However, one common habit at the changing table or bathroom counter might be working against your efforts: scooping emollients and barrier creams directly from a tub with your fingers.

Healthy skin has a strong protective barrier that defends against irritants and microbes. Eczema (atopic dermatitis) compromises this barrier. Food sensitisation and allergy typically develop through the inflamed skin barrier, so gaining control is very important, even more so in young infants.

When a child has eczema, their skin microbiome is often out of balance, with a higher prevalence of Staphylococcus aureus bacteria. If a tub of emollient cream becomes contaminated with bacteria from fingers, every subsequent scoop transfers those microbes directly onto broken, inflamed, or sensitive skin. This significantly increases the risk of secondary bacterial infections and can worsen itching and inflammation. We showed this effect clearly in this publication: Staph-infected skin was independently associated with more severe eczema, more allergen IgE, more peanut allergy, and a lower chance of outgrowing egg allergy.

Bacterial contamination risk of some Tubs and Jars

Many heavy, medical-grade emollients and barrier creams come in large, wide-mouth tubs designed for frequent, liberal use. While convenient, these containers present specific challenges:

• Microbial Growth: Emulsions containing water provide an ideal breeding ground for bacteria and fungi. Every time unwashed or damp fingers enter the tub, they introduce organic matter and microbes that feed on the product.
• Overwhelmed Preservatives: While manufacturers include preservatives, repeatedly introducing high bacterial loads can exhaust these systems long before the tub is finished.
• Compromised Efficacy: Microbial breakdown can alter the pH, texture, and active properties of the cream, reducing its ability to soothe dry skin.

Practical Tips to Keep Eczema Creams Pure

You do not need to throw away your favourite tubs, but adopting stricter hygiene habits protects your child's skin barrier:

1. Ideally, Switch to Pumps or Tubes: Whenever possible, choose emollients packaged in pump dispensers or squeeze tubes. This keeps the product away from fingers and air.
2. Designate a Clean Spatula: If you must use a tub, keep a dedicated metal or plastic cosmetic spatula nearby. Use it to scoop out the required amount of cream onto the back of a clean hand or a clean dish.
3. Wash and Sanitise Application Tools: Wash the spatula thoroughly with warm water and soap after every use, or wipe it down with antibacterial spray. Never double-dip the spatula back into the tub without cleaning it first.
4. Never Dip Bare Hands: Ensure anyone applying the cream washes their hands thoroughly with soap and water before handling the product, or better still, rely solely on the spatula method.

By making these small adjustments to your daily eczema routine, you ensure that every application remains hygienic, soothing, and fully effective for your child's skin.

For more support, visit Eczema UK and/or the British Association of Dermatologists

The full manuscript is available in the NEJM; here are some take-home messages we wanted to communicate -

Prevention:

• Early introduction of peanut protein reduces the prevalence of peanut allergy by approximately 80%; this very strong effect even in this higher-risk population (i.e., infants with moderate to severe eczema and/or egg allergy).
  
• This is a time-sensitive intervention, delaying the dietary introduction of peanut protein significantly diminishes its preventative efficacy, the window of oppertunity closes by month (mostly in the first year of age).
  
• Effective prevention requires a weekly ingestion of approximately 2 g of peanut protein (one teaspoon of smooth peanut butter) for low-risk infants and 4 to 6 g for high-risk infants.
  
• Population-wide early introduction strategies reduce the overall disease burden more effectively than targeting only high-risk groups.
  

Treatment:

Starting peanut immunotherapy in younger children (aged 1 to 3 years) yields greater efficacy and higher clinical remission rates than in older children.

If interested in the topic, please do read the paper, or attend our London Allergy Consults Clinic for a full discussion around food allergy prevention and treatment options - https://www.londonallergyconsultants.co.uk/

Cross-sectional and descriptive studies have examined maternal diet and its relation to allergy outcomes, but few, if any, randomised trials (a more rigorous way to test hypotheses). Many families feel a burden of guilt that their child has developed a food allergy and often ask us in clinic what they could have done differently.

In the absence of firm evidence, expectant parents have received conflicting advice with respect to the benefits and possible harms of allergen intake during pregnancy.

A landmark clinical trial recently published in the New England Journal of Medicine PrEggNut trial : ) , published its findings to help settle much of this debate.

Its publication in the NEJM, despite showing no differences between the groups, shows how important this message is and how well the study was designed and conducted.

Herewith, a very brief take on the study findings, and what is, in fact, a complex topic.

What Was the PrEggNut Trial?

Researchers wanted to know if a pregnant and breastfeeding mother, eating higher than normal (for that population) amounts of two common allergens, in this case egg and peanut, could lower the risk of their baby developing food allergies (the study also looked at some secondary outcomes, e.g. eczema, growth... ).

The study followed a large cohort of 2,137 mother-infant pairs from families with a strong history of allergic diseases (such as eczema, asthma, or hay fever), randomising them into two distinct groups:

• The High-Intake Group: Instructed to consume at least 6 eggs and 60 peanuts every single week during pregnancy and breastfeeding.
• The Control Group: Followed a standard diet, restricted to consuming no more than 3 eggs and 30 peanuts per week (reflecting typical background adult consumption in Australia).
• There was no placebo or zero-intake group, as this would not have been ethical given healthy dietary advice that encourages allergen intake. The two study groups still differed in diet, allowing for comparisons.

The Big Results: Did It Prevent Allergies?

In short, for this study population, the answer is no.

When researchers tested the infants at one year of age using diagnostic clinical tools, including skin-prick testing combined with medically supervised oral food challenges as needed, the study found:

• Allergy Rates: 7.8% of infants in the high maternal intake group developed an egg or peanut allergy, compared to 8.4% in the control group. This minor difference was not statistically significant.
• Infant Eczema: Rates of medically diagnosed infant eczema at 4 and 12 months were virtually identical between both groups.
• Infant Growth: Tracking weight, length, and head circumference showed that babies grew normally, with no physical differences whether their mums ate a high-allergen diet or a standard one.

The Good News: While it didn't prevent or cause higher allergy rates, this healthy intervention was Safe!

Serious adverse events for both mums and babies were almost identical across both groups (roughly 3.6% vs. 3.8%). Consuming exceptionally high quantities of these foods during pregnancy and breastfeeding is entirely safe and causes no harm, abnormal growth, or increased risk.

Strengths and weaknesses of findings:

• High-Risk Focus: Because the study strictly enrolled families with a strong history of allergies, the findings apply directly to high-risk households, but if no effect was seen in an at risk population, then its fair to imagine that this would apply to lower risk allergy populations (which are the largest portion of society).
• Household Dust: The allergy assessments were made at a year of age. The high intake intervention was only in place during part of pregnancy and the early part of the infant's life. Ingested allergens are found in the environment, and we know that sensitisation through the skin is important. The trial tracked internal dietary intake but did not measure background environmental exposure, such as household food allergen dust. However, randomisation ensured these background variables balanced out across groups, and eczema rates were similar.
• Dietary Adherence: Eating 6 eggs and 60 peanuts every week proved a tough logistical challenge for some participants over several months, highlighting how hard it is to enforce strict dietary interventions. An effect may also be seen if a 'no or low' intake group were included, but this was not ethically possible.

The Takeaway for Parents

If you are expecting or breastfeeding, you do not need to ingest higher than normal (for you and your family) quantities of specific allergens into your diet for allergy prevention.

The PrEggNut trial reassures us that a normal, balanced diet during pregnancy is fine. Instead of stressing over heavy maternal loading, current evidence points to focusing on direct infant feeding windows (introducing allergens directly to babies when they start solid foods, per modern paediatric guidelines), as our LEAP Study findings suggest.

We receive a significant amount of correspondence on this topic in our London Allergy Consults practice.

Historical anxieties around egg-based vaccine manufacturing have frequently caused unnecessary hesitation, making evidence-based reassurance essential as the annual immunisation rollout approaches. Helpful guidelines are available; we have summarised them here: Current scientific consensus from the UK Health Security Agency (UKHSA) Green Book, the British Society for Allergy and Clinical Immunology (BSACI), and paediatric guidelines confirm that the overwhelming majority of egg-allergic patients can be safely vaccinated. Indeed, in our practice, we have not encountered significant reactions in egg-allergic patients using the recommended UK vaccines each year.

1. UK Flu Vaccine Products and Licensed Ages

Influenza vaccines use different manufacturing substrates, categorised primarily as egg-derived or using alternative technologies.

• Live Attenuated Influenza Vaccine (LAIV / Fluenz): This is the standard vaccine in the UK for children, and is administered intranasally as a nasal spray.
  • Licensed Age: 24 months to under 18 years of age.
• Inactivated Egg-Cultured Quadrivalent/Trivalent Vaccines (IIV): Widely used across adult and some paediatric cohorts. While manufactured using egg proteins, trace amounts rarely trigger systemic allergic reactions, and these vaccines have an excellent safety record.
  • Licensed Age: Varies by from 6 months of age onwardsthrough adulthood and older age groups.
• Cell-Based Inactivated Vaccines (QIVc): Grown in mammalian cell lines rather than eggs. While not universally mandated as a primary tool for egg allergy mitigation given the safety of standard vaccines, they remain an option when indicated.
  • Licensed Age:aged 2 years and olderfrom 2 years of age onwards (depending on the specific marketing authorisation).

2. Contraindications and Allergy Guidelines: Green Book, BSACI, and Paediatric Standards

Aligning with the UKHSA Green Book (Chapter 19) and BSACI guidelines, the clinical position on egg allergy and influenza immunisation is clear:

• General Rule:
  • An egg allergy is not a general contraindication for the annual influenza vaccines in the UK.
• The Only Absolute Contraindication: The sole exception is a confirmed history of a severe systemic anaphylactic reaction (requiring intensive care support) to a previous dose of an influenza vaccine itself, or hypersensitivity to an active vaccine component (other than ovalbumin) or excipient. Both these clinical criteria are exceptionally rare.
• Anaphylaxis and Asthma History: Even children and adults with a history of severe anaphylaxis to dietary egg can safely receive routine inactivated injectable flu vaccines and the nasal LAIV spray in primary care settings. Specialist hospital referral is not routinely required solely because of an egg allergy.
• The Rare Exception: The only scenario requiring specialist allergy input is if a patient has experienced severe systemic anaphylaxis to a previous dose of an influenza vaccine.

3. Optimising Patient Care and Reassurance

The safety profile of modern influenza vaccines means that withholding the vaccine poses a significantly higher clinical risk of severe influenza morbidity than the negligible risk of an allergic reaction.

However, navigating complex food allergies alongside medical interventions can sometimes feel overwhelming, particularly for parents managing children with multiple atopic conditions, and often with concomitant asthma (the allergic march starts with eczmea, then food allergies may develop and then hayfever and asthma may devlop).

Consult With Us at London Allergy Consultants

If you or your child have a complex medical history, severe systemic reactions, or if you remain anxious about navigating this season's immunisation rollout, our team at London Allergy Consultants offers expert clinical evaluations to provide clarity, tailored advice, and absolute peace of mind. Tel - 0330 678 5168

Discovering a red rash on your infant after mealtime can be alarming. When aubergine is involved, many parents worry about severe food allergies. However, the medical literature and our clinical experience shows that these reactions are often harmless, manageable, and frequently outgrown.

Understanding Nightshade Skin Reactions

Aubergine belongs to the nightshade (Solanaceae) family, alongside potatoes, tomatoes, and peppers. When infants develop skin reactions after handling or messily eating these foods, it is rarely a sign of a lifelong severe allergy.

Nightshade skin reactions can come about for different reasons:

• Immediate Contact Urticaria: This occurs within minutes to one hour of contact. It presents as localised hives, itching, or redness. These IgE-mediated reactions involve the immune system reacting immediately to specific proteins in the food. Systemic symptoms, such as wheezing, are extremely rare. The clinical history is enough to make this diagnosis, skin testing or allergy blood testing is not required.
• Delayed Allergic Contact Dermatitis (Type IV): This delayed hypersensitivity reaction appears hours to days after exposure, driven by T-cells rather than IgE antibodies. While more commonly associated with handling tomato plants or oleoresin extracts, it can occur with other nightshades and is generally seen as an occupational allergy in adults.
• Non-inflammatory Staining (Xanthoderma): Plant hairs (trichomes) from nightshades can release oily substances that stain the skin yellow. This is a harmless physical mimic of dermatitis that resolves with simple washing over a few days.

Reassurance for Parents

• Most reactions are local: Skin contact reactions are generally confined to the area that touched the food.
• They are commonly outgrown: Children frequently tolerate these foods as their immune and skin barrier systems mature.
• Anaphylaxis is rare: Simple contact reactions seldom progress to severe systemic allergies.

Please reach out to our practice if greater reassurance is required at appointment for the exclusion of troubling allergies - office@londonallergyconsultants.com or 0330 678 5168

In our London Allergy Consultants Clinic, we find September to be one of the busiest months - not just because of the autumn pollen surge, but because of the palpable wave of anxiety I see in parents and children preparing to return to nurseries and schools.

Handing over the care of a child with a potentially life-threatening food allergy to teachers, support staff, and catering teams can feel terrifying. If your stomach turns into knots thinking about school lunches, bake sales, and playground swaps, I want you to know: your feelings are completely valid.

Fortunately, the landscape of school allergy safety in much of the UK is shifting profoundly. With major new statutory standards rolling out under Benedict's Law, schools are now held to much stricter, legally backed safety requirements.

Benedict's Law has done much to drive this process forward and will come into law in Sept - https://benedictblythe.com/benedicts-law/

Here is a brief breakdown of what you can realistically expect from your child's educational setting and the resources available to help you advocate for your family.

What You Can Expect From Schools (The New Standard)

In the past, allergy management varied wildly from one school gate to the next.

When you partner with your nursery or school, you have the right to expect:

• A Standalone Allergy Policy: Schools must have a specific, easily accessible allergy policy published on their website—not buried inside a generic medical conditions policy.
• Mandatory Staff Training: It is no longer just the designated first aider who needs to know what to do. All school staff—including teaching assistants, lunchtime supervisors, administrative teams, and bus drivers—are expected to undergo basic allergy awareness and anaphylaxis training.
• Individual Healthcare Plans (IHPs): Every child with an active food allergy should have a clear, co-produced IHP. This document outlines their specific triggers, symptoms, emergency medication protocols, and any reasonable adjustments needed for trips or P.E. lessons.
• Emergency "Spare" AAIs: Schools are heavily expected to stock spare, in-date Adrenaline Auto-Injectors (like EpiPens, Jext, or Emerade and soon EurNeffy) in central, easily accessible locations to use as a backup in an emergency.
• Inclusion, Not Isolation: Safety should never come at the cost of your child's mental wellbeing or social inclusion. Schools are required to manage risks thoughtfully so that children with allergies are fully included in classroom activities and mealtimes without being stigmatised.

Practical Steps to Prepare for the Term

1. Book an Early Review with Your Allergy Clinic: Ensure your allergy action plan is up to date, your child's diagnosis is clear, and your prescriptions for emergency auto-injectors are renewed before the term begins. Examples of such plans are available to download from the BSACI website; your Allergy HCP will need to sign this
2. Schedule an IHP Meeting: Meet with the school’s designated allergy lead well ahead of the first day. Walk them through your child’s specific early warning signs—sometimes children express symptoms in unique ways (e.g., "my tongue feels funny" or "my throat feels scratchy").
3. Map Out Medication Access: Confirm exactly where emergency medications will be kept. They must be immediately accessible to staff (not locked away in a distant school office) and ready to travel with your child on off-site trips.

Helpful Resources for Families

You do not have to navigate this alone. There are fantastic patient advocacy groups and charities offering free, practical toolkits to help you and your school bridge any gaps:

• Anaphylaxis UK/Allergy UK: Provide brilliant, evidence-based resources, school award schemes, and practical guides on safely managing allergy data within educational settings.
• Benedict's Law resources - https://benedictblythe.com/benedicts-law/
• The Allergy Team: Offers invaluable toolkits and guidance designed to help schools achieve complete compliance with the latest safety standards while keeping children safely included.

These robust new legal standards are here to wrap a tighter safety net around your child. Here is to a safe, happy, and confident school year!

It is not uncommon for parents to seek advice in clinic for infants who are experiencing 'symptomatic teething' with one or more of the following symptoms:

• new-onset troublesome facial rashes, resembling or even exacerbating eczema
• excessive drooling and associated peri-oral and neck skin fungal infection
• disrupted sleep
• poor feeding
• general irritability.

Teeth often erupt around the same time infants are being weaned onto solid foods and receiving routine vaccinations. Children with eczema also develop their most troublesome symptom at the age of teething.

Overlapping Infant Milestones (3 to 6 Months)

It is very common for parents to feel confused when trying to identify the root cause of new symptoms like facial rashes, drooling, or irritability, as several major milestones coincide during this window:

• Average Age of Weaning (UK): The NHS and the UK Department of Health and Social Care recommend introducing solid foods at around 6 months of age (and never before 17 weeks/4 months). In practice, most parents in the UK begin introducing solids between 5 and 6 months, and our research into allergy prevention encourages this from 4 months of age so as not to miss the window of opportunity!
• Atopic Eczema Onset: Peak onset typically occurs between 3 and 6 months of age, frequently presenting as dry, red, or itchy patches on the cheeks and face (which can be exacerbated by drooling).
• Primary Vaccinations: The core infant immunisation schedule is delivered at 8, 12, and 16 weeks (2 to 4 months of age).
• First Tooth Eruption: Lower central incisors emerge on average between 6 to 10 months, accompanied by localized gum tenderness and increased salivation.

With all these overlapping milestones and new-onset symptoms, exhausted parents can understandably find it difficult to pinpoint what is causing what and will often seek to exclude allergy.

Teething is a completely natural developmental milestone, but watching your baby experience sore, inflamed gums and fussiness can be challenging.

1. First-Line Comfort: Non-Pharmacologic Relief

With a vast array of teething gels, rings, and remedies on the market, knowing what is genuinely safe, effective, and aligned with British health guidance can feel overwhelming.

Both the NHS and the British Dental Association (BDA) align with clinical guidelines in recommending non-pharmacologic (non-medicinal) physical comfort measures as the safest and most effective first-line approach for soothing sore gums.

A clinical trial involving 270 children aged 8 to 36 months evaluated various teething management strategies. The study found that simple physical comfort measures provided the highest rate of parent-reported symptom relief:

• Gentle Gum Massage: Wash your hands thoroughly and gently rub or massage your baby's gums with a clean finger.
• Clean, Cool Objects: Supervised chewing on a clean, cold cotton flannel or washcloth wetted with cool water provides both texture and cold relief.
• Cuddle Therapy & Distraction: Extra physical affection, carrying, and gentle distraction were ranked among the most effective ways to ease teething distress in clinical trials.
• Chilled Teething Rings: Offer a solid silicone or rubber teething ring that has been cooled in the refrigerator. These should be the best quality material possible to avoid contact rubber irritation and the swallowing of degrading plastics.

Crucial Safety Rule: Never freeze teething rings. Frozen rings become too hard, which can bruise fragile gum tissue or cause frostbite-like cold injury. Additionally, the NHS explicitly warns never to tie a teething ring or dummy around your baby's neck, as this presents a serious strangulation hazard.

(I also recommend chewing on healthy, safe foods, often as part of the weaning regimen, as a safe alternative to plastic objects BUT

• Always Supervise: Never leave a baby unattended while they are eating or chewing on food. Keep them sitting upright in a highchair to prevent choking.
• Avoid Raw Hard Foods: Never give infants raw apple slices, raw carrot sticks, or hard raw vegetables. These do not break down easily with saliva and can snap off into sharp, hard lumps, presenting a major choking hazard.
• Avoid Rusk Biscuits with Added Sugar: Check labels on commercial teething rusks, as many contain high amounts of sugar, which can cause early tooth decay as soon as milk teeth erupt.
• No Honey Under 12 Months: Never brush teething rings or foods with honey (or give honey directly) to infants under one year old due to the risk of infant botulism.
• Beware of Whole Small Foods: Keep whole grapes, cherry tomatoes, and nuts away from infants unless cooked and thoroughly crushed/blended.)

2. When Medication Is Needed: Safe Use of Oral Analgesics

If physical comfort measures are not enough and your child’s discomfort is significantly affecting their sleep or feeding, short-term oral pain relief can be considered.

Choosing Between Paracetamol and Ibuprofen

Clinical evidence demonstrates that both paracetamol and ibuprofen are effective for acute paediatric pain when used correctly. A systematic review examining nearly 28,000 infants under two years of age found similar, exceptionally low rates of serious adverse events between the two medications (OR 1.08, 95% CI 0.87–1.33).

• Sugar-Free Infant Paracetamol (from 2 months+): The NHS recommends opting for sugar-free oral suspensions. This is the preferred option if your child is unwell, eating less, or if there are mild dehydration concerns.
• Sugar-Free Infant Ibuprofen (from 3 months+ & weighing >5kg): Highly effective for localised gum inflammation, but should only be used if your baby is well-hydrated and drinking fluids normally.

Dosing Best Practices

• Always calculate dosage based on your child’s current weight, using the oral syringe provided.
• Use the minimum effective dose for the shortest possible duration.
• Never give aspirin to children or young adults under 16 due to the risk of Reye's syndrome.

3. What to Avoid: High-Risk Products, Gels & Myths

Clinical guidelines, the Medicines and Healthcare products Regulatory Agency (MHRA), and the BDA explicitly warn against several common teething remedies due to severe safety risks, lack of efficacy, or potential harmful ingredients:

Topical Anaesthetic & Teething Gels (MHRA & NHS Stance)

• Benzocaine Warning: Health regulators (including the US FDA and ADA) strongly advise against using products containing benzocaine in children under two due to the risk of methemoglobinemia—a rare but life-threatening condition that drastically reduces the blood's ability to carry oxygen.
• Lidocaine Gels (MHRA Update): In the UK, the MHRA strictly restricted oral lidocaine-containing teething gels (e.g., Anbesol, Dentinox) to pharmacy-only (P) access. Pharmacists will only recommend them as a secondary measure if non-medicinal steps have failed. Saliva rapidly washes gels away, rendering them mostly ineffective and increasing the risk of swallowing the drug.
• Choline Salicylate Gels: UK guidance explicitly states that topical gels containing choline salicylate are contraindicated in children under 16 due to the potential risk of Reye's syndrome.

Opioids & Prescription Anaesthetics

Opioids—specifically codeine and tramadol—are strictly contraindicated in infants and young children for acute pain due to the risk of severe, life-threatening respiratory depression.

Teething Necklaces & Amber Jewellery

Amber, wooden, or silicone teething necklaces and bracelets pose severe risks of strangulation and choking (if a bead breaks loose). They are strongly advised against by the NHS and global paediatric authorities.

Homoeopathic Powders & Untested Tablets

Homoeopathic teething products are not recommended by the NHS due to inconsistent manufacturing standards, documented risk of toxic contaminants (such as belladonna), and a lack of scientifically established clinical benefit.

4. Teething vs. Infection: When "Teething" Isn't the Cause

It is common to attribute various childhood symptoms to teething, but clinical research shows that teething causes only mild, localised signs: slight gum swelling, increased drooling, mild irritability, and a subtle rise in body temperature on the exact day a tooth breaks through.

Teething does NOT cause true fever, widespread body rashes, vomiting, or severe diarrhoea.

If your child exhibits any of the following symptoms, do not attribute them to teething—seek medical evaluation from your GP or call NHS 111:

• Fever: Any temperature of 38°C or higher in infants under 3 months, a fever lasting longer than 5 days, or any temperature reaching 40°C.
• Breathing Difficulties: Rapid breathing, chest/rib retractions (skin pulling in), grunting, or stridor (harsh noise when breathing in).
• Hydration & Behaviour: Extreme lethargy, difficulty waking, inconsolable crying, or no wet nappies for over 12 hours.
• Other Red Flags: Persistent vomiting, severe ear pulling with pain, or a non-blanching rash (tested with the "glass test").

NHS & British Dental Association (BDA) Oral Care Rules

1. Start Brushing Immediately: Brush as soon as your baby's very first milk tooth emerges.
2. Toothpaste Guidance:
   • Under 3 years: Use a tiny smear of toothpaste containing at least 1,000 ppm fluoride. (Avoid "low-fluoride" baby toothpastes below 1,000 ppm as they do not adequately protect against decay).
   • 3 to 6 years: Use a pea-sized amount of toothpaste containing 1,000 to 1,500 ppm fluoride.
3. "Spit, Don't Rinse": Encourage your child to spit out excess toothpaste after brushing, but do not rinse their mouth with water. Rinsing washes away the protective fluoride film left on the enamel.
4. First Dental Visit: The BDA recommends taking your baby to an NHS dentist when their first tooth appears, or by their first birthday at the latest. (NHS dental care is completely free for all children under 18).

Flouride recommendations

In the UK, public health authorities, including the NHS, the British Dental Association (BDA), and Public Health England, strongly advocate the daily use of fluoridated toothpaste from the moment an infant's very first milk tooth emerges. Clinical evidence demonstrates that fluoride safely and effectively strengthens tooth enamel, preventing early childhood caries—a prevalent and entirely preventable disease. To ensure complete safety and minimise any risk of dental fluorosis (faint white marks on adult teeth caused by swallowing excess fluoride while they develop), guidance stresses strictly controlling the quantity of toothpaste rather than withholding fluoride altogether. For children under three years old, parents should brush twice daily using only a tiny smear (a thin film covering no more than half the brush head) of toothpaste containing at least 1,000 ppm fluoride, ensuring excess paste is wiped away or spat out without rinsing with water afterwards.

Summary Checklist for Parents

• Start with cold & touch: Use a chilled (not frozen) silicone ring, a cold washcloth, or a clean finger massage.
• Protect the skin: Gently pat away excess drool to prevent a chin/facial rash, and apply a thin barrier cream (like petroleum jelly) before sleep.
• Use medication judiciously: If pain disrupts sleep or feeding, use weight-based sugar-free oral paracetamol or ibuprofen.
• Skip the gels & jewellery: Avoid numbing gels containing benzocaine or choline salicylate, and never use teething necklaces.
• Brush early: Start brushing with a tiny smear of fluoride toothpaste (at least 1,000 ppm) twice daily as soon as the first tooth breaks through.

If you would like your infant to be assessed so as to exclude an allergic cause of their symptoms at this age, then please reach out to us:

0330 678 5168 or office@londonallergyconsultants.com

Navigating pollen allergies can feel like an uphill battle. In clinic, we see many parents who struggle to keep their children’s hay fever at bay during the summer months. They report a mix of itchy, sneezing, and even wheezy symptoms throughout the day, often worse in the evenings. Here is what you need to know about London’s pollen patterns.

Specific pollen seasons

The UK pollen season comes in three distinct phases:

• Spring (March to May): Driven by tree pollen (birch, oak, and plane trees). Increasingly, patients are allergic to the pollen from the increasingly popular Olive trees (related to Ash).
• Summer (June to July): Grass pollen peaks, triggering symptoms in roughly 95% of UK hay fever sufferers.
• Late Summer (July to September): Weed pollen takes over, particularly nettle and mugwort.

The Daily Pollen Clock

Pollen counts follow a distinct daily cycle driven by heat and air currents:

• Morning Surge (6:00 AM – 10:00 AM): As the sun warms the ground, plants release fresh pollen into the air.
• Midday Lull (11:00 AM – 3:00 PM): On hot days, heat rises and carries pollen high into the atmosphere, often lowering ground-level exposure temporarily (unless it’s particularly windy).
• Evening "Pollen Shower" (5:00 PM – 10:00 PM): As the air cools, the high-altitude pollen sinks back to the ground. This drop causes a severe evening surge just as families are heading home or unwinding.

Why the City Makes Symptoms Worse

Managing allergies in polluted cities brings unique hurdles due to our built environment:

• Urban Heat Island Effect: Concrete and asphalt trap heat during the day and release it slowly at night. This delayed cooling keeps pollen suspended in the air far longer than in rural areas.
• Urban Canyons: Tall buildings trap street-level pollution and pollen together, creating pockets of heavily concentrated allergens.
• Diesel Exhaust Particles (DEPs): Vehicle emissions attach to pollen grains. This damages the pollen shell, causing it to release extra allergenic proteins and making symptoms noticeably more severe.

Actionable Tips

You can significantly reduce your/your child’s exposure with a few targeted adjustments:

• Try to seal the house from pollen at night: Keep bedroom windows closed during the evening pollen shower and overnight to prevent allergens settling on bedding.
• Filter indoor air: Run a HEPA air purifier in your child’s bedroom and wipe down hard surfaces regularly with a damp cloth.
• Post-park washdown: Have children change their clothes and wash their face and hands (or take a quick shower) immediately after playing outside.
• Medications: If over-the-counter antihistamines are not keeping symptoms under control, immunotherapy is recommended. We are happy to discuss options, e.g. SLIT or SCIT, with you at London Allergy Consultants.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

office@londonallergyconsultants.com

0330 678 5168

Instagram: @London_Allergy_Consultants

This is an important and common question in our allergy community as well as in the wider scientific community.

Early Milk Exposure and Food Allergy:

Navigating the early days of parenthood can feel like a minefield of conflicting advice, especially when it comes to infant feeding and food allergies. A common worry for new parents is whether giving a newborn a formula in the hospital might trigger a cow’s milk allergy down the line. More recently, families are even asking whether this is protective.

While most healthcare settings heavily and appropriately promote breastfeeding under global frameworks like the UNICEF Baby Friendly Initiative, parents have a legal right to choose how to feed their baby. Breastfeeding is not always possible for many different reasons. Rather than banning formula, most policies focus entirely on restricting milk formula marketing and supporting families to breastfeed.

Leaving aside the strong ethical debate around infant milk selection, as an Allergy clinic, we need to better understand the allergy consequences of these choices.

A study from Australia’s HealthNuts project offers key insights into early formula use and milk allergies. We can never ethically design randomised trials where any one arm excludes breast milk, so we need to rely on well-designed observational studies to help us answer the question.

Breast Is Best: Supporting Your Feeding Journey

Before diving into the numbers, let’s highlight a fundamental truth: breast milk provides optimal nutrition and health benefits for your baby.

• Gold standard protection: Breastfeeding supports infant immune development, protects against early infections, and provides balanced nutrition tailored to your growing baby.
• No need to supplement for allergy prevention: You do not need to give formula to "train" your baby’s immune system or prevent allergies.
• Reassurance without guilt: Breastfeeding should always be protected and supported, but if your baby receives temporary formula in the hospital while awaiting your full milk supply, a not uncommon practice worldwide, you have not harmed your child's long-term health.

Back to the research, what did the Study Find?

Researchers evaluated 940 children to see if giving cow’s milk formula (CMF) in the first week of life - or during the first three months - influenced the risk of developing a cow’s milk allergy or sensitisation by age 1 or age 6.

Here is what the evidence showed:

• No added risk from early formula: Temporary, brief formula feeding in the maternity ward (known as very early transient exposure) showed no significant link to cow’s milk allergy at age 1 or age 6.
• Rates fall dramatically over time: The prevalence of cow’s milk allergy dropped from 0.7% at age 1 down to just 0.1% at age 6.
• Natural resolution: By the time children reached primary school age, milk allergy and sensitisation were rare, showing that most children outgrow milk allergy naturally regardless of early formula patterns.

Practical Takeaways for Parents

1. Don't Stress Over Hospital Supplementation If your baby needed a top-ups of formula in the nursery, rest easy. Brief hospital supplementation does not appear to increase long-term allergy risk.

2. Focus on Breastfeeding First Breast milk remains the ideal choice. There is no medical reason to intentionally introduce early formula to "prevent" a milk allergy.

3. Milk Allergies Are Usually Outgrown If your child is diagnosed with a cow’s milk allergy during infancy, the outlook is very positive—the vast majority outgrow it by age 6.

Understanding the Study: Strengths & Limitations

To interpret scientific studies effectively, it helps to weigh what was done well against the design's limitations.

Strengths

• Accurate Data: Researchers linked parent-reported questionnaires with hospital birth records (Victorian Perinatal Data Collection), which captured early formula use accurately.
• Long-Term Follow-Up: Children were tracked systematically from birth through age 6 with clinical assessments.
• Careful Adjustments: The researchers controlled for influencing variables like family allergy history, sex, socioeconomic status, and early eczema.

Limitations

• Small Case Numbers: Because milk allergy is relatively uncommon, the total number of children with an allergy was small, leading to statistical uncertainty (wide confidence intervals).
• No Oral Food Challenges at Age 1: Milk allergy at 1 year was classified as "probable" using skin prick testing and reaction histories, rather than formal oral food challenges, due to ethical guidelines at the time.
• Observational Design: While well-designed, observational studies cannot completely rule out minor biases or unmeasured factors.

Summary for Clinicians & Parents

While international guidelines (such as EAACI) have cautiously suggested avoiding formula supplementation in the first week of life, this study indicates that brief, clinical supplementation in the maternity ward is unlikely to cause long-term allergic harm.

Protecting breastfeeding remains the priority, but parents can feel confident that temporary top-ups do not set a child up for long-term food allergies

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

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office@londonallergyconsultants.com

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For decades, managing severe allergic reactions (anaphylaxis) in children and young adults has relied exclusively on intramuscular adrenaline auto-injectors (AAIs), such as EpiPens or Jext. In less well-resourced settings, patients and their families have needed to be trained in drawing up adrenaline from an ampule for injection. Whilst cost-effective, this is a complex task to do in an acute medical setting.

Whilst the allergy community has grown used to the concept of carrying an injectable emergency device, the mere fact that it contains a needle has created a significant barrier to the timely and effective administration of adrenaline. However, a major shift in emergency allergy care has arrived.

The Medicines and Healthcare products Regulatory Agency (MHRA) recently approved the first needle-free adrenaline nasal spray, EURneffy. Originally launched for adults and older children, a lower 1 mg dose has now been approved for younger children aged four and over (weighing 15 kg to 30 kg).

The needle-free adrenaline nasal spray device. Source: ALK Pro UK / EURneffy® | For UK HCPs

Traditional adrenaline auto-injectors. Source: React First / How to use adrenaline auto-injectors like EpiPen, or Jext

Why the Shift to Nasal Adrenaline Matters

Surveys show that over half of adults at risk of anaphylaxis carry their auto-injectors irregularly, and roughly one-third fail to use them during an emergency due to needle anxiety or hesitation. It is hoped that the nasal alternative will address these behavioural and physiological hurdles.

Key Advantages of Nasal Adrenaline

• Zero Needles: Eliminates needle phobia, which frequently delays life-saving care in panicked settings. AAI needles can result in lacerations if the patient kicks while the needle is still embedded; this is not uncommon in vigorous young children.
• Temperature Stability: Unlike liquid injectables, the nasal device remains stable at temperatures up to 50°C and is not ruined by accidental freezing.
• Longer Shelf Life: Offers a shelf life of 24 to 30 months, reducing the frequency of costly device replacements.
• Rapid Absorption: Clinical trials show that adrenaline absorption through the nasal lining is at least as effective as a standard intramuscular thigh injection, even in patients with a cold or nasal congestion.

Direct Comparison: Nasal Spray vs Injectable AAIs

Important Clinical Considerations

While the nasal spray is a groundbreaking alternative, experts from the British Society for Allergy and Clinical Immunology (BSACI) emphasise that it may not be suitable for everyone right away.

Critical Safety Rule: Patients who have historically required multiple doses of adrenaline to control severe anaphylaxis, or those with severe venom allergies causing dangerous blood pressure drops, should continue to rely on traditional intramuscular auto-injectors.

It is exciting for us as Allergists to now be able to offer a choice of adrenaline administration devices; we certainly have enjoyed a lot of choice with regard to other allergy medicines such as antihistamines and asthma sprays.

It may also be that the nasal device leads to earlier administration of adrenaline, which interrupts the immune cascade that occurs in anaphylaxis. It has been shown that adrenaline acts as an allergy cell stabiliser, so this should provide additional protection during reactions.

Whichever device you select as a family, the baseline emergency protocol remains unchanged.

In the UK, the devices are beginning to be rolled out nationwide in the NHS.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

office@londonallergyconsultants.com

0330 678 5168

Instagram: @London_Allergy_Consultants

Parents frequently ask whether they have to undergo multiple separate protocols for each related nut, specifically because cashew and pistachio are closely related (sharing homologous proteins like Ana o 3 and Pis v 1). In this blog, we seek to answer this question and describe successful desensitisation to cashew that can co-desensitise or protect against pistachio, thereby reducing the treatment burden.

What is the best direct evidence for cashew ± pistachio OIT efficacy?

Cashew OIT efficacy (desensitisation on therapy): In the NUT CRACKER prospective cohort (Allergy 2022), 44/50 (88%) OIT-treated patients tolerated 4000 mg cashew protein vs 0/15 controls (p<0.001); 3/50 (6%) required epinephrine for home reactions. Relevance: the largest dedicated cashew OIT cohort with an observational control group and standardised oral food challenges.

• In the NUT CRACKER study, after cashew desensitisation, all pistachio co-allergic patients challenged (35/35, 100%) were cross-desensitised to pistachio. Relevance: directly answers whether treating one nut (cashew) can cover the closely related nut (pistachio).
• This study directly mirrors our experience in the Allergy Centre of Excellence OIT program, where most children with cashew allergy are younger than the participants in the study above.

What about pistachio cross-desensitisation after cashew OIT:

Frequently Asked Questions

• Are there everyday lifestyle restrictions during the OIT up-dosing phase?

  Core Lifestyle Restrictions

  To keep your child safe, our paediatric OIT programmes rely on a few essential daily rules, at least the begining of the OIT journey:

  • Exercise Windows: Avoid strenuous activity for 2–3 hours after dosing. We also generally advise avoiding intense exercise shortly before the dose is taken i.e. your childs hear rate and temprature should be normal in and around dosing.

  • No Empty Stomachs: Always take the daily dose with food, or immediately after a meal or snack

  • Hot Baths and Showers and nhot environmental tempratures: Avoid hot showers or baths soon after dosing. The heat causes vasodilation (widening of blood vessels), which can act as a co-factor and increase the risk of an allergic reaction.

  • Illness Adjustments: Reduce or withhold the dose during viral infections, fevers, gastrointestinal illnesses, or flares of asthma and allergic rhinitis. We will provide you with a written plan detailing exactly how to adjust the dose during these times.

  • Medication Co-factors: Avoid or seek specialist advice before using NSAIDs (like ibuprofen), as they can lower the reaction threshold in some patients.

  • Fatigue and Sleep: Take extra caution when your child is significantly sleep-deprived or fatigued, as tiredness can increase the risk of a reaction.

  Practical Implications for Family Life

  When planning your family's routine, we will help you think through these high-yield practical considerations:

  • Sports and PE: You will need to carefully time the daily dose so that the 2–3 hour post-dose quiet window does not conflict with school PE, sports days, or evening training sessions.

  • School and Daycare: School staff must be informed that your child requires timed dosing, temporary activity restrictions after eating the allergen, and immediate, ready access to their AAI and action plan.

  • Travel and Holidays: Travel and holiday illnesses frequently disrupt OIT schedules. If doses are missed, you must follow our specific re-escalation guidelines rather than automatically resuming the full maintenance dose.

• Will cashew/pistachio OIT be a lifelong commitment

  • Decreasing Test Results: Over time, we anticipate that the Skin Prick Test (SPT) and blood IgE tests to cashew and cashew components will come down, leading to a gentler clinical journey.

  • Treatment Adjustments: As these levels drop, we will discuss moving towards less frequent dosing and higher target doses.

  • Long-Term Outlook: Whilst some children can completely 'outgrow' their allergy on OIT (at a higher rate than the 15% seen in the general cashew-allergic population), this is not the case for the majority. Because of this, we usually encourage ongoing, long-term consumption, albeit less frequently.

  The London Allergy Consultant clinic, our allergists, and our ACE Allergy team will join you on this journey, discussing options with you at various time points.

• What are the main side effects of cashew OIT?

  The more common side effects, usually during up-dosing, include: transient oral itching or abdominal cramping. Anaphylaxis can occur with dosing, especially when co-factors e.g. illness are at play. Longer term gastrointestinal issues like Eosinophilic Oesophagitis (EoE), but this is rare, and reversible. We will discuss this all indetail in a shared decision making process, prior to commencing any OIT program.

• Where can we acess Cashew OIT in the UK

  We offer the largest OIT service in the UK and Europe. Do reach out to our practivce if you would like to be referred in, or reach out to the ACE clinic directly.

  Do not undertake home-based unsupervised programs as anaphylaxis can occur on OIT.

  Provision standards recommended by EAACI list -

  • Setting/oversight: Perform OIT only in research centres or highly specialised clinical centres with extensive FA-AIT experience.

  • Staff/equipment: Supervision by clinicians trained in food allergy diagnosis, OFC, and management of anaphylaxis with immediate access to resuscitation capability.

  • Where dosing occurs:Initiation and each dose escalation/up-dosing in a clinical setting; maintenance doses are typically taken at home with clear written plans.

  • Patient safety requirements: Prescribe and train in use of adrenaline autoinjector; counsel to avoid/adjust dosing with common co-factors (intercurrent illness, exercise, etc.). 1

  • Eligibility/contraindications (key): Confirm persistent IgE-mediated food allergy and ensure adherence capability; avoid OIT with uncontrolled/severe asthma or eosinophilic esophagitis; individualise for relative contraindications (e.g., beta-blockers/ACE inhibitors).

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

office@londonallergyconsultants.com

0330 678 5168

• Burping newborns after feeds is a near-universal cultural practice, yet there is a significant lack of robust clinical evidence supporting its actual medical benefits, we are often asked about best practice in our children’s allergy clinic.
• Current paediatric data, including randomised controlled trials, show that routine burping does not significantly prevent or reduce episodes of infantile colic. Indeed, evidence suggests that active burping techniques can sometimes have the opposite effect by unintentionally increasing episodes of gastric regurgitation (spitting up).

📊 The Science of Winding: Fact or Fiction?

Ever wondered if we actually need to wind (burp) a baby after every feed? Despite being a common practice, albeit mainly in westernised countries, the clinical evidence behind routine winding is surprisingly slim! It is worth delving a bit deeper into the evidence hsower, as when parents present with an unsettled baby, it is very distressing and tiring for all, and this seems like an innocent intervention that many hope will bring some relief. 🧵👇

🔍 What Does the Evidence Say?

Although generations of families and healthcare professionals have recommended winding after feeds, clinical trials do not provide robust support for the routine winding of healthy, term infants (James & Savargaonkar, 2025).

Here is what the landmark randomised controlled trial (RCT) published in Child: Care, Health and Development (Kaur et al., 2014) discovered when comparing routinely burped babies to a non-burped control group over three months:

• Infantile Colic 🚫: There was no statistically significant difference in the frequency or severity of colic episodes between the two groups. Current science links colic more closely to gut and nervous system immaturity rather than trapped air alone (Banks, 2023).
• Regurgitation (Spitting Up) 🍼: Surprisingly, the data revealed a statistically significant increase in spitting up in the group of infants who were routinely burped.

Why? Physically manipulating or patting a baby post-feed can put pressure on a full stomach and a relaxed lower oesophageal sphincter, inadvertently triggering or worsening gastroesophageal reflux.

💡 Modern Practical Tips

A 2025 comprehensive review confirmed that routine winding lacks an empirical baseline and shows no clear clinical benefit for healthy newborns (James & Savargaonkar, 2025). Instead of following a rigid rule, a more responsive approach is recommended:

1. Follow the Baby, Not the Clock: If an infant is comfortable, settled, or falls asleep contentedly after feeding, there is no medical need to rouse them just to force a burp. If they need and want to burp, they will!
2. Try Better Postures: For babies prone to mild reflux, gentle upright positioning or utilising left lateral positioning (under supervision) supports comfort and gastric management far more effectively than active patting (James & Savargaonkar, 2025; Jung et al., 2012).

The Bottom Line: Winding is a cultural tradition rather than a medical necessity. If a baby shows signs of distress, a gentle attempt is completely harmless—but if they are content, caregivers can comfortably skip it! 👶✨

📚 Clinical References & Evidence

• Banks, J. B. (2023). Infantile Colic. StatPearls.
• James, V., & Savargaonkar, R. (2025). Science of the burp: understanding aerophagia and eructation in newborns. BMJ Paediatrics Open, 9(1), e004066.
• Jung, W. J., et al. (2012). The Efficacy of the Upright Position on Gastro-Esophageal Reflux and Reflux-Related Respiratory Symptoms in Infants... Allergy, Asthma and Immunology Research, 4(1), 17–23. https://doi.org/10.4168/aair.2012.4.1.17

Kaur, R., Bharti, B., & Saini, S. K. (2014). A randomized controlled trial of burping for the prevention of colic and regurgitation in healthy infants. Child: Care, Health and Development, 41(1), 52–56. https://doi.org/10.1111/cch.12166

Frequently Asked Questions

• Evidence - burping vs no burping

  • Burping has little evidence of benefit in preventing colic, and the best available RCT evidence suggests it may increase regurgitation—and yes, it appears largely cultural/learned (it varies by family/region and is commonly taught despite limited efficacy data).

  • Randomised controlled trial (community setting; 71 mother–infants; follow-up 3 months):

    • Colic: no significant reduction with burping

    • Regurgitation: significantly increased with burping
      

  Indirect evidence (reducing swallowed air/aerophagia rather than “burping” itself)

  • Large multicenter RCT (China; 1,055 infants age 0–90 days; 14 days; bottom-vented vs teat-vented bottles):

    • No difference in mild GI discomfort at 2 weeks

    • Less crying during/after feeding with bottom-vented bottles
      

• Is burping cultual

  • Yes—practice is strongly shaped by tradition and advice networks.

    • 2025 BMJ Paediatrics Open review characterises burping as widely recommended by clinicians/family/parenting sources despite lacking supportive efficacy evidence and notes cultural traditions strongly influence practice.

    • Cross-sectional survey (Palestine; 450 mothers of infants with colic): 50.4% of mothers perceived burping as preventive, and information sources were mostly family/friends rather than professionals.
      

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

• Cow's milk protein colitis (also called food protein-induced allergic proctocolitis or FPIAP) is a benign, self-limited, non-IgE-mediated food allergy that typically presents in otherwise healthy infants with blood-streaked, mucoid stools.
• It is the most common cause of rectal bleeding in infancy and usually resolves within the first 1-2 years of life.

Clinical Presentation

Affected infants are typically well-appearing and thriving, with the hallmark symptom being visible blood and mucus in the stool.

The condition most commonly presents in the first few months of life, with approximately 60% of cases occurring in exclusively breastfed infants.

Cow's milk is the most common trigger (94.5% of cases), though other foods, including egg (37.4%), beef, wheat, and soy, can also be implicated.

Diagnosis

Diagnosis is entirely clinical and based on symptom resolution with elimination of the suspected food and recurrence upon reintroduction.

There are no validated diagnostic laboratory tests or biomarkers - faecal calprotectin, eosinophil-derived neurotoxin, and other proposed markers show poor reliability in infants.

Visible blood typically resolves within 3 days (median) of dietary elimination, while excess mucus may persist for up to 30 days.

A 2-week elimination period is generally sufficient to assess response.

Management

For breastfed infants, maternal elimination of the trigger food (most commonly dairy) is recommended while continuing breastfeeding.

For formula-fed infants, rice-based infant formula (more palatable) or extensively hydrolysed formulas are the first-line choice.

The condition is benign and self-limited, with most infants developing tolerance by 1-2 years of age. Recent evidence suggests that a 3-month intervention period may be sufficient for tolerance development in most cases, with 96.5% of infants achieving tolerance by an average age of 6.3 months.

Early reassessment for tolerance is recommended to minimise unnecessary dietary restrictions and support continued breastfeeding.

Frequently Asked Questions

• What are the main CMPA baby symptoms?

  Cow's milk allergy presents differently depending on the immune pathway involved. Unlike immediate reactions, non-IgE-mediated CMA causes delayed symptoms that appear hours or even days after consuming cow's milk protein.

  Because these signs mimic standard infant upset, diagnosis is often challenging.

  Common Delayed Symptoms

  • Tummy troubles: Frequent vomiting (including severe episodes like FPIES), chronic diarrhoea, reflux, abdominal pain, and blood in the stools (allergic proctocolitis).

  • General well-being: Persistent crying, colic-like irritability, and poor weight gain (failure to thrive).

• Testing for cows milk allergy

  Figuring out whether it is a true allergy—and what type—involves looking at your child's symptoms alongside specific medical tests.

  1. The Starting Point: Your Child’s Story

  Before any testing happens, the most crucial element is a detailed conversation about what happens when your child consumes milk. We look closely at the timing and nature of their symptoms to see which category they might fall into:

  • IgE-mediated (Immediate): Symptoms like hives, swelling, or vomiting that appear quickly—usually within minutes to a couple of hours.

  • Non-IgE-mediated (Delayed): Symptoms like eczema, reflux, tummy pain, or loose stools that develop hours or even days later.

  2. Testing for Immediate (IgE-Mediated) Allergies

  If the symptoms point toward an immediate reaction, we use targeted tests to look for specific allergy antibodies (called IgE).

  • Skin Prick Testing (SPT): We place a tiny drop of milk protein on your child’s forearm and gently scratch the surface. If a small, itchy bump (a wheal) appears within 15 minutes, it shows the immune system is sensitised. A negative result is incredibly reliable at ruling an immediate allergy out, especially in young babies.

  • Blood Tests (Specific IgE): This measures the amount of milk allergy antibodies in the blood. While higher numbers make an allergy more likely, a positive result simply proves "sensitisation" (the body recognises the protein). It doesn't automatically mean your child will react when they drink milk.

  • Component Testing: This is a more advanced blood test. Instead of looking at milk as a whole, it breaks it down into individual proteins (like casein or whey). This helps us understand if your child might tolerate baked milk (like biscuits) or if they are likely to have a more persistent allergy.

  3. Investigating Delayed (Non-IgE) Allergies

  If your child’s symptoms are delayed, standard skin prick and blood tests will usually come back negative. This is because a different part of the immune system is involved.

  While alternative tests like patch testing or stool markers are sometimes talked about, they aren't standardized or reliable enough for routine use.

  Diagnosis here relies much more heavily on a structured dietary elimination and reintroduction.

  4. The Gold Standard: The Oral Food Challenge

  Neither skin nor blood tests are definitive on their own. The absolute gold standard for confirming or ruling out a milk allergy is an Oral Food Challenge.

  This involves giving your child gradually increasing amounts of milk in a safe, medically supervised clinic setting to see if a reaction occurs. It is particularly useful if the previous test results are unclear, or to safely prove a child has outgrown their allergy.

  Summary

  Diagnosing a cow’s milk allergy is a jigsaw puzzle. We combine your child’s medical history with skin prick tests, blood tests, and—when needed—a supervised food challenge to get the definitive answer you need.

  If you are navigating this with your child and want expert guidance, please do get in touch with us at London Allergy Consultants. We offer all of these diagnostic tools at our specialist clinic and can help you build a clear, safe plan moving forward.

• Which milk is safe for my milk allergic infant

  If your baby has a confirmed or suspected cow's milk allergy, managing their diet can feel overwhelming. Under medical guidance, here are the safe milk options available in the UK, alongside what you must avoid.

  Safe Options (Under Medical Supervision)

  • Breastfeeding: This remains the ideal source of nutrition. If your baby reacts, your specialist might advise you to exclude dairy. However, we prefer to avoid maternal dietary restrictions if possible; exposing your baby to tiny amounts of cow's milk protein through breast milk may help build natural tolerance.

  • Hypoallergenic Formulas (Prescription Only):

    • Extensively Hydrolysed Formulas (EHF): The first-line option for mild-to-moderate CMA. The milk proteins are broken down into tiny pieces so the immune system is less likely to recognise them.

    • Amino Acid Formulas (AAF): Reserved for severe cases or if an EHF isn't tolerated. These are made from individual protein building blocks (amino acids) and contain no cow's milk at all.

  • Hydrolysed Rice Formula: A palatable, safe, and hypoallergenic option now available from birth in the UK. It uses extensively hydrolysed rice protein instead of dairy.

  • Soya-based Formulas (Over 6 Months Only): Soya is not suitable for babies under six months. While some older infants can react to soya, recent scientific reviews show this risk is uncommon and often overstated. Note that these formulas can currently be difficult to access in the UK.

  What to Strictly Avoid

  • Standard Cow's Milk Formula: This will trigger an allergic reaction.

  • Lactose-Free Milk: Lactose is a sugar, not a protein. Lactose-free products still contain the cow's milk proteins that cause the allergy.

  • Other Mammalian Milks (Goat or Sheep): The proteins in these milks are highly similar to cow's milk and will likely cause the same allergic reaction.

  • Standard Rice Milk: Do not give standard supermarket rice milk to children under four and a half years old due to its naturally occurring arsenic content. (Note: This is entirely different from prescribed hydrolysed rice formula, which is perfectly safe).

  • Shop-Bought Plant Milks (Oat, Almond, Coconut): These are not nutritionally complete and must not be used as a main drink for babies under one year. They may only be used in small amounts for cooking or on cereal from six months, provided they are calcium-fortified.

• Breastfeeding and cows milk intake, does this pass through to baby?

  How Does Cow's Milk Get Into Breast Milk?

  If you consume dairy products, components of cow's milk can pass into your breast milk. However, it does not travel there directly as whole milk.

  • The Process: When you eat dairy, your digestive system breaks down the cow's milk proteins (such as beta-lactoglobulin and casein). These broken-down fragments—called peptides—are absorbed into your bloodstream and then transfer into your breast milk.

  • The Reality: The concentration of these proteins in breast milk is extremely low and highly variable. Most breast milk samples contain only minimal or completely undetectable levels of dairy peptides.

  Understanding the Two Types of Milk Allergy

  Because the amount of dairy protein in breast milk is so small, the risk and type of reaction depend heavily on whether the allergy is IgE-mediated or non-IgE-mediated.

  1. IgE-Mediated Milk Allergy (Immediate Reactions)

  This type of allergy involves the immune system producing IgE antibodies. It causes fast, classic allergic reactions.

  • Symptoms: Hives, swelling, vomiting, or wheezing, usually occurring within minutes to two hours after a feed.

  • The Risk via Breast Milk: Very low. Because only trace amounts of dairy peptide fragments reach your breast milk, they are usually well below the threshold needed to trigger an acute, immediate IgE reaction.

  2. Non-IgE-Mediated Milk Allergy (Delayed Reactions)

  This is the type of allergy where symptoms are delayed and do not involve IgE antibodies. This is the more common culprit when breastfed babies react to dairy in a mother's diet.

  • Symptoms: Delayed gastrointestinal issues, most notably mucus or streaks of blood in the baby's stool (allergic colitis), severe reflux, or chronic eczema. These symptoms can take hours or even days to develop.

  • The Risk via Breast Milk: Possible. Even though the levels of cow's milk proteins in your milk are exceptionally low, these trace amounts are still capable of triggering a non-IgE-mediated condition like colitis in highly sensitive infants.

  What Should You Do?

  If your baby has immediate symptoms (like swelling or hives), seek medical advice straight away, as this suggests an IgE-mediated reaction.

  If you suspect a non-IgE allergy due to persistent symptoms like blood in the stool or severe colic, speak to your Allergy Doctor, GP or a paediatric dietitian before cutting dairy out of your diet. Eliminating dairy requires careful planning to ensure you still get the calcium and nutrients you need while breastfeeding.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

0330 678 5168

office@londonallergyconsultants.com

If you walk through London’s squares in late spring and find your eyes streaming and your throat tickling, you are likely meeting the London Plane (Platanus × acerifolia).

Representing over half of the trees in central London, this majestic species is a staple of our urban landscape. However, for allergy sufferers, it poses a unique dual threat: a traditional pollen allergy combined with a physical irritant known as "Plane Tree Dust."

Why So Many Plane Trees in London?

The London Plane is a hybrid, born of a chance encounter in the 17th century between the Oriental Plane (from Southeastern Europe) and the American Sycamore.

It became the darling of Victorian town planners for one primary reason: It is virtually indestructible. During the Industrial Revolution, London was choked by "pea-souper" fogs and heavy coal soot. While most trees suffocated, the London Plane thrived. Its secret? Exfoliating bark. By shedding large bark flakes, the tree literally peels off soot and pollutants that would otherwise clog its pores (lenticels).

This self-cleaning mechanism—combined with a tolerance for compacted soil and heavy pruning—led to its mass planting in iconic spots like Berkeley Square (1789) and the avenues of Marylebone. Today, it is just as popular in other major cities, including New York (where its leaf is the symbol of the Parks Department), Paris, and Philadelphia.

The "Dual Irritation": Pollen vs. Trichomes (yellow dust)

Unlike many other trees that cause hay fever purely through microscopic pollen, the London Plane irritates in two distinct ways:

1. The Pollen (The Allergic Trigger): Like birch or grass, the tree releases wind-borne pollen. This triggers a standard IgE-mediated allergic response: sneezing, a runny nose, and itchy eyes.
2. The "Dust" (The Physical Trigger): As the leaves and seed balls (those "pom-poms" hanging from branches) emerge in spring, they are covered in tiny, stiff, umbrella-shaped hairs called trichomes. As these break off, they create a fine yellow dust. These hairs are physically "spiky" and act as a mechanical irritant to the mucous membranes of the eyes and throat.

Symptoms often include:

• "London Eye": Intense grittiness, redness, and watering of the eyes.
• The "Plane Tree Cough": A dry, tickling cough or "scratchy" throat caused by inhaling the physical hairs.

Pollination & Distance travelled

• When: The peak season is typically mid-April to early May, though it can begin as early as March depending on the winter.
• Distance: Unlike the lightweight pollen of birch trees, which can travel for miles, Plane tree pollen is relatively heavy. However, because these trees are planted in high density along London’s streets, the "pollen load" in the immediate vicinity is exceptionally high. You don't need to be in a park to be affected; just walking down a street in Marylebone can be enough.

The Pollen - Pollution Connection

Research (including studies from 2026) suggests a "synergistic effect" between urban pollution and Plane tree symptoms.

• Enhanced Allergenicity: Nitrogen dioxide and ozone can chemically alter the pollen proteins, making them more "aggressive" to the immune system.
• Trapped Particles: Pollutants can stick to the physical trichomes (hairs), meaning when you inhale the "dust," you are also inhaling a concentrated dose of urban toxins deep into your lungs.

Management Tips for Londoners

• Shield Your Eyes: Wrap-around sunglasses are essential during late April and May to block both pollen and physical hairs.
• Rinse Regularly: If you’ve been walking through tree-lined streets, use a simple saline eye wash or "artificial tears" to rinse out the physical irritants.
• Timing: Pollen counts are often highest on dry, breezy days. If a "pollen bomb" is forecast, try to keep windows closed during the day.
• Barrier Creams: Applying a small amount of allergen barrier balm around the nostrils can help trap pollen and larger trichome hairs before they enter the nasal passage.
• Install air purifiers in your bedroom
• Medications: high-dose non-sedating antihistamines, eye drops, and nasal sprays may all be needed
• We offer Pollen Immunotherapy: oral (SLIT) and subcutaneous (SCIT).

The London Plane is a remarkable survivor that helps cool our city and clean our air - but for three weeks a year, it certainly demands our respect (and perhaps a few extra antihistamines).

Frequently Asked Questions

• Characeteristics of Plane Tree Pollen

  Pollen Characteristics: The Science of the "Spiky" Grain

  While the London Plane's physical hairs (trichomes) cause immediate mechanical irritation, the pollen grains themselves are the primary cause of the late-spring "hay fever" response.

  What Does it Look Like?

  Under a microscope, London Plane pollen is distinct. It is tricolpate, meaning it has three long grooves (apertures) running along its surface.

  • Size: It is relatively mid-sized for pollen, typically measuring around 20–25 micrometres ($20–25\,\mu\text{m}$).

  • Surface: Unlike the smooth grains of some species, the surface (exine) of Plane pollen has a delicate, net-like (reticulate) pattern.

  • Weight: It is heavier than the buoyant pollen of the Birch tree. This means that while Birch pollen can travel hundreds of miles from Scandinavia to London, Plane pollen tends to settle more quickly, leading to "hotspots" of high concentration directly under the tree canopies in London’s squares.

  Is it Unique or Related to Other Trees?

  In the world of allergy, we look closely at cross-reactivity—when the immune system confuses the proteins of one species with another.

  • Taxonomic Isolation: The London Plane belongs to the Platanaceae family. It is botanically quite distant from the most common UK "allergy" trees, such as the Birch, Alder, and Hazel (which belong to the Betulaceae family) or the Oak.

  • The "Sycamore" Confusion: In the UK, people often confuse the London Plane with the Sycamore (Acer pseudoplatanus). While they look similar to the naked eye, they are unrelated. The Sycamore is a member of the Soapberry family and is insect-pollinated, meaning it rarely causes significant hay fever compared to the wind-pollinated London Plane.

  • Cross-Reactivity Risks: Interestingly, if you are allergic to London Plane pollen, you may also experience Pollen-Food Syndrome (Oral Allergy Syndrome). The proteins in Plane pollen share similarities with:

    • Hazelnuts and Peanuts

    • Celery

    • Peaches and Apples

    • Lettuce

  This means some Londoners might find their mouth itches when eating a salad or a peach specifically during the weeks the Plane trees are in bloom

• London Plane vs PLane Trees in other cities

  London isn't the only "Plane-choked" city. It is a dominant urban tree in Madrid, Barcelona, and Melbourne.

  In Mediterranean cities, the Plane tree season is often much more explosive due to the warmer, drier climate, which allows the pollen to stay airborne longer. London’s humidity and frequent spring showers often help "wash" the heavy pollen and irritating trichomes out of the air, providing temporary relief—until the pavement dries and the wind picks the dust back up.

• Is Plane Tree pollen similar to other tree pollens?

  In the world of allergy, we look closely at cross-reactivity - when the immune system confuses the proteins of one species with another.

  • Taxonomic Isolation: The London Plane belongs to the Platanaceae family. It is botanically quite distant from the most common UK "allergy" trees, such as the Birch, Alder, and Hazel (which belong to the Betulaceae family) or the Oak.

  • The "Sycamore" Confusion: In the UK, people often confuse the London Plane with the Sycamore (Acer pseudoplatanus). While they look similar to the naked eye, they are unrelated. The Sycamore is a member of the Soapberry family and is insect-pollinated, meaning it rarely causes significant hay fever compared to the wind-pollinated London Plane.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

0330 678 5168

office@londonallergyconsultants.com

Pulses such as lentils, chickpeas, and peas have transitioned from health-food niche to mainstream staples in the UK. Certain traditional cuisines, such as South Asian cuisines, also commonly contain pulses. For parents of children with allergies, navigating this landscape requires a mix of keen label-reading and an understanding of the botanical relationships within the pulse family.

Cross-Reactivity: The "Legume Link"

If a child is allergic to one pulse, there is a biological possibility they will react to others, but it is far from a certainty. Clinical cross-reactivity (where the body reacts to the similar proteins in different pulses) occurs in about 5% to 15% of cases.

Interestingly, many children allergic to "true" pulses like lentils or chickpeas can safely tolerate green beans, string beans, or runner beans. This is because the protein structure in "succulent" pods differs significantly from that of the dried seeds (pulses).

At London Allergy Consultants, we will usually recommend a cautious, supervised introduction rather than a blanket avoidance of all legumes. Depending on clinical history, we will perform skin prick tests using whole foods as allergens and blood tests, including component IgE tests.

If a child is allergic to one pulse, there is a biological possibility that they will react to others, but it is far from certain. Clinical cross-reactivity (where the body reacts to similar proteins in different pulses) occurs in about 5% to 15% of cases.

Interestingly, many children allergic to "true" pulses like lentils or chickpeas can safely tolerate green beans, string beans, or runner beans. This is because the protein structure in "succulent" pods differs significantly from that of the dried seeds (pulses). However, because the risk of a multi-pulse allergy is higher than in the general population, an allergist usually recommends cautious, supervised introduction rather than a blanket avoidance of all legumes.

Labelling

Under UK Food Information Regulations, peanuts and soya are the only legumes that must be emphasised (e.g., in bold) on an ingredients list by law. However, other pulses, such as chickpeas, lentils, and peas, are not among the 14 major allergens that require mandatory bold labelling. This means parents must scan the full ingredient list diligently. While many UK manufacturers are voluntarily improving their labelling to highlight "Lentil Flour" or "Chickpea Protein," it is not legally mandated in the same way as milk or nuts, making vigilant "back-of-pack" checking essential.

Cultural and Dietary Importance

Pulses are the backbone of various global cuisines and dietary patterns:

• Cultural Staples: In South Asian (Dhal), Middle Eastern (Hummus/Falafel), and Mediterranean diets, pulses are primary protein sources.
• Vegan and Vegetarian: As more families reduce meat consumption, pulses serve as the primary alternative to animal protein.
• Gluten-Free: Pulse flours are the standard replacement for wheat in many specialty breads and crackers.

The Nomenclature Trap

One of the biggest hurdles for parents is nomenclature. A pulse might be listed under several names depending on the product’s origin or the specific variety used:

• Chickpeas may be listed as Garbanzo beans or Gram flour (Besan).
• Lentils come in various colours (red, green, Puy) but may simply be labelled as "Vegetable protein."
• Broad beans are often referred to as Fava beans.

Frequently Asked Questions

Is peanut allergy always associated with pea, lentil and chickpea allergy?

No, peanut allergy is not always associated with pea, lentil, and chickpea allergy.While cross-sensitization (positive IgE testing) is common, occurring in approximately 64% of peanut-allergic children, clinical cross-reactivity (actual allergic reactions) is uncommonThe American Academy of Allergy, Asthma, and Immunology guidelines state that "patients with peanut allergy generally tolerate other legumes, including soy," and therefore "a recommendation to empirically avoid all legumes is generally unnecessary." Possible legume allergy should be evaluated on a case-by-case basis.

Is pea, lentil and chickpea allergy outgrown?

Recent clinical data suggests that allergies to legumes such as peas, lentils, and chickpeas, follow a protracted clinical course similar to peanut allergy. While many childhood allergies to milk or egg resolve by age five or six, legume sensitivities often persist well into adolescence. Specifically, only 2.2% to 8.3% of children outgrow these allergies by age five, with resolution rates rising more significantly between the ages of 10 and 15. By mid-adolescence, approximately 20% to 32% of patients achieve tolerance, with the highest resolution rates observed in bean allergies (32.9%) and the lowest in chickpeas (19.3%).Predicting the likelihood of outgrowing these allergies depends heavily on initial diagnostic markers. Children presenting with lower specific IgE (sIgE) levels and smaller skin prick test (SPT) wheals at the time of diagnosis demonstrate a higher probability of developing natural tolerance. Conversely, factors such as comorbid atopic disease, multiple food sensitivities, and high initial IgE levels are associated with long-term persistence.

Is Oral Immunotherapy (OIT) to Pulses available?

Yes, we offer OIT for lentil and pea allergies within our Allergy Centre of Excellence (ACE) program.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

0330 678 5168

office@londonallergyconsultants.com

As we transition from winter to summer, many patients present for assessment due to recurrent infections. Families often wonder whether an immune deficiency or an allergy is contributing to these persistent symptoms. In older children, some of these symptoms may be due to hay fever from tree pollen, while in younger children, frequent illnesses are usually just a normal part of the cycle of infections associated with nursery or school environments.

A recent study indicates the expected frequency of infections in children:

- Respiratory Infections: 12 to 15 cases per year (approximately one per month)

- Gastrointestinal Illnesses: 2 cases per year (such as diarrhoea and vomiting)

- Rash-Causing Infections: 1 to 2 cases per year (for example, roseola or chickenpox)

A significant new review, published in March 2026 by researchers from University College London (UCL) and the University of Cambridge, provides detailed evidence on infection rates for children attending nurseries in the UK.

The paper is published in Clinical Microbiology Reviews

Trends and Context (2025–2026)

The research highlights that while nursery attendance increases the frequency of illness in the short term, it offers long-term immunological benefits.

Observation Long-term Benefit

Children with prior nursery experience have significantly lower infection rates when they start primary school than those cared for at home.

Rate of Improvement

Infection rates typically drop by 50% each year of attendance as the child’s adaptive immune system matures.

Viral Load

Under-fives are found to carry at least one respiratory virus approximately 50% of the time, though they may not always show symptoms.

Recent Outbreaks

Between January and March 2026, 34% of England’s measles cases occurred in the 1–4 age group (nursery age), emphasising the importance of the new MMRV vaccine introduced in early 2026.

The research in Summary:

The researchers found that while nursery attendance accelerates infection rates between ages one and five, it also provides a "boot camp" for the immune system. Consequently, these children tend to have fewer illnesses during their early school years than those who stayed at home, who then face a similar "catch-up" period of frequent illness upon starting school.

The paper also highlights that these infection rates result in an average of 13 days off due to illness in the first year, suggesting that employers need to have more realistic expectations for working parents.

A Practical Guide for Childcare Facilities

Maintaining a healthy environment in childcare settings requires a multi-faceted approach. Data suggests that clinical outcomes improve significantly when facilities move beyond basic hygiene to integrated, educational protocols.

Hand Hygiene: The Power of Targeted Sanitisation

While soap and water are foundational, research indicates that hand sanitiser programmes combined with education for staff, parents, and children significantly outperform traditional methods.

• Respiratory Health: A randomised trial of 911 children demonstrated that sanitiser use reduced respiratory infections by 23% and antibiotic prescriptions by 31%.
• Gastrointestinal Health: These interventions also reduce episodes of acute gastroenteritis, particularly during the winter months.
• When to use Soap and Water: Use traditional washing if hands are visibly soiled or when managing specific pathogens such as Norovirus, Cryptosporidium, or C. difficile, as sanitisers are less effective against these pathogens.

Rigorous Environmental Cleaning

Viruses can persist on surfaces for extended periods. Regular disinfection of toys and surfaces is a critical barrier against transmission.

• Frequency: Disinfecting communal items every two weeks significantly reduces the presence of viral genetic material, including RSV.

• Best Practices: * Use chlorine-based disinfectants for hard surfaces (fomites).

  • Clean up the vomit immediately with paper towels, then apply the appropriate chemical cleaners.

  • Launder bed linens and clean toys daily to provide maximum protection.

Strategic Facility Management

The physical organisation of a nursery plays a vital role in infection control.

• Zoning: Maintain a strict physical separation between food-preparation areas and nappy-changing zones to prevent cross-contamination.
• Staffing: Avoid "mixing" staff between different child groups. Limiting staff to specific areas and maintaining optimal child-to-staff ratios reduces the opportunity for a pathogen to spread throughout the facility.
• Risk Factors: Consider removing sandpits and paddling pools, as they are identified environmental risk factors for the spread of illness.

Illness Management and Prevention

A proactive stance on illness is more effective than a reactive one.

1. Exclusion and Cohorting: Promptly exclude ill children and staff. If exclusion is not immediately possible, cohort ill children together away from the healthy population.
2. Immunisation: Ensure all children and staff are up to date with age-appropriate immunisations to build herd immunity within the setting.
3. Education: Implement written infection control policies and provide recurring staff training to ensure protocols are followed consistently.

Clinical Insight: Reducing exposure to large group settings and emphasizing respiratory etiquette (cough hygiene) remain the most effective non-pharmaceutical interventions for protecting high-risk infants.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

• Sesame OIT is a treatment in which you eat tiny amounts of sesame under medical supervision, gradually increasing the dose over time to help your body become less allergic.
• The goal is to reduce your risk of severe reactions from accidental sesame exposure.
• We offer Sesame OIT within our Allergy Centre of Excellence.

Does Sesame OIT work?

• Studies show that about 88-95% of people who complete sesame OIT can tolerate much larger amounts of sesame than before treatment
• Sesame OIT offers better protection against accidental exposures and the ability to eat foods that may contain traces of sesame.
• In many patients, at the end of at least a year of maintenance dosing, higher amounts of sesame will be tolerated, and the doses need not be taken every day; we can reduce to one to three days of dosing per week.

What are the side effects of Sesame OIT?

• You may experience allergic reactions during treatment, including mouth itching, stomach upset, or skin reactions.
• Most reactions are mild, but some people (8-17%, depending on the study) may need adrenaline during treatment. Using our ACE Sesame regimen and support, allergic reactions requiring adrenaline are <10%, especially in very young children.

What else should I know before commencing Sesame OIT?

• Sesame OIT must be performed in a specialised safe allergy centre, such as ACE, under close medical supervision. Allergy specialists should guide therapy.
• You'll need to take your daily sesame dose consistently, and the treatment requires a long-term commitment.
• Depending on your journey and tests over time, a less rigorous regimen may be offered.
• The therapy can significantly improve quality of life by reducing anxiety about accidental exposures and expanding food choices.
• Prof du Toit has co-authored recent EAACI guidelines on the management of IgE-mediated food allergy, including Sesame Allergy. EAACI guidelines on the management of IgE-mediated food allergy

Frequently Asked Questions

• Tell me about Sesame Allergy

  Sesame allergy is an IgE-mediated food allergy that affects approximately 0.1-0.2% of the population in the UK and other Western countries

  Sesame Allergy typically develops in early childhood and is one of the least likely food allergies to be outgrown, with only about 20-30% of children naturally losing their allergy over time.

  Symptoms range from mild reactions like hives, itching, and gastrointestinal upset to severe anaphylaxis, which occurs in approximately 30-50% of sesame-allergic individuals.

  Reactions are usually triggered by sesame seeds in hummus and tahinni, where there are greater concentrations of the allergen.

  Diagnosis involves clinical history, skin prick testing, and sesame-specific IgE blood tests. Component-resolved diagnostics measuring Ses i 1 can help predict severity, as higher levels are associated with more severe reactions. If the disagnosis remains uncertain, we undertake oral food challenges.

  Management traditionally relies on strict avoidance and carrying epinephrine auto-injectors or Nasal Adreanline (Neffy).

  Sesame is now recognized as a major allergen in many countries, requiring mandatory labeling on packaged foods in the US (as of 2023), Canada, UK, EU, and Australia.

  Hidden sources include tahini, halva, baked goods, and some cosmetics.

• Who is eligible for Sesame OIT?

  Eligibility includes:

  • A firm diagnosis of Sesame Seed Allergy

  • A decicion based on shared decision making

  • Controlled stable asthma

  • In ACE, we do not yet offer this treatment for those older than 18 years

• How many visits to ACE are required for Sesame OIT?

  The Sesame OIT regimen in ACE involves at least 8 supervised updosing visits in our bespoke 10 Duchess Street facility.

  If more visits are required, for whatever reson, thisis built into the year long program of supervision

  At the end of a years treatment we will discuss options wrt higher dosing, or less frequent dosing.

• If undergoing Sesame OIT, can we simultaneously treat other allergies?

  Yes, within ACE we can offer OIT to three allergens simultaneously for children < 6 years of age, 2 allergens for those < 12 years of age, and for one allergen at a time for older children.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

• The manufacturer of Palforzia has announced that production of the treatment will be stopping worldwide. As a result, they have advised services not to start any new patients on Palforzia after 1 April 2026.
• Peanut OIT: Peanut allergy is the most extensively studied food allergen for Oral Immunotherapy (OIT), providing a robust foundation of safety and efficacy data over many years.
• Our London Allergy Consultants, Prof Du Toit and Dr Foong, have made significant contributions to the landmark research studies in this field (see reference below).
• Peanut OIT provision: At Allergy Centre Excellence, we have significant experience with peanut OIT, having been one of the largest providers of Palforzia and non-Palforzia. Please visit our website, which outlines a plan forward for patients about to start Palforzia or already on Palforzia.

Peanut OIT:

• Peanut OIT has been recognised as a treatment option for the management of peanut allergy, as detailed in a recent EAACI Guidelines, in which Prof. du Toit was a Senior Author - EAACI guidelines on the management of IgE-mediated food allergy
• Palforzia was the first-ever FDA-approved treatment for food allergy, but is no longer in production. This was a "real first" that broke a decades-long ceiling in the field of food allergy. Securing regulatory approval provided a blueprint for the entire field, driving the OIT industry forward immeasurably and paving the way for future treatments for milk, egg, and multi-allergen sensitivities.

Are there lessons we have learnt from Palforzia that we now apply to peanut OIT?

• Safety: Prior to Palforzia, OIT often used varying grocery-store flours. Palforzia demonstrated that a pharmaceutical-grade, characterised allergen with consistent protein ratios is essential for safe, predictable up-dosing. These findings can now be applied to other non-commercialised well-characterised peanut products.
• "Bite Protection" is a Meaningful Clinical Goal: We learned that a "cure" (total tolerance) isn't necessary for success. Increasing a patient’s threshold to 600 mg or 1,000 mg (approximately 2–4 peanuts) provides a critical safety net against accidental cross-contamination, which is meaningful to the vast majority of patients and families.
• Early Intervention Yields Superior Results: Data from younger cohorts (preschoolers) suggest that the immune system is more "plastic" early on, leading to higher rates of desensitisation and better overall safety profiles than in adolescents. In some of these patients, the allergy markers may go away entirely.
• The "Dose Forgiveness" Threshold: Long-term follow-ups showed that after ~2 years of maintenance, the immune system "matures," allowing some flexibility. Occasionally, patients who miss a dose or two are less likely to lose their desensitisation.
• Treatment Burden vs. Quality of Life: Palforzia highlighted that the "burden" of daily dosing and gastrointestinal side effects must be balanced against the "fear" of accidental ingestion. It shifted the clinical conversation toward shared decision-making.

Landmark scientific publications regarding Peanut OIT to which Prof du Toit and Dr Foong have contributed:

• Oral Immunotherapy for Peanut Allergy in Children 1 to Less Than 4 Years of Age - Authors: George Du Toit, Kari R. Brown, Andrea Vereda, Anne-Marie Irani, M.D., et al for POSEIDON Study Group. Published October 23, NEJM Evid. This pivotal trial focused on toddlers (ages 1–3) and showed that 73.5% of toddlers achieved desensitisation to 600 mg, suggesting better outcomes when started earlier.
• PALISADE (Pivotal Phase 3) NEJM (2018) Vickery BP, Vereda A, Casale TB, Beyer K, Du Toit G, Hourihane JO, Jones SM, Shreffler WG, et al. This landmark trial showed that 67% of participants (ages 4–17) tolerated a single dose of 600 mg peanut protein (approx. 2 peanuts) after 1 year, compared to only 4% in the placebo group.
• ARTEMIS (European Phase 3)The Lancet Child & Adol. Health (2020) Hourihane JO, Beyer K, Abbas A, Fernandez-Rivas M, Turner PJ, Akdis C, Du Toit G, et al. This novel trial confirmed the efficacy of OIT in a European cohort. 58% of treated children tolerated a 1000 mg dose (approx. 3-4 peanuts) vs. 2% for placebo.
• ARC004 (Long-term Safety) (2021) Fernández-Rivas M, Vereda A, Casale TB, Vickery BP, Du Toit G, et al. In a long-term Follow-up. These open-label extension studies show that continued daily maintenance leads to sustained desensitisation and a decrease in side effects over time (up to 5 years).

Please list some Peanut OIT highlights:

Evolution of Care: Peanut allergy management has shifted from strict avoidance to active treatment, using controlled exposure to raise a child's reaction threshold.

1. Proven Efficacy: Key trials, such as PALISADE, led to the first regulatory approvals, demonstrating that most treated children can eventually tolerate the equivalent of several peanuts.
2. Early Intervention Wins: Recent research (including the IMPACT trial) shows that starting OIT at ages 1–3 can lead to "remission," in which a child remains non-allergic even after stopping treatment.
3. New Treatment Standards: While pharmaceutical powders such as Palforzia have paved the way, the Allergy Centre of Excellence now uses characterised peanut products to ensure wider access and precision.
4. Safety First: While OIT is highly effective, it carries a higher risk of mild-to-moderate reactions than avoidance; therefore, expert supervision and emergency preparedness remain essential.

Frequently Asked Questions

• Why is Palforzia leaving the Global market?

  While effective, Palforzia required a significant commitment from both families and clinicians:

  • Intensive Clinical Monitoring: Every dose increase (occurring every two weeks for several months) required a multi-hour clinic visit for professional observation.

  • High Demands on Staff: These visits required constant, dedicated oversight from senior consultants and nursing teams.

  • Strict Lifestyle Rules: Daily home dosing came with "the rest hour"—a window where children had to avoid exercise, hot showers, or being unwell—which many families found difficult to sustain.

  • Proven Safety: It is important to note that Palforzia is not leaving the market due to concerns over safety or efficacy; its exit is purely commercial.

• Where can we access (non-Palforzia) Peanut OIT in the UK

  We offer (non-Palforzia) peanut OIT in the Allergy Centre of Excellence, which is the largest provider of OIT in the UK.

  Ace provides unmatched Allergy Specialist care, with a team of Nurses, Allergists, Dietitians, Psychologists, and a PICU Drs covering all activity.

  In ACE, we also offer a constant telephone emergency line in the event of reactions.

• The Benefits of Peanut Flour Approach

  Transitioning from a brand-name pharmaceutical to natural, well-quantified peanut flour allows us to refine the OIT experience for our families. Here is why we are confident in this next step:

  • Same Science, More Flexibility: We use the same proven principles of incremental exposure. By using precisely measured peanut flour, we can often tailor the "up-dosing" schedule more closely to your child’s specific needs.

  • A Sustainable Long-Term Solution: Unlike a proprietary drug, high-quality peanut products are not subject to the same commercial exits. This ensures your child’s treatment path is stable and won't be interrupted by market changes.

  • Streamlined Logistics: While safety remains our top priority, we aim to make the "home dosing" lifestyle more manageable. Our team provides practical guidance on integrating treatment into your family's daily routine without the rigid constraints of a branded protocol.

  • Expert Oversight: Because our consultants helped pioneer the original Palforzia , we have the unique Specialist expertise required to transition patients safely to natural peanut protein while maintaining the highest clinical standards.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

• Lactose is a mammalian sugar and the reason infants love the taste of breast milk so much.
• It is extremely rare for infants to be born lactase-deficient, so nearly all babies should be able to tolerate lactose.
• A common cause of lactose intolerance is transient intolerance, which occurs for a short period after diarrhoea, illness, or a course of antibiotics.
• Severe chronic illness affecting the GIT can also cause this.
• Lactase non-persistence (which occurs in much of the world) only comes on with increasing age, not in infancy.

Symptoms and Signs of Lactose Intolerance in Infants

• Lactose intolerance in infants typically presents with the following classic symptoms:

  • Watery, acidic diarrhoea

  • - Abdominal distension

  • - Flatulence

  • In severe cases, continued intake of lactose-containing feeds can lead to failure to thrive and dehydration. It's important to note that hives, immediate-onset rashes, and tissue swelling are signs of Cow's Milk Protein Allergy (CMPA), not lactose intolerance.

• Symptoms usually appear after the ingestion of breast milk or standard infant formula, both of which contain lactose.

• In cases of congenital lactase deficiency (alactasia), which is extremely rare, symptoms emerge shortly after feeding begins, resulting in persistent diarrhoea that can cause weight loss and severe dehydration.

• Secondary lactose intolerance, which occurs more frequently (e.g., after infections or mucosal injury), presents with similar symptoms but may be less severe and often transient. Symptoms can include abdominal pain, bloating, and increased stool frequency. The onset of these symptoms is closely linked to lactose intake and typically resolves with the elimination of lactose from the diet.

For infants who develop lactose intolerance, numerous lactose-free formula options are available, including rice- and soy-based formulas.

Although breast milk contains lactose, there is no need to discontinue it, as transient lactose intolerance usually resolves on its own.

Our team is experienced in guiding you through a potentially challenging diagnostic process. For a more comprehensive evaluation of non-IgE adverse reactions, please refer to the EAACI guidelines titled "Diagnosis and Management of Non-IgE Gastrointestinal Allergies in Breastfed Infants" - an EAACI Position Paper, in which Prof. Du Toit participated.

Frequently Asked Questions

• How much lactose is in infant milks and breast milk?

  • Human milk has the highest lactose concentration, typically around 6.7–7.0 g per 100 mL (67–70 g/L).

  • In comparison, cow's milk has a lower lactose content, averaging about 4.6–4.9 g per 100 mL (or 46–49 g/L).

  • Most infant formulas in the United Kingdom are designed to mimic human milk (a hard task), and their lactose content is generally similar to or slightly lower than that of human milk, typically ranging from 4.5 to 7 g per 100 mL (45–70 g/L), depending on the brand and formulation.

• How to diagnose a lactose intolernce in infancy?

  We make us of clinical history, dietary elimination-and-rechallenge, expecting resolution of symptoms with lactose elimination and recurrence with reintroduction supports the diagnosis. In infants where formal testing is difficult.

  Hydrogen breath test (HBT) is the most widely used and recommended non-invasive diagnostic method for lactose intolerance in older children. It involves administering an oral lactose load (typically 1–2 g/kg, up to a maximum of 25 g) and measuring breath hydrogen at intervals. An increase in breath hydrogen ≥20 ppm above baseline is considered diagnostic for lactose malabsorption. The test is interpreted in conjunction with the presence of symptoms during or after the test, as symptom correlation is essential for diagnosing lactose intolerance rather than just malabsorption.

  Symptom assessment after lactose challenge is critical. Validated symptom questionnaires or direct observation of symptoms (such as diarrhea, abdominal pain, bloating, or flatulence) following a lactose load are used to confirm clinical intolerance, as malabsorption and symptoms do not always correlate.

  Genetic testing for lactase non-persistence (C/T-13910 polymorphism) may be considered, especially in populations with a high prevalence of lactase persistence or in cases where the breath test is not feasible. - However, genetic testing identifies predisposition to primary lactase deficiency but does not confirm current intolerance or secondary causes, which are more common in infants.

  Stool acidity and reducing substances may be used as supportive tests in infants, especially when breath testing is not feasible. Acidic stools (pH <5.5) and the presence of reducing substances suggest carbohydrate malabsorption but are not specific for lactose.

• Which ethnic groups are most at risk of decreasing lactase with age?

  Ethnic groups worldwide at increased risk for developing lactose intolerance include: East Asian, West African, Arab, Jewish, Greek, Italian, Hispanic/Latino, Native American, and most Indigenous Australian and Pacific Islander populations.

  In these groups, the prevalence of lactase non-persistence (and thus lactose intolerance) ranges from 70% to nearly 100% in adulthood, with the highest rates observed in East Asian and Native American populations.

  In contrast, Northern Europeans (e.g., Scandinavian, British, Irish) have the lowest prevalence of lactose intolerance, with lactase persistence rates exceeding 90% in some populations.

  Lactose intolerance, if it does develop, in at risk populations, usually presents after age 5yr, as lactase enzyme activity begins to decline following weaning.

  The onset of symptoms is most common in mid-childhood to adolescence, although the exact age can vary depending on genetic background.

  In populations with high rates of lactase non-persistence, the decline in lactase activity and the emergence of symptoms may occur as early as 5–7 years of age.
  

• Which milk is safe for my milk allergic infant

  Breastfeeding should be continued wherever possible, as human milk is generally well tolerated except in the exceptionally rare cases of congenital lactase deficiency.

  For lactose intolerant infants, the recommended infant formulas are rice or soy-based infant formulae, or lactose-free cow’s milk protein-based formulas.

  Lactose-free formulas are generally nutritionally complete and use alternative carbohydrates such as glucose polymers or corn syrup solids instead of lactose. These formulas are appropriate for infants with congenital lactase deficiency or secondary lactose intolerance (e.g., post-gastroenteritis) who are not breastfed and do not have cow’s milk protein allergy.

  Soy-based formulas are not recommended as first-line for ex-prem infants under 6 months due to concerns about phytoestrogen exposure.

  Avoid Soy milks if there is a coexisting soy allergy.

  Extensively hydrolyzed or amino acid-based formulas are not indicated for isolated lactose intolerance but are reserved for infants with severe cow’s milk protein allergy.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Is Your Baby Struggling with Colic?

• As Paediatric Allergists, we often see families who are exhausted and emotional due to their infant’s colic. It is very distressing when your baby appears to be in continuous pain for no medical rhyme or reason. Colic can have a massive impact on the mental health of the entire household.
• While "the three-hour rule" is used for a diagnosis of Colic (after the exclusion of all else), this remains a very long time to be comforting an inconsolable, screaming baby. Parents are understandably keen to know whether a food/food allergy is causing their infant obvious discomfort.
• Please read on for an update re our understanding that colic is seldom due to food allergy and more often linked to an imbalance in a baby's developing gut bacteria (the microbiota).

What Is Colic?

As Paediatricians, we usually diagnose colic using what we call the "rule of threes." To officially tick the box for colic, an otherwise healthy and well-fed (and fed with good technique) baby, needs to be having bouts of inconsolable crying that last:

• More than 3 hours a day...
• More than 3 days a week...
• For more than 3 weeks in a row.

How long will this last?

• It’s an exhausting cycle for parents, but there is one major silver lining: it is "self-limiting."
• Most babies start showing symptoms between 2 and 16 weeks of age, and in almost every case, the crying naturally tapers off by the three-to-four-month mark.
• We also look for a typical diurnal pattern. Colic is rarely constant throughout the 24-hour cycle. The crying spells typically cluster in the late afternoon and evening.
• If a baby is crying inconsolably for 24 hours straight without any settled periods, we would be much more concerned about a different diagnosis.

Diagnosis?

• In Paediatric Allergy clinic, our first job isn't actually to "diagnose" colic—it's to rule out everything else.
• Once we’ve completed a thorough physical exam and taken a detailed history to ensure they aren't ill or in pain for another cause, we can confidently label the symptoms as colic.
• We will discuss the possible role of food allergies (in mom's diet if breastfeeding, or in formula options if formula-fed) and the use of probiotics.
• Whilst allergies seldom play arole in this condition, it is a valid and obvious question for exhausted parents to ask, and there are a few other variables that can be put in place for babies at this age.

Infant and Maternal Diet and Colic:

• Infant diet MAY be associated with colic through several proposed mechanisms, including: food hypersensitivity (especially cow's milk protein), gut microbiota composition, and gastrointestinal immaturity. The relationship is complex, multifactorial and not fully understood, but dietary interventions are commonly considered in clinical practice. Indeed, many of the infants who attend our clinic have already failed dietary intervention of some sort.
• For breastfed infants, maternal elimination of cow's milk and other potential allergens may reduce colic symptoms, particularly when food allergy is suspected (eczema, hives, vomiting associated with high allergen intake in moms doet) or when standard management (correct feeding practices…) fails. It is important to note that the evidence for benefit is inconsistent and based on small, heterogeneous studies, so routine dietary restriction is not universally recommended by all Allergy and Paediatric Societies.
• Nonetheless, some mothers report improvement with the elimination of specific foods, such as cruciferous vegetables (broccoli, cauliflower, kale, cabbage, bok choy, Brussels sprouts, and radishes), which offer vitamins, fibre, and sulforaphane/glucosinolates; however, these findings are not robust and may reflect individual variation.
• In formula-fed infants, switching to a modified or non-mammalian milk formulae (e.g. extensively hydrolysed or amino acid-based formulas, modified rice formula, or infant soy-based formula) MAY improve colic symptoms, especially in infants with suspected cow's milk protein allergy. The use of Soy-based formula is no longer controversial, provided that soya allergy is excluded.
• There is no substantial evidence supporting the use of fibre-supplemented or low-lactose formulas for colic.
• Alterations in gut microbiota and markers of gut inflammation have been observed in some infants with colic, independent of feeding mode, suggesting that diet may influence colic via effects on the intestinal environment. However, the clinical significance of these findings remains unclear, and so we manage symptoms on a case-by-case basis.
• Overall, while dietary modification may benefit select infants with colic, especially those with suspected cow's milk protein allergy or other food hypersensitivities, current evidence and ninternational guidl;ines do not support routine dietary changes for all infants with colic.
• Management should be individualised, and parental reassurance remains a cornerstone of care.

And dont forget basics:

• Holding the baby through the crying episode, gently rocking or even trying novel holding positions, but ensure safety from dropping - The "Colic Hold": Carrying the baby face-down across your forearm.
• Reducing environmental stimuli.
• Gentle motion (such as pushing the pram or rocking the crib).
• 'White noise'
• Bathing the infant in a warm bath.
• Ensuring an optimal winding technique is used during and after feeds.
• Gentle abdominal light massage/tickling.
• Avoid Simeticone (such as Infacol®) or lactase (such as Colief®) drops.
• Avoid manipulative strategies such as spinal manipulation or cranial osteopathy (injuries have been reported).

Frequently Asked Questions

• What are the main Colic symptoms?

  Here are 10 common symptoms and signs of Colic:

  1. Paroxysmal Crying: This is crying that starts and stops suddenly for no apparent reason. The baby might be perfectly happy one minute and in full-blown distress the next.

  2. The "Inconsolable" Quality: Unlike hunger or a wet nappy, colicky crying doesn't usually stop when you feed, wind, or cuddle the baby. Movement in a pram or car is also often unsuccessful. It often feels like nothing you do makes a difference.

  3. High-Pitched Screaming: The sound of the cry is often more urgent, piercing, or distressed than their usual "I’m tired or wet" whimper.

  4. Flushed or Red Face: The intensity of the effort often causes the baby's face to become very red or even slightly dusky around the mouth during a peak episode.

  5. Drawing Up the Legs: You will often see the baby pull their knees up toward their tummy as if they are experiencing abdominal cramping.

  6. Clenched Fists: Physical signs of tension are common, particularly tightly balled-up fists and stiffened arms.

  7. Arched Back: During a crying fit, the baby may stiffen their entire body and arch their back (this can sometimes overlap with reflux symptoms).

  8. The "Witching Hour": While it can happen any time, symptoms classically peak in the late afternoon and evening (roughly between 4 pm and midnight) i.e. just when you want to relax!

  9. Abdominal Distension (Bloating): The baby’s tummy may feel hard or look slightly "tight" and swollen during the episode, often due to swallowing air while crying.

  10. Passing Gas or Drawing Up for a Bowel Movement: You might notice the baby seems to find temporary relief after passing wind or having a stool, though the crying often resumes shortly after.

• How to test for Colic?

  When we see a "colicky" baby in the clinic, our first job is to exclude other treatable causes. While we often categorise colic as a functional gut disorder, it’s rarely caused by just one thing. It’s usually a perfect storm of gastrointestinal immaturity, a shifting gut microbiome, and environmental factors.

  However, as clinicians, we try our best to exclude alternate diagnoses:

  • Cow’s Milk Protein Allergy (CMPA): Both IgE and non-IgE mediated allergies can cause extreme distress. If a baby is formula-fed and inconsolable, or a breastfed baby is reacting to proteins in the mother’s diet, supervised dietary avoidance can be trialled. Non-IgE requires supervised elimination-reintroduction diet and IgE can be tested for with SPT and/or IgE.

  • Feeding Dynamics: It sounds simple, but aerophagia (air swallowing) from a poor latch or a fast-flow teat can cause significant abdominal discomfort. We also have to look for transient lactase imbalance following antibiotics or gastro-enteritis), which often presents with frothy, green stools and a very unsettled infant.

  • GORD: Standard reflux is common, but when it becomes Gastro-oesophageal Reflux Disease, the associated oesophagitis can mimic the paroxysmal painful crying of colic.

  The "Must-Not-Miss" Red Flags

  If a baby presents with excessive crying, we will need to exclude:

  1. Intussusception

  2. Malrotation with Volvulus

  3. Non-Accidental Injuries

  4. Infection

  Systematic Clinical Workup

  A standard "colic" consult should involve a deep dive into the following:

  • Detailed Feeding History: Method, volume, frequency, and maternal caffeine or spicy food intake.

  • Stool Patterns: Are they passing blood or mucus? (Points towards CMPA or infection).

  • Physical Exam: A head-to-toe check, including a look inside the nappy for strangulated hernias, and a palpation of the abdomen for masses or distension.

  The Bottom Line:

  By ruling out the red flags and considering dietary triggers like CMPA early on, we can provide much more targeted relief for both the infant and the exhausted parents.

• Which milk is best for Colic babies?

  The Role of Breastfeeding

  Breastfeeding remains the gold standard and should be encouraged and continued.

  While maternal diet is often the first thing parents want to change, the evidence for routine dietary exclusion is weak.

  We do not recommend blanket restrictions for all breastfeeding mothers.

  However, if we have a high clinical suspicion of Cow’s Milk Protein Allergy (CMPA)—especially if the crying is paired with eczema, reflux, or stool changes—a maternal elimination diet (removing all dairy for 2–4 weeks) is a reasonable diagnostic step. If symptoms don't improve within that window, dairy should be reintroduced to avoid unnecessary nutritional restriction.

  Formula-Fed Infants:

  When we suspect a true sensitivity or CMPA, we select from:

  Rice-based modified infant formula

  Soy-based infant formula (if Soy allergy excluded)

  Extensively modified Milk Formulae

  Amino Acid Milk Formulae

  What Doesn't Work?

  It is equally important to counsel parents on what the evidence doesn't support. Currently, there is no robust clinical data to suggest that the following provide any significant reduction in crying time:

  • Fibre-supplemented formulas

  • Lactase-supplemented formulas (e.g., adding Colief drops routinely without evidence of lactose intolerance)

  • Alpha-lactalbumin enriched formulas

  Clinical Summary

  Dietary management of colic must be targeted rather than scattergun. We reserve specialised formulas or maternal restriction for cases where CMPA is a legitimate differential, characterized by:

  • Gastrointestinal distress (vomiting/diarrhoea)

  • Dermatological signs (atopic dermatitis/urticaria)

  • Failure to thrive or poor weight gain

• Colic and Probiotics

  A Guide to Probiotics for UK Parents

  Lactobacillus reuteri DSM 17938

  If you’ve been searching for colic remedies, you’ve likely come across this specific strain. It is the most heavily researched probiotic for colic.

  What the science says:

  • Reduced Crying: Studies show it can reduce daily crying time by 40 to 65 minutes.

  • The Breastfeeding Factor: The benefits are most pronounced in exclusively breastfed infants.

  • Efficiency: We have a "Number Needed to Treat" of 2–3. In medical terms, that is incredibly good—it means for every 2 or 3 babies given the probiotic, one will see a significant improvement.

  Where to find it in the UK: The most common brand containing this specific strain is BioGaia Protectis (available as drops).

  You might also find L.R. in infant formulas specifically marketed for "digestive comfort," though the evidence for formula-fed babies isn't quite as strong as it is for breastfed ones.

  Bifidobacterium longum and Pediococcus pentosaceus (often shortened to BL+PP).

  Where to find it in the UK: This combination is found in AB-Kolicare. It’s becoming more widely available in the UK and is a great option to discuss with your GP or health visitor.

  Other Options: Bifidobacterium animalis lactis

  Another strain often mentioned is B. lactis BB-12. In the UK: You’ll often find this strain in Optibac Baby Drops or Kendamil formulas. It is recommended by the European Society for Paediatric Gastroenterology (ESPGHAN) for breastfed babies.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

The allergic march, aka the atopic march, is a concept describing the possible progression of allergies in your child. Allergic diseases are usually multi-system in nature, so it is not uncommon for infants with eczema to go on to develop one or more of food allergy, asthma, hay fever, and oral allergy syndrome. Whilst this is true at a study population level, it is very hard to predict the likely course for each child.

Whilst it’s not possible to alter any genetic predisposition, it does make sense to minimise the risk of progressing along this march through modifying environmental factors.

The two most significant disease-modifying interventions are the best eczema control and the introduction of common and relevant food allergens for your child. Healthy living strategies will help nurture the gut and skin microbiomes, so these seem prudent as well.

It may be that early mite and pollen immunotherapies may decrease allergic respiratory disease, but such studies remain under investigation.

Pollution and mould are harmful for all lungs, allergic and non-allergic alike, so steps to reduce them, e.g., air purifiers in bedrooms, seem wise.

As with asthma, there are many ‘eczemas’  - severe eczema, oozing, wheeping, crusting, staph-infected, and which are often on exposed skin areas (hands, feet, face, head and neck) seem to be most strongly associated with the development of food allergy, so early and proactive treatment of this is warranted.

We have separate posts regarding optimising skin control, restoring the gut biome and early weaning, so if the topic is of interest or concern to you, please read those as well.

What Is the Allergic March?

There is some data to support a typical progression of allergic diseases in childhood: starting with atopic dermatitis (eczema) and food allergies in infancy, transitioning to wheezing, asthma, and allergic rhinitis in later childhood and adolescence, with some conditions (like eczema) often remitting over time.

However, the Allergy March is not universal or linear. There is significant individual variability in trajectories, influenced by genetic predispositions, environmental exposures (e.g., microbiome, pollutants), and immunologic factors.

Not all children follow the typical sequence; some skip stages, and others may have persistent or atypical patterns. So please do contact us if you wish for a detailed assessment of your child's existing allergies and ways in which we may be able to treat and prevent additional allergies from developing.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

0330 678 5168

office@londonallergyconsultants.com

Families often attend the clinic suspecting that their infant has silent reflux.

Parents describe ‘silent, i.e. without visible regurgitation’, symptoms that may include:

• Feeding refusal
• Irritability (especially during or after feeds)
• Back arching / Leg drawing (flexion)
• Choking, gagging, or coughing and may smell of sick / vomit when this happens
• Gurgling and swallowing of the sick
• Unexplained or inconsolable crying (with painful tears), i.e. not so silent!

More Concerning Findings

While less common, some infants may also experience:

• Food/feeding refusal
• Hoarseness or a chronic cough
• Respiratory symptoms such as wheezing or recurrent pneumonia
• Growth faltering or "failure to thrive" (in more severe cases)
• Blood specs in vomit

What Is Silent Reflux and how to manage it?

Silent reflux is when stomach contents come back up into your baby's throat or oesophagus, but your baby does not visibly spit up or vomit. Because there is no visible "spit up," it can be harder to recognise. The condition is frequently suspected and hence a common presentation in our Allergy Clinic. We follow international guidelines when investigating the condition.

Key Points for Parents:

1. It usually gets better on its own. Silent reflux typically starts before 8 weeks of age, peaks around 4 months, and resolves by 12 months as your baby's digestive system matures.
2. Watch for subtle signs. Since babies cannot tell you they are uncomfortable, look for fussiness during or after feeds, back arching, feeding refusal, coughing, or choking—even without visible spit-up.
3. Simple changes can help. Hold your baby upright for 20–30 minutes after feeding, offer smaller and more frequent feeds, and burp your baby correctly during feeds.
4. Most babies do not need medication. Reflux is very common and usually does not require testing or medicine. We will assess whether there is an allergic component to the symptoms and whether medication is needed to reduce stomach acid production. Antacids may transiently neutralise gastric acid, but they do not address the underlying mechanism of reflux, which is primarily due to physiologic immaturity of the lower oesophageal sphincter in infants. The medical literature demonstrates inconclusive evidence for symptom improvement with antacids; most studies show no benefit over placebo for regurgitation, crying, or distress in infants with reflux.
5. Know when to call your doctor. Contact your paediatrician or come see us in clinic if your baby has forceful or green vomiting, blood in spit-up, poor weight gain, refuses to eat, or seems very uncomfortable.

[caption id="" align="alignnone" width="2048"]

Baby with reflux [/caption]

Frequently Asked Questions

• What are the main symptoms of Silent Reflux

  • Feeding refusal (reflux can be very painful, and its a central deep pain, moms often remember this well from during pregnancy!)

  • Irritability (especially during or after feeds)

  • Back arching, and hip flexion, often going rigid with pain/discomfort.

  • Choking, gagging, or coughing and may smell of sick when this happens

  • Unexplained or inconsolable crying (with painful tears)

  Severe Findings

  While less common, some infants may also experience:

  • Food/feeding refusal

  • Hoarseness or a chronic cough

  • Respiratory symptoms such as wheezing or recurrent pneumonia

  • Growth faltering or "failure to thrive" (in more severe cases)

• How do we conservatively manage silent reflux?

  • The first-line therapy is parental reassurance.

  • Reassuringly, symptoms nearly always settle as your baby grows and the lower oesophageal sphinctor strengthens (it is just a muscle after all)

  Trial feeding modifications

  1. Smaller, more frequent feeds

  2. In formula-fed infants, thickened feeds., but these can constipate and practically can be difficult to work with

  3. Extensively hydrolysed Rice or milk-based amino acid-based formulas may be considered for infants with suspected cow’s milk protein allergy. Hydrolysed rice milk formula is thought to be more palitable than most modified infant formula.

  4. Maternal elimination of dairy may be trialled in breastfed infants. The major Allergy Societities discourage this but many parents have already trialled dietary eliminations before attending our clinic. In our expeience, some babies will be more comfortable with maternal dietary modification, but this needs to be monitored by a Dietitian. We discourage multiple allergen avoidance in moms diet, this seldom ever helps.

  5. NB! Positional therapy is not recommended due to safe sleep guidelines which encourages sleeping on the back. Elevated cots can result in the baby slipping to the base and being coveed by blankets, a known risk for cot death.

  6. However, if your baby has productive reflux, and especially of they are tightly swaddled, it can be difficult for them to deal with any reflux which willl have to be swallowed. Loose swaddling may be more soothing and safer.

  7. The stomach anatomy allows for easier reflux into the oesophagus when laying on the RHS, so keep this in mind when posistioning your baby

• Are Antacid effective and safe for the tretment of silent reflux?

  • Pharmacological treatment (H2 blockers or PPIs) is reserved for infants with confirmed GORD who do not respond to conservative measures and have significant symptoms or complications.

  • Acid suppression does not stop the mechanical propcess of vomiting, but will reduce pain and acid irritation (which itself may calm the mucosa and nerves down in an irritated lower oesophagus).

  • Acid suppression should be used for the shortest duration possible (typically 4–8 weeks)

  • If Acid supression hads not unequivocally helped after at least 3-4 days, then there may be little point in continuing, but discuss with your Doctor. A positive response is normally very obvious to all, especially tired parents.

  • Acid suppression is not adequate for non-acid reflux and carries risks, including infection and altered microbiome with possioble links to subsequent allergy development.

• What are the more worrisome symptoms of silent reflux?

  The following "alarm symptoms" are not typical of silent reflux and warrant urgent evaluation for alternative diagnoses:

  • Bilious (green) vomiting

  • Hematemesis (blood in vomit)

  • Persistent, forceful vomiting

  • Important: Growth faltering should always prompt further evaluation for underlying pathology.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

(No COI to declare re this post)

A Rice hydrolysed formula (RHF), which uses extensively hydrolysed rice protein, is available in the UK as an alternative option for infants who require a non-animal-based, hypoallergenic diet.

This choice is beneficial for babies who find other modified milks unpalatable, a common issue in clinical settings.

Arize (by Similac/Abbott) is a nutritionally complete, extensively hydrolysed rice protein formula designed for the dietary management of infants with cow's milk protein allergy (CMPA).

Like other specialist formulas for CMPA, these products are classified as foods for special medical purposes. They should be used under medical supervision and are typically available only via prescription in the UK.

**Important Distinction from Rice Milk:** It's essential to understand that rice milk or rice drinks available in supermarkets are not suitable as a primary milk for children under 4.5 to 5 years in the UK, due to concerns about naturally occurring arsenic levels. The rice-based infant formula mentioned above is specifically manufactured and regulated for infant safety.

If you suspect that your infant has a cow's milk allergy, please consult your GP or visit our Allergy Clinic. We can conduct a thorough diagnosis and prescribe the most appropriate formula for your baby's specific needs.nd we can make a rigorous diagnosis and prescribe the most appropriate formula for your baby's particular needs.

Many patients report that, before reacting to sesame paste (e.g., tahini or hummus), they tolerated a few loose seeds and sesame oil. This may create a false impression of ‘tolerance’ toward sesame.

In our clinic, for patients with significantly positive test SPT and/or IgE results to sesame but tolerance to low exposure levels, we recommend avoiding loose sesame seeds and sesame oil. The only way to be certain of tolerance levels is through an incremental oral food challenge in a safe, supervised setting.

However, most patients tolerate sesame oil and a few loose seeds (as the allergen may be contained within the sesame seed and may not always be exposed to the immune system during digestion), because commercial cooking sesame oil does not contain significant amounts of sesame protein.

The process of oil extraction, particularly chemical refining or expeller pressing, removes the vast majority of protein from the oil; the protein fraction remains in the press cake or meal rather than in the oil. Analytical studies confirm that the protein content of refined sesame oil is extremely low, often below the threshold that would trigger allergic reactions in most sesame-allergic individuals.

However, trace amounts of protein can occasionally be present, particularly in cold-pressed or unrefined sesame oils. Still, these levels are generally considered negligible compared to whole seeds or sesame meal. Clinical reports have documented rare cases of allergic reactions to sesame oil, but these are typically associated with less-refined oils that may contain residual protein contaminants.

For highly sensitive individuals, even trace contamination may be clinically relevant; however, for the general population, commercial cooking sesame oil is not a significant source of sesame protein and is therefore safest to avoid.

Contact us on 0330 678 5168

Where does the mucus come from?

The intestinal mucosa produces mucus as a protective barrier. It may be present in the stool of healthy infants due to the immaturity of their gastrointestinal tract and the rapid transit of stool, particularly in breastfed infants, who typically have softer, more frequent stools. This can be more common when weaning or teething.

When to be concerned?

However, persistent or copious mucus, especially if accompanied by blood, changes in stool frequency or consistency, poor weight gain, or systemic symptoms (such as fever or vomiting), may indicate an underlying pathology such as cow's milk protein allergy, infectious colitis, or other gastrointestinal disorders.

Contact us on 0330 678 5168

IgE-mediated cow's milk allergy is a common food allergy among younger children.

In situations where human milk is unavailable, numerous milk alternatives can be considered, each varying in safety, cost, and importantly, taste.

Modified formulas are often unappealing to babies accustomed to human milk, which is high in lactose. A recent review by Abrams et al., published in the Journal of Allergy and Clinical Immunology: In Practice in 2025, supports my long-held clinical belief that soy-based modified infant formula is a safe option for infants, provided the infant is not allergic to soy.

The Bottom Line of this review

The authors conclude that the current guidelines—which push soy to a "third choice" option or ban it for infants under 6 months—may be outdated.

They suggest that Soy-Based Formula is a safe, nutritious, and cost-effective option for healthy infants with IgE-mediated Cow's Milk Allergy, provided the child does not have a separate soy allergy.

Frequently Asked Questions

• The "Cross-Reactivity" Myth

  • Old Belief: Older studies suggested a low-moderate rate of "coallergy" (where a child reacts to both milk and soy), estimating it as high as 10%–14%.

  • New Findings: These authors argue that the old studies were flawed (retrospective or mixed different types of allergies).

  • Key Insight: They state there is no biological or chemical basis for cross-reactivity between cow's milk and soy protein because they are unrelated species (one a mammalian milk, and the other a legume protein).

  • Conclusion: Recent prospective studies show that in infants with IgE-mediated (immediate reaction) Cow's Milk Allergy (CMA), the rate of actual soy allergy is very low or even absent.

• Safety of Phytoestrogens (plant hormones)

  • The Concern: Historically, there has been fear that isoflavones in soy (which look like estrogen) could affect a baby's reproductive development. This is why many guidelines currently say "wait until 6 months."

  • The Findings: The paper reviews 40 years of use and recent longitudinal studies. It finds "minimal concern" and "no overt toxicity."

  • Long-term Effects: Comparison studies showed no significant differences in:

    • Sexual development (puberty onset).

    • Immune function.

    • Growth or height in adulthood.

    • Reproductive history (pregnancy capability).

• Nutritional Adequacy

  • Growth: Modern Soy-Based Formulas (SBF) are fortified with specific amino acids (methionine, taurine, carnitine) and minerals to ensure they are nutritionally complete.

  • Bone Health: Despite containing phytates (which can inhibit absorption), soy formulas are fortified to compensate for this. Studies showed bone mineral density in soy-fed infants was comparable to that of those fed cow’s milk formula.

• Comparison to Hydrolysed Formula (eHF)

  • The Problem with eHF: The paper points out that Extensively Hydrolysed Formula (the standard medical recommendation) is expensive and tastes bad (low palatability). Furthermore, eHF is not 100% safe; there are case reports of children having anaphylaxis to hydrolysed milk formulas.

  • The Benefit of Soy: Soy formula is significantly cheaper, tastes better, and (according to this review) has a favourable safety profile.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Yes, under current NHS and Joint Committee on Vaccination and Immunisation (JCVI) guidelines for the 2025/2026 flu season, a child can receive the flu vaccine even if they have an egg allergy.

The vaccines may be administered in the usual setting.

The only possible contraindication would be a child who has required ICU admission for severe egg-induced anaphylaxis; this scenario is scarce!

For more specific details, please refer to the attached blog post. If you have residual questions, please visit London Allergy Consultants. We are also able to administer the vaccine to families who, for whatever reason, would not do so in a standard medical setting.

Children's Flu Vaccines for the 2025/2026 Season in the UK

As we enter the UK autumn and winter months, the NHS is rolling out its annual seasonal flu vaccination programme for children. For the 2025/2026 flu season, a nasal spray vaccine is the primary offering for most children, with injectable alternatives available for specific groups or circumstances.

The primary vaccine being offered to children aged 2 to 17 is the Live Attenuated Influenza Vaccine (LAIV), administered as a painless nasal spray. This vaccine, commonly known by the brand name Fluenz Tetra, is considered the most effective for children and helps to reduce the spread of the flu virus within the community.

For children who are unable to receive the nasal spray due to medical contraindications or whose parents object to the porcine gelatin content, an injectable vaccine is available. The recommended alternative is the cell-based trivalent influenza vaccine (IIVc). Should this be unavailable, an egg-cultured trivalent or quadrivalent influenza vaccine (IIVe/QIVe) will be offered.

For infants aged between 6 months and 2 years who are in a clinical risk group, the recommended vaccine is the injectable cell-based trivalent influenza vaccine (IIVc).

The nasal spray is not licensed for children under the age of two. If the IIVc is not available, the egg-cultured version (IIVe) will be administered.

The childhood flu vaccination programme extends to:

• Children aged 2 and 3 years old.
• All primary school children (from Reception to Year 6).
• All secondary school children (from Year 7 to Year 11).
• Children aged 6 months to 17 years with long-term health conditions.

Parents of eligible children will be contacted by their GP surgery or their child's school to arrange vaccination. The programme aims to protect children from the flu and reduce its transmission to more vulnerable members of the population.🩺

How much egg is actually in the flu vaccines?

For the 2025/2026 flu season, the flu vaccines available to children in the UK have varying levels of egg protein (ovalbumen), depending on the manufacturing process.

Briefly, there is very little egg protein in any one of the vaccines, but here's a breakdown of the egg content in the different types of vaccines offered:

Live Attenuated Influenza Vaccine (LAIV) - Nasal Spray (e.g., Fluenz™ Tetra)

The primary vaccine offered to most children aged 2 to 17 is the nasal spray. This vaccine is produced using eggs and therefore contains a very small amount of egg protein. The ovalbumen content in the LAIV nasal spray is less than 0.024 micrograms (µg) per 0.2ml dose.

Current NHS and Joint Committee on Vaccination and Immunisation (JCVI) guidance states that the nasal spray vaccine is safe for children with an egg allergy, including those who have previously experienced a severe allergic reaction (anaphylaxis) to egg.

The only exception is for children who have experienced a severe reaction that necessitated admission to an intensive care unit; these children should be referred to a specialist for their vaccination, there are very very few such children!

Cell-Based Influenza Vaccine (IIVc)

The cell-based trivalent influenza vaccine (IIVc) is an injectable option available to children who are unable to receive the nasal spray. As this vaccine is not produced using eggs, it is considered egg-free. This makes it a suitable alternative for children with a severe egg allergy who are advised against the nasal spray, or for those whose parents decline the nasal spray due to its porcine gelatin content.

Egg-Cultured Influenza Vaccine (IIVe/QIVe)

The egg-cultured injectable vaccines are another alternative. As the name suggests, these are grown in eggs and do contain residual amounts of egg protein. The ovalbumen content in these vaccines is very low, typically less than 0.12 micrograms (µg) per millilitre (ml), which is considered safe for most individuals with an egg allergy. These vaccines are generally offered if the cell-based version is not available.

So, whilst two of the three types of flu vaccines available to children in the UK contain traces of egg, the levels are extremely low. The cell-based vaccine provides an egg-free option, ensuring that all eligible children, including those with severe egg allergies, can be safely vaccinated against influenza.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

London Allergy Consultants is delighted to announce that we have moved into the new, purpose-built clinic at 10 Duchess Street in London. This move marks a significant step forward in expanding the reach and quality of allergy care available to our patients.

Established in 2025, the Allergy Centre of Excellence (ACE) is London’s first specialist allergy hospital. Founded by Professors Gideon Lack, Adam Fox OBE, and George Du Toit, the centre was created to bridge the gap in specialist care and bring a new level of clinical excellence to the UK. Excellent patient care and clinical research are our focus.

A bespoke centre for allergy care, from prevention, diagnosis and treatment.

The ACE clinic, located on Duchess Street, has been designed with patients at the heart of every decision. From its thoughtful layout to child-friendly features, the space reflects our commitment to making every visit safe, welcoming, and stress-free.

Multidisciplinary allergy expertise under one roof

The ACE clinic houses a full multidisciplinary team (MDT), ensuring patients benefit from the combined knowledge of leading specialists. The following medical specialists are available on site:

• Allergy Doctors
• Paediatric ICU Specialist medical cover
• Nurses,
• Allergy Dietitians
• Allergy Psychologists
• Research assistants
• and administrative staff, all focused on optimising your experience and safety.

Designed for convenience and safety

Every detail of the new space has been considered to provide a safe, convenient and reassuring experience for patients and their families. Modern facilities, central London access, and improved patient flow will all contribute to a smoother journey through what can sometimes be stressful appointments and treatments.

Building for the future

The Duchess Street move reflects our long-term vision: to create a dedicated environment where clinical excellence and patient comfort go hand in hand. By expanding into this bespoke clinic, LAC can deliver care that is not only comprehensive but also future-ready.

The ACE Research arm will facilitate cutting-edge clinical research trials on food allergy and other paediatric medical conditions, and our patients at London Allergy Consultants will benefit from this.

We look forward to welcoming our London Allergy Consultant Clinic patients to the ACE building.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

When is conker season?

This is the time when the spiky green cases of the horse chestnut tree ripen and fall to the ground, splitting open to reveal the prized conkers inside. The peak of the season often coincides with the onset of autumnal weather, with windier days helping to bring more conkers down from the branches.

Is it safe for my nut-allergic child to play conkers?

Conkers refers to a traditional British autumnal game where two players take turns trying to smash each other's horse chestnut ("conker") using a string. The game involves selecting a suitable conker, making a hole in it, threading it onto a string or shoelace, and then one player holds their conker steady while the other swings their conker to hit it. The goal is to be the last conker remaining unbroken. 

There are no documented cases or studies in the medical literature describing IgE-mediated allergy or anaphylaxis specifically to horse chestnut ("conker") exposure or ingestion. It follows, therefore, that there is no described allergy risk to this game, even for those with multiple and severe tree nut allergies.

There are, however, many eye and face injuries reported when playing conkers, so please take care to avoid traumatic injuries.  

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Jan 2026 - The National Health Service (NHS) has rolled out a chickenpox vaccination programme for children in England and Wales.

The new vaccine will be offered as part of the routine childhood immunisation schedule as a combined measles, mumps, rubella, and varicella (MMRV) vaccine. Children will receive two doses of the vaccine, the first at 12 months and the second at 18 months of age.

A catch-up program is available for older children.

• This is exciting and welcome news indeed, especially for the allergy community with eczema, who are particularly prone to skin complications, such as cellulitis, as a consequence of scratching the itchy chickenpox lesions and surrounding eczema.
• Chickenpox is not always a mild disease, and some children can become terribly ill. This is all so easily avoided through vaccination.
• Additional concerns and questions are addressed below, but we strongly encourage all patients and their families to get vaccinated.
• To date, this has only been available in private practice in the UK, but as of January, it is available in the NHS.

Frequently Asked Questions

• How effective is the chickenpox vaccine

  • The vaccine is highly effective in preventing chickenpox and its potentially severe complications. 

  • For healthy children, one dose of varicella vaccine provides moderate protection (approximately 81–85%) against any varicella and near-complete protection (98–100%) against moderate or severe disease. 

  • Breakthrough cases and community transmission can still occur with a single dose, especially in high-contact settings.[1

  • A two-dose regimen increases effectiveness to approximately 92–95% against all varicella and 99% against moderate or severe disease, with no evidence of waning immunity over at least 10 years of follow-up.

  • The incremental benefit of the second dose is substantial, both in reducing incidence and in preventing outbreaks.

  • Real-world studies from multiple countries confirm these findings, with two-dose effectiveness consistently above 93%.

  • The vaccine is also effective in reducing varicella-related hospitalizations and complications, with single-dose effectiveness against hospitalization reported at 96% and two-dose regimens providing even greater protection.

  • The optimal schedule is to administer the first dose at 12–15 months and the second dose at 4–6 years, as supported by long-term cohort and case-control studies.

  • In summary, the chickenpox vaccine is highly effective, especially with a two-dose schedule, in preventing varicella and its severe outcomes.

• Eczema and Chickenpox

  • When an individual with eczema contracts chickenpox, the broken skin barrier and altered immune response associated with eczema can lead to a more severe and complicated infection.

  • Back in 2015, Prof du Toit showed ‘It was found that children with atopic dermatitis were significantly more likely to have varicella zoster virus

    infection complicated by cellulitis (21% versus 6%; p=0.05), haemorrhagic varicella (14% versus 2%; p=0.04) and

    superimposed ‘skin and soft tissue infection’ (61% versus 34%; p=0.008). Subjective severity of scarring was scored

    significantly higher in children with atopic dermatitis compared to those without (p = 0.006). The chickenpox rash is often more widespread and intensely itchy in those with eczema, and scratching can easily lead to secondary bacterial infections, such as impetigo and cellulitis, which may require antibiotics.

  • There is also an increased risk of a rare but serious condition called eczema herpeticum, a widespread viral infection of the skin that requires urgent medical attention and antiviral treatment. While typically caused by the herpes simplex virus, the varicella-zoster virus that causes chickenpox can also lead to a similar severe eruption in individuals with pre-existing skin conditions like eczema.

  • Therefore, it is crucial for individuals with eczema, or parents of children with the condition, to be vigilant for signs of severe infection and to seek medical advice for appropriate management, which may include antiviral medication in addition to standard chickenpox care.

• Does chickenpox vaccine protect against shingles in later life?

  • Yes, the chickenpox vaccine significantly reduces the risk of developing shingles later in life. Both chickenpox and shingles are caused by the same virus, the varicella-zoster virus. After a person recovers from chickenpox, the virus remains dormant in the nerve cells. It can reactivate years later, causing the painful rash known as shingles.

  • The chickenpox vaccine contains a live, but weakened (attenuated), form of the varicella-zoster virus. This weakened virus is strong enough to trigger a protective immune response in the body but is much less likely to become dormant and reactivate as shingles compared to the wild virus that causes a natural chickenpox infection.

  • Therefore, individuals who have been vaccinated against chickenpox have a much lower chance of developing shingles than those who have had a natural chickenpox infection. While it is still possible to get shingles after being vaccinated, the risk is considerably lower, and if it does occur, the illness is often milder.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

In our London Allergy Consultants clinics, we see many patients who attend for assessment of an allergic cause for their infants’ GOR. Many of these children (and their breastfeeding mothers) are already on dietary interventions and antacid medications. Their parents are often exhausted and desperate for a rapid intervention; however, the best approach to management varies in each clinical scenario and requires a detailed interactive assessment.

There is considerable controversy amongst experts in the field regarding how best to manage GOR. This blog aims to reassure families and provide evidence-based advice, and seeks to caution regarding the overuse of antacids and elimination diets.

The recommended management of gastro-oesophageal reflux (GOR) in babies according to both United Kingdom (NICE) and European (ESPGHAN) guidelines is primarily conservative and supportive.

Both guidelines emphasise that GOR is a physiological process in infancy and usually resolves spontaneously by 12 months of age.

It is essential to recognise that common infant symptoms such as regurgitation, colic, and eczema are much more prevalent than cow's milk protein allergy, and most infants with these symptoms do not have the allergy.

Conservative approaches are first-line and include parental reassurance, education, and avoidance of overfeeding. Both guidelines recommend smaller, more frequent feeds and holding the infant upright after feeding.

Feed thickening (e.g., with rice cereal or commercial thickeners) is suggested for formula-fed infants with persistent regurgitation, as it can reduce visible vomiting episodes. However, it does not alter acid exposure. In our experience, such thickeners may cause constipation.

Dietary management is similar in both guidelines. For formula-fed infants with ongoing symptoms despite optimal conservative measures, a 2–4 week trial of extensively hydrolysed or amino acid-based formula is recommended to address possible cow’s milk protein ‘allergy’. For breastfed infants, maternal elimination of cow’s milk protein may be considered, as long as the maternal diet remains nutritionally complete. These interventions should, however, be a last resort, as the evidence base to support them is weak and their cost, taste, biome, formula access, and other implications are significant.

Pharmacological therapy is reserved for infants with severe, persistent symptoms or complications after non-pharmacological and dietary interventions have failed and where acid may be contributing to oesophageal function, or baby’s pain. Both guidelines recommend that acid-suppressing medications (H₂ antagonists, PPIs) should not be used for uncomplicated GOR, as randomised trials show no clear benefit and potential for harm.

However, if medication is considered, it should be for infants with confirmed gastro-oesophageal reflux disease (GORD) and only after other measures have failed, as it is physiologically normal for humans to have acid in their stomachs, facilitating food digestion and sterilisation as well as facilitating a healthy gut biome. It is important to note that antacid medications (proton pump inhibitors and H₂-receptor antagonists) are associated with an increased risk of developing food allergies in infants and children.

Positional therapy (prone or lateral positioning) is not recommended for sleeping infants due to the risk of sudden infant death syndrome.

In summary, conservative and dietary management are the mainstays of care for GOR in babies in both UK and European guidelines, with pharmacological therapy reserved for select cases with severe disease. There are no major differences between UK and European recommendations

Frequently Asked Questions

• Does my baby have 'silent' reflux - does this condition exist?

  Silent reflux is not a formal or recognized medical term in the pediatric gastroenterology literature. The correct terminology is gastroesophageal reflux (GOR), which refers to the passage of gastric contents into the esophagus, and gastroesophageal reflux disease (GORD), which is GOR associated with troublesome symptoms or complications.

  In infants, GOR is extremely common and often physiologic, occurring with or without visible symptoms such as regurgitation or vomiting; many infants experience episodes that are asymptomatic, sometimes referred to informally as "silent" reflux.

  Objective measurement using pH-multichannel intraluminal impedance (pH-MII) demonstrates that both acid and non-acid (often called "silent" or "nonacid") reflux episodes occur frequently in infants, with the majority of refluxate being nonacidic due to frequent feeding.These episodes may not produce overt symptoms like regurgitation, but can still be detected instrumentally. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recognize that reflux episodes in infants can be asymptomatic and that nonacid reflux constitutes a significant proportion of total reflux events.

  In summary, asymptomatic (or "silent") gastroesophageal reflux does exist in infants, and is considered a normal physiologic process. The term "silent reflux" is not used in guidelines or formal literature, but the phenomenon of asymptomatic reflux is well described and supported by objective diagnostic studies

• Can the use of antacids cause food allergy?

  Yes, antacid medications (proton pump inhibitors and H₂-receptor antagonists) are associated with an increased risk of developing food allergies in infants and children. 

  Multiple large cohort studies and meta-analyses from the United States and Europe demonstrate a consistent association between acid-suppressive medication use in infancy and subsequent diagnosis of food allergy, with adjusted hazard ratios for food allergy ranging from 1.28 to 2.59 depending on the drug class and duration of exposure.

  The risk appears to be dose-dependent, with longer duration of therapy conferring greater risk.

  The mechanism is thought to involve impaired protein digestion and altered gut microbiota, leading to increased sensitization to dietary antigens. This association persists even after adjusting for confounding factors such as indication for treatment (e.g., GORD) and antibiotic use.

  Current guidance from both the United States and European authorities, including the European Society of Pediatric Allergy and Immunology, is to use acid-suppressive medications judiciously in infants and children, reserving them for clear indications and for the shortest effective duration, due to these potential risks.

  The National Institute for Health and Care Excellence (NICE) in the UK and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition also recommend against routine use of acid-suppressive medications for uncomplicated gastro-oesophageal reflux in infants, reflecting concern about adverse effects including allergy risk.

  In summary, the use of antacid medications in infancy is associated with an increased risk of food allergy, and current US and European guidance recommends restricting their use to infants with clear indications.[1-5]

• When to suspect CMPA

  Cow's milk protein allergy should be suspected in infants who present with reproducible symptoms following exposure to cow's milk protein, either through formula, dairy-containing foods, or breast milk. 

  For IgE-mediated allergy, suspicion arises when infants develop immediate-onset symptoms (within 2 hours of ingestion), such as vomiting, urticaria, angioedema, erythema, respiratory distress, or lethargy. These symptoms typically resolve within hours and recur reliably with re-exposure.

  Non-IgE-mediated cow's milk protein allergy should be considered in infants with delayed-onset gastrointestinal symptoms, including persistent vomiting, diarrhea, blood in stools (especially in otherwise well-appearing neonates), chronic cutaneous symptoms, failure to thrive, or unexplained crying and irritability. In breastfed infants, symptoms may also occur due to transfer of cow's milk protein via breast milk.Notably, blood in the stool is a classic presentation in neonates and young infants, and eosinophilia may be present.

  It is important to recognize that common infant symptoms such as regurgitation, colic, and eczema are much more prevalent than cow's milk protein allergy, and most infants with these symptoms do not have the allergy. Therefore, suspicion should be heightened when symptoms are persistent, severe, reproducible with cow's milk exposure, and not explained by other common conditions such as gastroesophageal reflux or infection.

  Diagnosis is clinical, supported by history, and may be aided by skin prick testing or specific IgE measurement for IgE-mediated cases, and by elimination and oral food challenge for non-IgE-mediated cases.

• Which infant feed thickeners are available in the UK New Item

  In the UK, "feed thickeners" most commonly refer to products used to manage infant reflux and regurgitation. These are either pre-thickened formulas or thickening agents that are added to breast milk or standard infant formula.

  The use of these products should always be under the guidance of a healthcare professional especially if a food allergy is suspected.

  Common Ingredients and Types

  Feed thickeners work by adding a gelling or thickening agent to the liquid. These can lead to constipation. The most common ingredients found in UK products are:

  • Carob Bean Gum (also known as locust bean gum): This is a natural thickener derived from the carob bean. It is a key ingredient in many anti-reflux formulas and thickening agents. Products containing carob bean gum thicken the liquid in the bottle, helping it to stay down in the baby's stomach.

  • Starch: Some anti-reflux formulas, like SMA Anti-Reflux, use starch (such as potato or corn starch) as the thickening agent. Starch-thickened formulas are designed to become thicker in the baby's stomach, which can help reduce regurgitation.

  • Alginate: This is another natural thickening agent often used in products like Gaviscon Infant. It forms a gel-like raft on top of the stomach contents, which helps to prevent reflux.

  UK Products and Their Formulations

  Popular feed thickeners and thickened formulas available in the UK:

  • Cow & Gate Instant Carobel: This is a thickening agent that can be added to breast milk, infant formula, or other liquids. Its main ingredients are maltodextrin, carob bean gum, and some minerals. It is a food for special medical purposes and is suitable for use in full-term infants, children, and adults under medical supervision.

  • Aptamil Anti-Reflux: This is a nutritionally complete, pre-thickened formula. It contains carob bean gum to help manage frequent reflux and regurgitation. Because it is already thickened, it requires a fast-flow teat to be used for feeding.

  • SMA Anti-Reflux: Another nutritionally complete formula, this product uses a combination of starch and whey protein to manage reflux. Like other anti-reflux formulas, it is thickened and requires a specific method of preparation.

  • Cow & Gate Anti-Reflux: Similar to Aptamil, this is a thickened formula that uses carob bean gum. It is designed to be a sole source of nutrition from birth and is available over-the-counter but its use should be discussed with a healthcare professional.

  Important Considerations for Use

  • Medical Supervision: All of these products are classified as "foods for special medical purposes" and should only be used under the guidance of a doctor, health visitor, or dietitian. They are not recommended for routine use or for premature infants without medical advice.

  • Preparation: The preparation instructions for thickened feeds are often different from standard formulas. It is crucial to follow the manufacturer's guidelines precisely to ensure the correct consistency and to avoid health risks. For example, some may need to be shaken and then left to stand to thicken, and many require a specific type of teat (e.g., a single-hole, fast-flow teat).

  • Not a Sole Source of Nutrition: Thickening agents like Instant Carobel are not a complete food and should only be used in combination with breast milk or formula

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Hypoallergenic Dogs and Dog Allergies: Allergy Specialist clarifying the Facts

• Allergic families often inquire about the validity of claims regarding the hypoallergenicity of certain dog breeds.
• Hypoallergenic dogs are typically described as breeds that are believed to produce fewer allergens, making them more tolerable for individuals with dog allergies.
• Current evidence does not support the existence of truly hypoallergenic dog breed as all dogs produce allergens, as they are living mammals, there is some variability in individual allergic responses

Studies have shown that all dogs produce allergens, primarily a salivary protein called Can f 1, and that so-called ‘hypoallergenic breeds’ do not have lower levels of this allergen in their hair, coat, or home environment compared to non-hypoallergenic breeds.

Can f 1 is the most significant and prevalent allergen found in dogs. It is a type of protein known as a lipocalin that transports small molecules. While dogs produce several allergenic proteins (including Can f 2, Can f 3, etc.), sensitisation to Can f 1 is the most common and affects the majority of individuals with dog allergies.

Traditionally, allergy tests have used a whole-dog dander extract, which contains a mix of all dog proteins. While this can confirm a dog allergy, it does not identify the specific molecule causing the reaction.

We routinely perform SPT for dog allergy and Component IgE tests for dog allergen, including Can f 1.

The primary source of Can f 1 is a dog's saliva, produced in the epithelial tissue of the tongue. When dogs lick and groom themselves, this protein gets spread onto their skin and fur. As the skin cells are shed (as dander) and fur falls out, the allergen becomes airborne. These tiny particles, often invisible to the naked eye, can remain suspended in the air for extended periods and settle on surfaces throughout homes. This explains why individuals can experience allergic reactions even without direct contact with a dog.

Notably, because Can f 1 is microscopic and easily transported, it can be found almost everywhere, including on clothes and in homes and public spaces without resident dogs.

• While the amount of allergen shed can vary between individual dogs, no breed is truly allergen-free.
• Studies have found that hypoallergenic breeds do not necessarily have lower levels of Can f 1 in their environments than other breeds.
• TIP - Before bringing a dog into a ‘potentially allergic family’ as a pet, first expose yourself/child on a few occasions to make sure the specific dog/breed is not causing allergic symptoms. If this is not possible and a family is going ahead with acquiring a pet, always make sure children (if old enough) are aware that if symptoms do come on and medicines are needed chronically, especially asthma meds, the dog will need to be rehomed. This can be a difficult and emotional process.

Sensitisation to Can f 1 not only triggers common allergic rhinitis symptoms, such as sneezing and a runny nose, but is also strongly associated with more severe respiratory issues, particularly asthma.

For individuals predisposed to asthma, chronic exposure to Can f 1 can lead to airway inflammation and an increased risk of asthma attacks. The level of IgE antibodies that cause allergic reactions to Can f 1 often correlates with the severity of asthma symptoms in patients with dog allergies.

Component testing assists with:

• Accurate Diagnosis: Confirms that Can f 1 is the specific trigger and rules out cross-reactivity with other proteins.
• Risk Assessment: A high level of sensitisation to Can f 1 can indicate a greater risk of persistent symptoms and asthma.
• Informed Management: Knowing the specific allergen allows for more targeted advice and treatment strategies.

Management:

1. Avoidance and Environmental Control:

• Create pet-free zones in the home (if a pet dog is already owned), especially in the bedroom, where hours are spent each day.
• Use high-efficiency particulate air (HEPA) filters to remove airborne allergens.
• Regularly, thoroughly clean carpets, upholstery, the pet dog, and their bedding.
• Wash hands thoroughly after contact with a dog or its bedding, toys, etc.

2. Medications:

- Over-the-counter or prescription non-sedating antihistamines can help manage symptoms like itching, sneezing, and a runny nose. These can be taken prophylactically if exposure to dog allergens is anticipated.

- Nasal corticosteroid sprays can reduce nasal inflammation.

- For individuals with asthma, prescribed inhalers are essential.

3. Allergen Immunotherapy:

- For severe or persistent allergies, especially of dog exposure, which can not easily be avoided (family members’ own pets, people working in the related industries, guide dogs…), we recommend Sub-Lingual Immunotherapy (SLIT) using recombinant or allergoid dog allergen extract.

This treatment involves administering gradually increasing doses of the allergen to desensitise the immune system and reduce the allergic response over time. Identifying specific sensitisation to Can f 1 can help tailor this therapy more effectively. This process will require daily dosing of a liquid product under the tongue, held for a minute before swallowing, and continued for up to 3 years.

We inform patients that if they have had past reactions or asthma is unstable, and test results are high, it is not safe to obtain a non-allergenic or hypoallergenic dog, as all dogs produce at least one allergen. Allergen levels in homes with hypoallergenic dogs are similar to those with other breeds, and individual variability in allergen production is greater than breed differences.

If acquiring a dog is a ‘show stopper’ family issue, we advise exposure to the particular breed on a few occasions to assess for controlled reactivity. It is an emotional decision to rehome a pet, so it's best to be sure before the dog enters your lives.

In summary, the concept of hypoallergenic dogs is not supported by medical literature, and no breed can be reliably recommended as hypoallergenic for patients with dog allergies.

Frequently Asked Questions

• Hypoallergenic Dog Food

  • Dog food containing antibodies to dog saliva allergens is not supported in the medical literature.

  • There is no established evidence or clinical con

  • While dog saliva is a significant source of allergens relevant to human allergy diagnostics and immunotherapy, we focus in clinic on the exact allergen identification, diagnostic methods, and immunotherapy approaches such as sublingual immunotherapy

• Are there hypo allergenic vaccines for the dog

  Vaccinating the dog to reduce allergen production: This is an area of research, but currently, no intervention targeting the dog, including vaccination, has been shown to decrease Can f 1 levels.

• Does the age, coulor, sex, nutered status or breed reduce allergenicity

  Breed, sex, neutered status, age, and color of a dog do not reliably predict the level of allergenicity or the risk of dog allergy in humans.

  All dogs produce allergenic proteins, primarily Can f 1, and so-called "hypoallergenic" breeds do not have lower environmental allergen levels than other breeds.

  The American Academy of Allergy, Asthma, and Immunology specifically states that no breed can be considered nonallergenic.

  Studies show that while there is variability in Can f 1 production between individual dogs and some breeds (e.g., Labradors tend to have lower fur Can f 1 than Poodles or Yorkshire Terriers), these differences are small compared to the variability within breeds and do not translate into clinically meaningful differences in household allergen exposure.

  Neutered dogs may shed more allergen into the environment than unaltered dogs, but this is not a consistent finding across all studies and does not reliably affect human allergy risk.

  Dog age and coat color have not been shown to affect allergenicity in a way that impacts human allergic sensitization.

  The most important determinants of sensitization are host factors (such as family history, atopy, and environmental exposure) rather than dog characteristics.

  In summary, no specific dog breed, age, color, sex, or neutered status can be recommended to reduce the risk of dog allergy. Allergen exposure control should focus on environmental management rather than selection of dog characteristics.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

When it comes to stings you get in the sea from creatures like jellyfish or the Portuguese man o' war, there's a tremendous amount of folklore and "beach wisdom" that gets passed down through generations. Much of it is ineffective, and some can even make the sting worse. Let's break down the folklore and compare it to current medical advice.

1. The Urine Myth

This is perhaps the most famous piece of folklore, popularised by TV shows and films.

• The Folklore: The belief is that the ammonia and uric acid in urine will neutralise the venom from the jellyfish's stinging cells (nematocysts).
• The Reality: This is completely ineffective and not recommended. The composition of urine is not consistent enough to be a reliable treatment. The low concentration of salts in fresh urine (compared to seawater) can cause the stinging cells that haven't yet fired to discharge their venom, intensifying the pain and making the sting much worse.
• Verdict: Myth, and a potentially harmful one, and no one wants a well-meaning friend or family member embarrassing all on the beach!!

2. The "Cocktail" or Alcohol Remedy

This refers to using alcoholic drinks or rubbing alcohol on a sting.

• The Folklore: The idea is that alcohol, like spirits (gin, vodka) or surgical spirit, will "disinfect" the area and neutralise the venom.
• The Reality: Similar to urine, applying alcohol is a bad idea. It can also trigger the nematocysts to fire, increasing the amount of venom released into the skin and causing more pain.
• Verdict: Myth, and definitely one to avoid. What a waste of an expensive beach cocktail that would be!

3. Beach Plants and Natural Remedies

• The Folklore: People often suggest rubbing sand, seaweed, or specific coastal plants onto a sting. The idea behind rubbing sand is to scrape off the stinging cells physically. Other beliefs involve the soothing properties of certain plant saps. In some parts of the world, specific plants like the sea hibiscus are used traditionally.
• The Reality: Rubbing the area with sand or a towel is abrasive and will almost certainly trigger any remaining nematocysts, effectively "squeezing" more venom into the skin. While some plants may have soothing properties for general skin irritation, there is no scientific evidence that common UK beach plants can neutralise marine venom. This approach is more likely to cause further irritation and pain.
• Verdict: Myth. Do not rub the sting.

Other Common Folk Remedies

• Meat Tenderiser: The theory was that an enzyme (papain) in the tenderiser would break down the proteins in the venom. This has been scientifically debunked as the venom is injected too deeply into the skin for a surface application to have any effect.
• Baking Soda Paste: While less harmful than others, a baking soda paste is generally considered ineffective against the venom of jellyfish common to UK and European waters.

What Works: The Recommended First Aid

Medical advice has evolved, and the current best practice is clear and straightforward. Here’s what the NHS and RNLI recommend for stings from creatures found in UK waters:

1. Rinse with Seawater: Immediately rinse the affected area with seawater (not cold fresh water). This helps wash away any invisible stinging cells that have not yet fired.
2. Remove Tentacles: Use a stick, a credit card edge, or tweezers to carefully remove any visible tentacles. Do not use your bare hands.
3. Heat Application (The Best Pain Relief): For jellyfish and Portuguese man o' war stings, the best way to treat the pain is with heat. Immerse the affected area in hot water—as hot as can be comfortably tolerated without burning (around 43-45°C)—for at least 30 minutes. A hot flannel or towel can also be used. The heat helps to break down the proteins in the venom, providing effective pain relief.
4. Painkillers: Take simple painkillers like paracetamol or ibuprofen. If itchy, an antihistamine will help.
5. Local Anaesthetic: Apply local anaesthetic numbing creams.

A Note on Vinegar: You may have heard that vinegar (acetic acid) is recommended. This is only effective for certain types of jellyfish, most notably the Box jellyfish, which is not found in UK waters.

For the jellyfish and Portuguese man o' war common here, vinegar can make the sting worse by causing the nematocysts to discharge. Therefore, it should not be used in the UK or Europe as effectiveness depends on the type of envenomation, particularly the species of jellyfish involved. For Mediterranean jellyfish stings, especially those caused by scyphozoan species such as Pelagia noctiluca, vinegar (acetic acid) has been shown to trigger nematocyst discharge, which can worsen pain and local symptoms. Seawater is considered a neutral solution and is recommended for rinsing the sting site, as it does not induce nematocyst discharge or exacerbate symptoms. The use of vinegar, acetic acid, or commercial products based on these compounds is counterproductive for scyphozoan stings in the Mediterranean. In the United Kingdom, jellyfish stings are typically from scyphozoan species, and the evidence supports that vinegar is not effective and may worsen symptoms.

Frequently Asked Questions

• Which stingers are more common in UK waters?

  The water stingers more common in UK waters compared to the Mediterranean are certain species of jellyfish, particularly the Lion's Mane jellyfish, Compass jellyfish, and Blue jellyfish.

  While the Mediterranean has a greater diversity of stinging creatures, including the more venomous Mauve Stinger and the Portuguese Man o' War (which is rare in the UK), the UK's temperate waters are a more typical habitat for large blooms of the specific jellyfish mentioned above.

  ## Common UK Stingers

  The most frequently encountered stingers around the British Isles are jellyfish. You are much more likely to come across these in the UK than in the Med:

  • Lion's Mane Jellyfish (Cyanea capillata): This is the largest jellyfish in the world and is particularly common in the cooler waters of the North Sea and the Irish Sea, especially in late summer and autumn. It is far less common in the warmer Mediterranean.

  • Compass Jellyfish (Chrysaora hysoscella): Recognisable by the brown V-shaped markings on its bell, this jellyfish is a common sight in UK coastal waters from May to October.

  • Blue Jellyfish (Cyanea lamarckii): This striking blue or purple jellyfish is often found in the same areas as the Lion's Mane and is another common UK native.

  • Moon Jellyfish (Aurelia aurita): While also found in the Med, these are extremely common all around the UK. Their sting is very mild, often barely noticeable.

  ## Common Mediterranean Stingers

  The Mediterranean Sea has a different and generally more potent population of stinging marine life. These are all much less common in UK waters.

  • Mauve Stinger (Pelagia noctiluca): This is the most common and problematic stinging jellyfish in the Mediterranean, responsible for the vast majority of stings. It can form huge swarms and has a painful sting. It is only a rare visitor to the UK.

  • Portuguese Man o' War (Physalia physalis): Technically a colony of organisms (a siphonophore) and not a true jellyfish, it has a powerful sting. It is more common in the Atlantic-facing parts of the Mediterranean and is only occasionally blown into UK waters.

  • Sea Anemones and certain Corals: While present in the UK, the variety and accessibility of stinging anemones in shallow Mediterranean waters are greater.

  • Weeverfish: These small fish bury themselves in the sand in both UK and Mediterranean waters, but are a very common cause of painful stings in the shallow, warm sandy bays of the Med. Their sting comes from sharp, venomous spines on their dorsal fin.

• Are allergic reactions to sea venom stings common?

  Allergic reactions to marine animal venom stings, such as those from jellyfish or other sea creatures, are UNCOMMON in the United Kingdom and Europe compared to allergic reactions from bee or wasp (Hymenoptera) venom stings, which are the most frequent cause of venom-induced anaphylaxis in these regions.

  The majority of jellyfish and other marine stings in Europe result in local cutaneous symptoms—pain, erythema, and dermatitis—with systemic or anaphylactic reactions being rare events.

  For example, a study from southern Italy found that only 8.7% of jellyfish sting cases had complications, mainly allergic reactions, and most were not severe.

  In contrast, systemic allergic reactions to Hymenoptera stings occur in approximately 0.3% to 7.5% of the European population, with a significant proportion of severe and even fatal reactions, making Hymenoptera stings a leading cause of anaphylaxis in Europe.

  In summary, allergic reactions to marine animal venom stings are much less common than those from bee or wasp stings in the UK and Europe, and severe systemic reactions to marine stings are rare, whereas Hymenoptera venom allergy is a major public health concern due to its higher prevalence and risk of severe outcomes.

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Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

With wasp levels across the UK reaching a record high this August, it's crucial to understand the risks associated with insect stings.

Stings from wasps and bees are the most common cause of severe allergic reactions (anaphylaxis) in the UK.

Here's what you need to know about diagnosis, management, and the definitive treatment available.

Understanding Your Reaction

It’s important to distinguish between different types of sting reactions. A normal reaction involves localised pain, redness, and swelling. A large local reaction is more extensive swelling around the sting site.

However, a systemic allergic reaction is a medical emergency that affects the whole body, often within minutes. Symptoms include widespread hives, swelling of the face or throat, difficulty breathing, dizziness, and a drop in blood pressure.

The Path to a Clear Diagnosis 🩺

If you've ever had a systemic reaction to a sting, a referral to an allergy specialist in a centre like ours at London Allergy Consultants is essential.

Our comprehensive evaluation includes:

• A detailed discussion about your reaction history.
• Allergy testing, using a combination of skin tests and specific IgE blood tests to confirm an allergy and identify the specific insect.
• A baseline tryptase test. This simple blood test is recommended in international guidelines to check for any underlying conditions, like mast cell disorders, that could increase your risk of a severe reaction.

Management and Treatment

Emergency Plan

Immediate management for anyone with a confirmed venom allergy involves two key components: education on avoiding stings and carrying an adrenaline auto-injector (e.g., EpiPen®, Jext®) or Nasal Spray (Neffy) at all times.

The Definitive Solution: Venom Immunotherapy (VIT) ✅

The only treatment that targets the root cause of the allergy is Venom Immunotherapy (VIT). It's a life-changing option for those who have experienced a systemic reaction.

• What is it? VIT is a highly effective treatment that desensitises your immune system through a course of injections containing purified venom.
• How effective is it? It is one of the most successful treatments in allergy medicine, preventing severe reactions in up to 98% of patients.
• The Process: In the UK, VIT typically involves an initial build-up phase followed by maintenance injections for a period of three years. It is considered very safe and is recommended by all major international allergy organisations.

While approaches to venom allergy care can vary, our clinic is committed to providing treatment that aligns with the highest international standards. We undertake VIT at the Evelina Children's Hospital (for NHS patients) and at the Allergy Centre of Excellence (for Private Patients). If you have concerns about a past insect sting reaction, contact us at the London Allergy Consultants for an expert assessment.

Frequently Asked Questions

• Which 'venomous stingers' are more common in the UK

  Wasps and Bees Top the List of UK's Most Common Venomous Stingers

  In the United Kingdom, stings from wasps and bees are by far the most common venomous encounters for the public. These insects are widespread throughout the country, particularly during the warmer months, leading to frequent interactions with humans. While most stings result in only localised pain and swelling, they are also the leading cause of serious allergic reactions, including anaphylaxis.

  Wasps are often considered the most frequent source of stings, especially in late summer. Unlike bees, which typically sting only when provoked and can only sting once, wasps can be more aggressive and are capable of stinging multiple times. This increases the likelihood of being stung, particularly near their nests or when they are attracted to food and drink.

  Following insects, the next most common, though significantly rarer, venomous stings come from marine life. In coastal areas, jellyfish such as the Lion's Mane and Compass jellyfish can deliver painful stings to swimmers and beachgoers. Additionally, the lesser-known weever fish, which buries itself in the sand in shallow waters, can inflict a very painful sting on those who accidentally step on its venomous dorsal spines.

  The UK's only native venomous snake, the adder, is responsible for a relatively small number of venomous bites each year, estimated to be between 50 and 100 incidents in humans. Adders are shy creatures that typically only bite when they are trodden on or feel threatened. While an adder bite can be serious and requires medical attention, it is a far less common occurrence than an insect or marine sting. Hornets, while present in the UK and capable of delivering a painful sting, are less common than wasps and bees and therefore contribute to a smaller number of stinging incidents.

• First Aid for Bee and Wasp Stings in UK

  If you're stung by a wasp or bee, the first thing to do is move away calmly to avoid more stings. Most stings are painful but not dangerous.

  ## Immediate First Aid Steps

  1. Wash the area with soap and water to keep it clean.

  2. Apply a cold compress to the area for at least 10 minutes to reduce pain and swelling. You can use an ice pack wrapped in a tea towel or a cold, damp cloth.

  3. Keep the affected area raised if possible to help reduce swelling.

  4. Avoid scratching the area, as this can increase the risk of infection.

  5. Take an over-the-counter painkiller, such as paracetamol or ibuprofen, if you're in pain. An antihistamine tablet or cream can also help reduce itching and swelling.

  6. Apply local Anaesthetic Cream if you have this to hand

  7. The most important intervention for venom allergy, especially in the context of systemic or anaphylactic reactions, is rapid administration of intramuscular epinephrine, as emphasized by the American Heart Association and the American College of Allergy, Asthma, and Immunology

  ## Dealing with a Bee Sting 🐝

  Unlike wasps, honeybees leave their stinger and venom sac behind in the skin. It's important to remove this as quickly as possible.

  • Don't squeeze the stinger with your fingers or tweezers, as this can inject more venom.

  • Scrape the stinger out sideways using something with a hard edge, like a credit card, a long fingernail, or the blunt edge of a knife.

  ## When to Get Medical Help 🚑

  You must get help immediately if you have signs of a serious allergic reaction (anaphylaxis).

  Call 999 for an ambulance if the person has:

  • Difficulty breathing or wheezing

  • Swelling of the face, mouth, or throat

  • Feeling dizzy, faint, or confused

  • Nausea or vomiting

  • A widespread itchy rash (hives) that is spreading quickly

  • A fast heart rate

  Contact your GP or call NHS 111 if:

  • The swelling or pain is severe and doesn't improve after a couple of days.

  • The sting area looks infected (e.g., there's pus, or the redness and pain are getting worse).

  • You've been stung in your mouth, throat, or near your eyes.

  • You've been stung multiple times (more than 10). text goes here

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Seeds are an increasingly common feature in the modern UK diet, found in everything from breads and cereals to health foods and international cuisine. While they are a great source of nutrition, for some people, they can trigger an allergic reaction.

Like nuts, seeds contain specific 'storage proteins' that are essential for the plant's growth. It is typically these robust proteins that the human immune system mistakenly identifies as a threat. The allergens in seeds are very stable, meaning they aren't broken down by heat during cooking and are digested slowly, giving them time to cause a reaction.

Common Seed Allergies in the UK

In our specialist allergy clinics, the most frequent seed allergies we diagnose and manage are:

• Sesame

• Mustard

• Poppy Seed

• It is far less common to be allergic to:

  • Chia seeds

  • Linseeds and flaxseeds (these refer to the same seed, derived from Linum usitatissimum L).

These seeds are small and contain relatively little protein per seed. This is why some individuals might tolerate a few seeds sprinkled on a bread roll or use the seed's oil without issue. However, when these seeds are ground into pastes or flours (like tahini in hummus), the allergenic proteins are released and become highly concentrated. This significant protein load is much more likely to cause an allergic reaction. Nonetheless, it is safer to avoid all possible dietary forms of the seed if allergic.

Dr Foong and Prof du Toit of the London Allergy Consultants team have published extensively on sesame allergy.

Understanding Test Results: Sensitisation vs. True Allergy

A common concern among families dealing with a single seed allergy is whether other seeds will also cause a reaction. Allergy testing can sometimes add to this confusion.

A broad allergy test might show positive results for multiple seeds. This is often due to 'cross-reactivity', where the proteins in one seed look similar to those in another. A positive test shows that your body is 'sensitised' to that seed, but it does not automatically mean you will have an allergic reaction if you eat it.

In fact, far more patients who are sensitised to a seed will tolerate eating it than will react to it. A classic example in the UK involves patients with peanut allergy. Tests for fenugreek and lupine (both legumes, such as peanuts) are often positive, but clinical reactions to eating them are very rare.

Our Diagnostic Process: Achieving Certainty

At London Allergy Consultants, our priority is to move beyond diagnostic uncertainty. We achieve a precise diagnosis through a careful, structured process:

1. Detailed Medical History: We listen carefully to understand your or your child's experiences and symptoms.
2. Precise Allergy Testing: We use skin prick or specific IgE blood tests to identify sensitisations.
3. Oral Food Challenges: The 'gold standard' for diagnosis. This is a medically supervised procedure where a patient consumes a tiny, gradually increasing amount of the seed to determine for sure if it is tolerated.

To ensure patient safety, lower-risk challenges are performed in our outpatient clinics. In contrast, higher-risk challenges are undertaken in our dedicated Allergy Centre of Excellence (ACE), where advanced monitoring and support are available.

Advanced Treatment and Next Steps

Each seed allergy has its own unique characteristics. For a detailed understanding, please read through the specific seed descriptions on our website. At our Allergy Centre of Excellence (ACE), we also offer pioneering treatments like Oral Immunotherapy (OIT) for sesame and mustard allergies.

If you are unsure which seeds you or your child may be allergic to, we can provide expert guidance. Please visit us at our clinic in London or Surrey, where we can support you through our complete diagnostic and therapeutic process.

Different Type of Seeds Allergy

• Sesame Seed Allergy

  Sesame allergy is an immune system reaction to the proteins found in sesame seeds. It's one of the fastest-growing allergies in the UK, partly due to the increasing popularity of foods like hummus, tahini, and halva. While these foods are nutritious and delicious for many, for those with an allergy, they can cause reactions ranging from mild to severe.

  Symptoms of a Sesame Allergy

  An allergic reaction to sesame typically happens quickly after eating it. Symptoms can include:

  • Hives (a red, raised, itchy rash), flushing, or swelling of the face, lips, or eyes.

  • Tingling or itching in the mouth.

  • Abdominal pain, vomiting, or diarrhoea.

  • Difficulty breathing, wheezing, or a persistent cough.

  In the most serious cases, sesame allergy can cause anaphylaxis, a life-threatening reaction that requires immediate medical attention and the use of an adrenaline auto-injector or Nasal adrenaline device Neffy.

  How We Diagnose Sesame Allergy 🩺

  A precise diagnosis is the first step toward effective management. At our London clinic, we use a combination of methods to get a complete picture of your allergy.

  • Clinical History: We begin with a detailed conversation about your symptoms, your dietary habits, and any family history of allergies.

  • Skin Prick Testing: This simple and quick test involves placing a tiny drop of liquid containing sesame protein on your arm and gently pricking the skin. We often use tahini for this test as it is a potent form of the allergen and provides very reliable results.

  • Advanced Blood Tests: We measure the level of sesame-specific allergy antibodies (IgE) in your blood. Our clinic uses state-of-the-art platforms (like ALEX® or ImmunoCAP™) for component testing. This means we can identify the exact protein within the sesame seed (such as Ses i 1) that you're allergic to. This advanced detail helps us more accurately predict the severity of potential reactions.

  Management and Treatment Options

  Strict Avoidance

  For most people, the primary management strategy is the strict avoidance of all sesame-containing products. Sesame can be a "hidden" ingredient in many foods, so careful label reading is essential. Common sources include:

  • Pastes & Dips: Tahini, hummus, baba ghanoush.

  • Baked Goods: Burger buns, bagels, breadsticks, biscuits.

  • Cuisines: Often used in Middle Eastern, Asian, and Japanese dishes.

  Emergency Preparedness

  If you or your child are at risk of anaphylaxis, we will provide you with an emergency action plan and prescribe adrenaline auto-injectors.

  Advanced Treatment: Oral Immunotherapy (OIT)

  For suitable patients, our specialist Allergy Centre of Excellence offers Sesame Oral Immunotherapy (OIT). OIT is a cutting-edge treatment that aims to desensitise the immune system. It involves eating a tiny, gradually increasing amount of sesame protein each day under strict medical supervision.

  The goal of OIT is to build tolerance, significantly reducing the risk of a severe reaction to accidental exposure and improving quality of life. We find that the earlier this treatment is started in childhood, the easier and more successful the journey often is. However, OIT is a significant commitment and is not suitable for every family.

  If you are concerned about a potential sesame allergy, please contact us to schedule a consultation.

• Mustard Seed Allergy

  Understanding Mustard Allergy

  A mustard allergy is an immune system reaction to the proteins found in mustard seeds. When you eat mustard, your body mistakenly identifies these proteins as harmful and releases chemicals, like histamine, to 'defend' itself. This is what causes allergic symptoms.

  The proteins in mustard are very tough; they aren't broken down by cooking or digestion. This means that whether the mustard is cooked in a sauce, used as a spice, or eaten raw, it can still trigger a reaction.

  Symptoms of a Mustard Allergy

  Reactions can vary from person to person and can happen very quickly after eating. Symptoms can include:

  • Mild reactions: Itchy skin (hives), a rash, swelling (especially around the lips and face), or an itchy mouth.

  • Moderate reactions: Stomach cramps, vomiting, or diarrhoea.

  • Severe reactions: Difficulty breathing, dizziness, or a drop in blood pressure.

  In the most serious cases, a mustard allergy can cause anaphylaxis, a life-threatening reaction that requires immediate medical attention. ⚠️

  Cross-Reactivity: The Link to Other Allergies

  If you have a mustard allergy, you might find you're also sensitive to other foods. This is called cross-reactivity. It happens because the proteins in mustard are similar in structure to proteins in other plants. Your immune system gets confused and reacts to them as well.

  Common cross-reactivities with mustard include:

  • Other plants in the Brassicaceae family (like broccoli, cabbage, and rapeseed oil).

  • Nuts and legumes.

  • Certain fruits (like peaches and apples).

  • Mugwort pollen (a common cause of hay fever).

  It's important to note that just because you're allergic to mustard, it doesn't automatically mean you'll react to these other foods. Testing can help clarify any specific triggers.

  Diagnosis and Management

  If you suspect you have a mustard allergy, it's essential to see a doctor or an allergy specialist. A diagnosis is usually made using a combination of:

  1. A detailed clinical history of your reactions.

  2. Allergy testing, such as a skin prick test or a specific IgE blood test.

  3. An oral food challenge, where you eat a tiny, controlled amount of mustard in a safe, clinical setting to confirm the allergy.

  The main way to manage a mustard allergy is to strictly avoid it. For those at risk of anaphylaxis, you will be prescribed adrenaline auto-injectors (like an EpiPen® or Jext®) and taught how to use them in an emergency.

  Mustard and Food Labelling in the UK

  In the UK and the EU, mustard is one of the 14 major allergens that must be legally declared on all pre-packaged food labels.

  You should always check the ingredients list, where it will usually be highlighted in bold. Look for phrases like "Contains mustard" in the allergy information box. Be aware that mustard can be a 'hidden' ingredient in many foods, including:

  • Sauces, dressings, and marinades

  • Soups and stews

  • Processed meats like sausages

  • Spices and curry powders

  • Pizzas and savoury snacks

  Always read labels carefully and don't be afraid to ask about ingredients when eating out.

  Oral Immunotherapy to Mustard:

  We do offer OIT to mustard in our Allergy Centre of Excellence facility.

• Poppy Seed Allergy

  Poppy Seed Allergy: A Guide for Patients in the UK

  If you've been diagnosed with a poppy seed allergy or suspect you might have one, this guide is here to provide you with clear and helpful information.

  What is a Poppy Seed Allergy?

  A poppy seed allergy is a reaction that happens when your immune system mistakenly treats the proteins in poppy seeds as a harmful substance. Your body produces specific antibodies called Immunoglobulin E (IgE) to fight off these 'invaders'. When you next eat poppy seeds, these IgE antibodies trigger the release of chemicals, like histamine, which cause the symptoms of an allergic reaction.

  What are the Symptoms?

  Reactions to poppy seeds can vary from person to person. Some people may experience mild symptoms, while others can have a much more serious reaction.

  Mild to Moderate Symptoms can include:

  • Oral Allergy Syndrome (OAS): An itchy or tingling sensation in your mouth, lips, or throat.

  • Skin Reactions: Hives (raised, itchy red bumps), a rash, or swelling (angioedema), often around the face.

  • Stomach Upset: Nausea, stomach cramps, vomiting, or diarrhoea.

  • Hay fever-like symptoms: A runny nose, sneezing, or watery eyes.

  Severe Symptoms (Anaphylaxis): In some cases, a poppy seed allergy can cause a severe, life-threatening reaction called anaphylaxis. This is a medical emergency and you must call 999 immediately.

  Signs of Anaphylaxis include:

  • Difficulty breathing or wheezing

  • Tightness in the throat or chest

  • Feeling faint, dizzy, or collapsing

  • A sense of impending doom

  The Link to Other Allergies (Cross-Reactivity)

  Poppy seed allergy is quite rare, but it is often seen in people who already have other allergies, especially to tree nuts (like hazelnut), other seeds (like sesame), or certain pollens.

  This happens because the proteins in poppy seeds are very similar in structure to proteins in these other substances. This is called cross-reactivity. Your immune system can't tell the difference and reacts to both, which can sometimes make diagnosis more complicated.

  How is a Poppy Seed Allergy Diagnosed?

  If you think you might have a poppy seed allergy, it's important to see your GP. They can refer you to an NHS or private allergy specialist for proper testing. The diagnostic process usually involves:

  1. Allergy-Focused History: The specialist will ask detailed questions about your symptoms, what you ate, and your wider medical history.

  2. Skin Prick Test: A tiny drop of liquid containing poppy seed protein is placed on your arm and the skin is gently pricked. A positive reaction usually causes a small, itchy red bump, similar to a mosquito bite.

  3. Specific IgE Blood Test: A blood test can measure the amount of IgE antibodies to poppy seed in your blood.

  4. Oral Food Challenge: If the diagnosis is still unclear, you may be offered a food challenge. This is the 'gold standard' test and is always done in a safe, controlled hospital setting where you will be given tiny, increasing amounts of poppy seed to eat under close medical supervision.

  Managing Your Poppy Seed Allergy

  As there is currently no cure for food allergies, the main way to manage your condition is to avoid poppy seeds completely.

  • Be a Label Detective: Carefully check the ingredients list on all pre-packaged foods. Poppy seeds are often found in bread, bagels, cakes, muffins, and salad dressings.

  • Communicate Clearly: When eating out or ordering takeaways, always inform the staff about your allergy so they can advise you on safe menu choices and prevent cross-contamination in the kitchen.

  • Be Prepared for an Emergency: If you are diagnosed with a risk of anaphylaxis, you will be prescribed adrenaline auto-injectors (AAIs), such as an EpiPen®, Jext®, or Emerade®. It is vital that you carry two of these with you at all times and know how to use them. Ensure your family, friends, and colleagues also know how to use your device.

  Unfortunately, at present, there are no established immunotherapy treatments (like oral or sublingual immunotherapy) available for poppy seed allergy. Strict avoidance and being prepared for a reaction are the most effective ways to stay safe and well.

• Chia Seed Allergy

  A Guide to Chia Seed Allergy

  Chia seeds (Salvia hispanica) have become a popular health food in the UK, praised for their nutritional benefits and found in everything from puddings to smoothies. While they are safe for most people, a small number of individuals may experience an allergic reaction to the proteins they contain.

  Although a chia seed allergy is considered rare, it's important to recognise the symptoms and understand the risks, especially for those with other food allergies.

  Symptoms of a Chia Seed Allergy

  An allergic reaction to chia seeds can range from mild to severe. Symptoms may include:

  • Itching in the mouth or throat

  • Hives (a red, itchy skin rash) or swelling

  • Stomach discomfort, nausea, or vomiting

  • In serious cases, anaphylaxis, a severe and potentially life-threatening reaction requiring immediate medical attention.

  The Link to Other Allergies (Cross-Reactivity)

  The proteins in chia seeds can be similar to allergens found in other foods. This means that if you have an existing allergy, your immune system might mistake chia seed protein for your known allergen and trigger a reaction.

  • Key cross-reactivities have been noted with sesame and hazelnut.

  • The European Food Safety Authority (EFSA) has highlighted that the main safety concern with chia seeds is their potential to cause allergies. They advise caution for anyone with a known seed or nut allergy who is trying chia for the first time.

  How We Diagnose a Chia Seed Allergy

  Because chia is a relatively new food in our diets, standardised allergy tests are not as widely available as for allergens like peanuts. However, a diagnosis can be effectively made through:

  • A Detailed Clinical History: A thorough discussion about your symptoms and diet is the most important first step.

  • Skin Prick and Blood Tests: We can use skin prick tests and specific IgE blood tests to help identify an allergic sensitivity to chia.

  Management and Treatment

  Avoidance and Emergency Care

  The only way to manage a chia seed allergy is through strict avoidance. Always check the labels of health bars, cereals, baked goods, and drinks.

  If you are diagnosed with a chia seed allergy, we will provide you with a comprehensive emergency action plan. This may include having antihistamines for mild symptoms and an adrenaline auto-injector (like an EpiPen® or Jext®) for severe reactions.

  Treatment Outlook

  Currently, there are no established immunotherapy treatments for desensitisation to chia seeds. For this reason, we do not yet offer Oral Immunotherapy (OIT) for chia seed allergy in our Allergy Centre of Excellence (ACE) facility. Management is focused on avoidance and emergency preparedness.

  If you are concerned about a possible reaction to chia seeds, we recommend booking a consultation for an expert assessment and personalised advice.

• Fenugreek Seed Allergy

  A Guide to Fenugreek Allergy

  Fenugreek is a plant from the legume family, and its seeds are a common spice, especially in South Asian, North African, and Middle Eastern cooking. It's often found in spice blends like curry powder and is also used in some herbal teas and supplements. An allergy to fenugreek is an immune system reaction to the proteins in these seeds.

  Reactions can be triggered not just by eating fenugreek, but also by inhaling the powder during cooking or through skin contact.

  Symptoms of a Fenugreek Allergy

  An allergic reaction to fenugreek can vary in severity. Symptoms may include:

  • A runny nose, sneezing, and nasal congestion.

  • Skin reactions like hives (urticaria) or swelling (angioedema).

  • Breathing difficulties, such as wheezing or bronchospasm.

  • In severe cases, anaphylaxis, a serious, life-threatening reaction that requires immediate medical intervention.

  The Legume Family Link: Cross-Reactivity with Peanuts and Chickpeas

  This is a crucial point for anyone with a known legume allergy. Fenugreek is a member of the legume family, alongside peanuts, chickpeas, lentils, peas, and soya.

  The proteins in fenugreek are very similar to those in other legumes, particularly peanut and chickpea. This means that individuals with a peanut or chickpea allergy have a significantly higher risk of also reacting to fenugreek. An allergy to fenugreek can exist on its own, but it often appears in those who already have other legume allergies.

  How We Diagnose Fenugreek Allergy 🩺

  A precise diagnosis is essential, especially given the high chance of cross-reactivity. Our diagnostic process includes:

  • A Detailed Consultation: We start with a thorough discussion of your symptoms and dietary history.

  • Skin Prick Testing: This test checks for an immediate allergic reaction on the skin.

  • Specific IgE Blood Tests: These measure the level of allergy antibodies to fenugreek in your blood.

  • Oral Food Challenge: When necessary, a medically supervised food challenge—the gold standard for diagnosis—is used to confirm or rule out the allergy.

  Management and Treatment

  Avoidance and Emergency Care

  The primary management for a fenugreek allergy is strict avoidance. It's vital to read ingredient lists carefully, especially on:

  • Curry powders and pastes

  • Spice mixes (masala)

  • Pickles and chutneys

  • Some herbal teas and supplements

  For patients at risk of severe reactions, we will provide an emergency care plan and prescribe an adrenaline auto-injector (e.g., EpiPen®, Jext®).

  Treatment Outlook

  Currently, there are no established immunotherapy treatments for fenugreek allergy. Therefore, we do not yet offer Oral Immunotherapy (OIT) for fenugreek allergy in our Allergy Centre of Excellence (ACE) facility. The focus of management remains on vigilant avoidance and emergency preparedness.

  If you suspect an allergy to fenugreek or are concerned about cross-reactivity with a known legume allergy, please contact our clinic to schedule a consultation.

• Lupine Seed Allergy

  A Guide to Lupine Allergy

  Lupine (also spelled 'lupin') is a legume from the same plant family as peanuts, peas, and beans. It's increasingly used in the UK food industry, especially in gluten-free products, due to its high protein content. You can find lupine flour and seeds in foods like bread, pastries, pasta, and vegetarian meat substitutes.

  Because it can trigger severe allergic reactions, lupine is one of the 14 major allergens that must be legally declared and highlighted on all pre-packaged food labels in the UK.

  Symptoms of a Lupine Allergy

  A reaction to lupine can be triggered by very small amounts and can range from mild to life-threatening. Symptoms may include:

  • Itching in the mouth (Oral Allergy Syndrome)

  • Hives (a red, itchy rash) or swelling (angioedema)

  • Stomach pain or vomiting

  • Difficulty breathing or wheezing

  • In severe cases, anaphylaxis, a life-threatening reaction requiring immediate medical help.

  Occupational Allergy: People who work with lupine flour, such as bakers, can also develop respiratory allergies like rhinitis (runny nose) or asthma from inhaling the powder.

  The Peanut Connection: A Critical Warning ⚠️

  The link between lupine and peanut allergy

  • High Risk of Cross-Reactivity: As close botanical relatives, the proteins in lupine and peanuts are very similar. Studies show that up to 44% of people with a peanut allergy will also have IgE sensisation to lupine; but thankfully this seldom translates to clinical allergy, ie most patients can still eat and tolerate lupine. Our clinic will help you to differentiate between clinically relevent IgE sensitisation and ‘immunological cross reactive noise’ that is of no allergy risk to you.

  How We Diagnose Lupine Allergy

  Given the potential for severe reactions, a formal diagnosis is essential. Our comprehensive diagnostic process includes:

  • A Detailed Clinical History: We'll discuss your symptoms and dietary history in full.

  • Skin Prick Testing: This test can quickly indicate a sensitivity to lupine.

  • Specific IgE Blood Tests: These tests measure the level of allergy antibodies to lupine in your bloodstream.

  • Oral Food Challenge: This medically supervised test is the 'gold standard' for confirming or ruling out a food allergy with certainty.

• Pumpkin Seed Allergy

  An allergy to pumpkin seeds is an immune system reaction to proteins found within the seeds of a pumpkin. While considered uncommon, this allergy is important to recognise as pumpkin seeds are a popular healthy snack and a common ingredient in bread, salads, and granola bars.

  Symptoms of a Pumpkin Seed Allergy

  An allergic reaction can range from mild to severe and may be triggered by eating the seeds or, less commonly, inhaling dust from them.

  Symptoms can include:

  • Mild Reactions: Itching, tingling, or swelling in and around the mouth (Oral Allergy Syndrome).

  • Skin Reactions: Hives (a red, itchy rash) or swelling (angioedema).

  • Respiratory Issues: Difficulty breathing or wheezing.

  • Severe Reactions: In rare cases, a pumpkin seed allergy can cause anaphylaxis, a serious and potentially life-threatening reaction that requires immediate medical help.

  An Important Distinction: Seeds vs. Flesh 🎃

  A key feature of this allergy is that the allergenic proteins are concentrated in the seed. Many people who are allergic to pumpkin seeds find that they can safely eat the pumpkin flesh (pulp) without any issues.

  However, this is not guaranteed for everyone and must be confirmed by an allergy specialist. You should never assume the flesh is safe to eat without a proper medical evaluation.

  How We Diagnose Pumpkin Seed Allergy

  A clear diagnosis is the first step to managing the allergy safely. Our diagnostic process includes:

  • A Detailed Consultation: We start with a thorough discussion about your symptoms and diet.

  • Skin Prick Testing: This simple test can quickly indicate an allergic sensitisation to pumpkin seed.

  • Specific IgE Blood Tests: A blood test measures the allergy antibodies to pumpkin seed protein in your system.

  Because the proteins in pumpkin seeds can be similar to those in other nuts and seeds, we will also investigate any potential cross-reactivities as part of your evaluation.

  Management and Treatment

  Strict Avoidance and Emergency Care

  The only way to manage a pumpkin seed allergy is by strictly avoiding the seeds and products containing them, such as pumpkin seed oil. Always check the labels on:

  • Snack mixes

  • Multi-seed breads and crackers

  • Salad toppings

  • Granola and health bars

  For those at risk of a severe reaction, we will provide a comprehensive emergency action plan and prescribe an adrenaline auto-injector (e.g., EpiPen®, Jext®).

  Treatment Outlook

  Currently, there are no established immunotherapy treatments for pumpkin seed allergy. Therefore, we do not yet offer Oral Immunotherapy (OIT) for pumpkin seed allergy in our Allergy Centre of Excellence (ACE) facility. The focus remains on careful avoidance and being prepared for emergencies.

  If you are concerned about a potential reaction to pumpkin seeds, please contact our clinic to schedule a consultation for an expert assessment.

• Flaxseed (linseed Allergy)

  A Guide to Linseed (Flaxseed) Allergy

  First, let's clarify the names: linseed and flaxseed are different terms for the same seed from the Linum usitatissimum plant. In the UK, we traditionally use the term 'linseed', while 'flaxseed' is more common in North America. Today, the names are often used interchangeably on food products.

  An allergy to linseed is an immune system reaction to the proteins in these seeds. With their growing popularity in health foods, they are now found in everything from bread and cereals to smoothies and supplements, making awareness of a potential allergy more important than ever.

  Symptoms of a Linseed/Flaxseed Allergy

  An allergic reaction to linseed can range from mild to severe. Symptoms may include:

  • Skin Reactions: Hives (a red, itchy rash) or swelling (angioedema).

  • Gastrointestinal issues: Stomach cramps or vomiting.

  • Severe Reactions: In some cases, a linseed allergy can cause anaphylaxis, a serious, life-threatening reaction that requires immediate emergency treatment.

  A Potential Link to Peanut and Cashew Allergy 🥜

  Research has identified that some of the allergenic proteins in linseed are structurally similar to those in certain tree nuts and legumes.

  This means there is a potential for cross-reactivity, particularly with peanut and cashew nut. While not everyone with a peanut or cashew allergy will react to linseed, the risk exists. If you have a known nut allergy, you should be cautious and seek specialist advice before consuming linseed products.

  How We Diagnose Linseed/Flaxseed Allergy

  While linseed allergy is considered uncommon, a precise diagnosis is key to managing it safely. Our diagnostic process includes:

  • A Detailed Clinical History: We start with an in-depth conversation about your symptoms and diet.

  • Skin Prick Testing: This test can quickly show an allergic sensitisation to linseed.

  • Specific IgE Blood Tests: A blood test can measure the level of allergy antibodies to linseed.

  Expert interpretation of these tests is crucial, as standardised testing reagents for linseed are not as common as for other major allergens.

  Management and Treatment

  Strict Avoidance and Emergency Care

  The only way to manage a linseed allergy is through strict avoidance. It's important to read labels carefully, as linseed can be found in:

  • Multi-seed breads, crackers, and cereals

  • Health bars and granola

  • Smoothie mixes and "superfood" powders

  • Vegan products, where it is sometimes used as an egg substitute ('flax egg')

  For patients at risk of anaphylaxis, we will provide a comprehensive emergency care plan and prescribe an adrenaline auto-injector (e.g., EpiPen®, Jext®).

  Treatment Outlook

  Currently, there are no established immunotherapy treatments for linseed/flaxseed allergy. Therefore, we do not yet offer Oral Immunotherapy (OIT) for linseed/flaxseed allergy in our Allergy Centre of Excellence (ACE) facility. Management is focused on vigilant avoidance and emergency preparedness.

  If you are concerned about a potential reaction to linseed or its link to a nut allergy, please contact our clinic to schedule a consultation.

• Sunflower Seed Allergy

  A Guide to Sunflower Seed Allergy

  An allergy to sunflower seeds is an immune system reaction to the proteins found in the seeds of the sunflower plant. They are a very common food in the UK, eaten as a snack and used as an ingredient in multi-seed breads, cereals, and granola bars. Sunflower oil is a widely used cooking oil, and sunflower seed butter is a popular alternative to peanut butter.

  Symptoms of a Sunflower Seed Allergy

  Reactions to sunflower seeds can vary from mild to severe. Interestingly, symptoms can be triggered not just by eating them but also by inhaling dust from the seeds, for example, when handling bird feed.

  Symptoms can include:

  • Oral Symptoms: Itching, tingling, or swelling in the mouth and throat (Oral Allergy Syndrome).

  • Skin Reactions: Hives (a red, itchy rash), eczema, or swelling (angioedema).

  • Respiratory Issues: A runny nose, sneezing, or asthma-like symptoms (especially from inhalation).

  • Severe Reactions: In some cases, a sunflower seed allergy can cause anaphylaxis, a serious and potentially life-threatening reaction that requires immediate medical attention.

  The Hay Fever Connection: Mugwort Pollen 🌿

  Sunflower is a member of the Asteraceae (or Compositae) plant family, which includes plants like chamomile, ragweed (thankfully, uncommon in UK), and mugwort.

  A significant number of people with a sunflower seed allergy also suffer from hay fever, particularly an allergy to mugwort pollen, which is common in the UK from late summer to early autumn. This is a type of cross-reactivity, where the immune system recognises similarities between the proteins in the pollen and the proteins in the seed, triggering a reaction to both. This can sometimes also be linked to mild reactions to other foods like melon, cucumber, and celery.

  How We Diagnose Sunflower Seed Allergy

  A clear diagnosis is crucial for safe management. Our comprehensive diagnostic process includes:

  • A Detailed Consultation: We start with an in-depth discussion of your symptoms and potential exposure to sunflower seeds.

  • Skin Prick Testing: This simple test can quickly indicate an allergic sensitisation to sunflower seed proteins.

  • Specific IgE Blood Tests: A blood test measures the level of allergy antibodies to sunflower seeds in your system.

  Management and Treatment

  Strict Avoidance and Emergency Care

  The primary management for a sunflower seed allergy is strict avoidance. It's important to check the labels on:

  • Snack packs and trail mixes

  • Multi-seed breads, crackers, and bagels

  • Cereals and granola bars

  • Sunflower butter or spreads (e.g., Sun-butter)

  • Sunflower Oil: Highly refined sunflower oil is usually safe for most allergic individuals as the protein is removed. However, cold-pressed, unrefined, or gourmet oils may contain protein and pose a risk. We advise discussing this with a specialist.

  For patients at risk of a severe reaction, we will provide a clear emergency action plan and prescribe an adrenaline auto-injector (e.g., EpiPen®, Jext®).

  Treatment Outlook

  Currently, there are no established immunotherapy treatments for sunflower seed allergy. Therefore, we do not yet offer Oral Immunotherapy (OIT) for sunflower seed allergy in our Allergy Centre of Excellence (ACE) facility. Management is focused on vigilant avoidance and emergency preparedness.

  If you are concerned about a potential reaction to sunflower seeds, please contact our clinic to schedule a consultation for an expert assessment.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

If your baby has normal skin (as most do), NHS recommendations are that you do not need to bathe a newborn every day. Two to three times a week is generally sufficient. Daily "topping and tailing" (washing the face, neck, hands, and bottom) is a good alternative.

However, some 20% of babies in the UK develop eczema, and dry skin conditions are also prevalent. How should they be managed with respect to best bathing practice?

• If your child has eczema or infected eczema, what is the evidence regarding the best bathing practice?
• Bathing for atopic eczema should be performed frequently (daily to every other day), briefly (5–10 minutes), and with lukewarm water and a gentle, fragrance-free, dye-free cleanser. Major Dermatological Societies recommend the immediate and liberal application of moisturiser after bathing to reduce transepidermal water loss and maintain skin hydration, as water evaporation from the skin can worsen dryness if not promptly sealed with an emollient.
• The American Academy of Dermatology advises against the use of traditional soaps, which are alkaline and can disrupt the skin barrier, recommending instead non-soap cleansers (syndets) that have a neutral to low pH, are hypoallergenic, and are fragrance-free. Bath additives, such as oils or emollients, are not routinely recommended, as there is insufficient evidence to support their benefit over direct emollient application after bathing.
• For select patients, dilute unscented bleach baths may be considered as an adjunct to reduce bacterial colonisation, but the evidence is limited, and this should be reserved for those with recurrent infections or severe disease. All societies emphasise the avoidance of products with added fragrance, dyes, or essential oils due to their potential as irritants or allergens.
• The rationale for these recommendations is to maximise skin hydration, minimise barrier disruption, and reduce exposure to irritants and allergens, all of which are central to controlling atopic eczema.

So in summary:

1. Use Lukewarm Water: Hot water can dry out the skin and trigger itching. Keep the bath warm, not hot.
2. Keep it Brief: Aim for a bath of 10-15 minutes. Soaking for too long can have a drying effect.
3. Avoid Soaps and Bubbles: Standard soaps, bubble baths, and shower gels contain detergents (like Sodium Lauryl Sulphate) that remove natural oils and can irritate eczema-prone skin.
4. Pat, Don't Rub: After the bath, gently pat the skin dry with a soft towel.
5. Moisturise Immediately: Apply a generous amount of your regular emollient or moisturiser within three minutes of getting out of the bath to lock in moisture. This is often referred to as the "soak and seal" method.

What are the best water additives?

• Best for: General dryness and maintaining skin hydration.

Emollient bath oils are the most commonly recommended additives. They work by dispersing in the water and covering the skin in a fine, protective film. This film helps to reduce water loss from the skin, leaving it feeling softer and more hydrated. While recent research suggests they may not reduce the severity of eczema flare-ups on their own, they are excellent for gentle cleansing without soap and providing overall moisture.

• Oilatum Bath Formula / Junior Bath Additive: A long-standing product specifically for dry skin conditions.
• E45 Emollient Bath Oil: Fragrance-free and clinically proven to soothe and moisturise dry skin.
• Dermol 600 Bath Emollient: This is an antimicrobial emollient, which means it also helps to manage bacteria on the skin that can cause infections.
• QV Bath Oil: A gentle, non-greasy formula that is free from common irritants.

How to use: Add the recommended amount to running bath water. Be aware that these oils make the bath very slippery, so a non-slip bath mat is essential, especially for children and the elderly.

Examples available in the UK:

2. Colloidal Oatmeal (but make sure oat is in the diet of the child)

Best for: Soothing severe itching and inflammation.

Colloidal oatmeal is made from oats that have been ground into an extremely fine powder. When added to water, it creates a milky, soothing solution that helps to calm itching and reduce inflammation. Oats contain compounds called avenanthramides, which have anti-inflammatory and antioxidant properties.

How to use: Add the powder or sachet to running lukewarm water and stir to ensure it dissolves completely. Soak for 10-15 minutes. You can also make your own by grinding plain porridge oats into a fine powder in a blender and placing them in a muslin bag or old sock, which you hang under the tap.

Examples available in the UK:

Aveeno Soothing Bath Soak: Made with 100% natural colloidal oatmeal, specifically designed for dry, irritable, and sensitive skin.

OatSoak Dissolvable Bath Oats: A 100% natural colloidal oatmeal product made in the UK.

3. Antiseptic Additives

Best for: Infected or weeping eczema (use under medical guidance).

When eczema is severe, the skin barrier can break, allowing bacteria like Staphylococcus aureus to cause an infection. This can lead to weeping, crusting, and worsening inflammation. In these cases, a dermatologist or GP may recommend an antiseptic bath to reduce the bacterial load on the skin.

Important: This should only be done on the advice of a healthcare professional, as incorrect use can irritate. The most common method is a very dilute bleach bath.

How to use (under medical supervision only):

A small amount of household bleach (without fragrance or other additives) or a specific medical product is added to a full bath of water. For example, Milton Sterilising Fluid is often recommended by UK dermatologists as it's a stable, pure form of bleach. The resulting concentration is similar to that of a swimming pool and is safe when prepared correctly.

By selecting the right additive for your skin's specific needs and incorporating it into a consistent, gentle bathing routine, you can significantly enhance comfort and effectively manage eczema symptoms.

Frequently Asked Questions

Pat, Don't Rub

The single most important rule is to pat the skin gently, never rub. Rubbing with a towel creates friction, which can tear the delicate skin, trigger a nerve response that leads to more itching (the "itch-scratch cycle"), and worsen inflammation.Step-by-Step Guide:Select the Right Towel: Use a very soft, clean towel. Materials like soft cotton, bamboo, or microfibre are ideal. Avoid old, rough, or scratchy towels. Always use a fresh towel each time to minimise the risk of bacterial infection, which weeping skin is very prone to.Gentle Patting: Take the soft towel and gently pat the skin. You can either press the towel against the area and lift it, or gently lay the towel over the wet skin to let it absorb the excess water.Leave Skin Slightly Damp: Do not aim to dry the skin completely until it is bone-dry. The goal is to remove dripping water while leaving the skin feeling slightly damp. This residual moisture is what you will seal in with your moisturiser.The Crucial Next Step: "Soak and Seal"Immediately after patting the skin, you must apply your prescribed emollient or moisturiser. This is the most vital part of the process, often called the "Soak and Seal" method.Timing is Everything: You should apply the moisturiser within three minutes of patting the skin. This traps the water from the bath in the top layers of the skin, providing essential hydration and forming a protective barrier.Apply Generously: Don't be shy with your emollient. Apply it in smooth, downward strokes in the direction of hair growth. Do not rub it in vigorously, as this can also cause irritation.What to AvoidDo NOT Rub: As mentioned, this is the worst thing you can do. It is abrasive and will aggravate the eczema.Do NOT Air Dry Completely: Letting weeping eczema air dry might seem gentle, but as the water evaporates from the skin, it draws out the skin's natural moisture with it. This can leave the skin feeling tighter, drier, and more prone to cracking.Do NOT Use Abrasive Materials: Avoid any rough flannels, sponges, or towels.Do NOT Use High Heat: If using a hairdryer on eczematous areas (e.g., the scalp), always use the lowest, coolest setting to avoid drying out the skin.

Does water hardness matter?

Yes, water quality can have an effect on various aspects of healthy skin control. Damage to the Skin Barrier:Hard water has high concentrations of calcium and magnesium ions. You should be able to check on the quality of your water on your local council website, or ask the water provider directly. A 2017 study led by the University of Sheffield and King's College London found that these minerals, combined with a common cleansing ingredient (Sodium Lauryl Sulphate - SLS) found in many soaps and bubble baths, can damage the protective skin barrier. This barrier is already compromised in people with eczema, and hard water makes it more vulnerable to irritation from allergens and irritants.Increased Dryness and Irritation:The minerals in hard water reduce the solubility of soaps, creating a residue (soap scum) that is left on the skin. This residue can be highly irritating and drying, stripping the skin of its natural oils and moisture, which is a key trigger for eczema flare-ups.Potential pH Changes:Hard water is more alkaline. Healthy skin has a slightly acidic pH, which is crucial for its barrier function. The alkalinity of hard water can disrupt this delicate balance, further weakening the skin's defences.Chlorine in Tap WaterTap water in the UK is treated with chlorine to make it safe to drink. While the levels are low and safe for consumption, some individuals with very sensitive eczema find that chlorine can act as a minor irritant, contributing to dryness and itching. However, for most, the effect of hard water minerals is a much more significant factor.What You Can Do About ItWhile you cannot change the local water supply, you can take practical steps to mitigate the effects of hard water on your skin:Install a Water Softener: This is the most effective solution. A water softener works by removing the calcium and magnesium ions from the water as it enters your home. Many people with eczema report a significant improvement in their skin's condition after installing one.Use Emollient Bath Additives: As previously discussed, using emollient bath oils can help to create a protective barrier on the skin, counteracting the drying effects of hard water.Avoid Soaps and Detergents: Never use regular soap, bubble bath, or shower gel. Stick to soap-free cleansers or your prescribed emollient as a soap substitute. This minimises the chemical reaction with the hard water that creates irritating residue.Moisturise Liberally: The "soak and seal" method is crucial. Within three minutes of bathing or showering, pat the skin gently and apply a thick layer of emollient to lock in the moisture before it evaporates.Consider a Shower Filter: If a full water softening system isn't feasible, a filter that attaches to your shower head can help to reduce chlorine and some mineral content, which may provide some relief.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Navigating Autumn & Winter Bug Season: A Guide for Parents

As families return from holidays, head back to nurseries, and settle into the autumn term, a rise in childhood respiratory infections is inevitable. For allergic families, these symptoms can 'merge' with rhinitis due to Autumn mould and late pollens.

In a multicultural city like London, families return from diverse climates and winter seasons across the globe, introducing a wide array of circulating viral strains, so returning to nursery or school can feel like an immune challenge.

Combined with close contact in classrooms and nurseries, plus cooler, drier indoor air, viruses spread rapidly.

There are many viruses that can cause symptoms at this time of the year with the rhinovirus and respiratory syncytial virus (RSV) being common triggers.

Cladosporium and Alternaria are the most common airborne moulds active during autumn, thriving on decaying fallen leaves and damp organic matter, alergy to mould can give rhinitis symptoms and not uncommonly, a croup-like cough.

What Is Normal? (Nursery & Infant Expectations)

It is completely normal for healthy infants and young children in the UK to experience 8 to 10 colds per year.

• The Nursery "Boot Camp": Infants starting nursery can experience up to 12 to 15 infections in their first year alone as their immature immune systems encounter common viruses for the first time.
• Long-Term Advantage: Early exposure in nursery settings acts as an immune "boot camp". Children who acquire these exposures in nursery typically experience fewer illnesses once they start primary school than those who stayed at home.

Immunity & Allergy Protection

While constant winter snuffles are exhausting, everyday viral exposures play a key biological role:

• Immune Training: You can run, but you cannot hide—catching mild viral bugs is how a child's immune system learns and matures.
• Allergy Reduction: Under the "hygiene hypothesis," early exposure to common environmental microbes and infections helps calibrate the immune system. This lowers the risk of developing allergic conditions like asthma, hay fever, and eczema later in life.

Vaccination: Essential Protection

Ensuring your child's routine immunisations are up to date remains your strongest defence against severe illness.

• Annual Flu Vaccine: Offered to school-aged children and eligible nursery toddlers across the UK.
• Egg Allergy Safety: An egg allergy is not a contraindication to receiving the nasal spray flu vaccine or inactivated flu injections. Modern vaccines contain negligible egg protein and are safe for children with egg allergies (including prior severe reactions) in standard community settings.
• Maternal RSV Vaccine: Pregnant mothers can directly protect their newborns against RSV. Receiving the vaccine between 28 and 36 weeks of pregnancy transfers protective antibodies across the placenta (passive immunity). This protects infants from severe RSV complications like bronchiolitis and pneumonia during their vulnerable first six months.

Saline Nasal Washes: Proven Relief & Reduced Household Spread

Nasal saline drops (such as hypertonic saltwater solutions) provide far more than just quick comfort. The UK ELVIS-Kids randomised controlled trial (presented at the European Respiratory Society) demonstrates significant clinical benefits for children under six:

• Shorter Illness Duration: Children receiving saline nasal drops recovered two days faster—reducing cold symptom duration from an average of 8 days down to 6 days.
• Less Spread to Family: Using saline drops reduced virus transmission within the household, with significantly fewer family members catching the cold compared to standard care (46% vs 61%).
• How It Works: The chloride in saltwater helps the cells lining the nose produce hypochlorous acid - a natural defence mechanism that suppresses viral replication.
• Reduced Medication Use: Children using saline drops needed fewer additional over-the-counter medicines throughout their illness.

Practical Prevention Habits

1. Hand Hygiene: Encourage thorough handwashing with soap and water for 20 seconds.
2. "Catch It, Bin It, Kill It": Teach children to cough or sneeze into a tissue, throw it away immediately, and clean their hands.
3. Avoid Touching Faces: Remind infants and children to keep hands away from their eyes, nose, and mouth.
4. Lifestyle Support: Ensure adequate sleep, balanced nutrition, and daily outdoor activity.

Red Flags: When to Seek Medical Help

Most common colds resolve within 7 to 10 days, though post-viral coughs can last up to 3 weeks. Seek medical care if you observe any of the following:

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

0330 678 5168

@office@londonallergyconsultants.com

Anaphylaxis, a severe and potentially life-threatening allergic reaction, traditionally requires immediate intramuscular injection of adrenaline using an Adrenaline Auto-Injector (AAI).

Recently approved by both the FDA and EMA, Neffy nasal spray (also known as Eurneffy in Europe) offers an innovative, needle-free alternative.

The device is now available on the NHS. We can also script this privately in our Allergy Centre of Excellence (ACE) pharmacy.

At present, in the UK, only the 2mg dose (Body Weight >30kg) is available. Hopefully, we will have access to the 1mg dose in 2026.

Neffy assists significantly with anaphylaxis treatment.

What is EurNeffy?

Neffy is a novel, nasal-delivered adrenaline device designed specifically for individuals experiencing anaphylactic reactions.

Developed by ARS Pharmaceuticals, this needle-free nasal spray represents a significant advancement over traditional AAIs.

EurNeffy (adrenaline/epinephrine) is indicated for the emergency treatment of type I allergic reactions, including anaphylaxis, in adults and pediatric patients.

Licenses in different countries will vary. Currently approved in the UK for individuals weighing at least 30kg (typically around 10 years of age), a lower-dose (1mg) version for patients weighing 15kg and above is anticipated.

Advantages of EurNeffy Nasal Spray Over Traditional AAIs

Needle-Free Administration

One of Neffy’s most significant benefits is eliminating the anxiety and discomfort associated with needle injections. This makes Neffy especially valuable for children and individuals with needle phobia, enhancing compliance and confidence in managing allergic emergencies.

Ease of Use

Neffy’s nasal spray device is intuitively designed for rapid, uncomplicated administration. This user-friendly feature enables quick action during stressful allergic episodes, significantly reducing delays in administering life-saving adrenaline.

Shelf-life, Portability and Stability

Neffy’s compact nasal spray device is easier to carry and manage compared to traditional, sometimes bulky AAI devices.

Importantly. Neffy is expected to have an extended shelf life and greater stability even after exposure to higher environmental temperatures, addressing common concerns related to the storage and efficacy of AAIs.

How Does Adrenaline via EurNeffy Work?

Adrenaline (epinephrine) is a hormone naturally produced by the body. During anaphylaxis, administering adrenaline rapidly counteracts severe symptoms by:

• Increasing heart rate and blood flow

• Improving heart muscle contractions

• Opening the airways

• Reducing swelling and hives

  • It may help stabilise effector cells such as mast cells and basophils, hence earlier administration is recommended.

Neffy delivers adrenaline via nasal absorption, quickly entering the bloodstream to produce systemic effects comparable to those of traditional intramuscular injections.

Clinical Evidence Supporting EurNeffy’s Efficacy

Neffy’s approval by regulatory bodies such as the FDA and EMA was based on robust clinical data.

Neffy’s approval is based on clinical pharmacology studies demonstrating that the pharmacokinetic (PK) and pharmacodynamic (PD) profiles of Neffy are comparable to those of established intramuscular epinephrine injection products, such as EpiPen, with similar systemic exposure and hemodynamic responses (pulse rate and systolic blood pressure) in both healthy adults and patients with type I allergy.

A phase 1 crossover study in healthy subjects showed that Neffy 2 mg produced peak plasma epinephrine levels bracketed by those of EpiPen and manual IM injection, and resulted in comparable or greater increases in pharmacodynamic parameters (pulse rate, blood pressure) relative to injection products. In pediatric patients (4–17 years, ≥15 kg), a single dose of Neffy (1 mg for 15–<30 kg, 2 mg for ≥30 kg) produced PK/PD responses within the adult range, supporting extrapolation of efficacy to this population.

A phase 3 open-label study in pediatric food allergy patients demonstrated that Neffy successfully treated oral food challenge–induced anaphylaxis symptoms, with a median symptom resolution time of 16 minutes and no need for a second dose in the initial reaction. Adverse events were consistent with known epinephrine effects, including tremor and nasal erythema.

The FDA label specifies dosing as one spray of Neffy 2 mg for patients ≥30 kg and one spray of Neffy 1 mg for patients 15–<30 kg, with a second dose permitted after 5 minutes if symptoms persist. The safety and effectiveness in patients <4 years or <15 kg have not been established.

How to Administer EurNeffy Nasal Spray

Neffy is administered through the nostril. Aim for the forehead (this is a more straightforward technique than that required for hayfever nasal sprays).

If symptoms persist or worsen after the first dose, a second dose may be administered in the same nostril, contrary to standard AAI guidance, which recommends alternating injection sites.

The device need not be ‘primed’ (or a dose may be lost).

If this is your first time exploring allergy treatments for your child, consider consulting a paediatric allergy specialist in London to create a personalised care plan.

Potential Side Effects of EurNeffy

Like all medical treatments, Neffy has associated side effects, although they are typically mild and short-lived. Common side effects include:

• Nasal irritation, itchiness, or congestion (nasal stinging is reported as the most common side effect)
• Throat irritation
• Headache or dizziness
• Fatigue or jitteriness (as expected with adrenaline)
• Abdominal discomfort or nausea
• Sneezing or a runny nose

Despite these side effects, the benefits of rapid adrenaline delivery during anaphylaxis substantially outweigh any temporary discomfort.

Availability of EurNeffy in the UK

Currently, Neffy nasal spray has regulatory approval from both the FDA and EMA. It is being disseminated to the NHS UK market.

Patients can decide with their HCP which device they prefer to carry.

Managing Allergies Beyond EurNeffy

While Neffy offers an exciting new treatment option, long-term allergy management is essential. Regular allergy reviews, specialist follow-ups, and proactive care strategies such as oral immunotherapy can improve quality of life and reduce allergic reactivity over time.

Parents managing multiple allergies may find these guides helpful:

• Most common childhood food allergies
• Food allergy symptoms in infants

For an even broader overview, the London Allergies blog covers common conditions, triggers, and treatment advancements.

Conclusion

Neffy nasal spray represents a significant step forward in allergy emergency care, offering a needle-free and easy-to-use alternative for treating anaphylaxis.

With comparable effectiveness to traditional auto-injectors and added convenience for everyday use, it holds particular promise for children, schools, and individuals managing severe allergies.

While its NHS rollout is still pending, understanding how Neffy fits into your broader allergy treatment plans is vital.

Until it becomes widely available in the UK, ongoing support through allergy testing, specialist appointments, and personalised treatment strategies remains essential.

For those seeking up-to-date information or tailored care, London Allergy Consultants continues to provide trusted guidance for every stage of allergy management.

Frequently Asked Questions

• When will EurNeffy be available in the UK?

  EurNeffy is expected to be available in the UK market late 2025, subject to NHS approval and regulatory integration.

• Can children use EurNeffy?

  Yes, children weighing at least 30kg (approximately 10 years and older) can use the currently approved 2mg dose.

  A 1mg dose suitable for younger children is also anticipated later in the year.

• Is EurNeffy as effective as an adrenaline auto-injector?

  • Clinical trials indicate that EurNeffy achieves comparable adrenaline blood levels and physiological effects as traditional AAI’s.

  • Data from clinic challenge settings suggest equivalent efficacy to that achieved with AAI, i.e., a single dose of adrenaline (regardless of whether this is given IMI or via the nasal route) will be effective. In 10% of cases, a second dose of adrenaline is required.

• Will EurNeffy completely replace AAIs?

  • No, EurNeffy provides a reliable alternative for suitable individuals, but traditional AAIs will remain essential, especially for children weighing under 30kg or patients unable to use a nasal administered product, such as those with nasal polyps, atresia, or neurodiversity.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way. We are happy to assess babies (infants), toddlers, young children, adolescents and young adults with allergies.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

What is Xolair?

Xolair is a medication used to reduce allergic reactions from accidental food exposure in patients with IgE-mediated food allergies. It is administered via subcutaneous injections and is not for emergency treatment of allergic reactions.

Xolair may be used for three different reasons. 

1. Ongoing treatment, over many months, to protect against food allergic reactions. 
2. Used for 2-4 months to protect during higher risk life events e.g travel, commencing university…
3. To facilitate Oral Immunotherapy (this is offered in ACE - Allergy Centre of Excellence, starting 2026)

Who Can Use Xolair?

• Age: Approved for patients aged 1 year and older. However, repeat injections may be challenging for younger children.
• Eligibility: Suitable for patients with severe or multiple food allergies, confirmed by a rigorous diagnosis.
• Contraindications:
  • Severe hypersensitivity to Xolair or its ingredients.
  • Latex allergy (present in needle caps of prefilled syringes).
  • Certain parasitic infections may increase risk.
  • Patients with cancer (potential increased risk of certain cancers).
• Note: Xolair is not for emergency treatment of allergic reactions.

Pre-Treatment Requirements

• Total Serum IgE Test: Must be measured and written on the prescription to determine dosing based on IgE levels and body weight.
• Confirmed Diagnosis: A thorough diagnosis of severe or multiple food allergies is required.

Dosing and Administration

• Dosing:
  • Determined by pre-treatment total IgE levels and body weight.
  • Ranges from 150 mg (1 injection) to 600 mg (4 injections).
  • Administered every 2 or 4 weeks (most commonly every 4 weeks; 2-weekly for very high IgE levels).
• Duration:
  • Continuous treatment for ongoing protection.
  • For travel, at least 2–3 months of treatment is needed before departure, with monthly injections during travel.
  • No "fast-track" option; the medication requires time to be effective.
• Administration:
  • Initiated in a healthcare setting, prepared to manage potential anaphylactic reactions.
  • After training, patients may self-inject.

Storage and Travel

• Storage:
  • Store in a refrigerator (2°C–8°C / 36°F–46°F) in its original carton to protect from light.
  • Do not freeze.
  • Can be kept at room temperature (up to 25°C / 77°F) for a maximum of 48 hours. Discard if not used within this time.
• Travel:
  • Ensure proper refrigeration during transport.
  • Plan for consistent dosing (at least 2 months before travel for effectiveness).

Benefits of Long-Term Use

• Reduced Severity: Desensitises the immune system, making accidental exposure reactions less severe.
• Improved Quality of Life: Decreases anxiety and fear related to food allergies.
• Enhanced Safety: Provides an added layer of protection against life-threatening reactions.
• Important: Xolair must be used with ongoing food allergen avoidance and standard allergy management (e.g., carrying adrenaline auto-injectors).

Key Reminders and what happens when we stop Xolair but continue with OIT

• Xolair is a maintenance therapy, not a cure or emergency treatment.
• Continue all standard allergy management protocols.
• Tolerance to the food allergen generally decreases when omalizumab is discontinued in patients undergoing food oral immunotherapy (OIT) with adjunctive omalizumab. Omalizumab acts by binding free IgE, thereby reducing allergic reactivity, but it does not induce long-term immunologic tolerance. Multiple studies and systematic reviews indicate that while omalizumab facilitates rapid and safer desensitisation during OIT, its discontinuation is associated with a loss of protection and an increased risk of allergic reactions, including anaphylaxis, particularly if OIT is continued without omalizumab or if omalizumab is stopped abruptly.Real-world registry data and clinical trials show that a subset of patients can maintain desensitisation after omalizumab withdrawal. Still, a significant proportion experience a decline in tolerance, with some reverting to clinical reactivity and experiencing adverse events. The risk of loss of tolerance is higher in those with higher allergen-specific IgE/total IgE ratios and in those with more severe baseline allergy.
• Sustained unresponsiveness (i.e., long-term tolerance after stopping both OIT and omalizumab) is achieved in only a minority of patients.Therefore, omalizumab should be viewed as a facilitator of desensitisation rather than a curative therapy, and discontinuation requires careful monitoring and risk assessment. The need for ongoing therapy versus the risk of adverse events after withdrawal should be individualised, and patients should be counselled that omalizumab does not induce permanent tolerance to food allergens.

As per recent EAACI guidelines, with Prof du Toit as Senior Author, OIT is recognised as a valid option for the management of food allergy.

Oral Immunotherapy to food was first described in 1908 in The Lancet  - a case of egg poisoning’ - by a physician practising in Harley Street (pre NHS). This report (open access on the link above) is highly informative. It reflects the process of OIT rather well, where even very allergic patients can enjoy a rise in the threshold of the allergen to which they are allergic.

OIT to foods has enjoyed a massive leap forward thanks to the rigorous, extensive international studies (Palisade & Artemis) that underpin the licensing of a peanut OIT product. Thanks to these studies, we now understand the best regimens and products for successful OIT and the likely associated risks and side effect profiles.

Oral Immunotherapy: A Treatment, Not a Cure, for Food Allergies

Oral Immunotherapy (OIT) represents a significant advancement in the management of food allergies, offering a proactive treatment approach for many patients. However, it is crucial to understand that OIT is not a cure for food allergies. Instead, it is a medical treatment aimed at increasing an individual's tolerance to a specific food allergen, thereby reducing the risk of severe reactions to accidental exposure.

The primary goal of OIT is to achieve a state of desensitisation. This is a temporary state where a person can consume a certain amount of their food allergen without triggering an allergic reaction, as long as they continue to consume a regular maintenance dose. If the person stops their daily dose, their allergy is likely to return. The main benefit of desensitisation is to provide a safety net against accidental ingestion of the allergen, which can significantly improve the quality of life for both patients and their families.

A more profound and less common outcome of OIT is sustained unresponsiveness, which is sometimes referred to as remission. In this state, an individual can stop taking their daily maintenance dose for a period of weeks or even months and still be able to consume the allergen without a reaction. While this is a more durable form of tolerance, it is not achieved by all patients and is still not considered a permanent cure. Even those who achieve sustained unresponsiveness are typically advised to continue carrying an epinephrine auto-injector. We now offer OIT to a wide variety of foods in our Allergy Centre of Excellence.

Currently, we offer OIT to the following allergens; more are being added each month.

• Sesame Oral Immunotherapy (OIT)
• Peanut Oral Immunotherapy OIT
• Palforzia Oral Immunotherapy OIT
• Almond Oral Immunotherapy OIT
• Walnut Oral Immunotherapy OIT
• Coconut OIT
• Brazil Nut OIT
• Cashew Nut OIT
• Mustard OIT
• Lentil OIT
• Pea OIT
• Chickpea OIT
• Milk OIT
• Egg OIT
• Wheat OIT

Please be aware of the following principles when considering an OIT program, as OIT is not for everyone and a shared-decision making process is always required:

• OIT is not curative; i.e., for most allergens, ongoing therapy is required to maintain tolerance.

• OIT seeks to raise the threshold at which a reaction would occur, aiming to render your child ‘bite proof’, i.e. protected from accidental everyday exposures.

• OIT is allergen-specific and protects only against the allergen that is eaten (except cashew and walnut, where protection may also be enjoyed for pistachio and pecan nuts, respectively).

• Based on the most common experiences of patients undergoing Oral Immunotherapy (OIT), the primary side effects are typically mild and may include:

  • Oral symptoms: Itching, tingling, or a metallic taste in the mouth.

  • Skin reactions: Hives, rash, or flushing.

  • Gastrointestinal issues: Abdominal pain, cramping, nausea, or vomiting.

  • Nasal or respiratory symptoms: Sneezing, runny nose, or a tight feeling in the throat.

  While less common, more severe allergic reactions, including anaphylaxis, can occur, which is why OIT is always conducted under strict medical supervision.common and usually affect the GI system

• More severe allergic side effects can occur, sometimes unpredictably, i.e. after months of tolerance. This can arise due to co-factors such as exercise, infections, and medication use.

• Emergency medication will, therefore, always be required on your person while undergoing OIT.

—————————————————————————————————————————————

Typically, the process of starting OIT in a private practice involves an initial consultation to assess your child's suitability for the treatment. This will likely include a detailed medical history and may require recent skin prick or blood tests. If OIT is deemed appropriate, the treatment will begin with a very small, controlled dose of the allergen administered in one of our ACE clinics. This is followed by a structured programme of daily doses at home, with regular visits to the clinic to increase the amount of the allergen gradually. The clinical teams provide close support and guidance throughout the process

Please feel free to discuss advances in the field and the potential for OIT for your child when consulting with Prof du Toit.

Prof Du Toit and Dr Foong have been investigators on many of these trials and are actively involved in research testing other treatment modalities, e.g. Viaskin trials.

Palisade Trial

Artemis

PACE Study

• Cow’s Milk Protein Allergy (CMPA) is one of the most common food allergies in infants, affecting around 2–7% of babies in their first year.
• This condition occurs when a baby’s immune system mistakenly sees cow’s milk protein as harmful and reacts against it.
• CMPA can be particularly distressing for both the child and the parent, especially when symptoms are hard to link back to dairy, e.g. eczema, blood in stool, repeat vomiting some hours later….
• Fortunately, recognising the signs early can lead to a timely diagnosis and a manageable treatment plan.

What Is CMPA?

CMPA, also referred to as cow’s milk allergy, is an immune reaction to proteins found in cow’s milk.

Unlike lactose intolerance, which is a digestive issue involving sugar in milk, CMPA is an immune allergic response to the protein in cow’s milk.

The responsible antibody is an IgE antibody, which can be readily measured by blood tests or skin tests.

In true CMPA, even small amounts of milk protein can trigger symptoms.

CMPA symptoms may develop in formula-fed babies and, in some cases, even in breastfed babies.

CMPA Symptoms can vary enormously -Watch For

Symptoms of CMPA can vary widely across infants and may affect multiple organ systems.

• One of the most common signs is skin irritation. The typical CMPA rash presents as salmon-pink, itchy patches called hives (urticaria). These rashes typically develop on the face, neck, or in skin folds. They come on soon after ingestion and usually subside in hours.
• In some cases, facial swelling of the lips or eyelids may occur after feeding - known as ‘angioedema’.
• Pre-existing eczema rashes may also flare for a few days after a CMPA reaction.
• Digestive symptoms are also frequent and can be misleading, sometimes resembling reflux or colic.
• Parents may notice that their baby cries excessively or arches their back in pain during or after feeds -these mannerisms often indicate stomach discomfort or acid reflux associated with dairy allergy.
• Some infants also present with respiratory symptoms, such as a new-onset, postprandial, persistent cough, wheezing, nasal congestion, or noisy breathing. These are less common but more serious than skin or digestive symptoms; they are more concerning and require an urgent medical opinion.
• Another concern is feeding difficulty. Babies with CMPA may refuse to feed, cry during feeding, or fail to gain weight as expected, all of which suggest that feeding is causing discomfort or pain in their mouths and tummy.
• Babies may vomit after feeding, experience frequent diarrhoea, or show signs of constipation (these symptoms suggest a non-IgE mechanism, so tests may be negative).
• Fresh blood streaks in the stool suggest a non-IgE variant of CMPA, known as Cow's Milk Protein-Induced Colitis (CMPIE).
• Another form of non-IgE CMP sensitivity is Food protein induced Enterocolitis syndrome (FPIES), typically presenting with profuse vomiting 2-4 hours after food intake. A rash is not noted with this variant.
• You may also find the EAACI Guidelines, in which Prof. du Toit was glad to participate as an author of use; Diagnosis and management of Non-IgE gastrointestinal allergies in breastfed infants- An EAACI Position Paper and  EAACI guidelines on the diagnosis of IgE-mediated food allergy

Frequently Asked Questions

• What are the main CMPA baby symptoms?

  The typical symptoms of cow's milk allergy (CMA) in infants and young children vary depending on whether the allergy is IgE-mediated or non-IgE-mediated.

  IgE-mediated CMA usually presents with acute onset symptoms (within 2 hours of exposure), including vomiting, urticaria, angioedema, erythema, lethargy, and respiratory symptoms such as wheezing or stridor. These symptoms are reproducible with subsequent exposures to cow’s milk protein and typically resolve within hours.

  Non-IgE-mediated CMA is characterized by delayed onset symptoms (hours to days after exposure), most commonly involving the gastrointestinal tract. These include vomiting, diarrhea, blood in stools (allergic proctocolitis), chronic diarrhea, regurgitation, abdominal pain, failure to thrive, and persistent crying or irritability. Cutaneous symptoms such as eczema and, less commonly, respiratory symptoms may also occur. The clinical presentation can overlap with common infant symptoms, making diagnosis challenging.

  Most infants with CMA have symptoms involving more than one organ system, with gastrointestinal (50–60%), cutaneous (50–60%), and respiratory (20–30%) manifestations being most frequent. Symptoms may be immediate (within 1 hour) or delayed (after 1 hour) following ingestion of cow’s milk protein.

  It is important to note that many of these symptoms are nonspecific and common in infancy, so diagnosis should be confirmed by elimination and challenge procedures to avoid misdiagnosis.

• Testing for cows milk allergy

  Testing for cow's milk allergy involves a combination of clinical assessment and diagnostic procedures. The process begins with a detailed clinical history and physical examination to assess the likelihood of cow's milk allergy and to characterize the type of reaction (IgE-mediated, non-IgE-mediated, or mixed).

  For IgE-mediated cow's milk allergy, the following tests are used:

  • Skin prick testing (SPT) with commercial cow's milk extracts or, if unavailable, with fresh milk (prick-prick method). A wheal ≥3 mm larger than the negative control is considered positive. SPT is sensitive but not highly specific, and a negative result has a high negative predictive value, especially in infants.[4][5]

  • Serum cow's milk-specific IgE measurement (using assays such as ImmunoCAP or similar). Elevated levels support sensitization, but the predictive value depends on the cutoff used and the clinical context. For example, a specific IgE level ≥2.5 kU/L has a high positive predictive value in infants with a convincing history. However, sensitization alone does not confirm clinical allergy.

  • Component-resolved diagnostics (e.g., measuring IgE to casein, α-lactalbumin, β-lactoglobulin) can refine risk assessment and may help predict the likelihood of reaction during oral food challenge.

  For non-IgE-mediated cow's milk allergy, SPT and specific IgE are often negative. In these cases, atopy patch testing and emerging biomarkers (e.g., faecal calprotectin) have been studied, but their diagnostic utility is limited and not standardized.

  The gold standard for diagnosis is the oral food challenge (OFC), typically performed in a supervised setting after a period of elimination. This is especially important when test results are equivocal or when non-IgE-mediated allergy is suspected.

  Allergy Societies emphasize that OFC is required to confirm the diagnosis in most cases, as neither SPT nor specific IgE alone is definitive.

  In summary, testing for cow's milk allergy is based on clinical history, SPT, serum-specific IgE, and, when necessary, oral food challenge, with the latter being the definitive diagnostic tool.

  Please do get in touch with us if you require testing, we offer all the above modalities.

• Which milk is safe for my milk allergic infant

  In the UK, if an infant has a confirmed or suspected cow's milk allergy, the following milk options are generally considered safe and are recommended under medical supervision:

  1. Breastfeeding: Breast milk is the ideal source of nutrition for babies. If a breastfed infant is reacting to cow's milk protein, the mother may be advised to eliminate cow's milk and dairy products from her own diet, but we try not to do this if possible as it is more natural for the allergic infatnt to ‘see’ the cows milk protein through moms diet.

  2. Hypoallergenic Formulas: For formula-fed babies, a healthcare professional we will prescribe a special "hypoallergenic" formula. These are not available over the counter and are specifically designed for infants with cow's milk allergy. There are two main types of hypoallergenic formulas:

  Extensively Hydrolysed Formulas (EHF): These are the first-line treatment for most cases of mild to moderate cow's milk allergy. The cow's milk proteins have been broken down into smaller pieces, making them less likely to trigger an allergic reaction.

  Amino Acid Formulas (AAF): These are used for infants who have severe allergic reactions or who do not tolerate an extensively hydrolysed formula. The protein in these formulas is completely broken down into its individual building blocks (amino acids) and is not based on cow's milk.

  Soya-based Formulas (for some infants over 6 months):

  Soya-based formulas are not suitable as a first-line alternative for infants under six months of age. For infants over six months, a dietitian may advise on whether a soya formula is appropriate, as some babies with a cow's milk allergy can also react to soya protein. These are hard to access in the UK.

  Rice based milk formula. This is a palatable and safe option now available in the UK, trading as Arize. Arize contains extensively hydrolyzed rice protein instead of cow's milk protein, is hypoallergenic, and can be used from birth onwards.

  What to Avoid:

  Standard Cow's Milk Formula: This is not safe and will cause an allergic reaction.

  Other Mammalian Milks: Milks from other animals like goats and sheep are generally not suitable as they contain similar proteins to cow's milk and are likely to cause a reaction.

  Lactose-free Milk: This is not a substitute for hypoallergenic formula as it still contains the cow's milk protein that causes the allergy.

  Plant-based Milk Alternatives (e.g., oat, almond, coconut, hemp): These are not nutritionally complete for babies and should not be used as a main milk drink for infants, especially under the age of one. They can, however, be used in small amounts in cooking or on cereal for babies over six months, provided they are fortified with calcium and other essential nutrients, and with the guidance of a healthcare professional.

  Rice Milk: Due to its naturally occurring arsenic content, rice milk should not be given to children under 4.5 years old. description

• Breastfeeding and cows milk intake, does this pass through to baby?

  Transfer of Cow's Milk Components

  • Yes, transfer occurs: Components of cow's milk, specifically cow's milk proteins such as beta-lactoglobulin and casein-derived peptides, can pass into human breast milk after a mother consumes dairy products.

  • Mechanism: The process involves the digestion of cow's milk proteins in the mother's gut, absorption into her bloodstream, and subsequent transfer into the breast milk, often as peptide fragments rather than fully intact proteins. The most commonly detected protein is beta$-lactoglobulin, but casein fragments may also be present.

  Concentration and Allergy Risk

  • Trace Amounts: The concentration of these proteins in breast milk is generally very low and highly variable.

  • Low Risk for Most Infants: For most infants, these trace amounts are well below the threshold required to trigger an allergic reaction, even in those diagnosed with Cow's Milk Allergy (CMA).

  • Rare Sensitisation: In rare cases, clinical challenge studies have demonstrated that highly sensitive infants with proven CMA may react to these minimal levels of transferred proteins.

  • Overall Probability: The overall probability that a single breastfeed contains sufficient antigen to elicit an acute allergic reaction in a sensitive infant is considered low, with the majority of breast milk samples containing minimal or undetectable levels of these proteins.

• Does the smell of my babies poo indicate a CMPA?

  • A slightly bizarre but frequent question in the clinic. The answer is generally no. But an ‘upset’ GI biome can produce abnnormal poos in many different ways (colour, texture, smell…)

  • There is no evidence in the medical literature that abnormal odour of stool or body is a diagnostic feature of CMPA.

  • The clinical presentation of CMPA in infants is variable and may include gastrointestinal symptoms such as vomiting, diarrhoea, blood in stool, constipation, and failure to thrive, as well as cutaneous and respiratory manifestations, but abnormal stool or body odour is not recognised as a specific or reliable sign

• Is Goats Milk safe for Cows Milk Allergic Infants?

  Goat's milk should not be used as a substitute for cow's milk in individuals with cow's milk allergy due to the high risk of allergic reactions and cross-reactivitity.

  Goat's milk proteins exhibit substantial similarity and immunologic cross-reactivity with cow's milk proteins, resulting in frequent allergic reactions in individuals with cow's milk allergy, especially those with IgE-mediated disease.

  Double-blind, placebo-controlled food challenge studies demonstrate that the majority of children with cow's milk allergy will react to goat's milk, and skin prick testing and IgE inhibition assays confirm strong cross-reactivity.

  Severe reactions, including anaphylaxis, have been reported following goat's milk exposure in this population

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a severe, non-IgE-mediated food allergy primarily affecting infants and young children. Often described as an "atypical food allergy," FPIES triggers gastrointestinal symptoms, including severe vomiting and diarrhoea, after ingestion of specific food proteins. 

Despite its seriousness, FPIES remains frequently misdiagnosed due to its unique and varied presentations, e.g. delayed onset in symptoms and features such as profuse self-resolving vomiting.

Increasing awareness among parents and healthcare providers is critical for early identification and proper management.

Prof. Du Toit participated in a UK birth cohort (2001–2018) involving 158,510 children, of whom 214 cases were found to have FPIES, with a prevalence of ~0.14 %. The British Paediatric Surveillance system recorded an incidence of 0.006% during 2019–2020. In the US, 0.51 % of children and 0.22 % of adults had FPIES in 2015–2016.

FPIES Symptoms

Symptoms of FPIES typically begin shortly after ingesting the triggering food protein. Common symptoms include:

• Severe and persistent vomiting BUT only 2-4 hours after ingestion, sometimes ending in bile-stained green vomit.
• Vomiting, sometimes associated with diarrhoea.
• Towards the end of the vomiting spells, lethargy and pallor (pale skin) may ensue, often described as a ‘rag doll’ appearance.
• Dehydration is rare but possible. Shock (hypovolaemic shock in severe cases) is exceptionally rare.

These symptoms may mimic sepsis, seizures, or a cardiac event, often leading to confusion and delayed diagnosis. According to Allergy UK, approximately 20% of affected infants may initially receive an incorrect diagnosis.

For further insight into common allergic symptoms, our blog on food allergy symptoms in infants provides additional context.

FPIES Diagnosis

Accurate diagnosis of FPIES requires a careful evaluation of symptoms, a thorough dietary and clinical history, and the exclusion of other conditions.

Oral food challenges are required to assist with the diagnosis in some cases and will be needed to assess for resolution (which usually occurs within 1-3 years after the last symptoms).

Diagnostic Methods Include:

• Comprehensive clinical evaluation
• Oral food challenges under clinical supervision (considered the gold standard, unless the history is unequivocal)
• We undertake controlled oral challenges to definitively diagnose FPIES, ensuring patient safety and accurate identification of triggers.

Common FPIES Triggers

Cow’s milk is the predominant trigger worldwide (35–67 % of cases) according to multiple studies. Soy reactions occur in 36–40 % of US infants. Fish, eggs, grains, fruit, or vegetables are also common, often depending on the region. FPIES triggers vary widely but typically include proteins from:

• Cow’s milk (most common trigger, affecting approximately 50% of FPIES cases)
• Root vegetables
• Soy
• Grains (oats, barley, rice)
• Fish and shellfish
• Eggs
• Poultry

Awareness of these triggers significantly reduces the risk of recurrent episodes. Identifying these triggers often requires careful food diaries and supervised reintroduction by allergy specialists.

FPIES Rash and lack of Skin Manifestations

Gastrointestinal symptoms dominate.

FPIES does not typically cause transient rashes, unlike IgE-mediated food reactions.

Understanding FPIES Poop Changes

Stool characteristics in FPIES may involve frothy loose stools around the time of reactions. Blood in stool would indicate a separate non-IgE mediated condition, called food-induced colitis.

Stool Test Abnormalities in FPIES Reactions

Stool tests in FPIES are nonspecific but may show abnormalities during reactions.

Stool examination may reveal intact polymorphonuclear neutrophils or eosinophils, indicating gastrointestinal inflammation.

Continuation of Stool Test Abnormalities in FPIES Reactions

1. Reducing Substances:

   • Increased carbohydrates in stool may be detected, reflecting malabsorption due to intestinal inflammation, which should be short-lived.

1. Bloody or Mucousy Stools: only in food-induced colitis, usually milk-induced colitis.

Identifying FPIES Trigger Foods

Recognising trigger foods involves rigorous dietary tracking and supervised food reintroduction under medical guidance if needed.

Each case requires individualised care, often involving dietitians to manage nutritional needs and avoid deficiencies.

Food Protein Allergy vs FPIES

FPIES differs significantly from typical food protein allergies (IgE-mediated):

• FPIES reactions are delayed (often 1–4 hours after ingestion)
• No immediate respiratory or skin symptoms are associated (but these are typical in IgE allergies)
• Requires different diagnostic and management strategies

Understanding these distinctions is crucial for appropriate medical intervention and dietary management.

Chronic FPIES

Chronic FPIES presents prolonged diarrhoea and poor growth due to continuous exposure to trigger foods, complicating diagnosis. This diagnosis should only be made after a thorough exclusion of more common and harmful chronic GI diseases.

Management involves careful dietary management, nutritional supplementation, and ongoing monitoring by allergy specialists to support growth and development.

Cow’s Milk Protein-Induced Enterocolitis (CMPIE)

Cow’s milk is among the most common triggers of colitis. This condition most commonly occurs in infants after exposure to cow's milk protein through breast milk or a cow's milk-based infant formula. Fresh blood is typically noted in the infant's stool, which rapidly resolves with maternal milk elimination (if breastfed) or switching to a modified cow’s milk formula.

In addition to blood in the stool, the infant may exhibit painful gastrointestinal symptoms, and the stools may be frothy and abnormal, containing flecks of fresh blood.

Cow's Milk protein enterocolitis requires complete avoidance, particularly in formula-fed infants. Alternative nutritional options, such as extensively hydrolysed or amino-acid-based formulas, are recommended under the supervision of a specialist.

Does FPIES Go Away?

Many children outgrow FPIES by the age of 3 to 5, especially with milk and soy triggers. Studies show that around 60-90% of children outgrow milk and soy FPIES by age 3. However, reactions to fish or shellfish may persist into adulthood, necessitating lifelong dietary caution.

Regular monitoring and carefully supervised food trials are essential for safely determining if and when trigger foods can be reintroduced.

Managing and Treating FPIES

Currently, there is no definitive cure for FPIES. Management strategies include:

• Strict avoidance of trigger foods
• Emergency preparedness (hydration and emergency treatment plans)
• Nutritional support and guidance from dietitians
• Regular medical follow-ups and growth monitoring
• Educating caregivers on recognising early symptoms of reactions

Prompt medical intervention is crucial during acute reactions to prevent severe complications.

When to Seek Immediate Medical Attention

Parents and caregivers should seek immediate medical attention if signs of shock or severe dehydration occur:

• Extreme lethargy or unresponsiveness
• Severe, uncontrollable vomiting
• Pale, clammy skin
• Weak or rapid pulse

Our blog on what to do if your baby has an allergic reaction to food provides additional emergency response advice.

Expert FPIES Care at Our Clinic

Our allergy clinic, led by Prof George du Toit, a leading paediatric allergy specialist in London, specialises in diagnosing and managing FPIES. Prof du Toit’s extensive research and clinical expertise ensure patients receive cutting-edge care, including supervised oral food challenges, tailored dietary management, and detailed educational resources for families.

Resources and Support for Families

Families managing FPIES can access additional resources, peer support, and detailed information through organisations such as IFPIES, an international resource dedicated to improving outcomes for FPIES patients. Support groups and patient forums provide invaluable emotional support and practical guidance for daily management. 

Families can find further reading on our blog, including ‘What to do if your baby has an allergic reaction to food’ and ‘Most common childhood food allergies’. Peer support groups like IFPIES UK provide vital emotional and practical guidance.

Conclusion

Understanding Food Protein-Induced Enterocolitis Syndrome (FPIES) is crucial for effective management and improved outcomes. Accurate diagnosis, careful dietary management, and expert medical support empower families to effectively manage this challenging condition. For specialised FPIES diagnosis and care, our clinic provides comprehensive services tailored to each patient’s needs.

For more information or to book an appointment, please contact us.

Frequently Asked Questions

Can breastfeeding protect against FPIES?

Exclusive breastfeeding does not eliminate risk of developing FPIES

Are siblings at higher risk of developing FPIES?

Yes, siblings of children with FPIES have a slightly increased likelihood of developing the condition.

How common is FPIES?

FPIES is relatively rare, with precise prevalence uncertain due to frequent misdiagnosis.

Can adults develop FPIES?

FPIES primarily affects children, but rare adult-onset cases have been reported, most commonly to shellfish

Is FPIES life-threatening?

While FPIES reactions can be severe, prompt recognition and treatment significantly reduce risks.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way. We are happy to assess babies (infants), toddlers, young children, adolescents and young adults with allergies.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

The connection between the microbiome and allergies has become increasingly compelling, providing essential insights into why some people develop allergies while others do not. According to the Harvard School of Public Health, the human microbiome, consisting of trillions of microorganisms like bacteria, fungi, and viruses, plays a pivotal role in immune system development and function. 

This detailed guide explores the influence of microbiome health on allergies, examines recent scientific findings, provides practical guidance on optimizing gut health, and highlights ways to potentially mitigate allergic responses.

What is the Microbiome?

The microbiome refers to the extensive ecosystem of microorganisms residing primarily in the gut, but also found on the skin and other body parts. As detailed by the National Institutes of Health (NIH), these microbes are crucial for digestion, nutrient absorption, and the regulation of immune responses. A balanced microbiome promotes overall wellness, while imbalances, known as dysbiosis, can lead to numerous health issues, including heightened allergic reactions.

The microbiome's diversity and stability depend on various factors such as diet, environment, medication, and genetics, influencing individual health outcomes significantly.

The Connection Between Microbiome & Allergies

Scientific evidence underscores a robust relationship between the microbiome and allergic diseases. According to the American Academy of Allergy, Asthma & Immunology, disruptions in gut microbiota, particularly during critical developmental periods such as infancy are strongly associated with elevated risks of allergies and asthma.

Key factors from current research include:

• Early-life Exposure: Early interactions with microorganisms shape immune development. For instance, babies born via cesarean section or those not breastfed may have altered microbiomes, the impact of which on our health is still being studied. Exclusive breastfeeding in infancy is associated with a gut microbiome dominated by Bifidobacterium species, which is considered beneficial for immune development and protection against pathogens. Human milk oligosaccharides in breast milk selectively promote these taxa, while formula feeding leads to a more diverse but less bifidogenic microbiota, with higher abundance of potentially pathogenic species
• Antibiotic Overuse: Frequent antibiotic treatments during early childhood can severely disrupt microbiome balance.
• Dietary Impacts: Diets dominated by processed foods and low in fiber negatively influence gut flora, correlating with a heightened likelihood of allergic reactions.

How the Microbiome Influences Allergies

The microbiome profoundly impacts immune education and regulation. Imbalances within the microbiome can trigger misguided immune responses, resulting in allergies where harmless substances are incorrectly flagged as threats, prompting unnecessary immune reactions.

For comprehensive allergy evaluations, including detailed food allergy testing, consider visiting London Food Allergy Testing.

According to the Cleveland Clinic, microbiome diversity is critical for maintaining immune tolerance, significantly lowering the risk of allergic conditions.

Probiotics & Allergies: Can They Help?

Probiotics, beneficial bacteria obtained through supplements or fermented foods, have been extensively studied for their potential to positively influence microbiome composition and reduce allergic symptoms. 

Research from Johns Hopkins Medicine indicates that specific probiotic strains may effectively reduce allergy severity, particularly conditions like eczema and hay fever, however the strength of the evidence is not compelling.

Prebiotics and probiotics can modulate the microbiome, particularly in situations of dysbiosis or in infants at risk (e.g., those born by cesarean section or exposed to antibiotics). Prebiotics such as inulin and galacto-oligosaccharides increase Bifidobacterium abundance, while certain probiotic strains (e.g., Bifidobacterium, Lactobacillus) may help restore or maintain a healthy microbiota, though effects are strain-specific and evidence for routine use in healthy children remains limited

Key considerations regarding probiotics include:

• Effective strains, such as Lactobacillus and Bifidobacterium, have shown the most promise in reducing allergies. However, ingesting high enough amounts of live bacteria can be challenging, as most commercial products are freeze-dried and the majority of the organisms are not viable.
• Timing: Practices that aim to achieve normal gut colonisation during infancy and early childhood may prove to be the most effective in preventing allergies.
• Diet Synergy: Probiotics work best when integrated with dietary diversity, fermentable foods and a fibre-rich diet (prebiotics), fostering a more balanced microbiome.

To address your child's biome health, please consult with London Allergy Consultants.

Practical Tips to Support Your Microbiome & Reduce Allergies

Adopting these actionable steps can effectively enhance gut health and reduce allergy symptoms:

• Consume a Fiber-Rich Diet: Foods high in dietary fiber, such as vegetables, fruits, legumes, and whole grains, nourish beneficial gut bacteria.
• Include Fermented Foods: Incorporate naturally probiotic-rich foods like yogurt, kefir, kimchi, sauerkraut, and miso to boost microbiome diversity. Be cautious if allergic to cow's milk, which may be in some of these products.
• Limit Antibiotics: Use antibiotics responsibly and only under medical advice to minimise microbiome disruption.
• Breastfeeding Benefits: Breastfeeding provides infants with vital probiotics and prebiotics, which aid in early immune system development. Skin-to-skin contact with healthy parental skin may also assist with normal colonisation.
• Supplement Wisely: Select clinically-tested probiotics formulated explicitly for allergy prevention and immune health; most commercial products are freeze-dried with few living colonies within these products.

Conclusion

Exploring the link between microbiome and allergies reveals powerful strategies for managing and potentially mitigating allergic reactions. By thoughtfully nurturing your microbiome through balanced dietary choices, probiotic supplementation, and lifestyle modifications, you can significantly enhance your immune response and overall health. 

If you have specific concerns related to allergies, asthma, eczema, hay fever, or other allergic conditions, consider consulting London Allergy Consultants for specialized advice. Ongoing research continually expands our understanding, opening exciting possibilities for harnessing microbiome science to improve daily life.

Frequently Asked Questions

What diet best supports microbiome health?

A balanced diet rich in plant-based, fibre-rich foods, fermented foods, and minimal processed products is ideal for fostering microbiome diversity. Dietary diversity is also very important. Fermentable foods may also help establish a healthy gut microbiome.

Are probiotics safe for everyone?

Probiotics are generally safe for most individuals, but those with compromised immune systems or chronic health conditions should consult healthcare providers before starting supplementation with live organisms.

How long before probiotics improve allergy symptoms?

Improvement of allergy symptoms from probiotics alone is unlikely, but when used as part of a holistic gut health program, it may lead to improved GI symptoms within weeks.

Can improving gut health completely eliminate allergies?

Enhancing gut health has the potential to reduce allergy severity, but it may not fully eliminate allergies. It is most effective when part of a broader, holistic approach.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way. We are happy to assess babies (infants), toddlers, young children, adolescents and young adults with allergies.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Witnessing your baby experiencing an allergic reaction to food can be frightening and overwhelming. However, understanding exactly what steps to take during this critical moment can help you respond quickly, effectively, and confidently, ensuring your baby's safety and health. 

Around 5-8% of children experience food allergies. Thankfully, in younger children, most reactions will be of a mild to moderate nature; however, severe reactions, such as anaphylaxis, are possible. Older children are more prone to severe reactions at lower doses than younger children.

In this Blog, you'll learn to identify common allergy symptoms, take immediate steps for managing reactions, recognise severe reactions, know when to seek emergency help, follow effective aftercare, and develop long-term strategies to prevent future episodes.

Empowering yourself with this knowledge can significantly reduce stress and help maintain your baby’s well-being.

Recognising Food Allergy Symptoms in Babies

Identifying symptoms quickly is essential in managing food allergies. These symptoms vary from mild to severe:

Mild Symptoms:

• Redness around the mouth or eyes
• Mild swelling of the lips or face
• A few small raised bumps (hives/urticaria) or itchy rash
• Slight discomfort or fussiness
• Aversion/dislike of the food just eaten

Moderate Symptoms:

Mild symptoms (as above) and/or:

• Vomiting or diarrhoea shortly after eating
• Persistent coughing or wheezing
• Altered behaviour, e.g. noticeable irritability or prolonged restlessness
• Nasal symptoms include congestion or a runny nose, often accompanied by profuse nasal discharge and repeated sneezing.
• More hives

Severe Symptoms (Anaphylaxis):

A combination of the above symptoms and/or:

• Generalised pink/red colour
• Multiple hives all over body and intense scratching.
• Difficulty breathing, noisy or wheezing breath, altered voice, wheezy cough or wheezing
• Severe swelling, especially of the face, lips, digits or tongue
• Weakness, limpness, lethargy, or unusual, sudden-onset sleepiness
• Intense abdominal pain
• Pale or bluish skin colour
• Loss of consciousness, floppy or suddenly sleepy.

If severe symptoms arise, immediately treat them as an emergency and seek medical assistance without delay.

Immediate Actions: Detailed Step-by-Step Guide

Acting quickly and clearly is crucial when a baby shows signs of an allergic reaction. Follow these immediate, practical steps:

Stay Calm & Remove child from the Allergen.

• Immediately discontinue feeding the suspected allergenic food.
• Gently and carefully clean your baby's face and mouth with a soapy, damp cloth or a wet wipe to remove any traces of the allergen.

Administer Prescribed Medication Promptly:

• Give your baby an antihistamine if previously prescribed by your Doctor for mild reactions, strictly following dosage instructions.
• If your baby vomits an oral dose of antihistamines, repeat the dose.
• In cases of severe reactions, immediately administer an epinephrine auto-injector (such as an EpiPen or Neffy nasal adrenaline device when available), this is the drug of choice and will improve most allergy symptoms.

Monitor Your Baby’s Condition Closely:

• After calling for help, watch your baby’s breathing, skin, behaviour, and responsiveness carefully to detect any worsening symptoms promptly.

Call Emergency Services Immediately if Symptoms Intensify:

• If your baby’s symptoms escalate or you notice breathing difficulty, call emergency services (999 in the UK or 911 in the USA) without hesitation.

When to Seek Emergency Help

Anaphylaxis is a severe and potentially life-threatening allergic reaction that requires immediate medical intervention. According to the NHS, if your baby exhibits severe symptoms such as difficulty breathing, severe swelling, or faintness, emergency services must be called immediately. Rapid response can save lives, and every second counts.

Aftercare: Essential Steps After an Allergic Reaction

Once your baby is stabilised and safe after an allergic episode, consider these important follow-up actions:

• Schedule an appointment with an allergist or paediatrician to accurately identify and confirm the allergen. Our team can be found at London Food Allergy Testing.
• Create a detailed allergy management plan in collaboration with healthcare providers, explicitly tailored to your baby’s needs.
• Educate all caregivers, babysitters, family members, and anyone regularly involved in your baby's care about recognising allergy symptoms and responding effectively.
• Always keep prescribed medications accessible and inform caregivers of their location.

Preventing Future Allergic Reactions

Proactive measures can significantly lower the risk of future allergic episodes:

• Introduce potential allergenic foods carefully and gradually, one at a time, monitoring closely for reactions.
• Maintain a detailed food diary to help identify triggers quickly.
• Regularly consult and update your approach with pediatric allergy specialists, such as those at London Allergy Consultants, ensuring your allergy treatment strategies remain effective and current.
• Stay informed about the latest developments and recommendations in allergy prevention and treatment.

Conclusion

Quick, correct responses are essential when your baby experiences an allergic reaction to food. Recognizing symptoms, having a clearly defined action plan, seeking immediate medical help, and following preventive strategies will significantly improve outcomes. By educating yourself thoroughly and collaborating with healthcare professionals, you can confidently manage allergic reactions and ensure your baby’s safety and comfort. For further assistance or inquiries, contact us directly.

Frequently Asked Questions:

How are food allergies diagnosed in babies?

Allergists typically use clinical history (if previously exposed to the allergen) skin prick tests, blood tests, elimination diets, and supervised food challenges to accurately diagnose food allergies.

Should allergenic foods be completely avoided for babies?

No, current guidelines recommend early introduction of allergenic foods around 4-6 months of age. Studies such as the LEAP and EAT Studies, which Dr’s Du Toit and Dr Foong were involved with, have led to these dietary changes. Feel free to consult with them to get the very latest advice in this regard. There is a Blog on this topic on this website.

How quickly can an allergic reaction occur?

Allergic reactions usually appear rapidly, within minutes, and usually within the first hour. After initial symptoms, eczema may flare over hours.

Can babies outgrow food allergies?

Many babies outgrow allergies to milk, eggs, wheat, and soy by the time they enter school i.e. at around 6 years of age. However, allergies to these foods may persist in some patients, and in most patients, allergies to peanuts, tree nuts, fish, and shellfish typically persist into adulthood.

What foods commonly cause allergies in babies?

Common allergenic foods for babies include milk, eggs, sesame, peanuts, tree nuts, wheat, soy, fish, legumes and shellfish.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way. We are happy to assess babies (infants), toddlers, young children, adolescents and young adults with allergies.

[caption id="" align="alignnone" width="5792"]

Dr. George du Toit [/caption]

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Are you aware of how food allergies might impact your infant's health? Many parents struggle with anxiety when introducing new foods, fearing potential allergic reactions.

Statistics from FARE (Food Allergy Research & Education) highlight that 6-8% of infants develop food allergies. Egg and milk allergies are the most common allergies in young infants, then, peanut, cashew, other tree nuts, and sesame make up common allergies. Soya, wheat and fish are less common in the UK.

Understanding food allergy symptoms and effective management strategies provides immense value and empowers parents to be proactive in allergy prevention and, eventually, treatment if needed.

Updated Food Allergy Guidelines

The European Academy of Allergy and Clinical Immunology (EAACI) has recently overhauled its clinical guidelines for IgE-mediated food allergy, with the latest updates on Diagnosis (2023) and Management (2024/2025).

These updates represent the first major revision in a decade and emphasise a more personalised, "holistic" approach rather than a strict avoidance. Prof du Toit was glad to be a senior author on this collaboration.

Recognizing Food Allergy Symptoms in Infants

Prompt identification of food allergy symptoms in infants is essential. IgE-mediated allergy symptoms usually surface within minutes to two hours after consuming an allergen e.g. hives, swelling, dislike of the food. Usually, but not always, more than one body system will be involved e.g. skin rash and a vomit.

Non-IgE symptoms are more delayed, such as blood in stool, gastrointestinal reactions, and skin flares.

Skin Reactions:

• Hives or red, itchy bumps are common allergic reactions infants may display soon after ingesting allergenic foods.
• Eczema flare-ups might worsen noticeably following allergen consumption, suggesting a possible food-related trigger that necessitates professional eczema treatment.
• Active dislike, or aversion of the food and swelling around lips, face, tongue, or eyes indicates immediate allergic responses that warrant careful monitoring.

Digestive Issues:

• Infants might experience abdominal paind and/or vomiting shortly after consuming problematic foods, indicating an adverse reaction requiring close observation.
• Persistent diarrhoea following food introduction, often watery or mucous-filled, may signify allergy-related digestive disturbances, but as an isolated symptom, this will usually be of a non-IgE nature. The presence of blood in the stool may indicate a food-induced colitis, usually milk.
• Symptoms resembling colic or visible stomach discomfort can occur in infants due to food allergies.

Respiratory Symptoms:

• Wheezing or persistent coughing could develop during an allergic reaction; indeed, this will meet the criteria for anaphylaxis.
• Uncontrolled asthma is a risk factor for more serious allergic reactions.
• Nasal congestion, frequent sneezing, or a runny nose might also appear as part of an allergic response in infants.

Severe Reactions (Anaphylaxis):

• Infants struggling to breathe or swallow urgently need immediate medical assistance, as these indicate life-threatening reactions.
• Weakness, dizziness, fainting, or loss of consciousness are alarming symptoms that suggest severe allergic reactions or anaphylaxis.
• Pale or bluish skin or lips are critical indicators of oxygen deprivation and necessitate immediate emergency care.

If severe allergic symptoms occur, seek emergency medical care immediately.

Common Food Allergies in Infants

Certain foods commonly trigger allergic responses in infants. Awareness of these prevalent allergens allows proactive dietary management to minimize potential reactions, helping ensure infants safely navigate dietary transitions while protecting their health and wellbeing from severe allergic incidents.

Cow's Milk:

Cow's milk allergy frequently affects infants, with exposure via formula or maternal consumption. It generally resolves naturally by early childhood.

2. Eggs:

Egg allergies predominantly relate to egg whites. Some infants may tolerate baked or thoroughly cooked eggs, which can reduce the severity of their reaction. Seek advice before trialling this yourself.

3. Peanuts:

Peanut allergies cause some of the most severe reactions. Introducing peanuts under medical supervision early in life might decrease the risk.

4. Tree Nuts:

Allergies to almonds, cashews, hazelnuts, or walnuts typically persist throughout a person's life, necessitating careful lifelong dietary avoidance measures.

5. Soy:

Soy allergies, sometimes linked to infant formulas, typically diminish by school age but require dietary vigilance in early childhood.

6. Wheat:

Wheat allergies can mimic gluten intolerance or celiac disease, but frequently resolve naturally as children mature beyond infancy.

7. Fish & Shellfish:

Although less common in infancy, fish and shellfish allergies can produce intense reactions and are generally lifelong concerns.

Consultation with a paediatric allergy specialist offers specialised guidance tailored to individual infant needs.

Immediate Actions for Food Allergy Reactions in Infants

When an allergic reaction occurs, rapid action is critical. First, immediately cease feeding the suspected allergen, and observe the infant carefully for symptom progression. Administer any prescribed antihistamines or epinephrine promptly according to medical guidance, ensuring your infant's safety while preparing for potential emergency intervention.

Stop Feeding Immediately:

Immediately stop providing the suspected allergenic food once symptoms present, minimizing further allergen exposure and associated risks.

Evaluate Symptoms:

Quickly assess your infant for respiratory difficulties, swelling, or significant behavioral changes, guiding further immediate intervention steps effectively.

Use Prescribed Medication:

Administer antihistamines or epinephrine auto-injectors (EpiPens) precisely as prescribed by healthcare providers, addressing allergic reactions swiftly and effectively.

Seek Emergency Help:

If your infant exhibits severe reactions like breathing difficulties, facial swelling, or signs of anaphylaxis, contact emergency services immediately for urgent assistance.

Maintain detailed records of symptoms and consumed foods, facilitating accurate diagnosis and informed medical intervention by allergy specialists.

Conclusion

Early detection and management of food allergy symptoms in infants are crucial for preventing severe reactions and safeguarding your child's health. With diligent observation, proactive preventive strategies, and prompt medical responses, parents can successfully navigate food allergies. For expert diagnosis, personalized guidance, and ongoing allergy management, consult pediatric specialists at London Allergy Consultants.

Frequently Asked Questions

What should I do if my infant shows signs of a severe allergic reaction?

Immediately discontinue the allergenic food, administer prescribed medications such as antihistamines or an EpiPen if instructed, and seek urgent medical care if breathing difficulties or swelling occur.

Can infants outgrow food allergies?

Yes, many infants outgrow allergies to milk, eggs, soy, and wheat. However, allergies to peanuts, tree nuts, fish, and shellfish often persist into adulthood and require lifelong management.

Which foods most commonly cause allergic reactions in infants?

The most common allergens include cow's milk, eggs, peanuts, tree nuts, soy, sesame, pulses, wheat, fish, and shellfish. Introducing these foods gradually under medical supervision will reduce risks.

At what age can infants develop food allergies?

Infants can develop food allergies as soon as they start eating solids, typically around 4 to 6 months old. Symptoms usually appear soon after exposure to allergenic foods.

How do I know if my baby is allergic to a certain food?

Watch closely for symptoms like hives, vomiting, wheezing, or swelling shortly after feeding. Document any reactions and consult an allergist for a professional evaluation and testing.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way. We are happy to assess babies (infants), toddlers, young children, adolescents and young adults with allergies.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Could your child unknowingly be affected by a hidden autoimmune condition? Coeliac disease remains misunderstood despite affecting 1 in 100 children in the UK. Recognising symptoms early can dramatically improve long-term health outcomes, yet confusion between coeliac disease and gluten allergy persists. 

We understand your worries and offer valuable insights and support resources, specifically tailored for managing coeliac disease in children.

What is Coeliac Disease?

Coeliac disease is an autoimmune disorder triggered by gluten, a protein found in wheat, barley, and rye. According to the NHS, when children with coeliac disease consume gluten, their immune system attacks the lining of the small intestine. This immune response damages villi, tiny finger-like projections vital for nutrient absorption, and can severely impact a child’s growth and wellbeing.

Symptoms of Coeliac Disease in Children

Identifying coeliac disease can be challenging due to its varied manifestations. Common symptoms include:

• Digestive issues: Chronic diarrhoea, constipation, abdominal bloating, and pain
• Growth problems: Poor weight gain, delayed growth, or failure to thrive
• Fatigue: Ongoing tiredness due to inadequate nutrient absorption
• Behavioural changes: Irritability or anxiety linked to chronic discomfort

You can read more about common childhood food allergies and intolerances that may resemble or overlap with coeliac symptoms.

Understanding Gluten Allergy in Infants

Unlike coeliac disease, a gluten allergy (more precisely, an IgE-mediated wheat allergy) in infants results in immediate immune reactions after consuming gluten-containing foods. Symptoms include:

• Skin reactions like hives or rashes
• Facial swelling
• Breathing difficulties or nasal congestion

Specialists may recommend an oral food challenge to confirm gluten or wheat-related allergies under controlled clinical supervision. These symptoms do not cause long-term intestinal damage but require immediate management. The American College of Allergy, Asthma & Immunology (ACAAI) provides helpful information on wheat allergy in children. 

Diagnosing Coeliac Disease in Children

Accurate diagnosis is crucial and usually involves a combination of the following, widely available across London:

• Detailed clinical History
• Blood tests: To identify specific antibodies related to coeliac disease
• Endoscopy and biopsy: To visually confirm intestinal damage
• Genetic testing: To detect predisposition in inconclusive cases

Specialist clinics like London Allergy Consultants offer full diagnostic pathways tailored for paediatric patients. Families can start by booking comprehensive food allergy testing in London, which includes screening for coeliac-related markers. Where needed, we will refer them for GI biopsies.

Managing Coeliac Disease in Children

Managing coeliac disease means committing to a strict gluten-free diet for life. Effective strategies include:

• Dietary education: Helping families learn how to read labels and avoid hidden gluten, with guidance from Coeliac UK.
• Nutritional support: Collaborating with paediatric dietitians to ensure balanced nutrition. We closely moitor growth and elements such as Iron stores and Full Blood Count.
• Monitoring and follow-up: Regular check-ups to track symptoms and nutrient levels.

Support from a qualified paediatric allergy specialist in London ensures children receive the right care and guidance. In some cases, oral food and drug challenges are used to rule out other allergens that might complicate a coeliac diagnosis or present alongside it.

Support for Coeliac Disease in London

London is uniquely equipped to support families navigating coeliac disease:

• Paediatric gastroenterologists
• Allergy-focused clinics that treat coeliac and co-occurring conditions such as eczema, asthma, and hay fever
• Pollen allergy support for children experiencing seasonal flare-ups
• Immunotherapy options in suitable cases, to manage coexisting allergic conditions
• Child-focused dietitians: Experienced in managing complex dietary needs.
• Support groups: Local branches of Coeliac UK provide community-based assistance.
• Medical consultations: Book directly with London Allergy Consultants for specialist input.

Comprehensive care is available at clinics like London Allergy Consultants, where parents can receive both diagnosis and long-term support.

Living Gluten-Free in London

Living gluten-free in London is not just possible—it’s increasingly doable. The city offers:

• Restaurants with certified gluten-free menus
• Supermarkets and health shops stocking gluten-free essentials
• Educational events and workshops to help parents and children manage dietary changes confidently

For practical tips on living gluten-free in London, consult with London Allergy Consultants. Combined with ongoing monitoring through specialist testing, children can live confidently and healthily on a gluten-free diet.

Conclusion

Effectively managing coeliac disease in children goes beyond symptom awareness—it requires a committed, informed approach to diet, diagnosis, and long-term support. With access to expert care from London Allergy Consultants, families in London are well-positioned to take proactive steps. Because when knowledge and support meet action, children can thrive—gluten-free and full of life.

Frequently Asked Questions

Is there a cure for coeliac disease?

There’s no cure, but symptoms and damage can be managed by maintaining a gluten-free diet.

Is coeliac disease hereditary?

Yes, it runs in families. Testing is advised for first-degree relatives. Negative HLA Gene testing can be very reassuring as the disease is unlikely. Positive testing will require a more detailed assessment to see if the disease is present.

How common is coeliac disease in children?

Approximately 1 in 100 children in the UK are affected, although many remain undiagnosed (NHS).

What's the difference between gluten allergy and coeliac disease?

A gluten (wheat) allergy causes immediate reactions, and IgE allergy tests will be positive. In contrast, coeliac disease causes long-term gut (and other) symptoms, and specific IgG and IgA antibodies will be positive if gluten is eaten at the time of testing.

Can infants have coeliac disease?

Yes, it can develop once gluten is introduced, typically around four to six months of age.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way. We are happy to assess babies (infants), toddlers, young children, adolescents and young adults with allergies.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Many Londoners will be living with allergic disease of varying severity, including hay fever, eczema, food allergies, and asthma.

Most patients with one form of allergy will have another allergic disease; for example, at least 30% of children with eczema will have (or develop) a food allergy. The allergic burden can therefore be high and significantly impact the quality of life.

At least 25% of people in the UK will be diagnosed with hay fever. According to the World Air Quality Index, London's combination of dense urban populations, extensive green spaces, and elevated pollution levels creates a unique and challenging environment for individuals with allergies.

Our patients often report an exacerbation of their allergy symptoms when returning to London from travels abroad.

Children born in London, like many other Industrialised countries, have a high allergy burden. This report examines why allergies in London are particularly troublesome, the most prominent allergens affecting residents, and practical ways to manage them effectively.

Why Are My Allergies So Bad in London?

Several Key Factors Contribute to the Severity of Allergies in London:

Pollution Levels

According to the World Air Quality Index, London consistently ranks among the European cities with the highest levels of air pollution. Pollution is detrimental to all human lungs, but particularly so for those living with respiratory allergies. Pollution worsens allergy symptoms, intensifying reactions to pollen and other irritants.

Abundant Green Spaces

London's iconic parks, such as Hyde Park, Kew Gardens, Regent's Park, and Richmond Park, while stunning, produce significant and varied amounts of grass and tree pollen, particularly during the spring and summer months. Pollution facilitates the travel through the air of small pollens. Thunderstorms help liberate pollens, causing thunderstorm asthma.

Urban Heat Effect

Increased temperatures in city centers prolong pollen seasons, further aggravating symptoms for allergy sufferers (Met Office).

Densely Populated Areas

Higher population densities in London mean greater exposure to indoor allergens, such as dust mites. Pet ownership is also common, especially since the COVID-19 lockdowns, which increases the load of dust mite and pet allergies.

Common Aero Allergens Affecting London Residents

Londoners primarily contend with these common allergens:

1. Tree & Grass Pollen

Pollen allergies, commonly referred to as hay fever, peak from early spring through late summer. Grass pollen particularly affects many residents, leading to frequent discomfort.

2. Dust Mites

Dust mites thrive in London's humid indoor environments, particularly in carpeting, bedding, and upholstery. Reducing indoor humidity and regular cleaning help mitigate symptoms.

3. Pet Dander

Pet ownership is high in London and the UK, even more so after the Covid lockdowns.

4. Mould & Dampness

London’s damp climate and relatively high humidity, alongside older housing stock, encourage mould growth, causing respiratory irritation and aggravating asthma symptoms, as noted by the NHS. Indoor moulds are detrimental to the health of all individuals, but pose an increased risk for those living with aeroallergies and asthma.

5. Pollution

According to the Mayor of London's Air Quality, traffic congestion and industrial emissions exacerbate respiratory symptoms, making existing allergies harder to manage and increasing vulnerability to developing new aero-allergies and airway sensitivities.

Effective Strategies to Manage Allergies in London

Practical Measures Can Dramatically Reduce Allergy Symptoms:

Stay Updated with Pollen Forecasts

Regularly check local pollen forecasts (Met Office) to limit outdoor activities when counts are high.

Maintain Indoor Air Quality

Use air purifiers, keep windows closed during peak pollen hours, and regularly clean air ducts and filters.

Medical Interventions

Professional consultation with allergy specialists, such as London Allergy Consultants, can provide effective treatments for hay fever, asthma, and other allergies. After a thorough diagnosis of your allergies is made, we will discuss a personalised approach using a combination of modern medicines and immunotherapy.

Visual Guide: London's Allergy Calendar

Conclusion

Managing allergies in London is achievable by understanding triggers, adopting proactive measures, and seeking appropriate medical advice. Armed with knowledge and practical strategies, Londoners can significantly reduce discomfort and improve their daily quality of life.

Frequently Asked Questions

How can I reduce allergens in my home?

For general health, and allergen reduction (if allergic) reduce dust mite loads and mould loads within the home. If allergic to pets, this is usually to pet saliva (whcih is hen on their dander), learn how to reduce this burden. Regular cleaning with HEAP products, using allergen-proof bedding and installing air purifiers can reduce allrgen loads.

Should severe allergies prompt a doctor's visit?

Yes, persistent or severe allergy symptoms warrant professional medical advice to establish an effective treatment plan.

Are there effective natural remedies for managing allergies?

Natural methods like nasal saline rinses can clear pollen from the nasal passages. However, children do not always like doing nasal douching. Locally sourced honey will taste nice, but it has no more pollen than what you could inhale over several days; it has no immunotherapy effect. The nasal and respiratory biome, as well as the gut biome and immune system, can be optimised through a broad, expansive diet, outdoor healthy living, fermentable foods, high fibre intake, and live probiotics (not freeze-dried dead bacterial products). Immunotherapy is, in essence, a natural remedy, based on data from rigorous clinical trials.

Does air pollution make allergies worse?

Yes, air pollution irritates airways, significantly increasing sensitivity to allergens like pollen and dust, according to the British Lung Foundation. Pollution facilitates the travel of pollen through the air.

When does allergy season peak in London?

Allergy season typically spans from March to October, with pollen types peaking at varying times throughout this period. Dust mite is a perennial allergen, although levels can vary depending on humidity, ventilation and heat.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way. We are happy to assess babies (infants), toddlers, young children, adolescents and young adults with allergies.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Managing food allergies can be stressful, expensive and time-consuming. Patients and parents live in constant fear of accidental allergen exposure. While it is easier to manage allergen-avoidance at home, as children grow up, more and more caregivers and caterers need to be trusted.

Diagnosing relevant allergies and learning to recognise these foods early is critical to protecting your child's health. In this guide, we'll cover some key issues that parents need to confidently manage food allergies, keeping kids safe and well-nourished every day.

Milk & Dairy Allergies – Spotting the Signs Early

Milk allergy is among the most common childhood food allergies, affecting approximately 2 to 3% of infants & young children. Unlike lactose intolerance, which involves digestive discomfort from milk sugar, a dairy allergy triggers the immune system, causing reactions like hives, vomiting, difficulty breathing, or even anaphylaxis. 

While many children outgrow milk allergies by the age of 6, some continue to experience symptoms for longer. Early detection & dietary management are essential, as we can then cautiously guide early-life milk introduction or milk OIT for older children.

Parents should look for milk alternatives, such as hydrolysed formulae for infants, and alternatives like soy, almond, or oat milk for older children.

Patients and families need to learn to spot dairy ingredients. Patients will first develop tolerance to baked forms of milk, and then, over time, to any form of milk and dairy.

Food allergy testing in London can help identify milk allergies early and formulate a plan to manage them effectively.

Parents should carefully check ingredient labels, inform childcare providers and schools about the allergy, and always carry allergy medications or an EpiPen if prescribed.

Peanut & Tree Nut Allergies – Understanding the Risks

Peanut & tree nut allergies aren't just common, they're increasing. Currently, about 2% of children in the UK and U.S. suffer from peanut allergies, & 1% from tree nut allergies. These allergies often persist throughout life & can cause severe (even life-threatening) reactions.

Key Concerns:

• Cross-contamination from other foods.
• Difficulty managing accidental exposures in public spaces.
• Emergency preparedness, including training caregivers and carrying an EpiPen.

Recent studies suggest that early, controlled exposure to peanut, tree nuts or sesame (as Oral Immunotherapy, OIT) might reduce allergy risks, but parents should always consult a paediatric allergy specialist before attempting this approach.

Egg Allergies – Answers to Common Concerns

Egg allergies rank among the most common childhood food allergies, affecting about 1.3% of children under age 5. Symptoms typically include skin reactions (e.g. red rashes and hives), digestive discomfort (e.g. vomiting, abdominal pain), or respiratory issues (e.g. new-onset cough, voice change, wheezing, difficulty in breathing). 

Many parents wonder if cooked eggs are safer & the answer can be "yes," since cooking alters egg proteins, reducing heat-sensitive structural allerginic proteins. Importantly, around 70% of kids with egg allergies outgrow them by adolescence.

Nonetheless, careful dietary monitoring & allergist consultations remain important when making these dietary choices.

Wheat & Gluten Allergies – When Gluten-Free Matters

Wheat allergies affect children & can cause severe allergic reactions. Unlike gluten intolerance (celiac disease, mediated by IgA and IgG antibodies), wheat allergies involve an immediate IgE-mediated immune response that can trigger hives, vomiting, or respiratory issues. Slightly delayed reactions (within 1-2 hours) and reactions with respiratory symptoms can occur after ingesting wheat.

Managing wheat allergies requires strict dietary vigilance of wheat and related allergens, e.g. rye, barley, and spelt. Gluten-free alternatives, such as those made from oat, buckwheat, rice, or corn, are helpful, but parents must master their label-reading skills to avoid hidden wheat ingredients in processed foods.

Wheat sensitivity is also closely related to grass pollen allergies, so it’s wise to be aware of seasonal triggers that can complicate allergic responses.

Soy Allergies – Hidden Dangers & Safe Alternatives

Soy allergies, affecting approximately 0.4% of children, are often tricky to manage as soy appears in many processed foods. Symptoms include digestive distress, skin reactions, or breathing issues. 

Soy allergy can be a primary allergy (more troublesome and usually with an earlier onset) or secondary (as part of Oral Allergy Syndrome, aka Pollen Food Syndrome).

Parents must stay vigilant, avoiding hidden soy ingredients, especially higher amounts of the allergen. Nutritionally balanced diets without soy (incorporating alternatives like legumes or quinoa) can ensure children still get essential proteins & vitamins.

Since soy reactions may coincide with conditions like eczema or childhood asthma, getting a comprehensive allergy evaluation is beneficial.

Conclusion

Childhood food allergies demand careful attention, but they're entirely manageable with the right knowledge & tools. 

Early recognition, understanding symptoms, & clear dietary strategies can significantly improve your child's quality of life. If you suspect an allergy, don’t hesitate, consult an allergy specialist in London to secure personalized advice & safety plans. Your child's health & happiness depend on informed action & proactive care.

Frequently Asked Questions

What should I do if my child has an allergic reaction?

Immediately administer prescribed medication like antihistamines or epinephrine, & seek emergency medical care. Remember, antihistamines will not stop troubling internal symptoms, e.g. wheeze, cough, intense gut pain; for this, use Adrenaline.

How quickly does a food allergy reaction occur?

Symptoms typically appear within minutes toan hour after eating the allergenic food. Eczema may flare for a few days afterwards.

Can children outgrow food allergies?

Many children outgrow allergies like milk, egg, & soy by adolescence, but peanut & tree nut, sesame, legume, fin and shellfish allergies are often lifelong.

How do I know if my child has a food allergy?

Common signs of food allergies include red rashes and hives, digestive issues e.g. gut pain and vomiting, swelling of lips, difficulty breathing and wheezing, or severe reactions aka. anaphylaxis. Consult an allergist for a precise diagnosis.

What are the most common food allergies in children?

The most common childhood food allergies include milk, peanuts, tree nuts, sesame, eggs, legumes, wheat, soy, fish, & shellfish.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Baby Poop: What's Normal, What’s Not — Insights from a Paediatric Allergist

Baby poop is one of the most common concerns new parents bring up in our London Allergy Consultants clinics — and for good reason. It varies widely and can seem alarming if you're not sure what’s typical. This guide to baby poo aims to help parents understand what’s normal, when to seek advice, and how poop may relate to health, including allergies.

Introduction: Why Baby Poop Matters

As a paediatric allergist, one of the most common – and often surprising – topics I discuss with parents is their baby’s poop. While it might seem strange, observing a baby’s bowel habits provides a valuable window into their overall health. From colour and texture to frequency and smell, every nappy offers insights into what’s happening in your baby’s gut.

Thanks to smartphones, I frequently receive photos from concerned parents, often filed away in digital albums labelled “poop photos”. And while that might seem excessive, these images can be genuinely helpful in understanding whether something is normal or a potential sign of an underlying issue.

It’s worth noting from the start that newborn poop variations, on their own, very rarely lead to a diagnosis of an IgE-mediated allergy. When allergies are involved, poop irregularities are typically accompanied by other symptoms: hives, vomiting, food refusal, rashes, or even anaphylaxis. In such cases, we may suggest oral food and drug challenges or consult a paediatric allergy specialist. Unique and particularly offensive smelling poo is alos not diagnostic of any pathology and reflects the changeing bacterial ‘zoo’ in your babies gut, which is living matter feeding on the same foods you feed your baby.

Still, having a medically sound guide to baby poo helps distinguish between what’s normal and what might need further assessment.

The Evolution of Baby Poop — What’s Normal at Each Stage

Understanding what to expect from baby poop at different developmental stages can reassure parents and help them spot true red flags.

The appearance of baby poop depends on age, feeding type, and gut microbiome development. During the first year, it’s normal to see variations in colour (yellow, green, brown) and texture (runny, seedy, pasty).

Babies have rapidly developing gut flora—more bacterial than human by cell count. According to NIH research, the infant microbiome is shaped by delivery method, feeding type, antibiotics, vaccines, and other factors.

No two babies will have exactly the same gut microbiome—or the same poop.

1.1 Newborns (First 48–72 Hours): Meconium

Your baby’s first stool is called meconium. It’s thick, sticky, black or very dark green, and tar-like in consistency. Meconium is composed of materials the baby ingested in utero, including amniotic fluid and skin cells.

• It’s entirely normal and expected.
• Babies typically pass meconium within the first 24–48 hours of life. If not, a doctor should be consulted.
• Colostrum — your first breast milk — helps expel meconium faster.

External reference: NHS: Newborn poo

1.2 Breastfed Babies

Breastfed infants tend to have:

• Yellow or mustard-coloured stools
• A runny or seedy consistency
• A mildly sweet smell

Some babies poop multiple times a day; others might go a few days without passing stool. After around six weeks, many healthy breastfed babies start pooping less frequently. This is completely normal as long as the baby is feeding well and gaining weight. Learn more about potential cow’s milk protein intolerance that can occasionally appear in exclusively breastfed infants. Breastfed infants tend to have stools with less offensive odour due to higher lactic acid and lower concentrations of volatile fatty acids and sulfur-containing gases, reflecting a gut microbiota dominated by bifidobacteria and lactobacilli.

1.3 Formula-Fed Babies

Compared to breastfed babies, formula-fed infants often have:

• Firmer, pastier stools
• Colours ranging from pale yellow to tan or greenish-brown
• A more pungent odour - attributed to higher levels of putrefactive bacteria and increased production of H₂S and CH₃SH. The presence and concentration of these gases are influenced by feeding type, the infant's age, and the maturation of the gut microbiome.

Poop frequency is usually once a day, though skipping a day is not uncommon.

If formula-fed babies show signs of constipation or blood in their stools, allergy assessments may be needed. See our London food allergy testing services for early diagnosis.

1.4 Weaning & Solids (From ~4–6 Months)

Introducing solids changes baby poop dramatically:

• Stools become thicker, darker, and more adult-like in smell.
• Undigested bits of food (like sweetcorn, grape skins) are common.
• Colour and texture can vary depending on diet.

Initially, babies may poop more frequently (3–5 times/day), which typically settles to once per day over time.

Explore our guide on oral food and drug challenges if your baby experiences ongoing digestive discomfort after introducing solids.

A Colour Guide to Baby Poop — What’s Normal and What’s Not

One of the most frequently asked questions from new parents is: “Is this poop normal?” The answer often depends on colour, which can reflect dietary changes, digestive development, hydration levels, or even medical conditions.

Below is a comprehensive guide to baby poo colours, incorporating clinical insights and references to help parents interpret what they’re seeing in the nappy.

Mucus, Blood, and Texture Changes

Mucous streaks: These can appear like clear jelly or slime. If your baby is otherwise healthy, mucus alone is usually harmless.

• Blood: Can indicate constipation, fissures, or an allergic colitis. This is particularly relevant when associated with exposure to cow’s milk.
• Very watery stools: Could point to infection or lactose intolerance.

When to worry about mucus:

If it persists for more than 2 days, is accompanied by fever, vomiting, or discomfort, see a specialist. Learn more from our paediatric allergy services in London.

Poop Frequency — How Often is Too Often?

Some babies produce huge nappies, others go days without a bowel movement. Both can be normal. What matters is whether the baby is gaining weight and appears comfortable. The frequency of baby poop varies widely:

• Newborns: May pass stool after every feed.
• 6+ weeks (breastfed): Can go several days without pooping.
• Formula-fed infants: Typically once daily.
• During illness or food changes: More frequent, looser stools are common.

Excessive pooping accompanied by poor weight gain, irritability, or signs of dehydration may indicate toddler diarrhoea or infection. See our post on the most common childhood food allergies.

Key Takeaways for Parents

• Newborn poop and baby poop vary widely
• Most changes are harmless and reflect diet, development, or microbiome shifts
• Use this guide to baby poo as a general reference
• If you’re concerned, trust your instincts and seek expert advice

Conclusion: Trust Your Instincts

There is a wide range of normal when it comes to baby poop. The colour, texture, frequency, and smell of your baby’s stool may change from day to day — and that’s often entirely fine.

But as a parent, your intuition is valuable. If something about your baby's poop or wellbeing feels “off”, don’t hesitate to seek guidance.

For concerns relating to allergies, digestion, or immune conditions in infants, our team at London Allergy Consultants is here to help.

Frequently Asked Questions

• What does normal newborn poop look like?

  In the first few days of life, newborn poop is thick, sticky, and black or dark green — called meconium. After this, poop from breastfed babies turns yellow and runny, while formula-fed babies produce firmer, pale brown or greenish stools.

• How often should a newborn poop?

  A healthy newborn may poop after every feed (6–10 times a day), but this varies. After about 6 weeks, breastfed babies may poop less frequently — sometimes just once every few days — and still be completely healthy.

• Why is my baby's poop green?

  Green baby poop is usually harmless. It may be due to:

  • Iron-fortified formula

  • Foremilk/hindmilk imbalance in breastfeeding

  • Diet changes

  • Viral illness

  If green stool is accompanied by diarrhoea, fever, or blood, consult your GP. Learn more about food allergy testing

• Is it normal for baby poop to have mucus?

  Mucus in baby poop can be normal, especially in early life or during teething. However, if it's persistent or combined with other symptoms like blood, vomiting, or fever, it may suggest an infection or allergy. Explore immunotherapy and allergy treatment options.

• Why does my baby poop smell so strong?

  Strong-smelling baby poop becomes more common with formula feeding and the introduction of solid foods. It may also indicate an underlying intolerance or infection. A persistent foul smell with diarrhoea may suggest a toddler’s diarrhoea or a viral illness.

  The metabolic byproducts of intestinal bacterial fermentation of undigested carbohydrates, proteins, and fats primarily cause the odour in babies' stool. The specific volatile compounds responsible for stool odour include hydrogen sulfide (H₂S), methanethiol (CH₃SH), and short-chain fatty acids, which are produced in varying amounts depending on the infant's diet and gut microbiota composition

• What kind of poop should I expect after vaccinations?

  After vaccinations, some babies may experience:

  • Temporary changes in stool frequency

  • Looser or greenish stools
    This is usually a normal immune response. However, persistent diarrhoea or other systemic symptoms should be reviewed by your healthcare provider.

• When to seek Medical Advice

  Seel medicl advice if:

  • No meconium within 48 hours of birth

  • Poor weight gain or faltering growth

  • White, red, or black stools (excluding beetroot or iron supplements)

  • Persistent diarrhoea that affects growth

  • Blood in stool, especially with cow’s milk exposure

  • Painful bowel movements or visible fissures

  • Severe rashes around the anus

  • Chalky white or very pale stools

  • Hard, pellet-like stools

  Blood in the stool may be a sign of cow’s milk protein-induced colitis, which often resolves with dietary changes. Learn more about this via oral food challenge testing in the UK.description

Explore More with London Allergy Consultants

At London Allergy Consultants, we support families through every stage of allergy testing and treatment. Whether you're dealing with food sensitivities, eczema, hay fever, or asthma, our paediatric experts are here to help.

Concerned About Baby Poop or Allergy Symptoms?

Book an assessment or explore our paediatric services today.

London Allergy Consultants

London Allergy Consultants is a leading UK centre for diagnosing and treating food and airborne allergies in children and young people.

Get in Touch

07754050302 , 07754050303

office@londonallergyconsultants.com

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity. It is under-recognised, frequently misdiagnosed, and characterised by severe, repetitive vomiting and/or protracted diarrhoea.

The vomiting is a striking feature; it is protracted and ongoing, often associated with vomiting dark green bile. Abnormal stools can be associated. Symptoms typically begin 1 to 4 hours after ingestion. This vomiting spell may then be followed by a floppy, grey or limp baby, sometimes described as a rag-doll appearance, terrifying to all. The patient then thankfully returns to normal health (unlike with viral gastroenteritis or food poisoning).

Unlike immediate IgE-mediated allergies, FPIES does not manifest with hives, angioedema, or respiratory symptoms, and standard diagnostic tests (skin prick tests, specific IgE blood tests) are typically negative. Clinicians establish the diagnosis through a detailed clinical history or a supervised oral food challenge.

Clinical Presentation & Risk of Misdiagnosis

Reactions range from mild (non-dehydrating vomiting/diarrhoea) to severe, potentially causing dehydration and shock

• Diagnostic Pitfall: Profuse vomiting, lethargy, pallor, and resultant acidosis can closely mimic acute sepsis and other neurological or cardiac presentations.
• Clinical Consequence: Without a detailed dietary history, recurrent reactions are frequently misdiagnosed as repeated episodes of sepsis, leading to avoidable intensive care admissions.

Common Triggers

• Infants: Cow's milk, soy, rice, oats, and legumes (though any food protein can act as a trigger).
• Older Children and Adults: Fish and shellfish.

Management & Safety

• Avoidance: Strict elimination of the causal protein is the usual approach, although we are able to discuss slow, home-based, dietitian-supervised microdosing to try to expedite the anticipated tolerance. ,
• Acute Management: Focus on fluid resuscitation and preventing dehydration. Ondansetron is commonly utilised to manage acute protracted vomiting.
• Adrenaline: Not indicated, as FPIES does not cause anaphylaxis.

Prognosis

FPIES is typically outgrown in early childhood, with most patients achieving tolerance by 3 years of age.

Clinic Expertise

Our specialist allergy clinic has extensive experience diagnosing and managing FPIES. Prof du Toit has published peer-reviewed research on the condition. We offer specialist consultation and supervised oral food challenges for diagnostic confirmation.

Here are key academic publications on Food Protein-Induced Enterocolitis Syndrome (FPIES) involving Dr George du Toit:

• Oral Food Challenge Guidelines: Bird, J. A., Barni, S., Brown-Whitehorn, T. F., du Toit, G., Infante, S., & Nowak-Wegrzyn, A. (2021). Food protein-induced enterocolitis syndrome oral food challenge: Time for a change? Annals of Allergy, Asthma & Immunology, 126(5), 506–515.PubMed Abstract
• British Isles Population & Surveillance Study: Stiefel, G., Alviani, C., Afzal, N. A., Byrne, A., du Toit, G., DunnGalvin, A., et al. (2022). Food protein-induced enterocolitis syndrome in the British Isles. Archives of Disease in Childhood, 107(2), 123–127.BPSU Overview & References
• UK Clinical Presentation and Referral Characteristics: Ludman, S., Harmon, M., Whiting, D., & du Toit, G. (2014). Clinical presentation and referral characteristics of food protein-induced enterocolitis syndrome in the United Kingdom. Annals of Allergy, Asthma & Immunology, 113(3), 290–294.PubMed Abstract
• FPIES Review: van der Poel, L. A., Fox, A., & Du Toit, G. (2009). Food Protein-Induced Enterocolitis Syndrome: A Review. Current Allergy & Clinical Immunology, 22(2), 56–57.The FPIES Foundation Toolbox

Proudly collaborating with international initiatives like IFPIES to advance global resources and awareness.

Eating insects and worms is not a new thing. In fact, it has been a part of the traditional diet of some European cultures for centuries. For example, crickets are a popular snack in Greece and Italy, and they are also used in some traditional dishes in Spain and Portugal. In Southern Africa, Mopane worms have long been a popular food. They are the large caterpillar of the emperor moth, Gonimbrasia belina. The worms are harvested during the rainy season, when they are at their fattest. They are then cooked in a variety of ways, including frying, grilling, and drying. Mopane worms are a good source of protein and other nutrients.

In recent years, there has been a growing interest in eating crickets in Europe as a sustainable and nutritious alternative to meat. Crickets are a good source of protein, fiber, and vitamins, and they require much less land, water, and feed to produce than traditional livestock.

There are now a number of companies in Europe that are producing and selling cricket-based products, such as cricket flour, protein powder, and snacks. These products are becoming increasingly popular, and they are seen as a way to help reduce the environmental impact of food production.

Crickets have a mild, nutty flavor that is similar to shrimp. They can be eaten raw, cooked, or roasted.

Crickets are a good source of protein, so they can be a healthy addition to your diet.

Crickets are a sustainable food source, so they are a good choice for people who are looking for ways to reduce their environmental impact.

As insect consumption increases, so will the rate of allergic reactions, these arise due to the tropomysins in insects (muscle proteins). Tropomyosin is a protein found in the muscles of insects (such as crickets), crustaceans, and other animals. It is a major allergen in shrimp, and it can also cause allergic reactions in people who are allergic to crickets.

The symptoms of a tropomyosin allergy can range from mild to severe and can include:

• Hives
• Itchy skin
• Swelling of the lips, tongue, or throat
• Difficulty breathing
• Anaphylaxis (a life-threatening allergic reaction)

If you have any of these symptoms after being exposed to crickets, it is important to seek medical attention immediately.

If you are allergic to tropomyosin, it is important to avoid exposure to insects that contain this protein. This may mean not eating crickets, avoiding places where they are commonly found, and wearing protective gear when handling them.

It is also important to be aware that tropomyosin can be cross-reactive with other allergens, such as those found in shellfish. This means that if you are allergic to tropomyosin, you may also be allergic to shellfish.

If you think you may be allergic to tropomyosin, it is important to see an allergist for testing. They can help you determine if you are allergic to tropomyosin and develop a treatment plan for managing your allergy.

Here are some additional things to know about tropomyosin allergy:

• Tropomyosin is a heat-stable protein, which means that it does not break down when cooked. This means that even if you cook crickets, you may still be allergic to them.
• Tropomyosin is also a common ingredient in some food products, such as insect flour and protein powders. If you are allergic to tropomyosin, it is important to read food labels carefully to avoid products that contain this protein.

If you have any questions or concerns about tropomyosin allergy, please do get i touch with our practice.

Thunderstorm asthma is a condition that causes asthma symptoms to worsen or trigger an asthma attack during or shortly after a thunderstorm. Other allergic symptoms may also flare at this time, e.g. atopic eczema.

The increase in allergencity of the pollen during this period is thought to be caused by the release and fragmentation of pollen grains into the air by the high winds and rain associated with thunderstorms.

The pollen grains are rendered smaller by the storms and can then be inhaled by people with asthma, triggering an allergic reaction that can lead to wheezing, coughing, chest tightness, and shortness of breath. Hayfever symptoms are also typically more troubling at these time.

Thunderstorm asthma is most common in people who have seasonal allergies, such as hay fever. It is also more common in children and young adults.

Symptoms of thunderstorm asthma can start suddenly and become severe very quickly. If you have asthma and you experience any of the following symptoms during or shortly after a thunderstorm, it is important to seek medical attention immediately:

• Wheezing
• Coughing
• Chest tightness
• Shortness of breath
• Wheezing that is worse when you breathe out
• Difficulty speaking

There are a number of things you can do to reduce your risk of being affected, including:

• Take your asthma medication as prescribed by your doctor.
• Keep a reliever inhaler (often Blue in colour) with you at all times.
• Try avoid being outside during thunderstorms, especially if you have seasonal allergies.
• If you start to experience symptoms of thunderstorm asthma, seek medical attention immediately.

Thunderstorm asthma is a serious condition that can be fatal is severe asthma develops and is left untreated.

Here are some additional tips to help you stay safe during a thunderstorm asthma event:

• Stay indoors and away from windows.
• If you must go outside, wear a mask to protect your airways.
• Avoid strenuous activity around these weather periods
• Monitor your asthma symptoms closely and use your inhaler as needed.
• If you experience any symptoms of an asthma attack, seek medical attention immediately.
• Be sure to have your allergies properly assessed and managed. Ideallyyou would treat your grass pollen allergy with immunotherapy to the relevent pollens

As simple as the devices appear, administration can prove tricky in the acute setting.

• Allergic reactions will vary in severity, this is true between patients and within patients i.e. not all reactions will be the same.
• Many variables determine the severity of a reaction; these include age, asthma diagnosis, amount and form of the food allergen eaten…
• Most allergic reactions will commence with ‘mild-moderate’ symptoms and signs and will progress no further. If symptoms are mild the patient can be observed, whilst communicating for medical help, and all symptoms will hopefully settle with time and antihistamine administration.
• Severe symptoms warrant the administration of an AAI. The challenge is to know what to do when symptoms are in a ‘moderate range’.
• I teach families, that for the most part, mild symptoms will be observed on the ‘outside of the body’ (e.g. redness, hives, lip swelling, vomiting). More worrying symptoms occur on the ‘inside of the body’ (e.g. altered voice, difficulty breathing, wheezing, new onset repetitive cough, suddenly sleepy/faint/dizzy/absent, tongue swelling). If a BP and/or Sat can be measured and is low then this is obv a severe sign.
• If in doubt, err on the side of AAI administration; it is a natural hormone of the body and will not harm (other than psychological stress for all).

Points I would like to emphasise that you may not have been taught include:

1. Please hold the patient's thigh firmly to prevent them from kicking; this can cause a laceration as the needle is long and strong’ and will tear the tissue if the thigh moves with force.
2. If a second device is required, please be sure to administer this in the alternate thigh to that in which the first device was administered. Adrenaline vasoconstricts and the first dose will reduce the absorption of the second dose if administered at the same site.
3. If you are uncertain if a dose has been administered, the patient’s pupils should dilate a few minutes after administration; this is normal as part of the ‘fight-or-flight’ response.

In allergic rhino-conjunctivitis, the nose and eyes bear the brunt of the inflammatory reaction. 

Depending on the severity of your hayfever, symptoms and signs may include one or more of the following:

• Blocked or runny nose, sometimes associated with a ‘nasal quality speech’ and reduced taste sensation.
• Repetitive violent sneezing (if this is worse in the morning and occurs all year round, then consider house dust mite allergy as a cause)
• Intense itching and rubbing of the nose and eyes. Rubbing of the nose may result in a clear line across the nose (called a nasal crease), and rubbing of the eyes may result in deep skin folds under the eye (called Morgan Denny’s folds); the dark areas under the eyes are sometimes called ‘allergic shiners’, making children appear fatigued. 
• Eczema flares around the eyes, under the nose, and behind the ears
• Mouth breathing can result in dry teeth, which can lead to halitosis and a propensity for poor dentition.
• Ongoing rubbing of an itchy mid-face during rapid growth may be associated with a high arched palate.
• Taste is impacted when eating with a blocked nose; children may prefer salty or spicy meals as a consequence.
• Dry and cracked lips, if licked repetitively, result in a ‘lip licking’ eczema. 
• Sleep patterns may also be disturbed; children with hay fever are frequently described as ‘restless sleepers’ as evidenced by chaotic bed linen in the morning. 
• Mood may also be adversely affected as a consequence of poor sleep and medication use. 
• Hay fever can impact schooling, particularly as exams are usually taken in the summer months when tree pollens are high. 
• A post-nasal drip may result in a ‘dry hacking cough’ and ‘anti-social throat clearing noises’. 
• Children with hay fever also blink repetitively and distort their itchy mid-facies, sometimes resembling a ‘nervous tick’.

At London Allergy Consultants, we will be happy to perform diagnostic tests and to discuss treatment options for any relevant seasonal and/or perenial allergens