If your baby or toddler is using reflux medicine, maybe it’s time to quit. Here’s why, and how.
This is one of my least favorite findings in a little one’s history. Why? Because the longer reflux medicines are used, the weaker a child’s digestion becomes. The weaker your baby’s digestion becomes, the harder it is to absorb food and nutrients. This creates a domino effect of trouble! Just click through this FDA powerpoint presentation to the Pediatric Advisory Committee to see what I mean. From fractures to fecal impactions, it’s not pretty.
Most parents report to me that reflux medicine seems to help a little at first, especially for quelling colic and crying. But soon, the benefit fades.
Then the baby becomes more picky, appetite more sluggish, stools more constipated and slow, belly more bloated. Feeding gets harder, not easier – and the reflux medicine dose goes up. After a few months, we have a fussy eater who is having tantrums about feeding, who is dependent on Miralax to have bowel movements, and growth pattern has slowed down. After a few years on reflux medicines, it’s common for me to be looking at a stunted child who is barely getting taller; who is epically picky, cranky, or anxious; who is struggling to learn, behave, or develop normally; and who is so stuck on Miralax even at ever increasing doses, it doesn’t work so well anymore.
The whole point of these medicines is to weaken stomach acid – presumably because too much acid is irritating the esophagus. Reflux medicines (“proton pump inhibitors” or PPIs) are the second most prescribed drug for infants and children, behind antibiotics. Does your baby even need it?
These medicines were created and approved for use in adults who may actually have too much acid gurgling up from the stomach into the esophagus. But this may not be what is happening in a baby or toddler’s digestion. Reflux medicines are not FDA approved for use in infants (kids under a year old) but are routinely prescribed anyway. Even if actual reflux was the issue, the only way to know for sure is to put the baby through an invasive procedure with something called a pH probe. A probe is stuck down the baby’s throat in “dip-stick” fashion so that a reading on the stomach’s acidity can be taken. Infants may need sedation and hospitalization to get through this procedure. Obviously, it’s all too easy for your pediatrician to hand you a prescription instead and say “try this”.
Before you try that, you should know that there are many drug-free options that work well, and leave your child’s digestion in tact. Try these instead – because reflux medicines have been found to have these negative side effects:
• reduce uptake of iron, zinc, calcium, and magnesium
• increase risk of breaking bones
• impede absorption of vitamin B12, and reduce serum levels of B12
• enhance fungal (yeast) infections in the gut or esophagus
• reduce the helpful bacteria in the gut (which makes digesting food even harder) while encouraging pathogenic bacteria
• cause bacterial infections of the small intestine
• cause Clostridia difficile infections, a hard to treat bacteria that causes diarrhea
• seizures under certain predisposing conditions
Yuck! Imagine all this going on in a tiny infant’s gut, which is just getting started in learning to digest and absorb food.
Basically, these medicines weaken stomach acid – and thus, make the stomach less capable of digesting anything. The ability to digest and absorb food is gradually weakened. Effects from using these for more than a few weeks? Examples from my own practice include linear growth grinding to a halt (kids can’t grow taller), delayed bone age (kids’ bones are not growing normally), and fractures of hip, wrists, or spine – in kids. Other nutrients become harder to absorb too, especially vitamin B12. Anxiety becomes prominent – and this is not surprising, as we learn more about how gut bacteria are linked to mood and anxiety.
But that’s not all. Changing the acid level of a human digestive tract means you change which microbes can grow there. The microbes we carry in our intestines do a lot for us. They help us digest food, communicate with our immune systems, and help fight off invading infectious microbes that can make us sick. Using reflux medicines favors microbes that are not ideal – such as Clostridia difficile (linked to seizures and autism like features in tests on rats) and fungal infections (Candida or other yeast species). These definitely do not help your baby or child. A healthy gut has a pH that will favor helpful species, like Lactobacillus strains or Bifido strains.
So what to do? Try these steps – and learn more detail in my book Special Needs Kids Go Pharm Free. The first chapter is all about babies, from feeding to colic to sleep, reflux, and more.
1) If you’re breastfeeding, trial a diet without the usual suspects. Remove dairy, gluten, nuts, eggs, or soy. Some babies fare better when brassicas are removed (cauliflower, broccoli, Brussel sprouts). Don’t remove all these foods at once. Experiment with rotations. Always put back in a strong, nutritious replacement for any food you take out. Use ample organic fats including eggs, ghee, meats and poultry, legumes, and vegetables. You may need to use alternate protein supplements to keep you strong and energized while your own diet is restricted. Need help with this? Contact me.
2) Change up the feeding routine. Milk and soy proteins are not what your baby was built to digest. So, if you’re using milk or soy formula, change it. This alone may ease “reflux” symptoms. Use a partly digested (“hydrolyzed”) formula instead. Some ideas here.
3) If you’re using milk protein formula, don’t switch to soy. It may be just as hard or harder than milk protein to digest. And soy. See step (1).
4) Switch to organic, GMO-free formula. GMO ingredients in conventional formula are potential trouble for your baby’s gut bacteria and gut health. Read here for why I tell my patients to avoid GMO foods. More scientists are expressing concern that GMO foods alone may be triggering autism in our children.
5) Use probiotics, like Klaire Labs Infant Therbiotic. This blends a number of beneficial strains that babies need in their guts for good digestion and to reduce inflammation. Klaire does not sell directly to the public, but you can purchase here or call them directly at 1-888-488-2488, with my provider authorization code 825.
6) Use an herbal tincture designed for babies and toddlers, in a glycerite base, that supports digestion. My favorite is from Gaia Herbs. Order at 10% off when you use my log in, MyNCFC and 80303 password, or call Emerson Ecologics at 1-800-654-4432. Tell them I’ve referred you and get 10% off.
7) Put Epsom salts in your baby or toddler’s bath at night. This is calming, and delivers both magnesium and sulfur via absorption through skin. Sulfur is a key mineral for many digestive functions. Dissolve one half cup in the bath and soak for twenty minutes.
8) Clear fungal infections. If your baby had thrush, he may need some stronger medicine to clear any lingering fungal load from the digestive tract. Fungal infections alone can alter the acidity of the digestive tract, and keep it sub-optimal – thus causing more reflux!
These are so easy to do. Use these steps to prevent ever getting on a reflux med, and to help your baby or toddler wean off. Let me know how it goes!
Thanks for stopping by! If you don’t see answers here to your baby’s situation and need more help, make an appointment to work with me – you can view options, fees, and access to my calendar here. I can’t answer treatment questions or give individual care advice in this forum, but look forward to working with you one on one.
Thank.you this all makes sense. What have you heard of giving infants grass fed ghee and what would be the dose? Could l sprinkle these probotics directly onto my nipples when feeding? Thanks!
Grass fed ghee would be great for infants – stir a melted half teaspoon into any soft food if you are introducing solids. More at one time may be hard to digest until a little older. Yes, you can dust nipple with probiotic prior to feeding, it’s easy. If your baby is under four months or so and you are breastfeeding, enjoy plenty of ghee and other healthy organic fats yourself, to replenish for your own milk supply – no need to give this food to baby just yet.
THis is very helpful, sadly my 15 month old has been on these medications since birth. I want to take him off them. He has a condition called laryngomalacia. Have you heard of it? The issue is that reflux can make his condition worse. I ordered your book, and hopefully will get some insights into how to go about it. Thank you!
Hi Katherine, I’m not familiar with laryngomalacia as I’ve not had kids in my practice with this condition, but I would be sure to ask your doctor if it is still necessary to stay on the reflux medicine. Long term use is known to diminish absorption of many nutrients including minerals. This may make it harder for your son’s larynx to structurally normalize itself in the long run. Now that he is older, perhaps a weaning plan can begin off the medicine – I ask your doc about this, and consider getting a couple opinions.
Hi! My son also has laryngomalacia and is on a high dose of Zantac and eats the Nutramigen. He’s 3 months right now and his weight is good.. he is slowly becoming a better eater. Last month he went on an antibiotic to help with inflammation so I am thinking adding a probiotic to his diet will help. Let me know if you have any tips!
Hi Nicole, I encourage weaning off the PPI as soon as possible, to preserve and protect digestive function. Begin lowering the dose with your doctor’s guidance. This may not work without further intervention for correcting the gut biome environment, but worth a try to start right away. Probiotics alone may not repair the shifts in his biome and may make him feel worse. A quick improvement may be seen if you ask for a course of Nystatin to clear the fungal species encouraged by using a PPI and antibiotics.
I just took my 2 year old off Prevacid. Looking for tips for getting his stomach acid back in balance. He’s having trouble eating and throwing up once a day. He can’t seem to drink milk anymore either.
He needs a bridge piece to link him from being dependent on Prevacid to dialing up his own digestive capacity. This can work with a weaning process while other natural support tools are brought in gradually. Assessing gut biome and food sensitivities can help too. Best for me to help one on one in an appointment, if the suggestions in this article haven’t done the trick. If that’s out of reach, have a look at my book Special Needs Kids Go Pharm Free for more details and ideas.
Ive found it gives great relief when I give my little one some grass fed ghee. I just use a very little and it solves the problem.
such great info and so happy i stumbled into your site,my 4 month old had stomach acid and thrush. He was prescribed anti acid and antifungal . I am not sure if thrush is completely gone.Just a little white patch in his mouth but he is starting to develop eczema.He is exclusively breastfed and im wondering if a probiotic would help since his stools have been watery since he was born
Yes the right probiotic could help – choosing these correctly for each situation can make or break success here. He may also need gentle tools to clear the fungal infection more directly. This may mean using an oral prescription medicine like Nystatin or Diflucan, or non-prescription anti-fungal herbal drops. The thrush and eczema should clear quickly once you have the right combination. For detailed guidance, I’m happy to do that, and you can set up an appointment anytime via my calendar here.
My baby had thrush and now has eczema. She has painful regurgitation of breast milk after every feed. At times it is very think when it comes back up.
Need help.
My baby is 2 and half month , dr.Described him nexuim for 10 days then change to zantac ,i didnt give him zantac but he is not getting better, he has reflux and swallow what goes up , am not sure what to do , they told me its better to use medicine because it hurts him and he has cough during the day and not happy after feeding, any help ?
Best option is to set up an appointment so I can advise and assist. I’m not able to do that in this venue, but would be happy to help if you like.
My 4 mo is exclusively breast fed and suffering from reflux. his weight gain has begun to taper off and has had green watery/ mucusy stools for three weeks. previous stool cultures have only shown pus cells but the latest one shows heavy Ecoli growth.
He has been taking half ampule of enterogemina on and off for the last 2 weeks but has recently been prescribed an antibiotic (cefuroxime)for 10 days to stave off the eColi. He is really not feeding well and I suspect this could be due to a tongue tie. His reflux is much better when fed from a bottle.
we recently started solids to see if the reflux would get better but it hasn’t helped. I’m afraid now that the doc will insist on reflux medication and I really don’t want to give it to him.
The Enterogermina (bacillus clausii) hasnt really helped. shall I try a different probiotic. do you agree with the treatment plan?
If the treatment plan hasn’t worked, then it’s time for a new plan. I can’t advise in this forum, but would be happy to investigate with you if you’d like to set up an appointment. Looking at more detail with functional stool microbiology is one of your options when working with me, as well as specifying best next steps on feeding and gain.
My son took nexium 10mg per day from 8 months to help with what we thought was reflux. Each 6 weeks we tried to wean him off but it was really hard and we continued the drug, being told if was safe. At 12 months, he started reacting to foods he previously was fine with and then at 14 minths he lost a lot of weight, became anxious and cranky, and struggled with food. I wanted him off nexium and a probe proved he had no reflux. So I took him off immediately. He now has fructose and lactose mslabsorption with bacteria in his tummy. Previously he ate fruits with little problem. After getting him off nexium, he improved but our health professionals wanted to give him more fats and he couldn’t take it. His behaviour changes when he eats and he had episodes when he just wobbles and falls over. He copes so much better when his foods are mashed. After being advised to stop breastfeeding at 15 months and going onto neocate things are just not right with my boy. When he eats whole foods he turns into an anxious child. It breaks my heart and I am trying to get my happy boy back again. I am now using probiotics which have helped, using magnesium baths, and seeking the advise of naturopaths whom are working with me to restore his tummy to better health. Is there any advise you could give me to improve his health now or have we done the permanent damage to my son? Can damage like this be reversed? I wish I could go back to breastfeeding as he was more settled too. My mum and I have been in tears thinking of how he is now compared to when he was younger. Unfortunately, I seem to be the only person who thinks nexium has done this – all others in the medical fields disagree with me. I live in australia and would really like your advise. Thankyou.
Hi Tania, please see my updated blog above – first / last paragraph. Would be happy to help.
Hi,
I have a 2 year old almost 3,his issues started when he was 14 months old with vomiting and his weight gain. He was 22 Olivé when he was 18 months, now he is 34 months and weights only 25lb. He is a really picky when it comes to food and he pretty much vomits 2 times a week. but since í complain a lot he was send to a gi clinic. They found something on his esophagus so they prescribe him reflux medicine for 8 weeks but after the first week his vomiting has increase now he vomits 4-5 times a week and lately 2 to 3 times a day. I stopped giving him the medicine after the 6th week. I don’t know what to do i am waiting for another endoscopy, they put him on that medicine so they can see if he has eoe.
What will you recomend?
I would not be able to recommend anything in this forum, but do indeed provide detailed and individualized care for toddlers in this situation. Your son has failed already with consult and invasive diagnostics from a GI doctor; he needs high level expert nutrition care, which you wouldn’t want to pluck for free off a website – it wouldn’t serve you or him. I invite you to make an appointment at my calendar here, and to book a three visit series (this saves you $75).
Thanks for taking the time to write this post and educate us. My son was prescribed Prevacid at 6 months old. Two years later we are weaning him off because of all the things I read about long term effects of PPI’s. It’s been a slow wean of 0.5 mL lower every Sunday. We only have two more weeks and he’ll be completely weaned. He’s a gtube kid and has always had some issues with vomiting and spit-ups so we were afraid to take him off. He’s been on probiotics (Pure Encapsulation) since he was one, as well as a whole food blenderized diet that contains no dairy, gluten, or sugar. We even did the raw cow’s milk formula Weston Price recommended from 8 months to 13 months. With those changes the vomiting and reflux have gotten better. Hopefully the gut is healing. Hopefully once the prevacid is completely removed the gut will do its job better. My son has started to show up on the growth chart over the last year. I wonder if there is anything else I could do to help heal his gut? to counteract the effects two years of using Prevacid?
Good work mom! Yes there is something you can and IMO must do: Prevacid profoundly changes gut biome and probiotics may not do the trick on their own. You might consider screening for fungal load with urine and stool tests. If this is still active (PPIs encourage fungal infections in GI tract, and possibly elsewhere) then leaky gut will persist and food allergies, reflux, and growth and feeding problems may also. Consider booking a single appointment so I can order that for you. This is a functional stool microbiology panel that assesses beneficial flora, fungal microbes, and detrimental non-pathogen bacteria as well. The urine test screens for fungal metabolites in urine. If positive, then a fungal UTI is a possibility. All can be addressed in a more targeted fashion with herbs, correct probiotics, and foods – some kids need prescription medicines for this piece but not all.
Hi. My daughter is 14 weeks old. she was on 5mg Nexium and then had to go onto 10mg and now she’s using 10mg and Infant Gaviscon roughly two to three times per day. She’s been on the Nexium for 2 full months already and is going onto month three. When we reduced the Nexium her crying bouts and poor feeding started again. She still has times like this which I’ve seen are largely due to something I’ve eaten so diet is utterly important because I breastfeed exclusively. I’m actually not sure what to eat because only a few things seem to be OK. I want to wean her so her digestive tract can heal and learn to operate by itself but I don’t want her to be in pain and have side effects from reflux either. She has improved since adding the Gaviscon, it been almost 3 weeks now. She’s also using Iberogast which has aided greatly with tummy cramps and she no longer gets constipated. What do you advise? Can I start weening her. She’s been on Nexiam for silent reflux from 5 weeks old. They clinically diagnosed her. No probe. She’s so tiny as she’s only 14 weeks old now. I feel at such a loss. I will do the diet things, I’ve removed nuts, flactulance causing veggies, and most gluten and it’s helped already. But she still needs the Nexium and Gaviscon.
Hi Geraldine, I don’t advise unless a child is a client of mine and I have full history – if working with me is not an option for you (I do remote consults routinely including for clients in other locales and countries), then I would definitely ask the doctor prescribing the proton pump inhibitors and other drugs for your daughter to guide you more thoroughly on feeding and growth/gain. These drugs are changing your daughter’s ability to digest and absorb food and are not good long term solutions.
Hi Judy, I just ran into your article and coincidentally I recently purchased the Klaire Infant Probiotic for my 3 month old son (he just turned 3 months three days ago. He has been on formula since 2 months and that is when his silent reflux got worse. What would be your recommendation on dosage for his age? Do I give him the dosage at one feeding or throughout multiple feedings (I would put it in his milk after heating it up to room temperature/lukewarm)? Also, how many days do you think it could take before seeing a difference/deciding if it actually is helping? Thanks so much!
Follow the label instructions for the product. I often adjust for my clients based on individual presentation, but since you’ve already purchased this and I don’t know any details, using the manufacturer’s instructions is reasonable. Always prudent to start low and work up to dose. You may see changes immediately but lasting improvements usually take about 2-3 weeks to evolve. If reflux worsens with this product then it doesn’t mean it’s a bad product but it may indicate other problems need attention. This is what I trouble shoot for babies, if you get stuck, and you can set up an appointment anytime.
Thank yuh very much for this useful article. I have a question that I hope you could answer. My 6 week old starting having a lot of gas and tummy discomfort at 4 weeks of age, to the point where he would not sleep at night crying in pain (his stomach would get rock hard) and would be very fussy during the day constantly trying to push out gas (he would pass 11 gas in an hour and have 8 poops a day). He will also sound very congested all the time and nasally and will present with projectile vomiting every other day once or twice a day but didn’t seem to be in discomfort when that happened. He was born early term at 37 weeks at 6 lbs 7 oz and has been gaining weight steadily and is now 9 lbs 9 10 oz. He is a great eater and up until 4 weeks of age he took 3-4 oz every 3-4 hours but then, when the discomfort started, he started feeding more often (1-2 hours) and taking less ounces per feeding (2-21/2 ounces). I should also mention that he takes exclusively breast milk but through bottle since he had trouble latching since birth (shallow) for which we are currently working with a lactation specialist in order to see if he will drink directly form the breast at some point in the near future. Besides this gas/colic issue he is a happy baby. I took him to his pediatrician due to the discomfort at 4 weeks and, after trying with Mommy’s bliss gripe water, mylicon and probiotics drops for a week without any results, she diagnosed him reflux to my surprise and prescribed Zantac. I had the little one on this nasty thing for only a couple of days because it made him miserable: he got constipated and his gas problem increased considerably, he started crying in pain during the day also and choking more during and after feedings. Called the pediatrician and she encouraged me to keep him on the Zantac but I am not budging. I am currently giving my child only the probiotics (Herbert brand with L. Reuteris strand) My questions are: What are your thoughts on mastic gum for Infants? What can I do for this gas/pain problem since a lot of approaches failed already? I am worry sick that he can’t sleep due to pain and seems miserable all the time so any recommendations would be appreciated. Thank you so much!’
Hi Sofia, what you describe for your baby’s initial symptoms (at 6 weeks) sounds like a milk protein intolerance – this can happen even with breastfed babies. This will create gas, colic, and feeding difficulties. Meanwhile, check if he has a tongue tie (the lactation consultant probably already has, but make sure) for latching issues. The probiotics may not be much use if the issue protein intolerance, tongue tie, or gut biome issues (which often need more direct correction). Mastic gum may also not do much good either, and wouldn’t be my first choice here. Now that you’ve tried so many things, I’d suggest doing some work up to get to the bottom of this, with a functional stool test, to review what is going on with that gut microbiome. This will help sort whether the issue is protein reaction, biome-related, reflux, SIBO or what. If you’d like help with that I invite you to schedule an appointment here and we can get started anytime.
I need your help–I’m so so so conflicted about things!
Currently my son is on Prilosec and I’m so sad about it, but I also don’t want to see him in discomfort. He is a breastfed baby and when I’m away he gets a bottle of pumped milk. He is a happy boy now at 5 months old, but was very unhappy from about 2 weeks-15 weeks. He was getting zantac for awhile and that was working for him, but then it didn’t. We are very anti meds but it was to the point where he wasn’t growing because he wouldn’t eat. It was a major problem and actually still is–he is at the 2nd percentile.
Now he still cries when he breastfeeds, but does not show any other symptoms. It is pretty bad when he eats from me. He’s on a lower prilosec dose so I wonder if it even makes a difference in his reflux. We give him probiotics, vitamin D and I am dairy free. I’d love to get some other ideas of how we could get him off of medication! Thanks for your information!
Hi Rachael, this is a common scenario, that the medicine works initially then fails. This is because – as the post here says – it buffers digestion more and more, to the point where appetite fades and discomfort increases; then the poor growth pattern ensues! So in the long run, these medicines don’t solve the problem and end up creating new ones. If you’d like help with how to back track out of this, you can set up an appointment anytime. It takes time and to start, assessing where this has landed your son’s digestion and GI environment. Click the appointment tab above to get started.
Hi! My 10 week old has been on prevacid for a week (7.5 mg in 1 2.5 mL dose daily). I would like to wean him off. What’s the best way to wean? Just to slowly reduce the dose?
Let your pediatrician know you would like to use this short term and ask how to wean off. Make sure your baby really needs this drug – it has been over prescribed and used loosely in recent years. That said, some babies are in a lot of pain and get some helpful rest from using it. Next, find the cause of the reflux. Does your baby have a milk protein intolerance? Gut flora imbalance? Correcting the feeding option and optimizing the gut biome profile can often make the reflux stop, without medicine. Once you have repaired those underlying problems, it can work well to slowly reduce the Prevacid dose.
I cut dairy from diet and have tried everything ( including probiotics). Nothing has worked. She is now on omeprazole at 9 weeks. I plan to wean her at 17 weeks and quickly then wean her off omeprazole once on food. Without omeprazole she is in constant discomfort. Is short term use really that bad or is it extended use where you see problems. I tried everything before giving in to it as hate doing it but can’t bare to see here in such discomfort
Hello Joanna, let your pediatrician know your plans to wean off the medicine. In the meantime, you have two options to see if there is a milk protein intolerance or other food intolerance (despite your dairy free diet, this can still occur) or if there is a disrupted gut flora environment making digestion harder. First, trial a semi elemental formula or an elemental formula. If that shows improvement then you may find it is best for her to be weaned off your breast milk to formula – sometimes this just works better for babies who have trouble even with mom’s milk. Second, you can use a functional stool test to check how her gut bacteria are helping or hurting her digestion. Best of luck with it and let me know if you’d like my help.
Hello there,
Thank you for this interesting article!
My 7 week old daughter is presenting all the classic signs of reflux. My lovely paed is reluctant to start reflux meds on such a tiny baby thankfully.
I have taken her to a pediatric chiropractor and I must say her winds and reflux have improved to some extent but she has terrible congestion which has been ongoing for weeks now!
Her spit ups aren’t bad but I can hear liquid rising after some feeds (I do hold her upright) and wet hiccups.
The congestion is bugging me the most as that keeps her up at night. I’ve raised her head – using saline etc
The doc also said if it was a dairy allergy she would have very loose stools very often and currently she only passes a stool every few days (normal mustard BF loose stool)
She is exclusively breastfed and on. Probiotics.
Could the congestion be from reflux? Or do these symptoms even constitute reflux at all?
I am in South Africa.
Hi Kate, one way to rule out reflux as a cause for the congestion is to try a gentle herbal support for digestion. Here in the US there are several herbal tinctures blended in glycerite commonly used for infants, such as Gaia Tummy Tonic or WishGarden Herbs Mo Betta Belly. Usual herbs for this task are peppermint, chamomile, or ginger root. If you have a local resource knowledgeable in using these who can oversee this with you then you might find the congestion symptoms improve – if the underlying cause is reflux. Other signs that can go with reflux are hard inconsolable crying, coughing, gurgling sounds, and hiccups. If nothing changes with a digestive aid, then look to rule out other triggers with your provider: Mold in your environment, milk protein intolerance or allergy, or environmental allergies.
Hi, my daughter is 11 months and has been making a gulping type sound along with burping and just started exhibiting a sour breath. She was prescribed ranitidine but I have not given this to her. Any first suggestions for my diet or hers? She is still breastfed. Thank you!
Hi Cait, these are common symptoms of SIBO or SIFO, which is a small intestine bacterial (or fungal) overgrowth. If your baby has had thrush, had a C section birth, or either of you has recently needed antibiotics, ranitidine may make all this a little better at first but worse in the long run. This may instead resolve with a course of Nystatin (anti fungal medicine) which can correct the cause of her symptoms. Ask your doctor about that. Otherwise you can start with usual eliminations in the top 8 allergens.