If you think allergy does not kill, think again. It can be fatal.
“Allergy is not something to be sniffed at. It is something very serious. If you look at the data on children, 80% of anaphylaxis cases in children is due to allergy.
“We need to have a better anaphylaxis action plan and that is why the World Allergy Organization (WAO) decided to bring out food allergy as the theme for this year's World Allergy Week,” said consultant paediatrician and clinical immunologist/allergist Dr Amir Hamzah Abdul Latiff, president of the Malaysian Society of Allergy and Immunology (MSAI).
He was speaking yesterday at the launch of the Cow’s Milk Protein Allergy (CMPA) Awareness Campaign at the Gardens Hotel & Residences in Kuala Lumpur. The campaign is in conjunction with World Allergy Week from April 8-14.
Championed by MSAI and the Malaysian Paediatric Association (MPA), the campaign hopes to raise awareness and educate parents and medical professionals about CMPA amongst children.
CMPA is the most common form of food allergy in infants. According to studies, CMPA can develop from birth and peak within the first year before subsiding in about three to four years. However, according to the MPA nad MSAI, a study involving 807 children with CMPA found that the condition can persist into adolescence in approximately one-third of these children, with 12% of them remaining allergic to cow’s milk until the age of 18 years.
“CMPA symptoms amongst young children can occur within minutes of ingestion, starting with skin irritation, digestive problems, extreme irritability and even anaphylaxis, a severe allergic reaction,” said Dr Chai Pei Fan, consultant paediatrician / paediatric gastroenterologist / hepatologist and member of the College of Paediatrics, Academy of Medicine of Malaysia (AMMCOP).
Children who are intolerant of a certain food may show the same symptoms as a child who is allergic to them. The difference is that an allergy is related to the child's immune system and an intolerance is not related to the immune system. It could just be that a child who is intolerant has lactase deficiency and is thus unable to digest milk.
A noticeable difference between an allergy and intolerance is the reaction time. Children with an allergy will have a reaction to the milk within a few minutes or within two hours after exposure – this includes drinking the milk, touching it or even smelling it.
Intolerance, on the other hand, can occur after two hours of consuming the milk and the amount of milk would also be a determining factor. A child might be able to tolerate two glasses of milk, but if he takes three glasses he might start exhibiting symptoms and they tend to be gastrointestinal.
“Parents need to know what they’re dealing with and take the next step to manage CMPA appropriately,” said Dr Chai.
He advised parents to take their kids to their regular general practitioner or paediatrician for a proper diagnosis rather than just diagnosing the symptoms themselves and trying different milk formulas to see which one agrees with their child.
“I see a lot of parents, even for very young infants, who very often try intervention themselves. A very common practice is to change from one brand of cow's milk formula to another brand which definitely will not work. Sometimes they also go for a lactose-free formula. As Dr Amir has pointed out, cow's milk protein allergy and lactose intolerance are different problems altogether.
“Some parents will look in the market and find a hypoallergenic formula. This formula is basically used for prevention, before the child develops cow's milk protein allergy. This milk is an option for parents who can't breastfeed and have a child who is at high risk of developing cow's milk protein allergy. But once your child has developed the symptoms, this milk is not appropriate. It is important to get the diagnosis from the healthcare professionals, and get the proper advice on which formula or substitute to get.
“Any doctor will do as long as the doctor is experienced and knows how to deal with it,” he said.
Misdiagnosis happens all the time when it comes to allergy, admitted Dr Amir. That's why it is important to go to a medical professional.
“There are tests that will help to guide in determining whether it is an allergy and then we'll be on firmer ground and we can initiate proper treatment. The problem is there are so many assumptions and it's not just from the public, even colleagues, I think. This is what we have to change – the mindset. Please diagnose CMPA properly and not just change milk formulas and go on to soya, which by the way, if you're allergic to cow's milk protein, there is a 10%-30% chance that you could be allergic to soy milk as well,” said Dr Amir.
Dr Chai concurred, pointing out that the CMPA In Children 2012 guidelines are aimed at creating more awareness among healthcare professionals and not just the public.
The guidelines, available in a pocket-sized booklet, are available at major medical centres.
“With these guidelines, we hope to provide a much-needed resource, especially at the primary care level, to help doctors recognise possible symptoms of CMPA so that they can help parents manage the condition and provide relief for their child,” explained Prof Lee Way Seah, chairperson of the Guidelines Committee and Senior Consultant Paediatric Gastroenterologist and Hepatologist Past President, College of Paediatrics, Academy of Medicine of Malaysia.
According to him, worldwide there seems to be a reported increase of CMPA incidences.
“Although we have no data for Malaysia, there are reasons to believe that Malaysia is no exception to what happens in other parts of the world. We have reasons to believe that there may be an increase of CMPA incidence,” said Prof Lee.
He attributes the increase to more awareness, an actual increase in numbers and possibly even the hygiene hypothesis.
“One theory for this is that the environment a child grows up in today is more hygienic. So, the exposure to environmental antigens has reduced and the immune system which is quite an integral part of the body's defence has less use so it diverts its energy to other antigens. This is the hygiene hypothesis.
“This increase and hyphthesis applies to all forms of allergy, not just food,” said Prof Lee.
The doctors say the best management of CMPA is to eliminate cow's milk protein from the child's diet. The best method is by breastfeeding – allergy or intolerance towards mother's milk is unheard of, said Prof Lee.
While a substitute formula is recommended for children under the age of two years and non-breastfed children, parents need to be mindful of the fact that soy-based formula is NOT suitable for children below six months old.
For the best options, parents should consult their GP or paediatrician.
For more information on MPA, go to www.mpaweb.org.my. MSAI's website can be found at www.allergymsai.org.
Quick info:
Around 220-250 million people worldwide suffer from food allergy.
Food allergies, especially in children, are increasing in developed and developing countries.
The severity and complexity of food allergy is also increasing.
Food allergies are complicated by other allergic diseases such as asthma and atopic eczema.
Food allergy can be fatal and appropriate diagnosis is essential.
According to the WAO, the vast majority of member countries surveyed have reported an increase in food allergy. No countries have reported a decline in food allergies over the past 10 years.
Food allergy symptoms include itching, hives, welts, swelling, mouth and lip itching, abdominal pain, vomiting, diarrhoea, runny nose, sneezing, cough, wheezing, tighness in throat, shortness of breath, anaphylaxis and shock.
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