A preschooler sits in the Emergency Room at midnight, breathing in a mist filled with medication to overcome the narrowing and inflammation in his airways. Meanwhile, his best friend lies wide awake in bed, scratching away at his inflamed, red, thick, elephant-like, itchy skin. From the same kindergarten class, a girl's mom, a habitual worrier and with good reason this time, sighs deeply, glad her child made it through another day without encountering unexpected exposure to peanuts.
What these three families are going through is not unusual. In fact, it is expected that allergies will become more common than ever before. Since most parents would like to sleep at midnight rather than administering puffers for asthma, steroids for itchy skins and adrenaline for peanut allergies, the question many would ask is, “Could this have been prevented?”
Dr. David Hill from the Department of Allergy at the Royal Children's Hospital in Melbourne, Australia, told delegates at a recent International conference on Allergy in Switzerland, that food allergies in infancy might have a true prevalence as high as 20% - 30%.
At the same meeting – which was facilitated by Nestle Nutrition, a company with a long history of conducting pioneering nutrition research at their research Center in Lausanne, Switzerland – Dr. Vandenplas, an academic allergist from Belgium, talked about a term familiar to some parents and allergists: The Allergic March. This visually descriptive term refers to the natural history of allergic disease when in infancy, the skin is the first organ to show signs of allergy; followed by the nose with hay fever symptoms; followed by the chest with asthma.
Can this march be arrested? Can we save billions of dollars worldwide by modifying allergies and perhaps preventing some completely? More importantly, can we imagine a time when less children and families suffer through the emotional and financial challenges that allergies place in their daily life-paths?
According to data published in the well respected and prestigious Journal of Allergy and Clinical Immunology in March 2003, the answer is yes. In Germany, between September 1995 and June 1998, a study of 2252 newborns resulted in potentially great news.
The German Infant Nutritional Intervention Study, referred to as the GINI study, was done prospectively, thus satisfying a higher standard of research often considered superior to studies done retrospectively. Babies were divided into two groups: those who were given conventional cow’s milk based formulas and those who were given three different types of hypoallergenic formulas.
The three formulas in the hypoallergenic category included two whey formulas (extensively hydrolysed and partially hydrolysed) and a partially hydrolysed casein formula. The predominant protein in cow's milk is casein and in mothers milk is whey. In allergies to milk, the protein is the usual culprit. Sensitivities, such as lactose intolerance, are not considered true allergies.
At one year of age the babies who were given extensively hydrolysed casein formulas and partially hydrolysed formulas early in life had significantly reduced skin allergies (atopic dermatitis) compared to the babies who were given cow's milk based formulas. In families where there was a predisposing history for atopic dermatitis, the benefits of using a hypoallergenic formula were convincing. In the absence of a family history, the benefits were even more pronounced when a hypoallergenic formula was used.
The GINI study will soon report on the impact of modifying other allergies such as hay fever and asthma. However, in instances where babies are not breast fed or where breast milk is replaced by a formula – especially early in life – the potential of hypoallergenic formulas in preventing allergies look very promising thus far.
Another study, also published in March 2003 in Archives Pediatric and Adolescent Med, showed that exclusive breast-feeding for at least 4 months appeared to decrease the incidence of the leading cause of hospitalization in young children – respiratory disease. Respiratory diseases affect as many as 6% of infants younger than one year.
However, according to the American Academy of Pediatrics (AAP), two thirds of mothers quit breast-feeding before six months. The AAP recommends exclusive breast-feeding for the first six months of life. When breast-feeding is halted, babies are put on formulas. Unfortunately, in my opinion at least, too often the wrong formula is used, especially when there is a family history of allergies. (For more details on which formulas to choose and when to use them, see my seminar together with another seminar on the potential of probiotics, used in preventing and modifying allergies.)
A study published March 13, 2003 in the New England Journal showed the intake of soy milk and the exposure to creams containing peanut oil were independently associated with the development of peanut allergies. In an article in Vitality, I also addressed the issue of breast-feeding mothers avoiding peanuts.
In the end, a family history of allergies may have the most important final say. For this reason, I am completely certain that a doctor interested in preventing allergies should always ask parents about this important piece of the puzzle. Pending the absence or presence of a family history of allergies, the physician should then give them sound advice based on data published in recent peer-reviewed journals. This may just translate into less sleepless nights, a bigger bank balance for parents and reduced sales of allergy and asthma medications.
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