Tessie had bad eczema. Her mother Sophie fed her only breast milk, but the eczema continued. When Tessie was 4 months old Sophie attended an allergy clinic and had testing done. Since Tessie’s big sister, Andrea, aged 5, had asthma and less severe eczema she has testing also. Sophie was surprised at the severity of the reactions as she had not seen any clear changes with particular foods. Tessie’s results were 6+’s to peanut and eggwhite, and three to egg yolk, wheat and milk. She was interested that Andrea had a severe reaction to peanuts even though this had not caused any worsening of symptoms during her 5 years.
When Sophie cut out all the egg, dairy, wheat and milk from her diet there was a great improvement in Tessie’s skin. She home cooked all her food.
However Tessie’s eczema flared Sophie she had orange juice which she had not had for some time. She found some information about additives and salicylates and excluded these from her diet as well. When the eczema decreased but did not clear and Sophie wanted to make longer term decisions about diet she made an appointment to see me for diet therapy.
She was also worried as Tessie was progressing but was small and did not have a great appetite. Before attending diet therapy Sophie filled out the Family Sensitivity History. The one reaction that Sophie had seen in Andrea was that she vomited severely after a paediatric syrup [not penicillin] high in additive colour and flavour. Sophie herself is allergic to penicillin and to bees. She has a very sensitive nose, noticing all smells. Her sister suspects yeast, beer, and rich foods. Her mother just can’t stand the smell of beer brewing. Tessie’s dad, Bryan, has hayfever with pollen and dust, his brother cannot eat lemons, fish or onion, and their mother, Tessie’s grandmother, also reacts to dust, pollen and many flowers.
To make sure we had a good baseline diet for Sophie to test various foods from we attended to all the detail for the low chemical diet, discussing suspect additives, using information on reported reactions to foods containing salicylates, amines, added flavours, and natural monosodium glutamate, as well as emphasising the role of smells. Since the allergy tests did not show positive for soy or fish they were still included.
A month later Sophie attended for her second diet investigation appointment. She was so pleased. Tessie’s skin had completely cleared. And importantly her appetite had improved. She had gained more weight and was much happier, playing more, and attending to whatever was going on around her. Sophie said that the main exclusions that had made the final difference were the peppermint toothpaste, the almonds in the nuts she had after carefully excluding all peanuts, and olive oil, which she had not thought about when attending to all the other foods high in salicylate.
She had a list of foods she wanted to gradually trial and we chose some low and high risk ones which she could use to clarify just what were necessary exclusions. First we introduced solids to Tessie as the foods tolerated in food sensitive babies and so Tessie was getting solids as well as breastfeeds using all the foods Sophie was eating.
They tested foods by Sophie eating them for three days to see if they had an effect via breast milk and then feeding them to Tessie as well for the next 4 days. Nashi fruit and banana were tolerated, and while capsicum seemed OK for the first three days Sophie had it but Tessie’s eczema got worse on the fourth day, so they stopped it. What was annoying then was the Tessie’s appetite went off as well and took 5 days to recover.
Sophie tested peanut in Andrea first, beginning with one speck of peanut paste increasing to one half of a peanut over a month, and maintaining the ½ peanut/day to maintain tolerance. She was happy with that and waited until Tessie was nine months to do the same for her. Meanwhile she tested dairy and wheat first gradually increasing one in her own diet and then testing it in Tessie. She used the information I had from other families as a dietitian on how to maximum tolerance in foods.
Tessie gradually tolerated wheat as home-made rusks, toasted preservative-free well cooked bread. By 12 months she had increased intake of dairy to include mild cheese and home-made ice cream, using just evaporated milk, pure cream sweetened with sugar. She still used soy as her main milk. Sophie decreased Andrea’s dairy intake by gradually incorporating more soy milk into her milk and she liked Tessie’s ice cream. Sophie says that she needs less asthma medication for Andrea now. Egg yolk is still being trialled beginning with eating only ¼ of a home-made biscuit of 24 made from a recipe with 2 cups of flour in it and the biscuits well cooked. Tessie’s eczema has remained well controlled apart from the flare-up after capsicum, and one drink of beer Sophie had on a very hot day.
Joan Breakey Dietitian www.FoodIntolerancePro.com