Wednesday, 5 August 2015

FAQ's: Is this an allergic reaction?

'Is this a reaction?'

It's one of the most frequently asked questions on online food allergy forums. 

Am I the only one who squirms slightly, when these pop up?

I completely understand why people ask these questions. As a mother myself of a child with a Non-Ige mediated food allergy I've been in that place where something-is-happening-and-you-don't-know-what any number of times!! The worry you go through, the need for answers, can become all consuming - even when the reaction is not in the least life-threatening. Something is happening to your child which is unpleasant and you immediately feel the need to understand/stop/control/prevent it from happening again! 

It doesn't help that these potential reactions often take place at inconvenient times - you know; in the evenings, in the middle of the night or at weekends, when getting hold of anyone can be quite tricky - especially someone with the expertise to help you! 

You need reassurance, understanding or maybe just a shoulder to cry on. You may have had a poor night's sleep or are having trouble keeping up with the washing or any one of a number of other things could also be pressing on your mind/attention. One other sudden, unexpected urgent thing on top of it all just seems too much to deal with. That's when people often turn to allergy forums/websites.

A lot of the contributors on these sites/forums are very experienced mums who have dealt with food allergy over some time. Some of them are also medical professionals (bonus!). You can learn a lot from them about suitable products, recipes etc. and forums can be a great place to safely rant/let off steam!! BUT one needs to be careful! Not all contributors are as experienced as others or medically qualified, so I get quite anxious when I see people ask the 'reaction question'. A photo might be offered  of a child's rash (some clearer than others), or a picture might follow of a poo-filled nappy. 

Pictures of rashes aren't always that clear! They're quite hard to photograph!

The problem I have with this is not that someone's shared the picture (although I often wish that some people would be a little more discreet about how they go about it - try to display children's private parts - you don't want to encourage the wrong kind of attention), but that it's really quite difficult to tell what could be the problem just from a picture of a rash or a nappy, or because a child has been sick or had a bout of diarrhea. This is because the symptoms to an allergic reaction can be so similar to a whole range of other illnesses - some as simple as a virus, which just needs to run its course, or a tummy bug, which still isn't great, but still just needs to run its course. 

I get concerned because despite the fact that most of these sites carry disclaimers, people seem far too ready to listen to advice from someone they've never met and I've often seen good advice disregarded over advice which I would consider not so helpful (please note, I'm not saying don't do this, just be careful). Yes, I know you don't always get the help you need even from your local Doctor - we got through two local GP's, who didn't spot the symptoms, before getting our diagnosis when we went private - but online forums are just not the ideal place to arrive at a diagnosis! Doctors will need to go through various assessments before they reach a verdict - they'll need a bit more info than a few pics! 

If you're new to all this and want to know where to start, you may find the 'Is it cow's milk allergy?' website helpful. It can give you some guidance as to what symptoms to look for and how you can go about getting a diagnosis. Their assessment sheet, is particularly helpful - it could be a very useful piece of evidence to take along with you, when you visit your GP.

If you're not new to all this and are just not sure if your child has reacted to something they ate today or even yesterday, the truth is this: if it's a delayed reaction the answer may not come immediately - it could take some time (days, weeks or maybe even months) to really work out where the problem really lies. 

So how can we tell, or get some idea as to what's going on?

Well first things first, if you suspect your child has had an allergic reaction that is potentially life threatening, you should use an epipen (if you have been prescribed one) and then call an ambulance. If you don't have an epipen, call the ambulance straight away! See here for more details about what to look for (and what to do) from NHS Choices.

If, like us (with 'Baby's' Non-Ige mediated milk allergy), your symptoms do not require immediate medical attention, then having cleaned up the initial mess and/or administered any necessary medication, then as much as we might like it to be sorted NOW, I'm afraid it's not that easy. I've found you usually have to kind of sit it out, wait for things to settle down, or for something else to happen. Often, else happening or even not happening can help you work out what's going on. 

So, for example, one time when we gave 'Baby' a scheduled food challenge at home, it took a while for symptoms to develop. She had a bit more wind than usual and her stools gradually changed colour and became looser, and she got the odd tummy ache, which then faded away. To begin with, I wasn't sure if it was the malted milk biscuit we had given her that had caused the problem or not, so let the challenge continue, to see if things would calm down. However, as the reactions became more intense and her botty began to get sore, I knew that I needed to stop. Although she was clearly tolerating milk better than she had previously, it became obvious to me that her body was not able to progress any further, it would just get worse. In all, this process took a couple of days.

I've found the best thing, if you suspect some specific item of food caused the problem (more obvious, I know, when undergoing a planned food challenge), is to remove it from your child's diet (unless it's gluten - see why here). Whether your kiddo is under the weather or experiencing a reaction, it's just not the right time to experiment with anything new. You need to stick to foods you KNOW are safe and wait for their body to settle down and recover. There's no point making them sicker, by giving them more of the same!

Then a few weeks later, keeping everything else 'safe' try again. If the same reaction occurs, then you may well have found the 'culprit'. At this stage, contact whichever healthcare professional (GP/Health Visitor/Allergy Nurse/Dietitian etc.) is overseeing your progress and discuss it with them (I have heard from some people who feel that they have been discharged from local services before their allergy has resolved or before they feel ready. If this has happened to you, and you still have concerns, you it would be best to go back to the GP, or find a new one.). If however, your little one appears to be fine with that food item, when it's presented to them (over three or four days) or, if it's not a scheduled 'milk challenge' and you've no idea why it's all happened, then maybe it's time to consider the following:

1) Are there any bugs going 'round?

Sometimes, when I have thought that 'Baby' has perhaps had a reaction to something, it has turned out to be a virus or tummy bug. The symptoms may be similar. Once when she had a sore throat and a tummy ache I was rather confused - her allergic reactions had never included a sore throat! I hadn't realised that there were glands in the abdomen.  

It's extremely easy for little ones to pick up tummy bugs. They crawl around on the floor and stick all kinds of things in their mouths. Unfortunately its par for the course with little ones. Its bound to happen sooner or later!! Then, unfortunately, it's a case of 'What can't be cured, must be endured!' 

Current advice in this instance is keep your child at home (this is important for up to 48 hours following the last issue of vomit/diarrhea to prevent spreading it around), keep them hydrated and feed them if they're hungry - keep it fairly bland though! See NHS Choices for more information.

Something else to consider, even if there are any bugs going around is the following...

2) Do the symptoms match the pattern of previous reactions?

The difference, with 'Baby,' is that if it's an allergic reaction her observable symptoms have usually taken place within the twenty four hours following an exposure to milk. Anything that continues beyond this (in our case, but not in all cases), is a bug, as far as we are concerned! So use your knowledge of how your little one tends to react.

For 'Baby' her reactions in the early days were intense tummy cramps, wind and diarrhea, within an hour or two of ingesting something which contained milk (and a very sore botty, from the diarrhea, when she was in nappies). But of course reactions can change, so this isn't a completely reliable measure! 

This caught me off guard recently, as I hadn't realised that 'Baby's' tummy was coping with milk more easily than it has done previously. So the intense tummy cramps were evident, but occurred much later - maybe five or even six hours later. Also the tummy cramps weren't followed by diarrhea. Her stools were still that distinct yellowy colour that always followed previous reactions, but instead, she appeared to tend towards constipation. 

Something to remember is that reactions can also become more intense - if the individual is unwell, or stressed or following exercise or has drunk alcohol (adults only, of course) or is affected by hormones (ladies, if it's you, consider your time of the month/pregnancy etc.). Also reactions can be different if it's an allergic response to another type of food.

3) Have you been out and about?

We manage things so well at home now, that most slip-ups occur when we've been out and about. It may follow a meal out at a restaurant or a cafe - in which case you can soon work out where things went wrong! However, whenever you're out and about you can come into contact with milk or its traces all too easily. 

Once (I am pretty sure - we'd not been anywhere else that day) 'Baby's' reaction stemmed from contact with traces of milk from a supermarket trolley (you see lots of kiddies eating all kinds of stuff whilst they're perched in the seats of these, I saw one spilling Actimel all over himself in one just today)! Hence I always take my wipes everywhere I go now - I religiously clean trolley handles apart from anything else, you'd be amazed at how dirty they can be! And, if we're eating out, I try to establish which restaurants/menu items are safe for 'Baby' before we go and communicate with staff about her milk allergy. But, even when you think you've covered your bases, life can throw you a curved ball. Looking back at days/times/events can help you here!

I've mentioned this before, but, when 'Baby' was younger she kept having tummy aches an hour or so after leaving a particular baby and toddler group ('Baby' was actually an articulate tot by this time, so she could actually give me some idea of what was happening inside her). After three or four weeks of this  I finally worked out that it was a particular day and time and that it must be because in this group children were allowed to wander around with food (sticky cakes were provided) and were leaving traces of their food (containing milk proteins) on the toys. It may have been minute, but it still caused my little one to react! Not everyone is as sensitive as this, so it might not be a problem for you, but it's as well to be aware!

The answer was to wipe 'Baby's' hands very thoroughly before eating, so she didn't transfer any traces to her food, and wash them thoroughly once we got home. If I stuck to this she was fine. Whilst at the group I also had to be vigilant - to make sure she didn't put anything in her mouth. Fortunately, for us, she's never been much of a one for doing that! 

Another time this helped was when I realised it was my trips to cafes like Starbucks and Costa that were causing the problem - about an hour or so after I left 'Baby' would have a severe tummy ache, even when she had been asleep in her pushchair the whole time and not touched/ate/drank anything there. My conclusion was that she must be reacting to the milk that had become areosolized when it had been frothed.

To test my idea, I eventually decided to just pop-in and grab a take-away coffee. If I did this the tummy aches stopped.  This was confirmed when one day The Hub decided to sit in with a coffee (did he think I was imagining things) and her tummy ache came back!  He did this a couple of times before he became more convinced. (This kind of reaction to milk is thought to be rare, but I have heard/read of other cases of the same (see here), so it is entirely possible. But I wonder if it has been under reported.)

More recently, timing helped me work out that 'Baby' had been exposed to food containing milk whilst at school. I knew because each time it occurred she had an intense tummy ache at more or less exactly the same time of day. It was always around 5 pm. At this stage apart from the snack that I always gave her after school, I knew that the last thing she had eaten was food from school (every child at her school has to have school dinners). 

It's harder to track what is in your food, when you're eating out and about!

Frustratingly this took a lot longer to solve, as there was no obvious pattern to this one, apart from time of day (it didn't happen every day) but also because other children at school had been having tummy bugs, which clouded the issue. It was only once we started a new term, with no new tummy bugs doing the rounds, that I could be sure that she hadn't picked up something from someone else! 

It's definitely much harder to solve this kind of thing when your child is spending time in another environment, particularly when you can't be there to help manage it. A food diary (see below) can help, when you can't see an obvious pattern, but my attempts to keep a food diary in this situation were frustrated because (from what I could gather from 'Baby') the menus published by the school kept changing and didn't match-up with what she was offered! Once the school became aware of the problem and put a better tracking system in place to prevent it happening, funnily enough the intense tummy aches stopped! 

4)  Is there a pattern as to when reactions occur?

Keeping a food and symptom diary can help isolate problems. It helped us, once, when 'Baby' was much younger. Food and symptom diaries are time consuming (particularly if still breastfeeding - you need to include your intake too) but can be a valuable tool for identifying a problem. 

Basically you track everything your the allergic individual has eaten/drank (including medication) and keep note of any potential symptoms that occur. Recording visible symptoms with photographs can also be helpful. If kept carefully over a week, or maybe longer, you should hopefully start to see a pattern emerge.

It might look something like this (sample of one day):

Food/Drink Ingested
8 am

Cheerios with
Soya milk (75mls)
Water to drink

10.30 am

Two small rice cakes
Four slices banana
12.30 pm

Half Tuna Sandwich
(Pure, Hovis Best of Both/Hellmann’s Mayo)
Handful of crisps*
3 slices apple
Small glass orange juice
Tummy pain between 2.30 and 4pm
3.00 pm

None (tummy still hurting)


Homemade Shepherd’s Pie
Robinson’s Jelly & Swedish Glace (Vanilla)
Water to drink

Anything to add:
100mls soya milk 6.30pm
Diarrhea around 7pm
Wakeful: 11pm, 2am, 4.30am

NB. Don’t forget to include milk feeds (if still breastfeeding), *brands of food and any medication.

If you prefer a more techie approach, there are apps like this one (I've not tried it, by the way) that can help you record what's going on.

4) Is there something you've missed?

Sometimes we've found that we haven't checked our labels properly, or taken it for granted that something is safe, only to find that it isn't - this was much more common in the early days of 'Baby's' allergy. The first time this happened it was a packet of salt and vinegar crisps. I just hadn't expected to find milk in those (I still had a lot to learn)! It was only once the reaction had occurred that I began to ransack the cupboard to examine all the ingredient labels on everything I'd eaten that day and discovered where I'd gone wrong!!

Another time, we discovered that it was jam (butter had been used to clarify it) that was the problem! Check home made or artisan-style jams for this - I've not seen it on any jams in supermarkets (hence I had never imagined it could be a problem)!

Click on this link for the full story!

5) Could it be a 'may contain'?

If your child is reacting and you've ruled everything else out, look at products which carry 'may contain' warnings or which could potentially have been made alongside milk products (for example chocolate and ice lollies that you know have not been made on specifically dairy free premises). 

Remember that 'may contain' warnings are not legally required on food labels, so some products may look safe - no milk listed in the ingredients or even hinted at in a 'may contain' warning - but they may still actually have picked up a trace, during the manufacturing process, which could cause a sensitive allergic individual to react. 

Not all individuals with a milk allergy react to small traces, it depends on how sensitive one is, but they have definitely been a problem for us in the past. It is becoming less of a problem in baked goods, now that 'Baby' appears to be tolerating a certain amount of baked milk, but milk that has not been baked so well is still a problem, therefore I would not risk products such as chocolate, yogurt or ice cream which 'may contain' traces of milk.

Clink on this link for a previous post for more details about 'may contain' risks.

And finally...

If you think you've isolated a problem that you didn't have before, please make sure you discuss it with your health care professionals - doctor, dietitian, etc. I know from personal experience that this isn't always as easy as it should be - some are more helpful/better informed than others, but hopefully they'll be able to help you confirm your suspicions. 

It's important to do so, as otherwise you/your little one may end up living on a more restricted diet than is necessary and miss out on vital nutrients. It may also affect the medications that you could be prescribed. But also, when it comes to registering your child at school, if you declare an allergy, they'll often ask you for a letter from your Healthcare Professional regarding your child's condition. Take it from me, getting appointments etc. can take some time, so it's better to have it all in place in advance!

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  1. Fabulous posting! Very comprehensive. Thank you.

  2. Hi Sally!

    Thank you, it's good to know that you found this post helpful xx