This month we are doing a series of blog posts on hidden food allergens. So far we have discussed hidden sources of the allergens dairy and soy, and this week we will discuss hidden sources of gluten.

If your little one has a gluten allergy or intolerance, you are quite aware of the many challenges it causes. Gluten is a protein commonly found in all forms of wheat and related grains like rye, barley and possibly oats. It is also in many other foods consumed daily, such as cereal, breads and pasta. Depending on the severity of the intolerance to gluten, different side effects may occur. They may be limited to GI discomfort, such as diarrhea, gas and bloating.  A more severe intolerance would be classified as celiac disease (CD), a lifelong digestive disorder that causes damage to the small intestine and prevents absorption.

Gluten-Free Diets

If you or a loved one is following a gluten-free diet, it is important to be aware of where gluten may be hidden. Luckily, a gluten-free diet is not as limiting as it used to be. Now, gluten-free breads, pastas and prepared foods are available, which really aid compliance on a tricky diet!  You can purchase these gluten-free foods from most grocery stores or online.

As a general rule of thumb, if following a gluten-free diet, you should avoid the following ^1,2 :

Wheat and Gluten Ingredients:

• Anything which contains: wheat, rye, barley, spelt and millet
• Hydrolyzed wheat protein, sprouted wheat or barley malt
• Anything with the term “gluten”
• Words that refer to the specific kind of grain or wheat
  • Ex: bulgar, durum, farina, macha, matzo or matza, kamut, graham, semolina, seitan, fu, udon, couscous, tabbouleh

Generalized terms which should be avoided with gluten allergies:

• Malt/Malted milk/malt extract/malt syrup
• Soy sauce/Teriyaki sauce
• Flour
• Beer (most contain barley or wheat)
• Bran
• Germ
• Orzo (pasta)
• Cookie crumbs/cookie dough
• Bread crumbs
• Gravy
• Seafood analogs (imitation crab contains wheat)
• Bouillon or broth

Everyday products which may contain hidden sources of gluten:

• Lip balm
• Sunscreen
• Children’s stickers
• Stamps and envelopes
• Soaps and shampoos
• Washing machine detergent
• Toothpaste and mouthwash
• Medicine and antibiotics
• Ground spices

For a complete list of foods to avoid and other resources about celiac disease, visit www.celiac.com

Can you think of any other hidden sources of gluten that weren’t mentioned?

-Nita

Sources:

1. Hidden Ingredients Containing Wheat or Gluten: Tips and Tricks on How to Discern Gluten Ingredients http://food-allergies.suite101.com/article.cfm/hidden_ingredients_containing_wheat_or_gluten#ixzz0oD3Qh3V2

2. http://gfcf-diet.talkaboutcuringautism.org/hidden-sources-of-gluten.htm

Grocery shopping is always a hard task, but it is even harder when you are shopping for someone with food allergies!  Worse, the ingredients your little ones may be allergic to can be hidden within the food label.  With our latest series, we will aim to uncover some of the sources of hidden allergens.

New food labeling laws require the top eight food allergens to be listed on food labels.  This is really helpful for those reading food labels; however, sometimes allergens can be hidden in the long words in the ingredient list.

Dairy is one of the ingredients which tends to be hidden in foods that you may have otherwise thought were safe. I wanted to share with you a list of some ingredients to watch out for. Some of these definitely contain diary, while others only possibly contain diary.

When viewing the list below, it’s important to always err on the side of caution.  If you think there may be traces of dairy in something, call the manufacturer of the product you would like to purchase and inquire.  If they cannot guarantee that the product is free of dairy, avoid it!

Foods with dairy ingredients:

• Milk and milk products(including condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, low-fat, malted, milkfat, milk protein hydrolysate, nonfat, powder, protein, skimmed, solids, whole)
• Butter, butter fat, butter oil, butter acid, butter ester(s), buttermilk
• Casein, casein hydrolysate, caseinates (in all forms)
• Cheese
• Cream
• Diacetyl
• Ghee
• Lactalbumin, lactalbumin phosphate, lactoferrin, lactulose
• Pudding
• Recaldent®
• Rennet casein
• Sour cream, sour cream solids, sour milk solids
• Tagatose
• Whey (in all forms), whey protein hydrolysate
• Yogurt

Foods with potential dairy ingredients:

• Artificial or natural flavorings (anything which is derived from butter, cream and egg flavors)
• Chewing gum
• Deli meats
• Fat replacers
• Many types of chocolate (although dark chocolate is often free of dairy)
• Margarine
• Prebiotics (galactooligosaccharides, also known as GOS, are derived from dairy sources. Don’t worry, Neocate Junior with Prebiotics only contains prebiotics in the form of fructooligosaccharides, also known as FOS, which are derived from vegetables.)
• Salad dressings

For a more complete list of foods to avoid when accommodating for a dairy allergy, visit the Food Allergies and Anaphylaxis Network website or check out Alisa Marie Flemming’s book Go Dairy Free: The Guide and Cookbook for Milk Allergies, Lactose Intolerance, and Casein-Free Living and website for more resources.

Can you share any foods you have found that have surprising hidden dairy ingredients?

- Nita

Jacob was only a month old, when he was hospitalized for vomiting and dehydration. An upper GI exam at the hospital revealed that he had gastroesophageal reflux disease (GERD), and he was discharged with a prescription for Zantac.

Despite the new prescription, Jacob continued to cry constantly and had horrible gas. Jacob’s parents barely got any sleep, and with both of them working, they were constantly exhausted and tense. “I hated seeing my son in constant pain — his stomach was always hurting and he was constantly vomiting,” says Michelle, Jacob’s mother.

Jacob Before Neocate

Michelle thought that Jacob might be allergic to her breast milk, and her pediatrician decided to try him on Nutramigen, a hydrolysate formula in which the protein chains are partially broken down. However, Jacob’s symptoms continued and he started developing blood in his stool.

The doctors switched Jacob to Similac Alimentum, another hydrolysate formula, and prescribed Prevacid for his reflux. But baby Jacob was still miserable.

Frustrated, sad and tired, Michelle searched the internet for anything that could help her son and found the Neocate Web site. Neocate is a hypoallergenic formula made up of individual amino acids (the building blocks of protein) instead of the partial protein chains found in the other formulas that Jacob tried.

“After reading through the Web site and testimonials I decided that the formula was definitely worth a shot,” says Michelle. “What did we have to lose? I figured, things could only get better at this point.”

Michelle consulted with her doctor and they decided to make the switch. Within two weeks of trying Neocate Infant, Michelle started to notice a difference. At five months old Jacob was finally able to sleep through the night and Michelle no longer had to give him gas drops.

In addition between five and seven months, Jacob was finally growing and thriving, improving from the 40^th percentile to the 85^th percentile for weight and the 75^th percentile for height.

 After five long months of trying everything from an elimination diet while breastfeeding to various formulas, Jacob and his family finally found Neocate.

“Neocate has allowed Jacob to be the happy, fun-loving baby I knew he could be,” says Michelle. “I only wish we would have found out about the formula sooner. Every pediatrician and gastroenterologist should be informed about Neocate.”

If you want to share your before and after photos, we’d love to see them! Send us an email at FoodAllergyLiving@shsna.com.  

To start off our ingredient series, I wanted to review the basics about fats and why they are an important part of a person’s diet. 

The main purpose of fats is to serve as a storage system. They can also be used as an energy source if the body is depleted of necessary carbohydrates. Fats provide more calories (9 calories/gram) than both carbohydrates and protein (4 calories/gram), but this doesn’t mean they are bad and should be avoided!  As you probably know, there are both good and bad fats.

Bad Fats

Saturated and trans fats are known as the “bad fats,” as they are linked to raising cholesterol levels and are attributed to increased risk for heart disease.  Examples of bad fats include butter, animal fats, fried foods, all those yummy pastries, stick margarines and shortenings.  Although these fats are known as the “bad fats” they are still okay to have in moderation, so it’s not necessary to strike them completely from the diet! 

Good Fats

There are two types of unsaturated fats – polyunsaturated or monounsaturated.  They are known as the “good fats” and aid in lowering cholesterol levels and are beneficial in fighting heart disease. Examples of good fats include vegetable oils, avocados, peanut butter, nuts, seeds and fatty fish like salmon and trout. If you want to learn more about good and bad fats, the American Heart Association has some fun facts.  

Triglycerides

Now that we know the basics of fats, I wanted to briefly discuss triglycerides. Triglycerides are the chemical form in which most fat exists in food as well as in the body.

There are two types of triglycerides — Medium Chain Triglycerides (MCTs) and Long Chain Triglycerides (LCTs). Both refer to the length of the carbon chain of a fatty acid. 

• MCTs are comprised of 6 to 12 carbon chains and are considered saturated fats. They are beneficial in the treatment of constipation or as a natural laxative and are digested more easily than LCTs. 
• LCTs have a carbon chain greater than 12 and can be monounsaturated, polyunsaturated and saturated fats.  LCTs have been studied and shown to repair the gut if it’s been damaged. ¹

Normal fats and oils contain LCTs and MCTs.  Both types of triglycerides are beneficial and should be incorporated into your child’s diet.    

DHA and ARA

Next, I wanted to touch on DHA and ARA which has been a hot topic for some time now.  DHA and ARA are polyunsaturated fatty acids which are naturally found in breast milk.  Studies have shown that they aid in brain and vision development, and are most effective when provided in the diet for up to 6 months of age.  With this, it was also found that formula fed babies were getting less DHA and ARA than breast fed babies, so now most formulas have a formula option with DHA and ARA. ^{2, 3, 4} This means, if your little one needs to be formula fed, now you can ensure that he or she is getting enough DHA and ARA that is needed to meet their needs!  

Now that we know the basics of fats, look out for Christine’s blog next week when she will continue this topic to discuss the fats found in Neocate! 

- Nita

References:
1. Warner BW, Vanderhoof JA, Reyes JD. What’s new in the management of short gut syndrome in children. J Am Coll Surg. 2000 Jun;190(6):725-36. 2. Birch, EE, Hoffman, DR, Uauy, R et al. Visual Acuity and the Essentiality of Docosahexanoic Acid and Arachidonic Acid in the Diets of Term infants. Pediatr Res. 44:201-209, 1998. 3. Birch, EE, Garfield, S, Hoffman, DR et al. A Randomized Controlled Trail of Early Dietary Supply of Long-Chain Polyunsaturated Fatty Acids and Mental Development in Term Infants. Develop Med Child Neurol. 42: 174-181, 2000 4. Hoffman DR, Birch EE, Castañeda YS, Fawcett SL, Wheaton DH, Birch DG, Uauy R.  Visual function in breast-fed term infants weaned to formula with or without long-chain polyunsaturates at 4 to 6 months: a randomized clinical trial.  J Pediatr. 2003 Jun;142(6):669-77.

EpiPens, for any child with allergies, can be a huge life saver.  However, sending your little one to school with their EpiPen can be rather stressful for a parent. There are a thousand questions that might go through your mind, “Will they be safe even with the EpiPen?” or “Will someone know how to use the EpiPen?”.

EpiPen and Anaphylactic Shock Basics

For those of you who don’t know, anaphylaxis or anaphylactic shock can be a life-threatening allergic reaction to specific triggers, such as food proteins and medication. This results in hives or swelling of the throat or tongue, which can lead to constricted airways and/or a dramatic drop in blood pressure.

An injection from an EpiPen is imperative when anaphylactic shock occurs and can save a person’s life.  An EpiPen is a premeasured dose of epinephrine, which is injected into someone’s body during a severe allergic reaction to avoid or treat the onset and symptoms of anaphylactic shock, which provides a window of time to seek further medical attention. ¹

EpiPens at Schools

If you are a parent of a child who is at risk for anaphylactic shock, you probably carry his or her EpiPen with you at all times, in case they are exposed to an allergen to which they are allergic.  This is excellent for when you are with your child; however, your child could be exposed to many more allergens at school when you and your EpiPen aren’t there!

In fact, one study of children and adolescents found that 10 out of 13 fatal or near fatal anaphylactic reactions occurred outside the home.  All the fatalities did not have an EpiPen and those who survived received an EpiPen shot before or within 5 minutes of developing severe symptoms.²

So, what does this mean? EpiPens can save lives!  You need to ensure that the other adults who spend time with your child are trained and able to assist in any situation if you’re not around.

Don’t worry, this isn’t as difficult as it sounds!  I suggest sitting down with your child’s teacher in the beginning of the school year to set up a 504 plan. This will ensure he or she receives proper care and attention when you aren’t there and that all adults that are around your child have the proper training to use an EpiPen if an emergency situation arises.

Also, there is good news for all you Massachusetts residents!  Thanks to your persistent neighbors, starting March 2010, all newly hired school bus drivers in the state of Massachusetts will be required to have EpiPen training. Unfortunately, the law doesn’t mandate the existing school bus drivers to be trained; however, it’s a step in the right direction. Hopefully the other 49 states will follow suit.  Good work Massachusetts!

How have you been able to ensure that your child is safe and can receive the proper care if they go into anaphylactic shock? Did it involve a 504 plan or EpiPen training?

- Nita

References:

1. www.epipen.com/

2. Sampson H, Mendelson L, Rosen J. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327:380-384.