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АТОПИЧЕСКИЙ ДЕРМАТИТ У ДЕТЕЙ
Атопический дерматит объединяет такие нозологические формы аллергических заболеваний, как детская экзема и нейродермит, которые характеризуются хроническим течением и клинически проявляются развитием воспалительных очагов на коже, расположенных симметрично и сопровождающихся зудом. Ранним проявлением атопического дерматита у детей является экзема. Она развивается, в основном, на первом году жизни, в последующие два-три года прогрессирует при отсутствии адекватного лечения, а затем у большинства трансформируется в нейродермит.
Наиболее важным в лечении атопического дерматита является, во-первых, раннее выявление аллергенных продуктов и назначение ребенку индивидуальной диеты с временным их исключением, что обеспечивает ремиссию (исчезновение симптомов) заболевания, снижает чувствительность больного к «виновным» аллергенам; во-вторых, адекватное лечение патологии пищеварительного тракта, что обусловливает нормализацию процессов пищеварения и всасывания и в последующем позволяет расширить диету; в-третьих, противорецидивное лечение.

лечение неврозов

PEANUT BUTTER

Almond butter and cashew butter are both delicious. They are sold by some healthfood shops or can be obtained by post. Be careful not to eat too much of either as nuts are frequently implicated as allergens. Hazelnut butter is another useful alternative, along with tahini (ground sesame seeds) and sunflower spread.

CHOCOLATE

Carob makes a reasonable substitute. Healthfood shops stock various carob products, and you can also buy carob powder for cake-making.

COFFEE AND TEA

Redbush or rooibosch tea tastes very similar to the real thing. It contains no caffeine and little tannin, but may still provoke symptoms in people who are sensitive to tea. Caffeine-free coffee substitutes abound, including dandelion coffee based on the roasted root, and Barleycup and Pioneer which are both based on roasted barley and chicory. Any coffee substitute may irritate the stomach lining of those who are already sensitive to coffee. Herb teas are much less likely to cause problems.

SNACKS

Pumpkin seeds and sunflower seeds make an excellent snack, and both are sold by most healthfood shops. Such shops also sell most kinds of nut, including some of the more unusual varieties, such as cashews, pistachios, Brazil nuts and pecans – these can be useful for keeping the diet varied. Macadamia nuts are very filling, although rather expensive – they are only sold in large supermarkets as a ‘cocktail nut’. Potato crisps without additives can be bought at healthfood stores, and make a good snack. Maize chips, also without additives, and popping corn are useful for those not sensitive to maize. Dried fruit, dessicated coconut and roasted chickpeas (sold in most Indian groceries) are other useful snack items.

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You can substitute other starchy foods such as sweet potatoes and buckwheat for some of these – see p301. Be careful to distinguish buckwheat from bulgur wheat – the latter is true wheat, but buckwheat comes from an entirely different plant. Millet is a cereal, but few people react to it. You should not eat it at first, but if you find you are unable to eat wheat, you could test it as a potential substitute.

If you are used to eating lots of bread, then you may feel rather empty and it might be tempting to stoke up on potatoes. Try to avoid this temptation, and use some other, less usual foods as fillers sometimes – parsnips or turnips, for example. Acquiring a sensitivity to potatoes is not going to be helpful.

Maize is found in sweetcorn, corn-on-the-cob, cornflour, corn syrup, cornflakes and popcorn; also in the American products known as grits or hominy grits. The Italian dish, polenta, is made with maize. The gum on stamps and envelopes is often made of cornstarch and highly sensitive people may react to licking these.

Wheat is found in macaroni, spaghetti and other forms of pasta, couscous, semolina, biscuits, cakes and pastry – as well as in bread, most breakfast cereals and most packaged foods. When labels say ‘flour’ they usually mean wheat flour – or maize.

If you are eliminating rice, then you should also avoid wild rice, since the two are related (though not closely). If you find you are sensitive to rice, then test wild rice later as a potential substitute.

Potato flour, rice flour or arrowroot can be used to thicken sauces and gravies – these are available from healthfood shops and delicatessans. Do not use instant mashed potato as this contains various additives.

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Antibiotics

If changes in the gut flora are an important factor in food intolerance, then the use of antibiotics must undoubtedly shoulder some of the blame. The major antibiotics have only been in widespread use since the 1940s, and no-one would deny their major contribution to medicine. Indeed, a short course of antibiotics is unlikely to do anyone much harm. It is prolonged use, or very high doses, that are most likely to affect the gut flora. In some situations the antibiotics are not strictly necessary – in treating acne for example, or in repeated childhood ‘infections’ that are not really infections at all but undiagnosed allergies.

Modern life

A lot of things have changed in the last 50-100 years. Of all the momentous changes that have occurred, is there anything that might have made people more susceptible to food intolerance? On the basis of what we already know about how food intolerance begins, there are several obvious candidates.

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Of course, it is not always easy to tell why a baby is crying – there may be many different causes. Even the question of how much crying is ‘natural’ is contentious. The following quotations illustrate the widely differing views of this common problem:

‘During the first few weeks of life the average baby sleeps a great deal but, when awake, cries lustily and often …. It is only from about six weeks of age onwards, when the baby is becoming aware of his or her surroundings, that there are some wakeful periods without crying…. There is no reason why the simple milk diet (whether natural or otherwise) of the normal baby should cause tummy ache. If the baby cries uncontrollably for several hours each evening, it is more likely that the cause is so-called 3-month or 10-week colic (sharp tummy ache). But, although some doctors consider that the baby has genuine physical pain, others believe that this is an example of the baby reacting to the tensions of the mother at the end of a hard day: and they believe that the crying stops after 10 to 12 weeks because by then the mother has become more competent and confident in her handling of the baby, and has communicated this new calmness to the baby.’ (The Macmillan Guide to Family Health, edited by Dr Tony Smith).

SOME MINOR SYMPTOMS THAT MAY ACCOMPANY COLIC

Frequent regurgitation of food (posseting) Loose stools Wind and bloating Constipation

Poor appetite, stops feeding and screams after a few minutes

Stuffy or runny nose, nose-rubbing

Frequent sneezing, coughing, sniffing or snorting

Noisy breathing

Frequent hiccoughs

Frequent ear infections or colds

Bad breath

Dry, cracked skin, rashes, eczema

Constant scratching or rubbing

Sweatiness, slight fever, or cold hands and feet

Redness around mouth or anus, or on cheeks

Swelling around eyes

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Until fairly recently, most conventional allergists believed that the sort of symptoms seen in a patient depended largely on the type of allergen involved: the part of the body affected would be the part that first encountered the allergen. Thus, allergens that fell on the skin or brushed against it, called contactants, would tend to produce skin reactions such as eczema. Inhaled allergens or inhalants, such as pollen or dust, would produce symptoms in the nose and airways. Food allergens, obviously, would produce symptoms in the lips, mouth, stomach and gut. It was all very logical.

Among the patients treated by allergists, there were always some whose allergens could not be identified. With these unfortunate patients, it was assumed that some other non-allergic mechanism was producing the symptoms. Asthma patients, for example, were given the label ‘intrinsic asthma’ if no allergen could be pinpointed. Like many of the labels used in medicine this is just a clever way of saying that no-one has any idea what is causing the disease. These insoluble cases were an indication that something was wrong with the traditional concept of allergies, although few doctors realized this at the time.

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