Food substitute for child Allergy Food

Test allergy in children - by google

Food allergies in the community is a general term for expressing an adverse reaction to food, including the fact that the non-allergic process is actually more accurately called intolerance. Food allergy is a collection of symptoms that affect many organs and body systems caused by food allergies. The first allergens exposed to the baby are cow's milk. IgE-class antibodies formed from the allergic inflammatory cascade, this cascade does not stop, and sensitive to other compounds will occur

Pathogenesis

Genetic factors play a role in food allergies. Bowel immaturity makes it easy for allergens to enter the body. Allergens can occur since the fetus in the womb and since infancy and are influenced by local habits and norms of life. Sometimes there are trigger factors: physical factors (cold, heat, rain), psychic factors (sadness, stress) or workload (running, exercise).

Allergens in food are proteins, glycoproteins or polypeptides with molecular molecules of more than 18,000 daltons, heat resistant and proteolytic enzyme resistant. In the purification of allergens in fish known allergen-M as a determinant even though the number is small. In ovomukoid eggs is known to be a major allergen. Beta-lactoglobulin (BLG), Alflalactalbumin (ALA), Bovine Serum albumin (BSA) and Bovine gamma globulin (BGG) are the major allergens in cow's milk, among which BLG is the most powerful allergen.

The most important peanut proteins as allergens are reaching and conarachin, whereas in purification there is an allergen called Peanut-1 a glycoprotein with a molecular weight of 180,000 daltons. Purification of shrimp gets Allergen-1 and Allergen-2 each with a molecular weight of 21,000 Dalton and 200,000 daltons. Albumin, pseudoglobulin, and euglobulin are the major allergens in wheat.

In the initial exposure, food allergens will be recognized by antigen presenting cells to subsequently express on T-cells directly or via cytokines. T cells are sensitized and will stimulate B-cells to produce antibodies from different subtypes. Allergens are not absorbed by the intestine in sufficient quantities and reach the cells forming antibodies in the intestinal mucosa and intestinal lymphoid organs, which in most children form antibodies of the IgG, IgA, and IgM subtypes.

In atopic children tend to form more IgE then further mucous cell sensitization in the gastrointestinal tract, respiratory tract, and skin. A very atopic baby is also sensitized through mother's milk to the food that the mother eats. Babies with early allergies to one food such as milk, also have a high risk of developing an allergy to other foods. The production of IgE antibodies started from early exposure and apparently continues despite an elimination diet. Complement will begin to experience activation by the antibody-antigen complex.

In the subsequent exposure, cytokine production by T cells occurs. Cytokines have various effects on various cells, especially in attracting inflammatory cells such as neutrophils and eosinophils, causing an inflammatory reaction. Complement activation and the occurrence of immune complexes will attract neutrophils

Combination of allergens with IgE in mast cells can occur in IgE that has been attached to mast cells or IgE-Allergen complexes occur when IgE is still not attached to mast cells or IgE that has been attached to mast cells activated by non-specific pairs, will cause mediated degranulation. Clinical symptoms that arise is the result of the interaction of mediators, cytokines and tissue damage caused.

Clinical Symptoms

Clinical symptoms of food allergies usually affect a variety of target organs such as skin, respiratory tract, gastrointestinal tract, eyes, ears, vascular ducts. The target organ may be sedentary, symptoms often found in infancy. Certain foods can cause certain symptoms in a child, but in other children can cause other symptoms. In a person's food, one can have another target organ with another food, for example, shrimp causes urticaria, while peanuts cause shortness of breath. Cow's milk can cause allergic symptoms in the airways, gastrointestinal tract, skin, and anaphylaxis. Bischop (1990) found in patients who are allergic to cow's milk: 40% with asthma symptoms, 21% eczema, 43% with rhinitis. Other researchers get cow milk allergy symptoms in the form: urticaria, angioneurotic udem, pale, vomiting, diarrhea, eczema, and asthma.

How to Check / Diagnosis

Diagnosis of food allergy is obtained from anamnesis, physical examination, laboratory examination and academically confirmed by "Double Blind Placebo Controlled Food Challenge". Clinically it can be done open elimination test and open provocation "Open Challenge". The first elimination is done with the food presented by the patient or his parents or from the skin test results. If there is no improvement then used regime certain diet.

Diagnosis of diet elimination

There are several dietary regimens that can be used:

1. "ELIMINATION DIET": Some foods should be avoided: Fruits, Milk, Eggs, Fish, and Beans, in Surabaya known by the abbreviation BSTIK. These are foods that are commonly found to cause allergic symptoms, so foods with high allergenicity index. This index may be different for other areas, for example with DBPFC getting eggs, peanuts, cow's milk, fish, soybeans, wheat, chicken, pork, beef, and potatoes, while Bishop gets milk, eggs, soybeans, and nuts.
2. "MINIMAL DIET 1" (Modified Rowe's diet 1): consists of several foods with a low allergenicity index. Unlike the "elimination diet", this regimen consists of several food ingredients that are allowed: water, rice, beef, coconut, soybeans, spinach, carrots, onions, sugar, salt and soy formula. Other foodstuffs are not allowed.
3. "MINIMAL DIET 2" (Modified Rowe's Diet 2): Consists of foods with other permissible low allergenicity indices, such as water, potatoes, mutton, red beans, beans, cabbage, onions, casein hydrolyzate formulas, other foodstuffs are not allowed.
4. "EGG and FISH FREE DIET": this diet removes eggs including foods made from eggs and all fish. Usually given to patients with complaints with major complaints urticaria, angioneurotic udem, and eczema.
5. "HIS OWN'S DIET": get rid of foods self-proclaimed by the sufferer as the cause of allergy symptoms.

Diet is done for 3 weeks after that done with 1 food provocation every week. Foods that cause allergic symptoms in this provocation are recorded. Called allergens if at 3 times provocation cause allergy symptoms. The time does not need to be in a row. If with one diet regimen there is no improvement when it is done correctly, then given another regimen. Before starting a new regimen, the patient is given "carnival" for a week, meaning that for 1 week all the food can be eaten (party). The point is to give a gift after 3 weeks of diet well, thus there is a spirit to follow the next diet. Furthermore, the next diet is also done for 3 weeks before provocation.

Supporting investigation

1. Skin test: as a screening test (eg with inhaled allergens such as mites, cotton, house dust, cat hair, grass pollen, or food allergens such as milk, eggs, nuts, fish).
2. Edge Blood: when eosinophilia is 5% or 500 / ml inclines in allergies. Calculate 5000 / ml leucocytes with 3% neutropenia commonly found in food allergies.
3. Total and specific IgE: normal IgE total price is 1000u / l until the age of 20 years.
4. IgE levels of 30u / ml generally indicate that the patient is atopy, or has a parasitic infection or cellular immune depression.

Implementation

It should be emphasized once again that the elimination/provocation diet is for diagnostics. If the allergen has been found it should be avoided as best as possible. Hypoallergenic foods are used as a substitute. If it is possible forever. Fortunately, cow milk allergy disappears in most cases at the age of 2 years. It should also be remembered that allergies cannot be cured, but controlled by the number of attack frequencies, less the intensity of the attacks, less use of the medicine, minus the number of days skipping school, improved quality of life. Desensitization of food allergies is not done because the reaction is great and very little evidence of success.

If successful, the patient also still have to get rid of food causes of the allergy attack, as well as desensitization with the dust of the house still cannot wear a cotton mattress. Parents should tell the replacement food because parents are often worried about the lack of vision in their child. Eating in restaurants is less safe and always recommended to read the label of food ingredients if buying food so (label reading). In infants who eliminate food that is still nursing in the mother, then the mother must also abstain from food that the baby challenged because allergens can be transferred through the mother's milk.

Read also : First Aid In Children Who Have Allergy Symptoms

Food Substitute

For babies who need primary prevention ie high-risk babies for allergies, when breast milk cannot be given, the choice of substitute formula is Partial Formula Hydrolysate, for example, is NAN HA, Enfamil HA, Nutrilon HA. SGM HA. In this formula is still allowed to contain Vitamin C, Vitamin E, DHA, Omega-3, and probiotics. In this group of infants it is important not to avoid cow's milk, but how can it lead to immune tolerance to cow's milk.

In bay-infants who have already experienced allergy symptoms, such as urticaria (biduren), atopic dermatitis (eczema). Allergic rhinitis, asthma or otitis media, requires secondary prevention, whereas breast milk cannot be administered, replacement milk is an extensive (total) hydrolyzate formula, for example, Pregestimil, Pepti Junior. For babies over 6 months old can use soy isolate formulas such as Nutrilon Soya, Isomil, Nursoy, Sobee, SGM Soya, Similac Soya. For babies with severe allergic symptoms such as severe eczema, severe asthma, or those who are intolerant to a total milk hydrolyzate formula, the amino acid formula may be given, eg Neocate.

In children who have already experienced allergy symptoms and tertiary prevention is needed to prevent further complications and disease progression, for example allergic rhinitis develops into asthma, eczema develops into asthma, so they get certain dietary regimens, they get dietary regimens such as elimination diet, diet at least 1, 2, Egg and Fish Free diet, His own Diet. There is a dilemma for children on a diet, that is, if loosely causing high morbidity, if too tight, it is not uncommon for malnutrition. Then the solution is the elimination diet should not be prolonged. For the purpose of diagnosis, the elimination diet is done for 3 weeks only after it is done a provocation.

Given alternate food alternatives. Children who should avoid fruit for 3 weeks, it is good to replace with vegetables, carrots. Those who need a diet of rice, a recommended substitute is potatoes. Cow's milk and eggs are often on bread so it needs to be replaced with pastries such as layer cake, bikang cake, cupcakes. Fish and eggs as an important source of protein in healthy foods are either replaced with beef or goat. Nuts are also sometimes to be avoided, as a substitute should be given soy, for example, tofu, tempe and soy sauce.