one before trying one.

Thickening Foods and Liquids

If your child does have GERD/GER, dysphagia or aspiration, altering the thickness of food and liquids can help make them easier to swallow. When fluids are too thin, some children have trouble using their tongues correctly, causing liquid to get caught in the airway passage and then get into their lungs.  Thickening the formula and other fluids will help to ensure that the liquids stay together in the esophagus, decreasing the risk of aspiration.

For infants with GERD symptoms, using rice cereal in their formula to thicken it may help. The recommended amount to add to formulas is one tablespoon per 2 to 4 ounces of formula to reduce vomiting. (Rudolph et al 2001). There are also other thickeners on the market to choose from. It is important to read labels and call the company if your child has food allergies to ensure that they aren’t ingesting any allergens in the thickener. A few options include:

• Thick-It
• ThickenUp
• Simply Thick

Have you used a thickener before for your child? If so let us know which you tried and how it worked!

- Christine

As part of our ongoing “Carb Series”, today’s post will discuss the carbohydrates found in Neocate.  As you found in Sarah’s Carb 101 post, carbohydrates are the major source of energy for humans.  Children require about 50% of their total energy to come from carbohydrate (remember there are 4 calories in 1 g of carbohydrate).

The carbohydrate source in Neocate is corn syrup solids.  This is probably the most asked about ingredient in the Neocate line of products!  Many parents aren’t sure if corn syrup solids are similar to high fructose corn syrup (HFCS).  It is important not to confuse the two. HFCS is chemically altered in order to make it much sweeter so it can be added to a wide range of processed/packaged foods.  The corn syrup solids we use, along with the fats, amino acids, vitamins, and minerals are an important part of the nutritionally complete blend of nutrients in Neocate.  

Another question we get asked a lot is whether the corn syrup solids in Neocate are safe for children with a corn allergy.  It is important to remember that the corn syrup solids in Neocate are highly refined. This means that the ingredient goes through several steps in order to take out all of the protein from the corn (since proteins are what cause allergic reactions).  This leaves only the complex carbohydrate source from the corn.  So, even if your child has an allergy to corn proteins, Neocate is still an appropriate choice for them. 

The corn syrup solids used in Neocate are considered to be complex carbohydrates meaning they consist of large (branched) chains of sugars.  This is important for patients who have severe gastrointestinal (GI) conditions such as Short Bowel Syndrome. Studies suggest that obtaining a good source of complex carbohydrates may be beneficial for patients who have had GI resections^1-2. The complex carbohydrates help with gut adaptation and rehabilitation to ensure proper nutrient absorption is taking place. 

Got any questions on carbohydrates or the corn syrup solids used in the Neocate family of products? Let us know!

-Christine

1.  J. E. Bines, R. G. Taylor, F. Justice, et al., “Influence of diet complexity on intestinal adaptation following massive small bowel resection in a preclinical model,” Journal of Gastroenterology and Hepatology, vol. 17, no. 11, pp. 1170–1179, 2002.

2.  J. Ksiazyk, M. Piena, J. Kierkus, and M. Lyszkowska, “Hydrolyzed versus nonhydrolyzed protein diet in short bowel syndrome in children,” Journal of Pediatric Gastroenterology and Nutrition, vol. 35, no. 5, pp. 615–618, 2002.