A. Case study
B. More information
C. Editors' comments
E. CPD questions (South Africa, Australia)
A. Case study
A 7-month-old boy
with eczema was referred to a dietitian for a dietary intervention.
The child had been exclusively breastfed for the first few months after
birth. At 4 months of age he started to develop slight eczema. At 5
months, the mother started to include solid foods in his diet. The eczema
got progressively worse until she decided to take him to a doctor (at
age 7 months). She was still breastfeeding him at this point.
These are the results
of the blood tests the doctor ordered (in KU/L):
Phadiatop: 0.46 (class 1)
[This is a screening test that measures the level of IgE to a combination
of the common inhalant allergens. A positive result indicates that the
subject is sensitized to 1 or more of these inhalants, but does not
indicate which. From there one can test for specific allergens.]
FX5: 40.10 (class 4)
[This is a screening test that measures the level of IgE to a combination
of the 6 most common food allergens. A positive result indicates that
the subject is sensitized to 1 or more of these foods, but does not
indicate which. From there one can test for specific allergens.]
Egg white: 10.2 (class 3)
Egg yolk: 1.25 (class 2)
Cow's milk: 26.50 (class 4)
Soya: 1.23 (class 2)
Wheat: 3.43 (class 2)
Maize: <0.35 (class 0)
Peanut: 9.47 (class 3)
Rice: 0.39 (class 1)
The reasons these
specific tests were done are not entirely clear. It is, however, established
that the mother was concerned about maize and rice causing the reaction.
These are not common foods to be allergic to at this infant's age, and
therefore it would not be routine to request the relevant blood tests
(as it would be in the case of the other foods).
What can cause or exacerbate eczema?
b. Chemicals and environmental allergens
a. Stress was not a factor.
b. The mother was questioned about these, but no specific problems could
be identified. The low IgE level shown by the Phadiatop CAP RAST blood
test also suggested that the common inhalant allergens were probably
not causing the reaction.
c. The FX5 test result showed relatively high IgE, but sensitization
to individual allergens appeared to vary widely. At this stage the boy
was eating sweet potato, butternut squash, paw paw, avocado, broccoli,
apple, banana, and pear. The mother had stopped giving rice and maize
a week before. As no correlation could be found between the adverse
reaction and possibilities in a and b (above), the possibility of a
food-related cause was investigated further.
What do the blood results mean?
Recent literature has shown that a low level of IgE to a specific allergen
indicates that the individual is probably merely sensitized to the allergen
and not yet symptomatic. The higher the IgE level to a specific allergen,
the more likely that the person is reacting to it. Here, the blood results
for egg yolk, soya, wheat, maize and rice indicated that the child was
probably merely sensitised to these foods and that they were not necessarily
eliciting a reaction. The milk result, belonging to class 4, and egg
white and peanut results, belonging to class 3, probably indicated that
the child was reacting to these as a result of being exposed to them
in some form. But if the child had not been ingesting any cow's milk,
egg or peanut, what could be the cause of these increased IgE levels?
a. The child had been exposed to these as hidden allergens in his diet.
b. The child had been exposed to these as hidden allergens in non-food
c. The mother ate milk, egg and peanut, and the child was reacting to
the allergens transferred through breast milk.
a. The foods the child had eaten were all plain and unprocessed, so
that they were very unlikely to contain hidden allergens.
b. After investigation, it was determined that one of the baby-care
products used did contain peanut oil. Highly refined peanut oil is unlikely
to contain peanut proteins and would therefore not elicit a reaction,
but less refined oil may. Baby-care products therefore needed to be
considered as a possible cause of the reaction.
c. This could be possible, as the mother, being a lacto-ovo-vegetarian,
did eat dairy products and egg, and a very small amount of peanuts.
It was decided to
ask the mother to replace the peanut oil-containing baby-care product
with one that did not contain peanut oil. Also, the question arose whether
the mother should exclude milk, egg and peanut from her diet in an effort
to improve her son's symptoms. As she was a vegetarian, this would have
restricted her diet immensely and possibly compromised her nutritional
status and the quantity and quality of her breast milk.
As small amounts
of peanut have been shown to elicit a reaction, it was decided to see
whether there were an improvement in symptoms after the baby-care product
was changed. The symptoms did not improve. But as the quality of the
peanut oil present in the previously used product could not be guaranteed
as consistent, the mother was advised to keep on using the peanut-free
product: regular exposure to even a low level of peanut could sensitize
the child to a greater extent, which could result in a reaction in the
The mother decided
to stop breastfeeding rather than change her diet. The question then
became which formula should be given to the child. Here are the main
a. Cow's milk-based formula
b. Soya formula
c. Partially hydrolysed formula
d. Extensively hydrolysed formula
a. This formula was not a good choice, as there was a high probability
that the child would develop an allergy because of the high level of
IgE to milk.
b. This formula was also ruled out, as there was a risk that the child
would develop an allergy, though his level of IgE to soya was not high.
About 25% of milk-allergic individuals could be expected to be allergic
to soya as well.
c. Partially hydrolysed formulas have shown some benefits in preventing
the development of allergy, but not in its treatment.
d. Extensively hydrolysed formulas are preferred in the case of milk
allergy. But it must be kept in mind that about 20% of cow's milk-allergic
individuals have been shown to react to extensively hydrolysed formula.
If this occurs, an elemental feed may be required.
The child was put
on an extensively hydrolysed formula and his symptoms improved dramatically.
The mother was advised to exclude cow's milk, egg and peanut from his
diet until the age of 2-3 years as part of normal measures to prevent
the development or progression of allergy. Thereafter he could be re-examined
to see whether he had outgrown the allergy.
|TIP for Allergy
selecting a suitable alternative feed for a cow's milk-allergic
infant, Allergy Advisor can assist by the allowing the user
to read up about cross-reactions between cow's milk and other
milks. This can be done by entering "milk - cow's"
into the search function and selecting the "CrossReactions"
patient is planning a family, the patient information sheet,
"Allergy prevention strategies for pregnancy and infancy",
can be printed out. This can be found under "Management",
"Patient information sheets" and will give the
person some guidance on what strategies can be implemented
to prevent their child of developing an allergy.
B. More information:
This newsletter will focus on the prevention and delay of the development
of allergy. The following are definitions of important terms concerning
When the body is first exposed to an allergen, it may see the allergen
as foreign and respond by activating the immune system. Allergen-specific
IgE antibodies are produced in an attempt to combat the allergen. The
body is thus "sensitized" to the allergen, but for some time
may not show any adverse reactions upon exposure to the allergen. But
a sufficient dose of the allergen may "elicit" a reaction
at some point. The phenomenon is called "elicitization".1
In many children, allergies follow a stereotyped course: children
tend to "outgrow" certain allergies and then develop certain
new ones. Before the age of 3 years, allergy usually expresses itself
as eczema and food allergy. In middle childhood, eczema and food
allergy generally resolve and give place to asthma. In the adolescent
years, asthma begins to stabilize and allergic rhinitis becomes
more prominent. A child with a food allergy is therefore more likely
to develop asthma and allergic rhinitis later in life. This progression
has been termed the "allergic march" (also known as the
"atopic march"). (See the chart demonstrating the allergic
There are various indications that an infant is at high risk for developing
allergic disease. Among these indications are 1) having at least 1 immediate
family member (mother, father or biological sibling) with allergic disease,
and 2) EITHER allergic disease in both parents OR in one parent or sibling,
combined with elevated cord blood IgE. (There is an association between
newborns having raised levels of cord blood IgE, and increased risk
of the development of allergic disease.) It has been suggested that
one should complement these criteria with tests to determine whether
the parents' allergies are IgE-mediated or non-IgE-mediated.3,4
3) Kjellma has suggested
the following method of determining whether a child is a "high-risk
Scoring is as follows:
2 points each for a mother, a father or a sibling with a medically confirmed
1 point each for a mother, a father or a sibling with a medically unconfirmed
but suspected allergic disease
0 points: mother, father and siblings with no allergic disease
risk to fetus and new-born
for preventative programme
4 and over
Very strong risk
Yes (before conception, during pregnancy and after birth)
5 Among high-risk
infants, prevention strategies can result in a lower prevalence and
severity of allergic disease.
BETTER THAN CURE
Genetic predisposition represents a major risk for developing allergies,
including food allergies. The chance of developing an allergy is:
5-15% if neither parent is atopic
20-40% if one parent is atopic
25-35% if one sibling is atopic
40-60% if both parents are atopic
If both parents have the same allergy, the child has a 60-80% chance
of developing that allergy.
appears to be a greater risk factor than paternal allergy. Boys tend
to have an earlier onset of allergic disease than girls.6
A child is more
likely to develop an allergy to 1 or more of the 6 major allergens (cow's
milk, egg, soya, fish, peanut and wheat).7 There are, however, great
differences in what are regarded as major allergens in different countries
and cultures. (See table of common allergies in various countries below.)8
There are 3 types
of allergy prevention:
Primary prevention: prevention of sensitisation
Secondary prevention: prevention of the
manifestation of disease in an already sensitised individual
Tertiary prevention: attempting to reduce
symptoms after allergic disease expression7,9,10
are proposed to prevent allergy or slow the allergic march:
restriction during pregnancy
studies suggest that in utero sensitisation, especially during
the 2nd and 3rd trimesters, is the first step in the allergic
march. This, however, has not been conclusively proven. Sensitisation
during this period might occur either from exposure to allergens
that cross the placenta, or from the fetus swallowing IgE from
the amniotic fluid.11
The different points
of view on what intervention should be recommended are:Where there is
a strong family history of allergy, 1 or more of the 6 major allergens
should be avoided in the pregnant woman's diet.
the relevant foods can easily lead to an unbalanced maternal diet, which
may be detrimental to the development of a healthy immune system in
the fetus. It has been proposed that a healthy maternal diet is more
important than the risk of exposing the unborn child to allergens.12
The evidence is
clearly not conclusive. Most authorities advise that foods not be excluded
from the mother's diet, but the American Academy of Pediatrics suggests
that peanut be avoided during pregnancy. The reason for this is that
peanut avoidance will not lead to nutritional deficits and that its
restriction during pregnancy can help prepare the mother for its avoidance
postpartum.10 Overall, the approach should be individualized
according to the child's family history. If a pregnant woman decides
to exclude foods from her diet, a dietitian should assist in compiling
a nutritionally adequate diet.7
The lactating mother should exclude 1 or more of the 6 major
allergens from her diet.10
Maternal restriction during lactation
It has been proven that allergens can be transferred to an infant
through breast milk and thereby sensitize the infant.10
Although the benefits of excluding allergens from the mother's diet
to prevent sensitization have been proven, specific guidelines for
intervention vary from country to country.4 If a child
is shown to be allergic to a specific food and is still being breastfed,
it is routinely recommended that the mother exclude the food from
her diet. Aside from this, however, there are different points of
view in the literature:
Excluding such allergens will compromise the mother's diet.
This may affect the quantity and quality of the breast milk and thus
the nutrition of the child, which may negatively influence the development
of a healthy immune system.13
Again, the approach should
be individualised. If there is a strong family history of allergies,
addressing which by dietary exclusion would not result in a nutritionally
inadequate diet, such exclusion may be worthwhile.7 If 1
or more allergens are excluded from the mother's diet, a dietitian should
assist in compiling a nutritionally adequate diet.
Exclusive breastfeeding for at least 6 months
Exclusive breastfeeding for at least 4 to 6 months to prevent or
delay the onset of allergic disease has been recommended in many
studies. This is very important, as even a single alternative feed
could result in sensitisation. This breastfeeding period allows
the gastrointestinal tract to mature sufficiently to be able to
withstand exposure to allergens.4,13,14,15,16
The American Academy
of Pediatric suggests exclusive breastfeeding until 6 months of age
and then nonexclusive breastfeeding until at least 12 months of age.
These breastfeeding recommendations are the same for all newborns, whether
at risk for atopy or not.7
(both proven and proposed) of breastfeeding:
It provides the infant with nutrients for growth and development.
It provides immunological protection during the critical period when
the infant's own defense mechanisms are immature.
It actively stimulates the development of the infant's own immune
The child is exposed, through its mother's milk, to a low dose of
cow's milk proteins, which may induce tolerance rather than allergic
It should be noted
that a large study on the relationship between breastfeeding and allergies,
particularly asthma, suggested that breastfeeding in the early months
of life can prevent allergies until the age of 2 years; but that breastfeeding
may lead to an increased risk of allergies once the child is older than
breastfeeding is impossible for the high-risk infant:
Cow's milk-based infant formulas should not be given as an alternative
because of the risk of developing cow's milk allergy. Many clinicians
suggest that soy formula should not be given, as it has been found to
elicit a reaction in more than 25% of cow's milk-allergic individuals.
But it should be kept in mind that 70-75% will not react, and soy could
be used if proven to be safe in a particular infant.6,10 The same
would be the case with other milks such as goat's and sheep's milk.
(It should be noted that 70-90% of cow's milk allergic patients will
be intolerant to goat and sheep's milk.)10,17
formula (eHF) is the formula of choice in the case of high-risk infants
who cannot have breastmilk.3,14,16 A concern is that even these feeds
have been shown to elicit a reaction in about 20% of cow's milk-allergic
infants.18 The formulas are often also not affordable in lower socio-economical
What about partially
hydrolysed formulas (pHF)? It has been claimed that pHF might induce
tolerance because of the presence of some allergenic activity, but recent
data indicate a greater benefit with eHF than with pHF.3,4 PHF is
not used if a child has already been diagnosed with cow's milk allergy.
If a child reacts to eHF, an elemental formula should be given.10
Avoidance of the highly allergic foods for a certain period
There is conclusive evidence that a high-risk infant should not
be exposed to the major allergens early in life. But the exact period
has not been determined. All 6 major allergens should definitely
be avoided for at least the first 6 months, preferably 1 year.
have indicated that high-risk infants should not be given dairy until
they are 1 year of age; eggs until age 2 years; and peanuts, nuts, and
fish until 3 years.10 (Incidentally, it is also said that
children under the age of 5 should not be given whole peanuts because
of the risk of choking.11) But these are only general guidelines.
On the other hand, some have suggested that a nutritious diet (a diet
which is less easily attainable if many foods are excluded) is more
important during the first few years of life than strict allergen avoidance.
Again, a regimen should be individualized according to the family history,
and a dietitian should be consulted to ensure nutritional adequacy of
be given to avoiding exposure to hidden allergens as well. Many baby-care
products contain allergens such as nut oils, cow's milk, egg, wheat
and sesame proteins. Also avoid highly perfumed products, as they may
contain substances that could sensitize the child. It is important to
read product labels carefully.
Avoidance of environmental allergens
Exposure to environmental allergens such as house dust mite, pets
(cats, dogs, birds), molds and cockroaches could sensitize the infant.
In the case of a high-risk infant, measures to reduce the allergen
load (such as anti-house dust mite measures) should be implemented
in the house and especially in the baby's room.6,10,19,20
has reported that infants born in the spring months (when the
pollen count is high) have a high risk of developing pollen-related
allergies. It is recommended that, if possible, the birth of a
high-risk infant be planned so that it does not coincide with
also be avoided during pregnancy and lactation. Children should
not be exposed to passive smoking.6,10,21
There has been conflicting
evidence about the avoidance of contact with other infants or adults
with viral infection within the first 6 months of a high-risk infant's
life. The theory is that viruses could exacerbate the development of
allergies. But it has also been said that children who are exposed to
peers and to infections early in life have a lower risk of developing
atopy. The evidence is not conclusive as yet.22
Several studies have shown promise for probiotics creating the correct
balance of microbial flora in the gut and thereby slowing down the
development of allergy. The immune system may develop protective
responses, and gut defense barrier mechanisms may be strengthened.
But the exact mechanism is not clear yet, and at this stage there
is insufficient evidence to validate this intervention as a standard
Recent studies have shown that a specific long-acting antihistamine
in high-risk infants markedly reduced or prevented the progression
from atopic dermatitis to asthma, if the drug was used at the earliest
appropriate moment.It seems, therefore, that in high-risk infants
and children who are already showing symptoms of allergic disease,
the use of this drug may significantly delay the progression of
the allergic process and prevent more serious allergic conditions
such as asthma. It has also been shown that, if administered daily
for a prolonged period (i.e., 3 years), the drug may hamper the
development of new sensitisations in monosensitised children: this
makes it a potential means of tertiary prevention of allergy.6,27,28
||compiled by Karen du Plessis
Food & Allergy Consulting & Testing Services (FACTS)
PO Box 565
Comments by our editors
M. Joneja Ph. D., RDN
There has been a great deal of interest in primary prevention
of allergy in an attempt to reduce the risk of the "atopic
march" from food allergy to asthma, to life-threatening anaphylaxis.
Many studies have attempted to find a key strategy to avoid the
early sensitization to allergens that starts with a Th2 response
wherein T helper cells produce cytokines that result in IgE antibodies
and mast cell degranulation - events which are central to the
allergic response. Until recently there was little consensus regarding
the conditions that might lead to this allergic reaction in early
life. In the past year or so, however, a few research studies
have indicated that it is the allergic history of the mother that
is key to the sensitization and subsequent allergy in her off-spring.
In fetal life, cytokines tend to be skewed to
the Th2 type of response to guard against rejection of the fetus
by the mother's immune system. Just prior to birth the baby tends
to have low levels of interferon-gamma, which is associated with
the Th1 response and production of IgG. Instead, cytokines typical
of a Th2 response, especially interleukin-4, associated with IgE
production, predominate. However, typically, at birth, IgG1 and
IgG3 from the mother tend to inhibit IgE, and it has been suggested
that in non-allergic mothers this process down-regulates the Th2
response and therefore suppresses any tendency to allergy. In
contrast, allergic mothers tend to produce IgE, and IgE and IgG4,
antibodies, which tend to predominate in allergy, are high at
the maternal/fetal interface. Thus the suppressive effect of IgG1
and IgG3 is absent, and the baby of the allergic mother may be
primed to respond with IgE production even before birth. In addition,
since IgG crosses the placenta, the high levels of IgG1 and IgG3
of the non-allergic mother may suppress fetal IgE, which appears
as early as 11 weeks gestation, but the IgG4 of the allergic mother
allows the IgE response to predominate (maternal IgE does not
cross the placenta). Since small amounts of food antigens reaching
the fetus from the mother's diet are thought to tolerize the fetus
in utero by inducing IgG rather than IgE, such tolerization would
not occur in the allergic mother. Thus, the fetus of the allergic
mother is at greater risk of sensitization to food allergens.
This response continues after birth, and there is evidence that
although food antigens in the non-allergic mother's breast-milk
are tolerizing, those in the milk of the allergic mother may be
sensitizing to the baby. In addition there is preliminary evidence
to suggest that the "tolerizing" cytokine TGF-b is lower
in the breast-milk of the allergic compared to that of the non-allergic
mother, again suggesting that it is the maternal immune system
that plays a key role in promoting allergy in her baby. No doubt
in future we shall see distinctly different directives regarding
allergy prevention in babies of allergic compared to those of
non-allergic mothers, especially with regard to maternal consumption
of potentially allergenic food.
Hamelmann E, Wahn U. Immune responses to allergens early in life:
when and why do allergies arise? Clinical and Experimental Allergy
Jones CA, Holloway JA, Warner JO. Does atopic disease start in
foetal life? Allergy 2000 55:2-10
Lilja G, Wickman M. The immunology of fetuses and infants. Allergy
Prescott SL. Early origins of allergic disease: a review of processes
and influences during early immune development. Current Opinion
in Allergy and Clinical Immunology 2003 3(2):125-132
For more information
on this subject and other allergy and intolerance related topics, visit:
To join a professional
food allergy discussion list where this subject can be discussed further,
go to http://groups.yahoo.com/group/AllergyDietitian
|We invite you to send us interesting
case studies. We pay US$100 for each case study we use in our newsletter.
To subscribe or
unsubscribe, send an e-mail to firstname.lastname@example.org
put "subscribe Educational" or "unsubscribe Educational
" as the subject.
1. Wood RA. The natural history of food allergy. Pediatrics 2003;111(6):1631-7.
2. Wahn U. What drives the allergic march? Allergy. 2000 Jul;55(7):591-9.
3. Dreborg S. Dietary prevention of allergy, atopy, and allergic diseases.
J Allergy Clin Immunol. 2003 Mar;111(3):467-70.
4. Halken S, Host A. Prevention. Curr Opin Allergy Clin Immunol. 2001
5. Kjellma N-IM. Serum IgE and the predictive value of IgE determination
In: Businco L, ed. Proceedings of International Allergy Workshop: Advances
I Paediatric Allergy. Amsterdam: Excerpa Medica, 1982;69.
6. Haus M, Potter PC. Prevention of allergic diseases. The ALLSA handbook
of practical allergy, 2nd Edition. Ince (Pty) Ltd., South Africa. 2001.
7. Zeiger RS. Food allergen avoidance in the prevention of food allergy
in infants and children. Pediatrics. 2003 Jun;111(6 Pt 3):1662-71.
8. Dalal I, Binson I, et al. Food allergy is a matter of geography after
all: sesame as a major cause of severe IgE-mediated food allergic reactions
among infants and young children in Israel. Allergy 2002;57(4):362-5.
9. Hide DW. Allergy prevention--an attainable objective? Eur J Clin
Nutr. 1995 Sep;49 Suppl 1:S71-6.
10. Metcalfe DD, Sampson HA, Simon RA. Food Allergy: Adverse Reactions
to Foods and Food Additives, 3rd Edition. Blackwell Publishing. 2003.
11. Kmietowicz Z. Women warned to avoid peanuts during pregnancy and
lactation. BMJ. 1998 Jun 27;316(7149):1926.
12. Arvola T, Holmberg-Marttila D. Benefits and risks of elimination
diets. Ann Med. 1999 Aug;31(4):293-8.
13. Hoppu U, Kalliomaki M, Laiho K, Isolauri E. Breast milk--immunomodulatory
signals against allergic diseases. Allergy. 2001;56 Suppl 67:23-6.
14. Fiocchi A, Martelli A, De Chiara A, Moro G, Warm A, Terracciano
L. Primary dietary prevention of food allergy. Ann Allergy Asthma Immunol.
2003 Jul;91(1):3-12; quiz 12-5, 91.
15. Foote KD, Marriott LD. Weaning of infants. Arch Dis Child. 2003
16. Chandra RK. 1989. Influence of Maternal Diet During Lactation and
the Use of Formula Feed and Development of Atopic Eczema in the High
Risk Infants. Br Med J 299:228-30.
17. Carroccio A, Cavataio F, Iacono G. Cross-reactivity between milk
proteins of different animals. [Editorial] Clin Exp Allergy 1999;29:1014-1016.
18. de Boissieu D, Matarazzo P, Dupont C. Allergy to extensively hydrolyzed
cow milk proteins in infants: identification and treatment with an amino
acid-based formula. J Pediatr 1997;131:744-747.
19. Peroni DG, Chatzimichail A, Boner AL. Food allergy: what can be
done to prevent progression to asthma? Ann Allergy Asthma Immunol. 2002
Dec;89(6 Suppl 1):44-51.
20. Apter AJ. Early exposure to allergen: is this the cat's meow, or
are we barking up the wrong tree? J Allergy Clin Immunol 2003 May;111(5):938-46.
21. Rance F, de Blic J, Scheinmann P. [Prevention of asthma and allergic
diseases in children]. Arch Pediatr 2003 Mar;10(3):232-7.
22. Hopkin JM. The rise of atopy and links to infection. Allergy. 2002;57
23. Matricardi PM. Probiotics against allergy: data, doubts, and perspectives.
24. Kalliomaki M, Isolauri E. Role of intestinal flora in the development
of allergy. Curr Opin Allergy Clin Immunol. 2003 Feb;3(1):15-20.
25. Kalliomaki M, Isolauri E. Pandemic of atopic diseases--a lack of
microbial exposure in early infancy? Curr Drug Targets Infect Disord.
26. von der Weid T, Ibnou-Zekri N, Pfeifer A. Novel probiotics for the
management of allergic inflammation. Dig Liver Dis 2002 Sep;34 Suppl
27. Ciprandi G, Frati F, Marcucci F, Sensi L, Milanese M, Tosca MA.
Long-term cetirizine treatment may reduce new sensitisations in allergic
children: a pilot study. Allerg Immunol (Paris). 2003 Jun;35(6):208-11.
28. Warner JO; ETAC Study Group. Early Treatment of the Atopic Child.
A double-blinded, randomized, placebo-controlled trial of cetirizine
in preventing the onset of asthma in children with atopic dermatitis:
18 months' treatment and 18 months' posttreatment follow-up. J Allergy
Clin Immunol. 2001 Dec;108(6):929-37.
Questions (For South African dietitians only. Australian
dietitians: where you have relevant learning goals, CPD hours related
to this resource can be included in your APD log.)
You can obtain 2 CPD points for reading
this newsletter and answering the accompanying questions. This
newsletter with questions has been accredited for dietitians.
CPD reference number: DT03/3/098/13
HOW TO EARN YOUR CPD POINTS
1. Complete your personal details below.
2. Read the newsletter and answer the questions.
3. Indicate your answers to the questions by making a "X"
in the appropriate block.
4. You will earn 2 CPD points if you answer more than 75% of the
questions correctly. If you score is between 60 and 75%, 1 CPD
point will be allocated. A score of less than 60% will unfortunately
not earn you any CPD points.
5. Make a photocopy for your own records in case your answers
do not reach us.
6. Cut and paste the area indicated below into a e-mail message
and e-mail it to email@example.com
to be received no later than 30 November 2003. Answer sheets received
after this date will not be processed.
ALL THE QUESTIONS
(There is only
one correct answer per question.)
1. Which of the following statements is true?
(a.) The chance of developing an allergy is 40-60% if both parents are
(b.) If both parents have the same allergy, the child has a 60-80% chance
of developing any allergy.
(c.) Paternal allergy appears to be a greater risk factor than maternal
(d.) Girls tend to have an earlier onset of allergic disease than boys.
2. True or false:
Where the unborn child has a strong family history of allergy, 1 or
more of the 6 major allergens should always be avoided in the pregnant
3. True or false:
It has been proven that allergens can be transferred to the infant through
breast milk and sensitize the infant to a specific allergen.
4. Which of the
following is not a possible benefit of breastfeeding:
(a.) It provides the infant with nutrients for growth and development.
(b.) It provides immunological protection during the critical period
when the infant's own defense mechanisms are immature.
(c.) It actively stimulates the development of the infant's own immune
(d.) The child is exposed, through its mother's milk, to a high enough
dose of cow's milk proteins to guarantee tolerance rather than allergic
5. Which is the
formula of choice in high-risk infants who cannot have breast milk?
(a.) Cow's milk-based formula
(b.) Soya formula
(c.) Partially hydrolysed formula
(d.) Extensively hydrolysed formula
6. True or false:
In the high-risk infant, the 6 major allergens should be avoided for
at least the first 6 months, preferably for 1 year.
7. What are the
suggested mechanisms by which probiotics may influence the development
(a.) Creating the correct balance of microbial flora in the gut
(b.) Allowing the immune system to develop protective responses
(c.) Strengthening gut defense barrier mechanisms
(d.) All of the above.
8. True or false:
Early use of a specific long-acting antihistamine in high-risk infants
has been shown to markedly reduce or prevent the progression from atopic
dermatitis to asthma.
paste this section below into an e-mail message
CPD Reference number: DT03/3/098/13
HPCSA number: DT
Surname as registered with the HPCSA:
Please make an "X"
in the appropriate block for each question
a [ ] b [ ] c [ ] d [ ]
a [ ] b [ ]
a [ ] b [ ]
a [ ] b [ ] c [ ] d [ ]
a [ ] b [ ] c [ ] d [ ]
a [ ] b [ ]
a [ ] b [ ] c [ ] d [ ]
a [ ] b [ ]