Q: In relation to a cows’ milk free diet, what are the most common dietary misconceptions you find?Misconception ‘Goat’s milk and other mammalian milks can be used in CMPA’.

Fact All mammalian milks are unsuitable for children with CMPA due to the homology in protein composition.

Misconception ‘Lactose free products can be used in CMPA’.

Fact Lactose free products are free from lactose (milk sugar) but still contain milk protein and would therefore provoke the same immune response as cow’s milk.

THE OATLY WAY- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

ISSUE 1june 2015

interview with rachel de boerQ: You have considerable experi-ence in paediatric food allergy; would I be right in thinking that cows’ milk protein allergy (CMPA) is the most common allergy you see? How often do you see concomitant soya allergy? Yes, CMPA is indeed one of the most common allergies we see in children; it occurs in 2-6% of infant and young children in the UK. Concomitant soya allergy is present in 10-14% of children with IgE-mediated CMPA1,2. In those children with non-IgE mediated (delayed) CMPA soya allergy is much more common affecting between 25% - 60%.3

Q: What are the most common presenting symptoms you see with CMPA? CMPA can manifest as a number of different clinical presenta-tions, mainly affecting the skin, gastro-intestinal tract and respiratory systems4,5 and can be classified into IgE-medi-ated (immediate onset) and non-IgE-mediated (delayed onset) re-actions depending to the timing of symptom development and organ involvement.

Click here for a summary of the common symptoms of CMPA.

say hello to the oatly family!

click here toREAD MORE ABOUT US

I am delighted to share with you the first issue of our e-newsletter The Oatly Way. In this issue you will find an interview with leading Paediatric Allergy Dietitian, Rachel De Boer. Rachel has worked at a leading London teach-ing hospital for more than seven years, specialising in the diagnosis and dietary management of children with complex dietary needs due to multiple food allergies. On page 3, Carina Tollmar, Sustainability Manager for Oatly, provides an insight into Sustainable Food Production. We hope you enjoy it and welcome any feedback.

Julia Strömblad Lenhoff Registered Dietitian, Oatlyjulia.stromblad.lenhoff@oatly.com

welcome!

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Misconception ‘It’s impossible to meet your calcium requirements without a supplement in CMPA’.

Fact It is possible to achieve adequate calcium intake using calcium fortified milk alternatives and other dairy free calcium rich foods however a child’s calcium intake should always be assessed by a Dietitian who is best placed to recommend whether a supplement is necessary or not.

Q: Can you explain the recommendations regarding the use of milk alternatives with children? Cow’s milk is an important source of energy, protein, calcium and other micronutrients in children. There are a wide range of milk alternatives available to buy but these are considerably lower in energy, protein and fat. In most cases it is therefore recommended that CMPA children use a hypoaller-genic formula as the main milk alternative until 24 months5. However in some cases, children between 12-24 months who are

eating a balanced and varied diet and growing well may be able to move onto a milk alternative between 12 – 24 months with dietetic

guidance. Milk alternatives

based on oats, soya, coconut, nut, pea and quinoa can be used in cooking, baking and with breakfast cereal from 6 months.

Q: What ‘top tips’ would you give to parents of children with CMPA on choosing a suitable milk alternative?- Always choose products fortified with calcium and vitamins; many of the organic versions aren’t fortified

- Rice milk should be avoided in children under the age of 4 ½ years due to concerns regarding its inorganic arsenic content6,7. - Ensure the milk alternative isn’t based on a food the child is allergic to.- Choose an alternative

that is as high in energy and protein as possible

Q: What useful resources are there for healthcare professionals working with CMPA?The Food allergy group of the BDA produce a range of ‘food-fact leaflets’ with basic food allergy information and a selection of more comprehensive allergy diet sheets for Dietitians to educate parents. In addition many milk alternative and hypoallergenic formula manufactures have useful and informative resources and websites with information on CMPA, products and useful recipes. Finally there a number of excellent UK based allergy focused organisations and charities with useful website:

CHILLI CHOCOLATE smoothieServes 2

300 mls Oatly Oat Drink - Original or Fresh, chilled2 frozen bananas (peel & chop into chunks before freezing)2 tsp cacao powder1 tsp ground cinnamonFresh red chilli, to taste

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Oatly AB. Stora Varvsgatan 6A, 211 19 Malmö. Consumer contact: info@oatly.com | 020 – 84 28 43 | www.oatly.com

1. Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr. 2012 Aug;55(2):221-9

2. American Academy of Pediatrics: Committee on nutrition. Hypoallergenic infant formulas. Pediatrics 2000, 106(2 Pt 1):346–349.

3. Venter C, Brown T, Shah N et al. Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy—a UK primary care practical guide. Clin Transl Allergy 2013; 3 (1): 23. Available at: www.ctajournal.com/content/3/1/23

4. NICE. Diagnosis and assessment of food allergy in children and young people in primary care and community settings. Clinical Guideline 116. NICE, 2011. Available at: www.nice.org.uk/guidance/cg116

5. Luyt. D. BSACI guideline for the diagnosis and management of cow’s milk allergy. Clinical & Experimental Allergy 2013. 642–672

6. Food Standards Agency. Survey of total and inorganic arsenic in rice drinks. Food Survey Information Sheet 02/09, 2009.

7. Meharg AA, Sun G, Williams PN et al. Inorganic arsenic levels in baby rice are of concern. Environ Pollut 2008; 152:746–9.

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Allergy UK www.allergyuk.org

Anaphylaxis campagin www.anaphylaxis.org.uk

British Society of Allergy and Clinical Immunology www.bsaci.org

The British Dietetic Association www.bda.uk.com

sustainable food productionAgriculture and grazing currently use more than 34% of the Earth’s surface1, and are the biggest reason for the loss of biological di-versity on a global scale2. In addition, agriculture contributes to the emission of greenhouse gases, over-fertilisation (or eutrophication) of lakes and seas, and pesticides contribute to the contamination and pollution of the environment.

The environmental impact from agriculture can be reduced by using less land and by reducing the environmental impact of the land which is used.

By increasing harvests in countries where they are low (primarily in less developed countries), more food is produced from a smaller area and less agricultural land is therefore required. This impor-tant initiative is called “closing the harvest gap”3. Reducing the amount of food that is wasted before it reaches the consumer is another important initiative which further reduces the need for agricultural land.

Through the use of different agricultural practices, the envi-ronmental impact on the land used can be reduced. This involves effective use of fertiliser, pesticides and other supplements so that the minimum amount possi-ble is used in food production.

However, a study published in the UK last year4, received a great deal of attention5,6 and showed that even if all of these measures were introduced in full this would be insufficient to prevent further agricultural land from being brought into use on a global scale or to reduce the emissions of greenhouse gases to the level required by 2050. The study showed that the consumption of meat and dairy products in the

Western world must also reduce significantly.

The production of animal prod-ucts requires much more land than the production of plants, because large amounts of fodder must be grown in order to feed the ani-mals. In addition, animal produc-tion has a significant climatic impact due to the methane emis-sions of ruminants, like cows. This means that environmentally sustainable agriculture requires not merely the use of better ag-ricultural practices and reduced waste, but also a transition to a more plant-based diet.

Carina TollmarSustainability Manager, Oatly

1. Ramankutty, N., Evan, A. T., Monfreda, C., & Foley, J. A. (2008). Farming the planet: 1. Geographic distribution of global agricultural lands in the year 2000. Global Biogeochemical Cycles, 22(1), GB1003. doi: 10.1029/2007GB002952

2. Millennium Ecosystem Assessment, 2005. Ecosystems and Human Well-being: Synthesis. Island Press, Washington, DC.3. Foley, J. A., Ramankutty, N., Brauman, K. A., Cassidy, E. S., Gerber, J. S., Johnston, M.,Zaks, D. P. M. (2011).

Solutions for a cultivated planet. Nature, 478(7369), 337-342. doi: http://www.nature.com/nature/journal/v478/n7369/abs/nature10452.html#supplementary-information

4. Bajzelj, B., Richards, K. S., Allwood, J. M., Smith, P., Dennis, J. S., Curmi, E., & Gilligan, C. A. (2014). Importance of food-demand management for climate mitigation. Nature Clim. Change, 4(10), 924-929. doi: 10.1038/nclimate2353

5. http://www.bbc.co.uk/news/science-environment-290077586. http://motherboard.vice.com/read/to-fix-climate-change-the-world-needs-to-change-how-it-eatsRe

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Oatly AB. Stora Varvsgatan 6A, 211 19 Malmö. Consumer contact: info@oatly.com | 020 – 84 28 43 | www.oatly.com

strawberry andavocado smoothieServes 2

300 mls Oatly Oat Drink - Original or Fresh, chilled150 g strawberries, frozen½ ripe avocado, peeledJuice of ½ lemon1 tbsp honey, or to taste2 tsp chia seeds, sprinkle on as topping

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