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'Pediatric Gastroenterology' Parentelligence posts

New Washington State Law to Help Children with Food Allergies

It is with great happiness that I update an earlier blog posted several months ago with the news that patients with food allergies now have a law that helps them afford their treatment.  On Friday March 28th, Governor Jay Inslee signed a law that makes Washington the most recent state in the country to set a mandate for medical coverage of elemental formulas in the treatment of Eosinophilic GI disorders (EGIDs).  EGIDs are a severe form of gastrointestinal inflammation that results from food allergy. 


FDA finally defines gluten free

On August 5th, 2013, the U.S. Food and Drug Administration (FDA) at long last published a formal rule regulating the use of the term "gluten free" on foods and beverages.  Even though this came with a big sigh of relief to the millions of people with celiac disease living in the US, consumers should be aware that the law gives manufacturers one year to be in full compliance (and goes into effect August 5, 2014).

As we head into the final months before the law’s final compliance date, I thought I’d highlight a few other key points about this brand new law:

1. No symbols needed.  The law does not require or recommend manufacturers use any particular symbol or food label, but if a label should include any of the following phrases, compliance must be ensured:
    •    “Gluten-free”
    •    “Free of gluten”
    •    “No gluten”
    •    “Without gluten”

2.  It’s voluntary.  A manufacturer may produce gluten-free foods, but just choose not to label them as such.   

3.  “Gluten-free” does not mean “zero gluten”. The new law defines "gluten-free" to mean that a food contains less than 20 parts per million (20 ppm) of gluten.  (This tiny amount can be visualized as less than a tenth of a grain of salt on a slice of bread, and is acceptable as the standard for people with celiac disease).

4.  As with any rule, there are exceptions.  Although ...

Infants with Milk Allergy

A 4 week-old infant and his mother came to my office last week.  The mother had started seeing small flecks of blood and stringy mucous in the infant’s diapers a week prior.  The baby was fine in every other way, breast feeding normally, and looked quite healthy when I examined him.

I diagnosed the infant as having cow’s milk protein-induced proctocolitis, the term referring to allergic inflammation of the lower gastrointestinal tract from exposure to cow’s milk. 

This is a diagnosis I make often. Here's what you should know about infants with milk allergies:

  1. It’s more common than you think. 2-3% of infants in the U.S. are allergic to cow’s milk protein. It is even more common in infants with eczema or who have parents or siblings with allergies.
  2. It’s seen in breast fed babies.  Over 50% of infants with this condition are breast milk-fed infants.  But remember, the babies are allergic to the dairy in their moms’ diets, not to their mothers’ breast milk per se!
  3. Switching to soy or goat’s milk doesn’t work.  Over two-thirds of infants with cow’s milk protein allergy “cross-react” to soy protein (which means that they may not be truly allergic to soy protein, but their immune systems are just too “immature” to know the difference between the two).  Similarly, if a mother switches from drinking cow’s milk to goat’s milk, it won’t help, because the source is still a “different species”; the infant’s immune system will still respond to the “foreign” protein.
  4. Treatment takes time. The inflammation resolves when all traces of cow’s milk (and soy), are  removed from the infant’s diet.  In the case of formula-fed infants, we switch to special hypoallergenic formulas.  Typically after a successful switch, the bleeding stops within a week.  However, with breast fed infants, the improvement can be a little slower.  Since it can take up to 2 weeks for the dairy in a mother’s diet to circulate into her breast milk, the full effects may not been seen for up to a couple weeks.
  5. Allergy testing is not recommended.  The type of allergy that ...

Tips for kids with Inflammatory Bowel Disease (IBD)

Working as a CMA (certified medical assistant) in Swedish Pediatric Gastroenterology, I have the responsibility and honor of taking care of children diagnosed with a variety of gastrointestinal problems, one of the most serious being Inflammatory Bowel Disease (IBD).  IBD is an autoimmune disease that causes chronic intestinal inflammation.  Crohn’s disease and Ulcerative Colitis are the two main types of IBD, depending on the location and depth of inflammation in the gut. 

As I work with the families of children diagnosed with IBD, I am constantly amazed at what a complicated job they have, balancing life between a chronic illness and the challenges of “normal childhood”. 

As the school year gets off to a start, seeing how hectic life can become for most kids, I wanted to write down a few ways children with IBD might better empower themselves to gain control over their chronic disease:

Dirt is good for kids

I remember one day during my pediatric gastroenterology fellowship, a mother and child were walking in front of my professor and me, as we made our daily rounds in the hospital.  When the pacifier fell out of the toddler’s mouth and the mother picked it up and put it right back into the child's mouth, my professor remarked to me, "mark my words....that child will never get Crohn’s disease!"   My professor was referring to the theory of the "Hygiene Hypothesis".  This theory  is thought to explain (at least in part) why so many more people in developed nations become afflicted with autoimmune diseases such as Inflammatory Bowel Disease (IBD - Crohn's disease and Ulcerative Colitis) as well as food allergies, compared to people in non-developed nations. 

In non-developed countries, where children are...

Advocating for Children with Severe Food Allergies

Eosinophilic Gastrointestinal Disorders (“EGIDs”) are a severe form of gastrointestinal inflammation that results from food allergy.  Children and adults in the U.S. are increasingly being diagnosed with this condition that unfortunately requires strict elimination diets, and many times, a life-long inability to eat foods that most of us take for granted each day, including dairy, wheat, soy, and eggs. 

For children requiring such restrictive diets, pediatric gastroenterologists like me work hard to find adequate alternate sources of nutrition.  For my patients with EGIDs, I often prescribe special “elemental formulas” as a treatment to both heal the intestinal inflammation and prevent further harm.  These formulas are completely allergen-free while meeting 100% of a child’s nutritional needs. 

However, in the state of Washington, most ....

Child’s Belly Discomfort Caused By Allergies

This is one of the most common questions that I get asked in the office. Allergic diseases are certainly becoming more and more prevalent in the developed world. General pediatricians and specialists are on ‘high-alert’ for this when evaluating a child that may be sick. Within the realm of intestinal diseases, however, a true allergy is actually not very common. To understand this, we must first understand what ‘allergy’ means.

An allergy is a biologic response from our body’s immune system. When our body senses a foreign invader, our army of immune cells attacks it. It does this by releasing chemicals into the blood stream and/or in to the organs where the threat may lie. Those chemicals are meant to destroy the invader, but often hurt our healthy organs as well. For example, airborn pollen may land in your eye, the immune system senses that pollen, releases those chemicals, and as a consequence we get itchy, puffy, watery eyes. The same thing can happen in the bowel if we ingest food that we are allergic to.

Intestinal manifestations of food allergies

One of the more common sites of an allergic response to food is in the esophagus—the food pipe. When the esophagus gets inflamed, it can manifest in a few different ways: heartburn symptoms, chest pain, chronic dry cough, upper abdominal pain, frequent regurgitation, or food that is stuck the chest. The name of this is Eosinophilic Esophagitis. Food allergies lower in the bowels can cause diarrhea, blood in the stool, abdominal pain, weight loss, anemia, and fatigue.

There are usually other red flags

One of the most important things to remember is ....

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