Prof Dr. Max J. Coppes is momenteel hoogleraar kindergeneeskunde
aan de Universiteit van Nevada, Reno School of Medicine and medisch directeur van het Renown Kinderziekenhuis in Reno (staat Nevada). Max J Coppes werd in Leiden tot arts opgeleid en vervolgens in Utrecht tot kinderarts. In 1988 vertrok hij voor een jaar naar Toronto om zijn opleiding tot kinderoncoloog te voltooien, maar is sindsdien in Noord Amerika gebleven. Hij werkte naast Toronto respectievelijk in Cleveland, Calgary, Washington DC, Vancouver, en nu dus Reno. Hij is bovendien met Nederland verbonden als lid van de raad van commissarissen van het recentelijk geopend Prinses Maxima Centrum voor kinderkanker in Utrecht. Een kinderoncoloog die bijna een vluchtchirurg werd, is hij net zo comfortabel in een benedictijnenklooster als in een internationale meeting met over 10,000 gedelegeerden. Voedselallergie:
5% of children in our country are affected or ~5,000 children in Washoe County are allergic to one food or another. But beware not all reactions to food are allergic in nature. Some food reactions are caused by the lack of a specific enzyme, e.g. the reactions seen in children who are lactose intolerant because they are unable to digest the sugar lactose in milk. Other reactions can be caused by food poisoning, a reaction to toxins in our food, whether natural (toxins in some mushrooms and pufferfish), chemical (pesticides), or infectious (bacteria, parasites). Food allergies are different in nature, they are caused by an overreaction of the immune system to a substance we should be able to tolerate because it is part of our normal diet. Why does it matter to know whether your child’s reaction to a certain food is allergic or non-allergic? Mainly because food allergies can escalate from initial mild symptoms to life-threatening reactions, while non-allergic reactions to food can be annoying but carry a very different risk over time. So if you suspect or notice a reaction to a food product in your child, I really encourage you to discuss this with your pediatrician who may refer you to a pediatric allergist.
The most common food allergies occur with cow’s milk, eggs, peanuts, tree nuts, and soy. What happens? Under normal circumstances, our immune system helps us fight against germs, microorganisms, and alien substances (for example a splinter) and by doing so keeps us healthy. As a child develops, the immune system needs to learn to distinguish between ‘good’ and ‘bad’. Obviously the immune system should not start fighting the child’s own cells, it needs to recognize them as ‘self’ and therefore ‘good’. Similarly it needs to recognize ‘foreign’ substances that are good and healthy to us. The first ‘foreign’ substance many children get is breastmilk and as the child grows older it is introduced to cow’s milk, rice cereal, and solids. Over time, the immune system expands its knowledge of what is ‘good’ and what should be considered ‘bad’. For most of us the immune system does a remarkable job.
For reasons still not completely understood, a food allergy occurs when the immune system categorizes a substance that should be in our ‘good’ column as ‘bad’. As a result it mounts a reaction, leading to the symptoms that we associate with food allergies. These vary from mild skin rashes, asthma, and gastrointestinal symptoms, to life-threatening hives or swelling similar to hives but under the skin instead of on the surface (called angioedema). The latter can cause swelling around the eyes, lips, and throat, and in severe forms cause difficulty with breathing. In other words food allergies can cause mild to life-threatening symptoms and unfortunately the fact that a child may only have had mild symptoms thus far does not guarantee that the symptoms will remain mild. That is why people who have been diagnosed with a food allergy need to carry an epi pen; their next reaction can be life-threatening.
Since the immune system has to learn distinguishing what is ‘good’ and what is ‘bad’, there have been many discussions about when to introduce new food products to children. Some people argued that introducing for example peanuts late in a child’s life would decrease the chance of developing an allergic reaction, while others reasoned just the other way: introduce peanuts early as the immune system is still young and ‘inexperienced’. The American Academy of Pediatrics just updated the guidelines in favor of early introduction for children that are at higher than normal risk for developing a peanut allergy. My recommendation: discuss what is best for your child with your pediatrician. They are up to date on national (often) international recommendations about how to optimize the health and well-being of children, they are a truly valuable resource to you.
Dr Max J Coppes
Physician-in-Chief Renown CHILDREN’S Hospital
Nell J Redfield Chair of Pediatrics, UNR Med