Archive for Allergy

20 Mar 2018

Milk ladders

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Food allergy management used to be simple: avoid avoid avoid!!

Research is increasingly telling us that this may not always be the best tactic.

Allergy to cow’s milk involves an immune response to proteins in cow’s milk. But, food processing such as cooking or baking at high temperatures, exposure to low pH and enzymatic digestion may destroy certain proteins (‘conformational epitopes’) in the milk – meaning that many children (some say up to 75%) may actually tolerate small amounts of baked milk containing foods like muffins, cakes, breads and waffles.

Furthermore, there may be some children who respond well to regular exposures to small amounts of heat-treated milk.

So what is a milk ladder?

A milk ladder provides a step-wise approach to gradually challenge a child with cow’s milk containing foods. The principle is to start with a very small amount of extensively heat treated milk within a product (such as a biscuit) and progress as tolerated. If the food in a certain step of the ladder is tolerated, the advice is for the child to continue eating that food, and then try the food in the next step.

Is a milk ladder for everyone?

No! Certain groups of children may react badly to any cow’s milk protein, and a challenge should only be undertaken with support from a doctor or the child’s dietitian. There are different milk ladders available – and no gold-standard (research is still being undertaken), so it’s best to discuss which ladder will be most suitable for you and your child.

Hayley Kuter

Paediatric Dietitian

28 Nov 2017

Peanuts and Eggs during weaning – when to introduce?

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I’m often asked about when to introduce foods that could potentially cause an allergic reaction. In the past, children have been held off eating peanuts up until their third birthday or possibly longer. However, it’s now thought that avoiding certain foods like peanuts or eggs may actually increase a child’s risk of being allergic.

Exclusive breastfeeding until the age of 6 months is still recommended. After 6 months, when weaning begins, the government’s food advisory panel (SACN) suggests starting children on peanuts, eggs and any other food thought to have allergic potential as part of the weaning process.

“The deliberate exclusion of peanut or hen’s eggs beyond six to twelve months of age may increase the risk of allergy to the same foods. If initial exposure is not continued as part of the infant’s usual diet, then this may increase the risk of sensitisation and subsequent food allergy”.

So – unless there is a known history of food allergy in the family, peanuts and eggs may be introduced as part of the weaning diet.

Hayley Kuter

Paediatric Dietitian

18 May 2017

New tool to detect Cow’s Milk Allergy

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Quite often, cow’s milk allergy goes undetected. Symptoms are either vague, seemingly unrelated and I’ve even heard from many parents that health professionals can label parents’ concerns as being slightly neurotic.

A new tool has been launched which can help parents and health professionals determine whether symptoms are related to cow’s milk allergy. Divided into 5 sections (crying, regurgitation, stools, skin and respiratory), you can rate the severity of each symptom and get a clearer picture of the presenting problem.

Here is the tool: comiss scoring form

Let me know what you think!

Hayley Kuter

Paediatric Dietitian

27 Mar 2015

Peanuts for children

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Peanut allergy – potentially life threatening – is on the rise. More people are allergic to peanuts than ever before, and yet this is despite them being a banned substance in many places. Schools, airlines, even cafes and food labels are all hot on avoiding peanuts. Fresh results of the LEAP study might explain why we are more allergic to peanuts, despite being so careful to avoid them.

The Learning Early About Peanut allergy (LEAP) results show some interesting results: children who avoided peanuts had a 17.2% incidence of allergy at 5 years of age, and yet children who were given peanuts in their weaning diet had an allergy incidence of only 3.2%.

Of course, more studies are needed to confirm the results of the LEAP study, but these results may hold the clue as to why peanut allergy is so common right now.

Hayley Kuter
Paediatric Dietitian
01 Oct 2012

Allergy-free recipes

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I’m always trying to find a good source of tried, tested and reviewed recipes that are allergy-friendly. By chance today I’ve come across PigIntheKitchen – a blog with a host of recipes for dairy, gluten, egg and other allergies. The gluten-free, egg-free, milk-free carrot cake looks amazing – I can’t wait to try it myself. Happy baking!


Hayley Kuter
Paediatric Dietitian
12 Oct 2011

What is the difference between food allergy and food intolerance?

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Food allergy is an adverse reaction to a food that is mediated or brought about by the immune system. By contrast, food intolerance is a non immune-mediated adverse reaction. Both reactions can cause discomfort and unpleasant symptoms, and both allergy and intolerance can be labelled as ‘food hypersensitivity’. These reactions are different from toxic food reactions (such as poison in non-edible mushrooms, or salmonella infection), which will generally cause a reaction in all humans, not just sensitive individuals.

Adverse reactions to food are common in infants. Cow’s milk protein allergy is one of the most common causes and occurs in 2-6% of infants. Cow’s milk protein allergy is an immune reaction to one or more of the proteins in cow’s milk. It is often confused with lactose intolerance, which is caused by a (usually temporary) enzyme deficiency, not an immune response.


20 Sep 2011

Infant Colic

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Infant colic may well be one of the most disconcerting problems of childhood. Despite over 50 years of research, the cause of colic remains unclear. An otherwise healthy baby will cry for hours upon end; ‘colic’ being an acronym for “Cause Obscure Lengthy Infant Crying”. Crying typically occurs in the evenings, episodes starting in the first weeks of life and usually ending at 4-5 months of age.

Initially, it is important to see your doctor to rule out any underlying problem or condition. Losing weight, vomiting and abnormal stools are not signs of colic and must be investigated. Possible causes of colic are; allergy or intolerance (though breastfed babies get colic too), an immature gut, swallowing air while crying, smoking in the house, and under- or over-stimulation of the infant.

Treatments for colic include:

  • Efforts to soothe your baby; lots of cuddles, gentle rocking, walking or taking for a drive, warm baths, distraction techniques.
  • Some parents find that changing the formula milk can help (see a Paediatric Dietitian for advice).
  • Some find that changing the teat on the bottle may also help.
  • If breastfed, changing mum’s diet may also provide some relief. A Paediatric Dietitian can also help with this.
  • Smaller feeds more frequently and regular winding is recommended.
  • Colic drops, gripe water, and Lactobacillus reuteri probiotics have been found to be of benefit for some.
  • Prescription medication is not recommended due to possible side-effects.

Although colic often takes a toll on the whole family, it doesn’t appear to have any long-lasting medical consequences. Babies who have colic grow and develop normally.

29 Aug 2011

Can a dairy-free diet be nutritionally adequate?

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Avoiding dairy products, both in childhood or adulthood, is often the only solution for those suffering from milk intolerance or allergy. But what are the nutritional consequences?

Calcium is the main concern. Milk and dairy products make a significant contribution to calcium intake in our diets. Milk alternatives such as soya, rice, oat or coconut milks are naturally poor sources of calcium, but fortified versions contain similar or higher levels. This is why it’s important to choose calcium-added milk alternatives (usually these are not organic unfortunately). The bioavailability of the calcium in fortified products is similar to that of milk.

For children, other nutritional concerns are the energy, protein, fat and fat-soluble vitamins that a dairy-free diet may be deficient in. Again, cow’s milk contains a whole host of benefits aside from just calcium, so avoiding milk means either finding a substitute that can mimic some of milk’s properties, or by ensuring the rest of the diet can make up for what is lost in avoiding milk. For this reason, it is really important to have your child’s diet assessed (and periodically re-assessed) by a paediatric dietitian who will ensure your child is getting everything they need. Children under the age of 2 will typically need a prescription milk. Older children can have soy (if tolerated) but other milk alternatives such as rice, oat or coconut milk are not usually recommended for toddlers. Rice milk is not recommended for children under the age of 4 due to arsenic levels.

Soy, rice and oat milks contain between 38-47kcal/100ml (about the same as semi-skimmed milk). Coconut milk has less than 30kcal/100ml (ie. lower in calories than skimmed milk) and therefore is not always suitable for growing, active children. The protein content of milk alternatives tends to be lower (some significantly lower). Quite often the sugars in milk alternatives are high, and the effect on teeth should be considered. I always suggest open cup drinking for children on milk substitutes (see my previous blog on open cups). Calcium content of any milk substitute should be at least 120mg/100ml.

16 Aug 2011

Back to School (or Nursery) with an Allergy

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Starting school or nursery can be an anxious time for families who have children with food allergies.

Here are some top tips to help reduce the risk of your child having an allergic reaction, and to keep the new school term as stress-free as possible.

Firstly, before starting school/nursery make sure you discuss your child’s allergy with the staff (preferably a manager) and highlight any perceived high risk times eg Christmas, birthdays, trips out etc. It always helps to bring a letter from your GP, dietitian, allergy nurse or other health professional to clarify the allergy and foods to avoid. A Management Plan can then be developed to minimise risks and documents a strategic plan for worst-case scenarios. If your child suffers from anaphylaxis reactions (severe, IgE type reaction), your doctor or allergy nurse should provide the school with an Action Plan and medical kit with epipen for emergencies. Include phone numbers/contacts for emergenices, and make sure the medical kit is stored out of direct sunlight. Make sure the staff are trained in administering the epipen. Most allergy nurses will be happy to visit nurseries and schools and provide staff training.

Make sure you get a copy of the school/nursery menu and ask staff about how the children eat snacks and food – is it at tables, on the floor, small groups, and how are they supervised? Will your child need one:one supervision? Is the food served ‘buffet’ style where everyone can help themselves, and thus increase the risk of contamination? It is usually helpful for you to bring in a comprehensive list of ingredients to avoid and those allowed – I have heard of children with milk allergies be refused any puddings in case they contained milk, so were only ever given fruit! If you are sending in your child’s food, make sure everything is clearly labeled – get a load of stickers made up in advance and stick them on everything!

Ask about trips out, special events and activities that may involve food. How do staff intend to supervise your child and how will they ensure that visitors to the school know about safe foods your child can eat. Can you send in ‘safe’ food that your child can eat during special occasions? I know of one mum who sends in wheat-free cupcakes that are kept in the nursery freezer and defrosted when needed.

Don’t forget to keep staff informed about any changes or updated allergy tests that may occur during the year. It helps if everything discussed is also written down – just to be on the safe side!

Finally, I have come across an excellent resource for children with allergies – t-shirts, stickers, badges and epipen totes that are really handy for sending in to nursery/school Have a look at:

Good luck!


07 Apr 2011

Allergy News – “allergy tests can be dangerous!”

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The National Institute of Clinical Excellence (NICE) published in February 2011 the first evidence-based guideline on the diagnosis and assessment of food allergy in children and young people. The guideline highlights the dangers of using alternative testing methods such as vega tests, applied kinesiology and hair analysis and does not recommend these tests at all.

Food allergies are becoming increasingly common in children in Read more