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Dziechciarz P, Stróżyk A, Horvath A, Cudowska B, Jedynak-Wąsowicz U, Mól N, Jarocka-Cyrta E, Zawadzka-Krajewska A, Krauze A. Nutritional status and feeding difficulties in children up to 2 years of age with cow's milk allergy. J Pediatr Gastroenterol Nutr 2024; 79:131-139. [PMID: 38291802 DOI: 10.1002/jpn3.12139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND/OBJECTIVES To assess the nutritional status and incidence of feeding difficulties in Polish children up to 2 years of age with cow's milk allergy (CMA) on cow's milk proteins-free diet. METHODS A cross-sectional, multi-center study included children aged 6 months to 2 years with confirmed or suspected (without oral food challenge) diagnosis of CMA on the elimination diet for at least 1 month. The primary outcomes were an assessment of proportion of children with impaired nutritional status (with the weight for length and body mass index (BMI) z-score > 1 and <-1), and feeding difficulties according to the Montreal Children's Hospital Feeding Scale. Children with confirmed and suspected CMA were assessed separately. RESULTS A 144 children with confirmed CMA and 88 with suspected CMA were included (57 and 78% with multiple food allergies, respectively). Among children with confirmed CMA, one-third (35.5%) of participants had any nutritional status impairment regardless of definition. Among those, most of children had mild malnutrition (10.4 vs. 9%) and possible risk of overweight (11.1 vs. 9.7%; following respectively BMI for age and weight for length z-scores). Only 16.0% of children had feeding difficulties. Feeding difficulties was identified to be a risk factor for moderate malnutrition compared to children without feeding difficulties (odds ratio 10, 95% confidence interval: 4-27). CONCLUSIONS Mild malnutrition and possible risk of overweight are concern in children up to 2 years of age on cow's milk proteins-free diet. Feeding difficulties are less common, however, may affect the nutritional status.
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Affiliation(s)
- Piotr Dziechciarz
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Agata Stróżyk
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Andrea Horvath
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Beata Cudowska
- Department of Paediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
| | | | - Nina Mól
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Elżbieta Jarocka-Cyrta
- Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia & Mazury, Olsztyn, Poland
| | - Anna Zawadzka-Krajewska
- Department of Pneumonology and Allergology for Children, Medical University of Warsaw, Warsaw, Poland
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Papachristou E, Voutsina M, Vagianou K, Papadopoulos N, Xepapadaki P, Yannakoulia M. Dietary Intake, Diet Diversity, and Weight Status of Children With Food Allergy. J Acad Nutr Diet 2024:S2212-2672(24)00266-1. [PMID: 38838813 DOI: 10.1016/j.jand.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Adoption of allergen avoidance diets may increase the risk of nutritional deficiencies and affect growth in children with food allergy (FA). How these dietary restrictions have an impact on diet diversity, a health-promoting eating behavior, remains unclear. OBJECTIVE To evaluate diet diversity, dietary intake, and weight status of children with FA. DESIGN Observational study. PARTICIPANTS/SETTING One hundred children with immunoglobulin E (IgE)-mediated milk, egg, or nut FA or multiple FAs and 60 children with perennial respiratory allergies (RA) matched as controls, aged 3 to 18 years, were consecutively recruited into the study. MAIN OUTCOME MEASURES Dietary intake and diet diversity (number of different foods consumed/day) were assessed through 4 24-hour recalls. Weight status (underweight, healthy weight, overweight, or obesity) was also evaluated. STATISTICAL ANALYSES PERFORMED Chi-squared test and 2-sample independent t test were used to test differences between groups. Adjustment for sex, age, and energy intake was made using linear regression. RESULTS The percentage of underweight was higher in children with FA (19.6%) compared with children in the control group (5.1%). Children with FA compared with children in the control group consumed more servings of meat (1.7, 95% CI, 1.6, 1.9 vs. 1.5, 95% CI, 1.3, 1.7 servings/day [Padj = 0.031]). No difference was observed in the diet diversity between the 2 groups (11-12 different foods/day). Within the FA group, children with allergy to milk proteins had lower energy intake from protein, lower intake of calcium, lower consumption of commercially prepared sweets, and higher consumption of eggs, compared with children with nut or egg allergy, but no difference in diet diversity was observed. CONCLUSIONS Diet diversity did not differ between children with FA and children with no FA, despite some differences in the intake from specific food groups. However, the higher percentage of underweight in children with FA suggests the need for targeted nutrition intervention as early as possible after FA diagnosis.
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Affiliation(s)
- Eleftheria Papachristou
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Maria Voutsina
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Kyriaki Vagianou
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Nikolaos Papadopoulos
- Allergy Department of the 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Xepapadaki
- Allergy Department of the 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.
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Sackesen C, Buyuktiryaki B, Gokce T, Gogebakan E, Gundogdu BS, Eltan SB, Karakoc-Aydiner E, Yilmaz EA, Can C, Cengiz H, Unlugedik O, Celik N, Incir S, Mutlu GY, Yildirim D, Ozel HG, Hatun S. The association of milk and multiple food avoidance with growth parameters in infants and children. Ann Allergy Asthma Immunol 2024; 132:745-751.e2. [PMID: 38447665 DOI: 10.1016/j.anai.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Recent studies reported that strict avoidance of milk products in cow's milk allergy (CMA) affects growth and bone turnover, causing negative calcium balance and changes in bone metabolism. OBJECTIVE To investigate biochemical parameters to predict bone turnover and its relations with height and weight measurements and nutritional intake. METHODS Height, weight, and body mass index z scores were plotted for age according to the World Health Organization. A 3-consecutive day food record was analyzed for nutritional values of foods. The blood levels of calcium, phosphorus, alkaline phosphatase, vitamin D, and parathyroid hormone (PTH) were determined. RESULTS The study included 69 controls, 66 children with isolated CMA, and 59 children with multiple food allergy (FA). The z scores for weight, height, and body mass index were lower in isolated CMA and multiple FA groups than controls (P < .001, P = .004, and P = .002, respectively). The nutritional intakes of protein, fat, carbohydrates, vitamins B2 and B12, niacin, calcium, and phosphorus were significantly lower in isolated CMA and multiple FA than controls. In infants (≤2 years of age), although blood calcium level was in normal range, it was significantly lower in isolated CMA and multiple FA than in controls (P < .001). In children older than 2 years, PTH level was significantly higher in isolated CMA and multiple FA groups than in controls (P = .003). CONCLUSION Our study revealed that children with isolated CMA and multiple FA had a high nutrition gap, growth deceleration, and unbalanced bone metabolism, as illustrated by low blood calcium and elevated PTH levels.
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Affiliation(s)
- Cansin Sackesen
- Division of Pediatric Allergy, Koc University School of Medicine, Istanbul, Turkey.
| | - Betul Buyuktiryaki
- Division of Pediatric Allergy, Koc University School of Medicine, Istanbul, Turkey
| | - Tugba Gokce
- Division of Pediatric Endocrinology, Koc University School of Medicine, Istanbul, Turkey
| | | | | | - Sevgi Bilgic Eltan
- Division of Pediatric Immunology and Allergy, Marmara University School of Medicine, Istanbul, Turkey
| | - Elif Karakoc-Aydiner
- Division of Pediatric Immunology and Allergy, Marmara University School of Medicine, Istanbul, Turkey
| | - Ebru Arik Yilmaz
- Division of Pediatric Immunology and Allergy, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ceren Can
- Pediatric Allergy and Immunology Clinic, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Hilal Cengiz
- Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Ozlem Unlugedik
- Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Nevin Celik
- Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Said Incir
- Department of Biochemistry, Koc University School of Medicine, Istanbul, Turkey
| | - Gul Yesiltepe Mutlu
- Division of Pediatric Endocrinology, Koc University School of Medicine, Istanbul, Turkey
| | - Damla Yildirim
- Nutrition and Dietetics Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Hulya Gokmen Ozel
- Nutrition and Dietetics Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Sukru Hatun
- Division of Pediatric Endocrinology, Koc University School of Medicine, Istanbul, Turkey
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Venter C, Roth-Walter F, Vassilopoulos E, Hicks A. Dietary management of IgE and non-IgE-mediated food allergies in pediatric patients. Pediatr Allergy Immunol 2024; 35:e14100. [PMID: 38451064 DOI: 10.1111/pai.14100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Abstract
Food allergies (FA) consist of both IgE and non-IgE-mediated entities, with varying phenotypes and overlapping and different considerations for each specific disease presentation. In general, all FAs place children at increased risk for inadequate nutritional intake and negative impacts on their nutritional status, as well as negative impacts on the quality of life for the entire family. To minimize these untoward effects, a multidisciplinary approach should be taken, including consultation and management with a dietitian trained in the varying presentations of FA. Families should be instructed on label reading as a first line of nutritional management. During a nutrition consultation, the age of the child, growth, and nutritional status should be considered. Food refusal should be assessed and addressed. Families should be educated on avoidance and appropriate substitutions. In the case of cow's milk allergy, a suitable specialized formula should be suggested if the infant is not breastfed or if breast milk supply is not sufficient. Other mammalian milk should be avoided and careful consideration should be given before plant-based milk is used in young children. Specific food allergies may differ in terms of advice provided on the level of avoidance required, whether precautionary advisory labels should be avoided, and if a maternal avoidance of the allergen during breastfeeding should be advised. The role of immunonutrition on overall health should be discussed.
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Affiliation(s)
- Carina Venter
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Franziska Roth-Walter
- Messerli Research Institute, Department of Interdisciplinary Life Sciences, University of Veterinary Medicine Vienna, Vienna, Austria
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Emilia Vassilopoulos
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Allison Hicks
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, USA
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5
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Venter C, Meyer R, Bauer M, Bird JA, Fleischer DM, Nowak-Wegrzyn A, Anagnostou A, Vickery BP, Wang J, Groetch M. Identifying Children at Risk of Growth and Nutrient Deficiencies in the Food Allergy Clinic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:579-589. [PMID: 38280452 DOI: 10.1016/j.jaip.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Food allergies affect growth in children by decreasing the availability of nutrients through decreased dietary intake, increased dietary needs, food-medication interactions, and psychosocial burden. Guidelines on food allergy management frequently recommend nutrition counseling and growth monitoring of children with food allergies. OBJECTIVE To provide clear guidance for clinicians to identify children with food allergies who are at nutritional risk and ensure prompt intervention. METHODS We provide a narrative review summarizing information from national and international guidelines, retrospective studies, population studies, review articles, case reports, and case series to identify those with food allergy at greatest nutritional risk, determine the impact of nutritional interventions on growth, and develop guidance for risk reduction in children with food allergies. RESULTS Children with food allergies are at increased risk of nutritional deficiencies and poor growth. Nutritional assessment and intervention can improve outcomes. Identifying poor growth is an important step in the nutrition assessment. Therefore, growth should be assessed at each allergy evaluation. Interventions to ensure adequate dietary intake for growth include appropriately prescribed elimination diets, breast-feeding support and assessment, supplemental formula, vitamin and/or mineral supplementation, appropriate milk substitutes, and timely introduction of nutrient-dense complementary foods. Access to foods of appropriate nutritional value is an ongoing concern. CONCLUSION Nutrition intervention or referral to registered dietitian nutritionists with additional training and/or experience in food allergy may result in improved growth and nutrition outcomes.
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Affiliation(s)
- Carina Venter
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo.
| | - Rosan Meyer
- Department of Medicine, Imperial College London, London, United Kingdom; Department of Nutrition and Dietetics, University of Winchester, Winchester, United Kingdom; Department of Medicine, KU Leuven, Leuven, Belgium
| | - Maureen Bauer
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo
| | - J Andrew Bird
- Department of Pediatrics, Division of Allergy and Immunology, UT Southwestern Medical Center, Dallas, Texas
| | - David M Fleischer
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo
| | - Anna Nowak-Wegrzyn
- Hassenfeld Children's Hospital, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Aikaterini Anagnostou
- Section of Allergy and Immunology, Baylor College of Medicine, Houston, Texas; Section of Allergy and Immunology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Brian P Vickery
- Children's Healthcare of Atlanta, Atlanta, Ga; Department of Pediatrics, Emory University, Atlanta, Ga
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marion Groetch
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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Vandenplas Y, Broekaert I, Domellöf M, Indrio F, Lapillonne A, Pienar C, Ribes-Koninckx C, Shamir R, Szajewska H, Thapar N, Thomassen RA, Verduci E, West C. An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy. J Pediatr Gastroenterol Nutr 2024; 78:386-413. [PMID: 38374567 DOI: 10.1097/mpg.0000000000003897] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/25/2023] [Indexed: 07/27/2023]
Abstract
A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.
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Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Ilse Broekaert
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, Paris University, Paris, France
- CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Corina Pienar
- Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Carmen Ribes-Koninckx
- Gastroenterology and Hepatology & Instituto de Investigacion Sanitaria, La Fe University Hospital, Valencia, Spain
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Lea and Arieh Pickel Chair for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rut Anne Thomassen
- Department of Paediatric Medicine, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Elvira Verduci
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Christina West
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Yan X, Yan J, Xiang Q, Dai H, Wang Y, Fang L, Huang K, Zhang W. Early-life gut microbiota in food allergic children and its impact on the development of allergic disease. Ital J Pediatr 2023; 49:148. [PMID: 37946309 PMCID: PMC10636907 DOI: 10.1186/s13052-023-01557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The prevalence of food allergies (FA) has been steadily increasing over 2 to 3 decades, showing diverse symptoms and rising severity. These long-term outcomes affect children's growth and development, possibly linking to inflammatory bowel disease. However, the cause remains unclear. Previous studies reveal that early infancy significantly impacts FA development through gut microbiota. Yet, a consistent view on dysbiosis characteristics and its connection to future allergies is lacking. We explored how early-life gut microbiota composition relates to long-term clinical signs in children with FA through longitudinal research. METHODS We employed high-throughput 16S rDNA gene sequencing to assess gut microbiota composition in early-life FA children in southern Zhejiang. Follow-up of clinical manifestations over 2 years allowed us to analyze the impact of early-life gut microbiota dysbiosis on later outcomes. RESULTS While the diversity of gut microbiota in FA children remained stable, there were shifts in microbiota abundance. Abundant Akkermansia, Parabacteroides, Blautia, and Escherichia-Shigella increased, while Bifidobacterium and Clostridium decreased. After 2 years, two of ten FA children still showed symptoms. These two cases exhibited increased Escherichia-Shigella and reduced Bifidobacterium during early childhood. The other eight cases experienced symptom remission. CONCLUSIONS Our study suggests that FA and its prognosis might not correlate with early-life gut microbiota diversity. Further experiments are needed due to the small sample size, to confirm these findings.
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Affiliation(s)
- Xiumei Yan
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO. 109 Xueyuan Road, Wenzhou, Zhejiang Province, 325000, China
- Key Laboratory of Structural Malformations in Children of Zhejiang Province, Wenzhou, Zhejiang Province, 325000, China
| | - Jingbin Yan
- Department of Ultrasonography, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, 325000, China
| | - Qiangwei Xiang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO. 109 Xueyuan Road, Wenzhou, Zhejiang Province, 325000, China
- Key Laboratory of Structural Malformations in Children of Zhejiang Province, Wenzhou, Zhejiang Province, 325000, China
| | - Huan Dai
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO. 109 Xueyuan Road, Wenzhou, Zhejiang Province, 325000, China
| | - Yinghui Wang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO. 109 Xueyuan Road, Wenzhou, Zhejiang Province, 325000, China
| | - Lingjuan Fang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO. 109 Xueyuan Road, Wenzhou, Zhejiang Province, 325000, China
| | - Kaiyu Huang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO. 109 Xueyuan Road, Wenzhou, Zhejiang Province, 325000, China
| | - Weixi Zhang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO. 109 Xueyuan Road, Wenzhou, Zhejiang Province, 325000, China.
- Key Laboratory of Structural Malformations in Children of Zhejiang Province, Wenzhou, Zhejiang Province, 325000, China.
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PARLAK Z, İLGÜN GÜREL D, SOYER Ö, ŞEKEREL BE, ŞAHİNER ÜM. Nutritional risks in children with food allergy. Turk J Med Sci 2023; 53:845-858. [PMID: 38031941 PMCID: PMC10765559 DOI: 10.55730/1300-0144.5648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/18/2023] [Accepted: 04/04/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Food allergies (FA) are a growing problem in the pediatric population and clinical features differ according to the underlying immunological mechanisms. While the primary management strategy is to eliminate the culprit food from the diet, assessment of the potential nutritional risks of elimination is also an integral part of management. In cases that do not improve over time; if you have basic food allergies and multiple food allergies, this can also lead to negative nutritional consequences. The contribution of basic nutrients, economical and easily accessible foods to the diet, is critical and has an important place in meeting the daily adequate intake of many nutrients. In the presence of food allergy, it is necessary to meet the vitamins and minerals that cannot be obtained from allergic foods, with alternative sources or supplements. For example, insufficient calcium intake in cow's milk allergy (CMA), the most common FA in early childhood, is very likely if an alternative supplement has not been introduced. In the management of CMA, choosing the appropriate formula and/or supplement for the clinical characteristics of children, when necessary, has an important place. In conclusion, nutritional risk assessment of children with FA requires a comprehensive, detailed, and multidisciplinary approach.
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Affiliation(s)
- Zeynep PARLAK
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
- Department of Nutrition and Dietetics, Hacettepe İhsan Doğramacı Children’s Hospital, Hacettepe University, Ankara,
Turkiye
| | - Deniz İLGÜN GÜREL
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Özge SOYER
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Bülent Enis ŞEKEREL
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Ümit Murat ŞAHİNER
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
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Coppola S, Carucci L, Oglio F, Di Sarra C, Ozen G, Berni Canani R. Nutritional Strategies for the Prevention and Management of Cow's Milk Allergy in the Pediatric Age. Nutrients 2023; 15:3328. [PMID: 37571266 PMCID: PMC10421120 DOI: 10.3390/nu15153328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/22/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Cow's milk allergy (CMA) is one of the most common pediatric food allergies. The prevalence and severity of CMA have increased dramatically in the last decades, under the pressure of environmental factors in genetically predisposed individuals. Among the environmental influences, nutritional factors play a crucial role. Diet is the most modifiable factor, representing a potential target for the prevention and treatment of CMA. In this review, we report the most scientific-based nutritional strategies for preventing and managing pediatric CMA. In addition, we propose the most complete supplement of compounds able to prevent nutrient deficiencies in CMA pediatric patients and to positively influence the disease course.
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Affiliation(s)
- Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
- Immunonutrition Lab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, 80131 Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
- Immunonutrition Lab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, 80131 Naples, Italy
| | - Franca Oglio
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
- Immunonutrition Lab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, 80131 Naples, Italy
| | - Claudia Di Sarra
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
- Immunonutrition Lab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, 80131 Naples, Italy
| | - Gulsum Ozen
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
- Immunonutrition Lab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, 80131 Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, 80131 Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, 80131 Naples, Italy
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10
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Meyer R, Venter C, Bognanni A, Szajewska H, Shamir R, Nowak-Wegrzyn A, Fiocchi A, Vandenplas Y. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guideline update - VII - Milk elimination and reintroduction in the diagnostic process of cow's milk allergy. World Allergy Organ J 2023; 16:100785. [PMID: 37546235 PMCID: PMC10401347 DOI: 10.1016/j.waojou.2023.100785] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 08/08/2023] Open
Abstract
The diagnosis of cow's milk allergy (CMA) in infants and young children remains a challenge because many of the presenting symptoms are similar to those experienced in other diagnoses. Both over- and under-diagnosis occur frequently. Misdiagnosis carries allergic and nutritional risks, including acute reactions, growth faltering, micronutrient deficiencies and a diminished quality of life for infants and caregivers. An inappropriate diagnosis may also add a financial burden on families and on the healthcare system. Elimination and reintroduction of cow's milk (CM) and its derivatives is essential for diagnosing CMA as well as inducing tolerance to CM. In non-IgE mediated CMA, the diagnostic elimination diet typically requires 2-4 weeks before reintroduction, while for IgE mediated allergy the time window may be shorter (1-2 weeks). An oral food challenge (OFC) under medical supervision remains the most reliable diagnostic method for IgE mediated and more severe types of non-IgE mediated CMA such as food protein induced enterocolitis syndrome (FPIES). Conversely, for other forms of non-IgE mediated CMA, reintroduction can be performed at home. The OFC cannot be replaced by the milk ladder after a diagnostic elimination diet. The duration of the therapeutic elimination diet, once a diagnosis was confirmed, can only be established through testing changes in sensitization status, OFCs or home reintroduction, which are directed by local protocols and services' availability. Prior non-evidence-based recommendations suggest that the first therapeutic elimination diet should last for at least 6 months or up to the age of 9-12 months, whichever is reached first. After a therapeutic elimination diet, a milk-ladder approach can be used for non-IgE mediated allergies to determine tolerance. Whilst some centers use the milk ladder also for IgE mediated allergies, there are concerns about the risk of having immediate-type reactions at home. Milk ladders have been adapted to local dietary habits, and typically start with small amounts of baked milk which then step up in the ladder to less heated and fermented foods, increasing the allergenicity. This publication aims to narratively review the risks associated with under- and over-diagnosis of CMA, therefore stressing the necessity of an appropriate diagnosis and management.
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Affiliation(s)
- Rosan Meyer
- Faculty Medicine, Imperial College London, Department Nutrition and Dietetics, Winchester University, UK and Faculty Medicine, KU Leuven, Belgium
| | - Carina Venter
- Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Evidence in Allergy Group; Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Anna Nowak-Wegrzyn
- Hassenfeld Children's Hospital, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alessandro Fiocchi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, Rome, Italy
| | - Yvan Vandenplas
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle, Brussels, Belgium
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11
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Héron D, Nosbaum A, Braun C. Management of atopic dermatitis by pediatricians: A French national survey-based study. Arch Pediatr 2023; 30:136-141. [PMID: 36804357 DOI: 10.1016/j.arcped.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/08/2022] [Accepted: 01/29/2023] [Indexed: 02/19/2023]
Abstract
PURPOSE Atopic dermatitis (AD) is a chronic skin disease affecting 10% of children in Europe. The treatment of AD is well codified; however, a gap sometimes exists between recommendations and medical practice. The objective of this study was to assess the practice of French pediatricians regarding the management of AD. METHODS We conducted a national practice survey from September 2021 to October 2021, using an online questionnaire emailed to pediatric physicians. RESULTS A total of 83 pediatricians from 33 different departments responded to the survey. The clinical features of AD were known by the majority of pediatricians, but 15 (18%) found the diagnosis difficult to establish. All pediatricians prescribed daily applications of emollients and 78 (94%) prescribed topical corticosteroids (TCS) during AD flares, but misuses remained: only 29 (35%) pediatricians prescribed TCS when eczema (even if minimal) appeared and 43 (52%) did so at the onset of pruritus, while 45 (54%) prescribed them for extensive or disabling eczema, and 53 (64%) when eczema persisted after an initial treatment with emollients. Regarding diet, 12 (14%) pediatricians recommended a diet low on or free of cow milk, 10 (12%) systematically referred children with AD to an allergist, and 20 (24%) delayed food diversification. CONCLUSION Despite improvements in AD management by French pediatricians in the past 15 years, barriers to its appropriate management still persist, including the misuse of TCS and inappropriate diets.
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Affiliation(s)
- D Héron
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - A Nosbaum
- Service d'Allergologie et Immunologie clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, UCBL1, ENS de Lyon, Lyon, France
| | - C Braun
- Université Claude Bernard Lyon 1, Villeurbanne, France; Service d'Allergologie et Immunologie clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Service de Pédiatrie, Pneumologie, Allergologie et Mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
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12
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Pezeshki PS, Nowroozi A, Razi S, Rezaei N. Asthma and Allergy. Clin Immunol 2023. [DOI: 10.1016/b978-0-12-818006-8.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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13
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Mărginean CO, Meliț LE, Borka Balas R, Văsieșiu AM, Fleșeriu T. The Crosstalk between Vitamin D and Pediatric Digestive Disorders. Diagnostics (Basel) 2022; 12:diagnostics12102328. [PMID: 36292016 PMCID: PMC9600444 DOI: 10.3390/diagnostics12102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Vitamin D is a cyclopentane polyhydrophenanthrene compound involved mainly in bone health and calcium metabolism but also autophagy, modulation of the gut microbiota, cell proliferation, immune functions and intestinal barrier integrity. The sources of vitamin D include sunlight, diet and vitamin D supplements. Vitamin D3, the most effective vitamin D isoform is produced in the human epidermis as a result of sunlight exposure. Vitamin D undergoes two hydroxylation reactions in the liver and kidney to reach its active form, 1,25-dihydroxyvitamin D. Recent studies highlighted a complex spectrum of roles regarding the wellbeing of the gastrointestinal tract. Based on its antimicrobial effect, it was recently indicated that vitamin D supplementation in addition to standard eradication therapy might enhance H. pylori eradication rates. Moreover, it was suggested that low levels of vitamin D might also be involved in the acquisition of H. pylori infection. In terms of celiac disease, the negative effects of vitamin D deficiency might begin even during intrauterine life in the setting of maternal deficiency. Moreover, vitamin D is strongly related to the integrity of the gut barrier, which represents the core of the pathophysiology of celiac disease onset, in addition to being correlated with the histological findings of disease severity. The relationship between vitamin D and cystic fibrosis is supported by the involvement of this micronutrient in preserving lung function by clearing airway inflammation and preventing pathogen airway colonization. Moreover, this micronutrient might exert anticatabolic effects in CF patients. Inflammatory bowel disease patients also experience major benefits if they have a sufficient level of circulating vitamin D, proving its involvement in both induction and remission in these patients. The findings regarding the relationship between vitamin D, food allergies, diarrhea and constipation remain controversial, but vitamin D levels should be monitored in these patients in order to avoid hypo- and hypervitaminosis. Further studies are required to fill the remaining gaps in term of the complex impact of vitamin D on gastrointestinal homeostasis.
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Affiliation(s)
- Cristina Oana Mărginean
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania
| | - Lorena Elena Meliț
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania
- Correspondence:
| | - Reka Borka Balas
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania
| | - Anca Meda Văsieșiu
- Department of Infectious Disease, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania
| | - Tudor Fleșeriu
- Department of Infectious Disease, County Clinical Hospital Târgu Mureș, Gheorghe Doja Street No 89, 540394 Târgu Mureș, Romania
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14
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Verduci E, Di Profio E, Fiore G, Zuccotti G. Integrated Approaches to Combatting Childhood Obesity. ANNALS OF NUTRITION AND METABOLISM 2022; 78 Suppl 2:8-19. [PMID: 35679843 DOI: 10.1159/000524962] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The global prevalence of childhood obesity has grown sharply in recent decades. Obesity is considered a public health problem which directly affects the health status of children in numerous ways. To combat this trend, integrated approaches are necessary to prevent childhood obesity. Strategies require a comprehensive perspective at individual and parental level alongside the adoption of measures to engage the community and environment. SUMMARY Prevention is addressed as crucial in limiting the pediatric obesity epidemic in the long term. Breastfeeding and appropriate complementary feeding are recognized as early dietary factors that affect the future risk of obesity development during the first 2 years of life. During childhood and adolescence, dietary patterns, eating habits, portion size, eating frequencies, and family meals are important dietary factors to target for preventive strategies, as well as parenting style which is influenced by parents' education. Physical activity promotion and the reduction of sedentary behavior are also recommended. The adherence of children and families to obesity prevention programs is highly dependent on socioeconomic factors. Moreover, setting food quality standards and public policies to promote healthy lifestyle habits is strongly advocated. The implementation of cost-effective preventive strategies is of high priority and requires an integrated approach by healthcare services. All stakeholders involved should take an active role in supporting and empowering children and families in order to cope with this multifactorial and complex disease.
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Affiliation(s)
- Elvira Verduci
- Department of Health Sciences, University of Milan, Milan, Italy.,Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Elisabetta Di Profio
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy.,Department of Animal Sciences for Health, Animal Production and Food Safety, University of Milan, Milan, Italy
| | - Giulia Fiore
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy.,Department of Animal Sciences for Health, Animal Production and Food Safety, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Sciences "L. Sacco," University of Milan, Milan, Italy.,Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy
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15
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D'Auria E, Pendezza E, Leone A, Riccaboni F, Bosetti A, Borsani B, Zuccotti G, Bertoli S. Nutrient intake in school-aged children with food allergies: a case-control study. Int J Food Sci Nutr 2022; 73:349-356. [PMID: 34503383 DOI: 10.1080/09637486.2021.1975658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Most studies assessed nutrient intake of young children with food allergy (FA) compared to healthy children. We aimed to compare macro- and micronutrient intake of school-aged children with FA to non-allergic children. This case-control study included 93 Italian children (52 with FA and 41 controls, median age 7.5 and 8.3 years, respectively). Macro- and micronutrient intake was assessed by a three-day food dietary record. Anthropometric measurements were also collected. The median height z-score was significantly lower in the FA group, despite a similar daily energy and protein intake. Calcium, iron and vitamin D intake was suboptimal in both groups, while protein intake was higher than recommended in both groups. Unexpectedly, children with FA consume more protein than controls, while having lower micronutrient intake, especially calcium. Our data suggest the importance of nutritional counseling for children with FA to ensure a balanced nutrient intake while on elimination diet.
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Affiliation(s)
- Enza D'Auria
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Erica Pendezza
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Alessandro Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Università di Milano, Milan, Italy
| | - Francesca Riccaboni
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Alessandra Bosetti
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Barbara Borsani
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - GianVincenzo Zuccotti
- Pediatric Department, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Università di Milano, Milan, Italy
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16
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Singh AM, Anvari S, Hauk P, Lio P, Nanda A, Sidbury R, Schneider L. Atopic Dermatitis and Food Allergy: Best Practices and Knowledge Gaps-A Work Group Report from the AAAAI Allergic Skin Diseases Committee and Leadership Institute Project. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:697-706. [PMID: 35101439 DOI: 10.1016/j.jaip.2021.12.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022]
Abstract
Allergists are often asked to evaluate children with atopic dermatitis (AD) for allergen triggers to disease. Testing, particularly for food triggers, often leads to elimination diets in an effort to improve AD control. However, the dual exposure hypothesis suggests that oral tolerance to food antigens is promoted through high-dose oral exposure, where sensitization occurs through lower dose cutaneous exposure. This suggests that strict elimination diets may pose some risks in children with AD. In addition, emerging evidence suggests an important role of skin inflammation in further allergic disease and the importance of dietary exposure to maintain oral tolerance. This work group report reviews current guidelines-based management for children with moderate-to-severe AD, the evidence for current recommendations for the evaluation and management of these children, provides a nuanced examination of these studies, and addresses current knowledge gaps in the care of these children.
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Affiliation(s)
- Anne Marie Singh
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, Departments of Dermatology and Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, American Family Children's Hospital, Madison, Wisconsin.
| | - Sara Anvari
- Department of Pediatrics, Division of Immunology, Allergy, and Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Pia Hauk
- Department of Pediatrics, Section of Allergy/Immunology, University of Colorado School of Medicine, Colorado Children's Hospital, Aurora, Colorado
| | - Peter Lio
- Medical Dermatology Associates of Chicago and Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas and Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Sidbury
- Department of Pediatrics, Division of Dermatology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Lynda Schneider
- Boston Children's Hospital, Department of Pediatrics, Division of Immunology, Harvard Medical School, Boston, Massachusetts
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17
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Salsabila HY, Putera AM, Baskoro A. Correlation between nutritional status and children's activity with food allergy: A cross-sectional study. Ann Med Surg (Lond) 2021; 68:102652. [PMID: 34401134 PMCID: PMC8355818 DOI: 10.1016/j.amsu.2021.102652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 10/27/2022] Open
Abstract
Background Food allergy in children affects nutritional status that limits their daily activities to prevent eating various foods to avoid allergic reactions. Objective Analyzing the relationship between nutritional status and daily activities in children with food allergies. Methods This study used a cross-sectional design that was carried out on children diagnosed with food allergies who underwent outpatient management of food allergies. The data were collected from January to May 2021 that included participant characteristics, nutritional status, and daily activities. Data analysis used Chi-Square and spearman rho test with p < 0.05. Results There was a significant relationship between age and FAIS (CI 1.83-4.24; p = 0.025). In addition, there was no significant relationship between the affected organs and FAIS (OR = 0.174; p = 0.052). Meanwhile, the relationship between nutritional status and FAIS was significant (OR = 0.161; p = 0.007). There was no significant relationship between parental education and FAIS (OR = 0.817; p = 0.776) as well as sex of the child and FAIS (OR = 0.982; p = 0.977). Conclusion Daily activities of children with food allergies are influenced by the nutritional status of children and children's age in choosing food.
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Affiliation(s)
| | - Azwin Mengindra Putera
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ari Baskoro
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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18
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Ercan N, Tel Adıgüzel K. Effect of early childhood cow's milk elimination diet on eating behaviours, nutrition and growth status at age 2-6 years. J Hum Nutr Diet 2021; 35:300-309. [PMID: 33974304 DOI: 10.1111/jhn.12914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The present study aimed to investigate the eating behaviour, nutritional status and growth of Caucasian children in ages 2-6 years who had a diet because of cow's milk protein allergy (CMA) [immunoglobulin (Ig)E-mediated and/or non-IgE-mediated] in early childhood. METHODS In this cross-sectional, case-control study, the cow's milk elimination (CME) group comprised children aged 0-2 years who were receiving a CME diet because of CMA, as confirmed by an oral food challenge test, and had reintroduced cow's milk for at least ≥ 3 months. The control group never had a restricted diet. Eating behaviour and children's growth was assessed. A 3-day food record was taken to determine the macronutrient and micronutrient intake of the children. Data on the children's socio-demographic, infant nutrition and family allergy history were collected from their medical records and face-to-face interviews with mothers. RESULTS In total, 62 children with a median age of 32 months were recruited for the study. The total scores of food avoidance and satiety responsiveness in the CME group (n:31) were higher than in the controls (n = 31) (p = 0.036 and 0.006, respectively). Weight-for-age and height-for-age are statistically lower in the CME group than in the control group (p < 0.001). A significant difference between groups in terms of dairy intake was recorded (p = 0.011). In the CME group, the current frequency of adequate energy, vitamin B1, folic acid, vitamin C and calcium intake was significantly lower than in the control group (p < 0.05). CONCLUSIONS Dietary interventions because of CMA at age 0-2 years can affect children's nutritional habits and parental-reported assessment of children's eating behaviours, resulting in growth restriction with insufficient micro/macronutrients and/or dairy products at the age of 2-6 years.
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Affiliation(s)
- Nazli Ercan
- Department of Child Health and Diseases, Pediatric Immunology and Allergy, Gülhane Education and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Kübra Tel Adıgüzel
- Department of Nutrition and Dietetics, Gülhane Faculty of Health Sciences, University of Health Sciences Turkey, Ankara, Turkey
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19
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Groetch M, Baker MG, Durban R, Meyer R, Venter C, Muraro A. The practical dietary management of food protein-induced enterocolitis syndrome. Ann Allergy Asthma Immunol 2021; 127:28-35. [PMID: 33757808 DOI: 10.1016/j.anai.2021.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E-mediated food allergy with potential risk of malnutrition related to the early onset of disease, frequent avoidance of cow's milk, and the possibility of multiple food triggers. This publication is aimed at providing an evidence-based, practical approach to the dietary management of FPIES. DATA SOURCES This is a narrative review summarizing information from national and international guidelines, retrospective studies, population studies, review articles, case reports, and case series to evaluate for nutritional risk and develop guidance for risk reduction in children with FPIES. STUDY SELECTIONS We have included retrospective clinical cohort studies, population-based studies, case reports, and case studies. We did not exclude any studies identified owing to the small number of studies addressing the nutritional management of individuals with FPIES. RESULTS Children with FPIES are at risk of malnutrition owing to suboptimal oral intake, limited food choices, and knowledge deficits related to feeding. In particular, children with 3 or more FPIES triggers seem to be at increased risk for poor weight gain and developing food aversion. Caregivers of children with FPIES also report a high degree of psychosocial burden. CONCLUSION Appropriate dietary management entails the following 3 essential components: supporting normal growth and development, avoidance of allergens, and advancement of complementary foods. Education to avoid the trigger food and assisting caregivers in creating an individualized, well-designed complementary feeding plan to meet the infant's nutritional needs for optimal growth and development are essential management strategies.
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Affiliation(s)
- Marion Groetch
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Mary Grace Baker
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raquel Durban
- Asthma & Allergy Specialists, Charlotte, North Carolina
| | - Rosan Meyer
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Carina Venter
- Section of Pediatric Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
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20
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Nowak S, Wang H, Schmidt B, Jarvinen KM. Vitamin D and iron status in children with food allergy. Ann Allergy Asthma Immunol 2021; 127:57-63. [PMID: 33705915 DOI: 10.1016/j.anai.2021.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 02/12/2021] [Accepted: 02/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Children with food allergy are at specific risk for nutritional deficiencies. OBJECTIVE To retrospectively determine prevalence of vitamin D and iron deficiencies in children with or without food allergy (FA). METHODS We compared the markers of vitamin D and iron status of 0 to 17-year-olds with cow's milk allergy (CMA) (n = 77), those with other FAs (n = 70), and those with atopy without FA (n = 87) at an academic pediatric allergy practice. Multiple linear regression analyses were performed to determine the impact of CMA and other FAs on vitamin D levels and iron markers. RESULTS Vitamin D deficiency was detected in one-fourth and insufficiency in one-third of children with CMA and other FAs and in those with atopic diseases but no FA, respectively. Vitamin D levels were associated with vitamin D supplementation and consumption of breast milk, cow's milk, infant formula, or plant-based milk beverage, but not with CMA or other FAs. Older children with FA who did not consume any cow's milk or alternative milk beverage were at highest risk for vitamin D insufficiency. Children with CMA have a higher rate of iron deficiency anemia (8%) than children with other FAs (1%) or those with no FA (5%, P < .001); however, suboptimal levels of transferrin saturation and iron were detected in up to one-third of children with CMA or other FAs. CONCLUSION Vitamin D deficiency and insufficiency is common in children with atopy overall, but children with CMA are at higher risk for iron deficiency anemia. Intensive nutritional counseling and nutrient intake monitoring, specifically for vitamin D and iron in those avoiding cow's milk, are necessary to optimize nutritional status.
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Affiliation(s)
- Sylwia Nowak
- Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Hongyue Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Brianne Schmidt
- Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Kirsi M Jarvinen
- Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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21
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Dupont C, Bocquet A, Tomé D, Bernard M, Campeotto F, Dumond P, Essex A, Frelut ML, Guénard-Bilbault L, Lack G, Linglart A, Payot F, Taieb A, Kalach N. Hydrolyzed Rice Protein-Based Formulas, a Vegetal Alternative in Cow's Milk Allergy. Nutrients 2020; 12:E2654. [PMID: 32878135 PMCID: PMC7551844 DOI: 10.3390/nu12092654] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 01/07/2023] Open
Abstract
Formulas adapted to infant feeding, although most of the time made from cow's milk proteins, can be made from hydrolyzed rice protein but they must be classified as "formulas for specific medical needs", according to European regulations. The nutritional quality of rice proteins is thus suitable to be used in infant formulas giving that it is supplemented by certain amino acids which can be lacking. Besides, hydrolysis is required to facilitate their water solubility and digestibility. Owing to a low allergenicity of rice and to the absence of the cross-allergy between milk proteins and rice proteins, these formulas are adapted to the diet of children with cow's milk protein allergy (CMPA), which explains their growing use in some countries. However, CMPA, an expanding disorder, has consequences for growth, bone mineralization, and often has an association with allergy to other foods, including cow's milk extensive hydrolysate, so that a surveillance of the adaption of hydrolyzed rice protein formulas (HRPF) to CMPA, the absence of unexpected side effects, and the appropriate response to its various health hazards seems mandatory. This paper analyses the health problem deriving from CMPA, the industrial development of hydrolyzed rice protein formulas, and the limited number of clinical studies, which confirms, at the moment, a good allergic tolerance and safety. The goal is to better advise heath care professionals on their use of HRPFs during CMPA.
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Affiliation(s)
- Christophe Dupont
- Pediatric Gastroenterology Department, Paris-Descartes University, 75006 Paris, France
- Pediatric Gastroenterology Department, APHP Necker-Enfants Malades Hospital, 750015 Paris, France;
- Marcel Sembat Clinic, 92100 Boulogne, France
| | - Alain Bocquet
- Association Française de Pédiatrie Ambulatoire (French Association of Ambulatory Paediatrics), 33400 Talence, France; (A.B.); (M.-L.F.)
- Medical and Pharmacy School, Franche-Comté University, 25000 Besançon, France
| | - Daniel Tomé
- UMR Nutrition Physiology and Ingestive Behavior, AgroParisTech, INRA, Paris-Saclay University, 75005 Paris, France;
| | | | - Florence Campeotto
- Pediatric Gastroenterology Department, APHP Necker-Enfants Malades Hospital, 750015 Paris, France;
| | - Pascale Dumond
- Pediatric Allergy Department, Children’s Hospital, University Hospital of Nancy, 54000 Vandoeuvre les Nancy, France;
| | - Anna Essex
- Sodilac Employee, Sodilac, 92000 Levallois, France;
| | - Marie-Laure Frelut
- Association Française de Pédiatrie Ambulatoire (French Association of Ambulatory Paediatrics), 33400 Talence, France; (A.B.); (M.-L.F.)
- Pediatric Practice, 16 Rue de Sept Fonds, 81000 Albi, France
| | | | - Gideon Lack
- Paediatric Allergy Research Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London WC2R ELS, UK;
| | - Agnès Linglart
- INSERM-U1185, Paris Sud Paris-Saclay University, 75005 Paris, France;
- APHP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Network OSCAR and ‘Platform of Expertise Paris Sud for Rare Diseases, 75005 Paris, France
- APHP, Endocrinology and Diabetes for Children, 75005 Paris, France
| | | | - Alain Taieb
- Department of Dermatology and Pediatric Dermatology, Bordeaux University Hospital, 33000 Bordeaux, France;
| | - Nicolas Kalach
- Department of Paediatrics, Saint Antoine Paediatric Hospital, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Catholic University of Lille, 59000 Lille, France;
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Madison JM, Bhardwaj V, Braskett M. Strategy for Food Reintroduction Following Empiric Elimination and Elemental Dietary Therapy in the Treatment of Eosinophilic Gastrointestinal Disorders. Curr Gastroenterol Rep 2020; 22:25. [PMID: 32222940 DOI: 10.1007/s11894-020-00758-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW This review presents the available data regarding efficacy of nutritional therapy, highlighting clinical decision points and a strategy for reintroduction of foods following an elemental diet for treatment of eosinophilic gastrointestinal disorders. RECENT FINDINGS Elemental and empiric elimination diets are highly effective treatments for eosinophilic gastrointestinal diseases. Standardization in the reintroduction phase, after utilizing the diet for disease remission, is lacking. Clinicians are confronted with multiple challenges regarding the best practice for food reintroduction and identification of potential dietary triggers including order of foods being challenged and duration between endoscopic procedures. Individualization is required for preference and adherence to optimize quality of life and treatment success for this burdensome and life altering immune driven gastrointestinal disorder. Age specific concerns for children, teenagers, and adults should be assessed using a patient centric approach.
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Affiliation(s)
- Jill M Madison
- Division of Clinical Immunology & Allergy, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Vrinda Bhardwaj
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Melinda Braskett
- Division of Clinical Immunology & Allergy, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Clinical Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA.
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23
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Fierro V, Valluzzi RL, Banzato C, Plaza MA, Bosque M, Íbero M, Echeverría LAZ, Mennini M, Dahdah L, de Castellar R, Tort G, Jiménez J. A well-tolerated new amino acid-based formula for cow's milk allergy. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:140-149. [PMID: 32109005 PMCID: PMC7212192 DOI: 10.1002/iid3.286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 11/25/2022]
Abstract
Objectives Infants with cow's milk allergy (CMA) are in need of a substitute formula up to 2 years. The are three requisites for a substitute of milk in CMA: tolerability, nutritional adequacy, and cost‐effectiveness. We evaluate here the tolerability of a new amino acid–based infant formula for the management of CMA. Methods In a phase III/IV prospective, multicentre, open‐label, international study, infants and children with immunoglobulin E‐mediated CMA were exposed to a diagnostic double‐blinded, placebo‐controlled food challenge with a new amino acid formula by Blemil Plus Elemental using Neocate as the placebo. If tolerant to it, the study formula was integrated into the patients’ usual daily diet for 7 days. Efficacy on day 7 was assessed in terms of symptoms associated with CMA, amount of formula consumed, nutritional and energy intake, and anthropometric data. Results Thirty children (17 M and 13 F; median age, 1.58; range, 0.08‐12.83 years) completed the open challenge and were able to consume the study formula for at least 7 days. No signs or symptoms of allergic reactions were recorded among children assuming either the test or the control formula, with a lower 95% one‐sided confidence interval for the proportion of subjects who did not experience allergic reactions above 90%. Sixteen patient under the age of two continued with the optional extension phase. Conclusions The study formula meets the American Academy of Pediatric criteria for hypoallergenicity and is well tolerated in short‐term use. During optional phase, growth of the patients was not hindered by the study formula.
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Affiliation(s)
| | | | | | - Ma A Plaza
- Hospital Sant Joan de Deu, Barcelona, Spain
| | | | | | | | | | - Lamia Dahdah
- Pediatric Allergy Unit, Bambino Gesù Hospital, Roma, Italy
| | | | - Gloria Tort
- Laboratorios Ordesa, Sant Boi de Llobregat, Spain
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24
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Abstract
Diet and nutrition play an important role in the development and management of food allergy. The diet of expectant mothers can have an effect on their offspring in terms of allergic outcomes. A host of confounding factors may influence this, with a maternal diet rich in fruits and vegetables, fish, vitamin D-rich foods associated with a lower risk of allergic disease in their children. More surprisingly, the consumption of milk and butter has also been shown to have a protective effect, especially in a farm environment. Similarly, the diet of the infant can also be important, not only in terms of breast feeding, but also the timing of the introduction of complementary foods, the diversity of the diet and the effect of individual foods on the development of allergy. One factor which has clearly been shown not to influence the development of food allergy is allergen avoidance by expectant mothers. In the infant diet, the manipulation of the gut microbiome to prevent the development of atopic disease is clearly an area which promises much, although studies have yet to provide a breakthrough in the prevention of atopic dermatitis. More concrete evidence of the value of diet in prevention has come from studies evaluating infant eating patterns which may protect gut health, through the consumption of large amounts of home-processed fruits and vegetables. The consumption of fish during the first year of life has also been shown to be protective. The importance of nutritional issues in children and adults who have a food allergy has become much more accepted in recent years. The primary allergenic foods in infancy and childhood, milk, egg, wheat and soy are also ones which are present in many foods and thus their avoidance can be problematic from a nutritional perspective. Thus, children with a food allergy can have their growth compromised through avoidance, especially pre-diagnosis, when foods may be excluded without any expert nutritional input. The management of a food allergy largely remains the exclusion of the offending food(s), but it is now clear that in doing so, children in particular can be at nutritional risk if insufficient attention is paid to the rest of the diet. Adults with food allergy are often thought not to need nutritional counselling; however, many will exclude a wide range of foods due to anxiety about trace exposure, or similar foods causing reactions. The avoidance of staple foods such as milk and wheat are common, but substitute foods very often do not have comparable nutritional profiles. Adults may also be more susceptible to on-line promotion of extreme nutritional regimes which can be extremely harmful. All food allergic individuals, whatever their age, should have a nutrition review to ensure they are consuming a healthy, balanced diet, and are not avoiding food groups unnecessarily.
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Affiliation(s)
- Isabel J Skypala
- Royal Brompton and Harefield NHS Foundation Trust, London, UK. .,Imperial College, London, UK.
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25
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Eigenmann PA, Beyer K, Lack G, Muraro A, Ong PY, Sicherer SH, Sampson HA. Are avoidance diets still warranted in children with atopic dermatitis? Pediatr Allergy Immunol 2020; 31:19-26. [PMID: 31273833 DOI: 10.1111/pai.13104] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 12/29/2022]
Abstract
Nearly 40% of children with moderate-to-severe atopic dermatitis (AD) have IgE-mediated food allergy (FA). This clinical observation has been extensively documented by experimental data linking skin inflammation in AD to FA, as well as by food challenges reproducing symptoms and avoidance diets improving AD. Although food avoidance may improve AD, avoidance diets do not cure AD, may even have detrimental effects such as progression to immediate-type allergy including anaphylactic reactions, and may significantly reduce the quality of life of the patient and the family. AD care should focus upon optimal medical management, rather than dietary elimination. Food allergy testing is primarily indicated when immediate-type allergic reactions are a concern. In recalcitrant AD, if food is being considered a possible chronic trigger, a limited panel of foods may be tested. An avoidance diet is only indicated in patients clearly identified as food allergic by an appropriate diagnostic food challenge, and after adequately informing the family of the limited benefits, and possible harms of an elimination diet.
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Affiliation(s)
- Philippe A Eigenmann
- Department of Woman, Child and Adolescent, Pediatric Allergy Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Kirsten Beyer
- Department of Pediatric Pneumology, Immunology and Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gideon Lack
- Department of Pediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London and Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Antonella Muraro
- Department of Woman and Child Health, Food Allergy Centre, Padua University Hospital, Padua, Italy
| | - Peck Y Ong
- Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Scott H Sicherer
- Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hugh A Sampson
- Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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26
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Calcium Intake in Children with Eczema and/or Food Allergy: A Prospective Cohort Study. Nutrients 2019; 11:nu11123039. [PMID: 31842448 PMCID: PMC6950300 DOI: 10.3390/nu11123039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 01/24/2023] Open
Abstract
Eczema and food allergy may impact diet. Using data from a cohort of Manitoba children born in 1995, we examined calcium intake, defined as the frequency and quality of calcium products consumed (with the exception of cheese), amongst Manitoba adolescents (12-14 years) with eczema or food allergy in childhood (7-8 years) or adolescence. At both ages, children were assessed by a physician for eczema and food allergy. Adolescents completed food frequency questionnaires. Calcium intake was defined as 1+ vs. <1 weekly. Linear and logistic regression was used as appropriate, with adjustments for confounders. Overall, 468 adolescents were included, of whom 62 (13.3%) had eczema only in childhood, 25 (5.3%) had food allergy only, and 26 (5.6%) had eczema and food allergy. Compared to children without eczema, those with eczema only had poorer calcium intake in adolescence (β -0.44; 95%CI -0.96; 0.00). Girls, but not boys, with eczema in childhood had poorer calcium intake in adolescence than girls without eczema (β -0.84; 95%CI -1.60; -0.08). These patterns persisted even if children experienced transient vs. persistent eczema to adolescence. Similar but non-significant trends were found for food allergy. Childhood eczema is associated with significantly lower calcium intake and consumption in adolescence. These differences persist to adolescence, even if a child "outgrows" their allergic condition.
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27
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Growth Pattern, Resting Energy Expenditure, and Nutrient Intake of Children with Food Allergies. Nutrients 2019; 11:nu11020212. [PMID: 30678148 PMCID: PMC6412797 DOI: 10.3390/nu11020212] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 01/27/2023] Open
Abstract
Growth impairment has been reported in children with food allergies (FA). However, the available data on the dietary intake of FA children are controversial, and no data are available on their resting energy expenditure (REE). The aim of this study was to test whether REE differs between FA and healthy children. In this study, 30 FA children were matched by sex and age, with 31 healthy controls using coarsened exact matching (CEM). Their REE was measured by indirect calorimetry (IC). Energy and macronutrient intake were evaluated using a three-day dietary record. Between-group comparisons were performed by robust median regression using CEM-related weights. The association of REE with allergies was also evaluated using robust median regression models. Anthropometric measurements, REE, and nutrient intake were similar in FA children and matched controls. Taking into account the association of REE with gender and age, a statistically significant but biologically negligible association was detected between median REE and allergy status (+9% in FA children). In conclusion, we did not find any biologically relevant difference in REE, anthropometry, and dietary intake in children with FA compared to healthy children.
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28
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Sinai T, Goldberg MR, Nachshon L, Amitzur-Levy R, Yichie T, Katz Y, Monsonego-Ornan E, Elizur A. Reduced Final Height and Inadequate Nutritional Intake in Cow's Milk-Allergic Young Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:509-515. [PMID: 30529059 DOI: 10.1016/j.jaip.2018.11.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Growth impairment was previously described in milk-allergic children but was not examined in adults on reaching final height. OBJECTIVES To investigate the dietary intake and final stature of young adults with IgE-mediated cow's milk allergy (IgE-CMA) as compared with nonallergic controls. METHODS Eighty-seven patients with IgE-CMA, median age 19.5 years (interquartile range [IQR], 17.3-22.7), and 36 control participants without food allergies, median age 22.7 years (IQR, 18.9-26.1), were studied. Anthropometric and nutritional data were collected. Age and gender z-scores were determined according to the Centers for Disease Control and Prevention growth charts. Nutrient intake assessment was based on dietary records. Individuals with conditions or treatments affecting bone metabolism or growth, other than asthma, were excluded. RESULTS Mean values of height z-scores were significantly reduced in CMA subjects compared with controls (-0.64 ± 0.9 vs -0.04 ± 0.7, P = .001). In contrast, no differences were found between the 2 groups in weight and body mass index z-scores. Patients with CMA had significantly lower intake of protein, and several essential vitamins (A, B12, and riboflavin) and minerals (calcium, potassium, phosphorus, magnesium, and zinc) compared with controls (P < .05), but the intakes of calories, carbohydrate, and fat were not significantly different between the 2 groups. Differences between actual and expected (based on midparental height) height z-scores were comparable in CMA subjects with or without asthma and between those with and without additional food allergies. CONCLUSIONS Young adults who have CMA from infancy are at risk of not reaching their growth potential. Growth and nutritional monitoring and appropriate dietary intervention are of particular importance in these at-risk individuals.
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Affiliation(s)
- Tali Sinai
- The School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Roni Amitzur-Levy
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Tamar Yichie
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Efrat Monsonego-Ornan
- The School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Yitzhak Shamir Medical Center, Zerifin, Israel.
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29
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Eigenmann P. Editorial comments on this issue of the Journal. Pediatr Allergy Immunol 2018; 29:787-788. [PMID: 30548707 DOI: 10.1111/pai.13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
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30
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Robison RG, Singh AM. Controversies in Allergy: Food Testing and Dietary Avoidance in Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:35-39. [PMID: 30501976 DOI: 10.1016/j.jaip.2018.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Rachel G Robison
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Anne Marie Singh
- Division of Allergy, Immunology and Rheumatology, University of Wisconsin-Madison, Madison, Wis.
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31
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Meyer R, Wright K, Vieira MC, Chong KW, Chatchatee P, Vlieg-Boerstra BJ, Groetch M, Dominguez-Ortega G, Heath S, Lang A, Archibald-Durham L, Rao R, De Boer R, Assa'ad A, Trewella E, Venter C. International survey on growth indices and impacting factors in children with food allergies. J Hum Nutr Diet 2018; 32:175-184. [DOI: 10.1111/jhn.12610] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- R. Meyer
- Department Paediatrics; Imperial College; London UK
| | - K. Wright
- Allergy Service; Department of Paediatric Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - M. C. Vieira
- Center for Pediatric Gastroenterology (Hospital Pequeno Príncipe) and School of Medicine (Pontifical University of Paraná); Curitiba Brazil
| | - K. W. Chong
- Allergy Service; Department of Paediatric Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - P. Chatchatee
- Division of Allergy and Immunology; Department of Pediatrics; Faculty of Medicine; King Chulalongkorn Memorial Hospital; Chulalongkorn University; Bangkok Thailand
| | | | - M. Groetch
- Division of Paediatric Allergy & Immunology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - G. Dominguez-Ortega
- Gastroenterology and Nutrition Department; Children Hospital Niño Jesús University Children Hospital; Madrid Spain
| | - S. Heath
- Department of Dietetics; Kings College Hospital NHS Trust; London UK
| | - A. Lang
- Wits University Donald Gordon Medical Centre; Johannesburg South Africa
| | | | - R. Rao
- KK women's and Children's Hospital; Singapore Singapore
| | - R. De Boer
- Department of Pediatric Allergy; Guy's and St. Thomas National Health Service Trust; London UK
| | - A. Assa'ad
- Division of Allergy and Immunology; Cincinnati Children's Hospital; Cincinnati OH USA
| | - E. Trewella
- Department Nutrition and Dietetics; Chelsea and Westminster Hospital; London UK
| | - C. Venter
- Children's Hospital Colorado; Aurora Colorado USA
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32
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Meyer R. Nutritional disorders resulting from food allergy in children. Pediatr Allergy Immunol 2018; 29:689-704. [PMID: 30044008 DOI: 10.1111/pai.12960] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022]
Abstract
The elimination of food allergens that contribute essential nutrients in paediatrics may lead to the development of nutritional disorders. The most common nutritional disorders include poor growth, micronutrient deficiencies and feeding difficulties. Of the aforementioned, growth faltering has been well studied and is seen as a common presenting factor in paediatric food allergy. However, the use of different criteria and cut-off values makes it difficult to establish the overall effect. The impact of number and type of foods eliminated and comorbidities has yielded varying results, although there seems to be a trend towards worsening growth with atopic dermatitis and the avoidance of cow's milk. Low micronutrient intake is common in paediatric food allergy; however, a low intake does not necessarily translate into a deficiency as measured by biomarkers. Vitamin D and calcium have been well studied, and a long-lasting impact on bone mineral density has been found. However, other micronutrient deficiencies have also been found and should also be considered. Feeding difficulties is a common complaint in clinical practice, but limited data have been published in food allergy. Poor growth and reflux/vomiting have been shown to be associated with feeding difficulties, in particular in non-IgE-mediated food allergies. There seems to be a long-lasting effect on feeding, in particular in cow's milk allergy, which needs to be taken into account with dietary input. The interplay between growth, feeding difficulties and micronutrient deficiencies has been implied in some studies, but cause and effect is not well established and requires further research.
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Affiliation(s)
- Rosan Meyer
- Department of Paediatrics, Imperial College, London, UK
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33
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Pascual Pérez AI, Méndez Sánchez A, Segarra Cantón Ó, Espin Jaime B, Jiménez Treviño S, Bousoño García C, Díaz Martín JJ. Attitudes towards cow's milk protein allergy management by Spanish gastroenterologist. An Pediatr (Barc) 2018. [DOI: 10.1016/j.anpede.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Manejo de la alergia a proteína de leche de vaca por los gastroenterólogos españoles. An Pediatr (Barc) 2018; 89:222-229. [DOI: 10.1016/j.anpedi.2017.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 11/23/2022] Open
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35
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Pavić I, Kolaček S. Growth of Children with Food Allergy
. Horm Res Paediatr 2018; 88:91-100. [PMID: 28359060 DOI: 10.1159/000462973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/09/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The prevalence of food allergy in children is increasing worldwide. Strict avoidance of identified allergens from the diet is still the cornerstone of the management of food allergies. There are widespread concerns that food allergy and elimination diet may predispose children to nutrient deficiencies and growth failure. AIM The aim of this paper was to review the current evidence on growth of children suffering from food allergy. Summarised is literature on the effects of the number and type of offending allergens, the child's age and affected organ system, as well as the importance of supervision by a dietician/nutritionist. CONCLUSION Children suffering from food allergy are stunted at the time of diagnosis and during the elimination diets, irrespective whether or not their nutritional requirements were fulfilled, and/or were under the control of a dietician. This underscores the need for further studies to obtain more precise insight into and better understanding of the mechanisms contributing to growth failure in children suffering from food allergy.
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36
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Micronutrient Status and Nutritional Intake in 0- to 2-Year-old Children Consuming a Cows' Milk Exclusion Diet. J Pediatr Gastroenterol Nutr 2018; 66:831-837. [PMID: 29481443 PMCID: PMC5916487 DOI: 10.1097/mpg.0000000000001942] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To study micronutrient status and nutritional intake from complementary feeding in children on a cows' milk exclusion (CME) diet. METHODS Fifty-seven children with cows' milk allergy, younger than 2 years, were included in a cross-sectional study. Blood was analyzed for micronutrient status. Complementary feeding was defined as all solids and liquids except of breast milk, and assessed by 3-day food diary. The results were analyzed according to 3 feeding patterns: mainly breast-fed (mBF), partially breast-fed, and no breast milk group (nBM). RESULTS The children had a median age of 9 months and micronutrient status was within normal range for total homocysteine (p-tHcy), s-B12, s-folate, b-Hb, s-ferritin, s-zinc, and s-25(OH)D. There were no significant differences between feedings groups, except for B12-biomarkers. The mBF had higher p-tHcy (P < 0.000) and lower s-B12 (P = 0.002) compared nBM. Vitamin B12 deficiency (p-tHcy >6.5 μmol/L combined with s-B12 <250 pmol/L) was found in 12% of participants, most frequently among the mBF (36%) and none in nBM group (P = 0.009). Vitamin B12 intake from complementary feeding was negatively correlated with p-tHcy (r = -0.479, P = 0.001) and positively with s-B12 (r = 0.410, P = 0.003). Iron deficiency anemia was found in 5%. Iron intake correlated positively with b-Hb (r = 0.324, P = 0.02). Zinc deficiency was found in 7% and low 25(OH)D in 9%. Vitamin D intake was positively correlated with the use of supplements (r = 0.456, P = 0.001). CONCLUSION The risk of B12 deficiency was high in mBF infants on CME diet, and complementary feeding was associated with better B12 status. Iron, zinc, and vitamin D deficiencies were present in all feeding groups. Complementary feeding should be introduced at 4 to 6 months of age. Vitamin D supplement is recommended to ensure adequate intake.
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Nutritional management of cow's milk allergy in children: An update. Arch Pediatr 2018; 25:236-243. [PMID: 29576253 DOI: 10.1016/j.arcped.2018.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Abstract
Cow's milk is one of the most common foods responsible for allergic reactions in children. Cow's milk allergy (CMA) involves immunoglobulin E (IgE)- and non-IgE-mediated reactions, the latter being both variable and nonspecific. Guidelines thus emphasize the need for physicians to recognize the specific syndromes of CMA and to respect strict diagnostic modalities. Whatever the clinical pattern of CMA, the mainstay of treatment is the elimination from the diet of cow's milk proteins. The challenge is that both the disease and the elimination diet may result in insufficient height and weight gain and bone mineralization. If, during CMA, the mother is not able or willing to breastfeed, the child must be fed a formula adapted to CMA dietary management, during infancy and later, if the disease persists. This type of formula must be adequate in terms of allergic efficacy and nutritional safety. In older children, when CMA persists, the use of cow's milk baked or heated at a sufficient temperature, frequently tolerated by children with CMA, may help alleviate the stringency of the elimination diet. Guidance on the implementation of the elimination diet by qualified healthcare professionals is always necessary. This guidance should also include advice to ensure adequate bone growth, especially relating to calcium intake. Specific attention should be given to children presenting with several risk factors for weak bone mineral density, i.e., multiple food allergies, vitamin D deficiency, poor sun exposure, steroid use, or severe eczema. When CMA is outgrown, a prolonged elimination diet may negatively impact the quality of the diet over the long term.
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Meyer R, Groetch M, Venter C. When Should Infants with Cow's Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:383-399. [DOI: 10.1016/j.jaip.2017.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/04/2017] [Accepted: 09/16/2017] [Indexed: 12/18/2022]
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Kliewer KL, Cassin AM, Venter C. Dietary Therapy for Eosinophilic Esophagitis: Elimination and Reintroduction. Clin Rev Allergy Immunol 2017; 55:70-87. [DOI: 10.1007/s12016-017-8660-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Affiliation(s)
- Wednesday Marie A Sevilla
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
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Maslin K, Venter C, MacKenzie H, Vlieg-Boerstra B, Dean T, Sommer I. Comparison of nutrient intake in adolescents and adults with and without food allergies. J Hum Nutr Diet 2017; 31:209-217. [PMID: 28707418 DOI: 10.1111/jhn.12495] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Exclusion diets for the management of food allergy pose a risk of nutritional deficiencies and inadequate growth in children, yet less is known about their effect in adolescents and adults. The present study aimed to compare the dietary intake of adolescents and adults with food allergies with that of a control group. METHODS A food allergic and a control group were recruited from Portsmouth and the Isle of Wight in the UK. Participants were recruited from a food allergy charity, allergy clinics, a local school and university, and previous research studies. Macro and micronutrient intake data were obtained using a 4-day estimated food diary. Sociodemographic and anthropometric data was collected via a constructed questionnaire. RESULTS This cross-sectional study included 81 adolescents (48 food allergic and 33 controls) aged 11-18 years and 70 adults aged 19-65 years (23 food allergic and 47 controls). Overall, 19 (22.8%) adolescents and 19 (27.1%) adults took dietary supplements, with no difference according to food allergic status. Adolescents with food allergy had higher intakes of niacin and selenium than adolescents without (P < 0.05). This difference persisted when dietary supplements were removed from the analysis. Adults with food allergies had higher intakes of folate and zinc than those without (P < 0.05); however, this difference did not persist when dietary supplements were removed from the analysis. Across all participants, the intake of several micronutrients was suboptimal. There was no difference in protein or energy intake, or body mass index, according to food allergic status. CONCLUSIONS The dietary intake of food allergic participants was broadly similar and, in some cases, better than that of control participants. However, suboptimal intakes of several micronutrients were observed across all participants, suggesting poor food choices.
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Affiliation(s)
- K Maslin
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Venter
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, UK.,Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| | - H MacKenzie
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,Graduate School, University of Portsmouth, Portsmouth, UK
| | | | - T Dean
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, UK
| | - I Sommer
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,Department for Evidence-Based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria
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Impact of elimination diets on nutrition and growth in children with multiple food allergies. Curr Opin Allergy Clin Immunol 2017; 17:220-226. [DOI: 10.1097/aci.0000000000000358] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Servin C, Hellerfelt S, Botvid C, Ekström M. Special diets are common among preschool children aged one to five years in south-east Sweden according to a population-based cross-sectional survey. Acta Paediatr 2017; 106:634-638. [PMID: 28118496 DOI: 10.1111/apa.13753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/12/2017] [Accepted: 01/20/2017] [Indexed: 11/28/2022]
Abstract
AIM Information about the prevalence of special diets in preschool children is limited. The aim of this study was to measure the prevalence of all special diets among preschool children in a Swedish municipality. METHODS This was a population-based cross-sectional survey of all 3276 preschool children aged one to five years in the municipality of Karlskrona, Sweden. The questionnaire assessed the number of children at each preschool, how many were on special diets, their dietary requirements, age, sex, whether they had a medical certificate and whether the special diet had a perceived medical cause. RESULTS We obtained data for 3221 (98%) of the children, and 19% had special diets, including 12% on nonmedical diets and 6.3% on medical diets. The five most common diets were avoiding pork (7.8%), a vegetarian diet (4.8%), and avoiding cows' milk (3.5%), hens' eggs (1.2%) and lactose (1.1%). Gluten avoidance was more common in girls than boys (0.8% versus 0.2%, p = 0.032). Half (47%) of the children on special medical diets lacked a medical certificate. CONCLUSION Special diets were common in preschool children in south-east Sweden, and the causes were mainly nonmedical. Mandatory medical certificates for medically based special diets might reduce unnecessary dietary restrictions.
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Affiliation(s)
- Caroline Servin
- Department of Pediatrics; Blekinge Hospital; Karlskrona Sweden
| | | | | | - Magnus Ekström
- Department of Clinical Sciences; Division of Respiratory Medicine & Allergology; Lund University; Lund Sweden
- Department of Medicine; Blekinge Hospital; Karlskrona Sweden
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Herbert LJ, Mehta P, Sharma H. Mealtime behavior among parents and their young children with food allergy. Ann Allergy Asthma Immunol 2017; 118:345-350. [PMID: 28094121 DOI: 10.1016/j.anai.2016.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/08/2016] [Accepted: 12/01/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Food allergies are increasingly prevalent in the pediatric population. Balancing allergen avoidance with the promotion of healthy eating behaviors can be challenging for families. OBJECTIVE To characterize mealtime behaviors among parents of young children with food allergy. METHODS Seventy-four parents of young children with food allergies (≤7 years of age) completed measures of mealtime behavior, perceptions of food allergy risk and severity, pediatric parenting stress, and food allergy-related quality of life. Mealtime behavior reports were compared with published data regarding typically developing children, young children with type 1 diabetes, and children with diagnosed feeding disorders (with or without related medical factors). RESULTS Parents of young children with food allergies reported frequent mealtime concerns. Specifically, they reported significantly more mealtime behavioral concerns than typically developing peers, comparable mealtime behavioral concerns to young children with type 1 diabetes, and significantly fewer mealtime behavioral concerns than children with diagnosed feeding disorders. Parental mealtime concerns were positively correlated with other parent perceptions of food allergy, such as risk of allergen exposure, illness-related parenting stress, and food allergy-related quality of life. CONCLUSION Young children with food allergy and their parents are more likely to exhibit mealtime behavioral concerns than typically developing peers and their parents. Future research should investigate the effect of food allergies and maladaptive mealtime behaviors on children's nutrition to provide clinical guidelines for parents who may benefit from psychosocial and/or nutritional support.
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Affiliation(s)
- Linda Jones Herbert
- Division of Allergy and Immunology, Children's National Health System, Washington, DC; The George Washington University, School of Medicine and Health Sciences, Washington, DC.
| | - Priya Mehta
- The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Hemant Sharma
- Division of Allergy and Immunology, Children's National Health System, Washington, DC; The George Washington University, School of Medicine and Health Sciences, Washington, DC
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Foong RX, Meyer R, Dziubak R, Lozinsky AC, Godwin H, Reeve K, Hussain ST, Nourzaie R, Shah N. Establishing the prevalence of low vitamin D in non-immunoglobulin-E mediated gastrointestinal food allergic children in a tertiary centre. World Allergy Organ J 2017; 10:4. [PMID: 28101293 PMCID: PMC5225666 DOI: 10.1186/s40413-016-0135-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/13/2016] [Indexed: 02/02/2023] Open
Abstract
Background There is no data on the prevalence of vitamin D deficiency in children with non-immunoglobulin-E (IgE) mediated gastrointestinal food allergy. The aims of our study were to understand the prevalence of vitamin D insufficiency and deficiency in children with non-IgE mediated gastrointestinal food allergy and identify predisposing factors. Methods This was a retrospective study which looked at data from Great Ormond Street Hospital from January 2002 to September 2015. Children 0–18 years old with a confirmed diagnosis of non-IgE mediated gastrointestinal food allergy who had a vitamin D level measured during the course of their disease were included. Low vitamin D levels were defined as <50 nmol/L; insufficient levels were defined as 25–50 nmol/L and deficient levels as <25 nmol/L. Patient characteristics and clinical factors were also recorded. Results Ninety-two patients met the study criteria; 49% were female and median age was 10 years 2 months [IQR: 4 years 8 months to 13 years 7 months]. Of the cohort, 26% (24/92) had low vitamin D levels; 16% had insufficient vitamin D levels and 10% had vitamin D deficiency. Gender (p = 0.043) and age (p = 0.035) were significantly associated with low vitamin D levels. Twelve percent of children who were on an amino acid formula (AAF) had low vitamin D compared to 31% of children who were not (p = 0.06). No other clinical factors were found to be significantly associated with low vitamin D levels. Conclusions Children with non-IgE mediated gastrointestinal food allergy are at risk of vitamin D insufficiency and deficiency. Further prospective studies need to be performed in all children with non-IgE mediated gastrointestinal food allergies. Trial registration The study was registered with the GOSH Research & Development department as a retrospective case note review. The Health Research Authority confirmed that NHS Research and Ethics Committee approval was not required; thus there is no trial registration number.
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Affiliation(s)
- Ru-Xin Foong
- Paediatric Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ; Institute of Child Health, University College, London, UK
| | | | - Robert Dziubak
- Paediatric Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Adriana Chebar Lozinsky
- Paediatric Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Heather Godwin
- Paediatric Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kate Reeve
- Paediatric Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Syeda Tahmida Hussain
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Romman Nourzaie
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Neil Shah
- Paediatric Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ; Institute of Child Health, University College, London, UK
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Wert AF, Posa D, Tsilochristou O, Schwerk N. Treatment of allergic children - Where is the progress (for the practicing allergist)? Pediatr Allergy Immunol 2016; 27:671-681. [PMID: 27614100 DOI: 10.1111/pai.12653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 12/12/2022]
Abstract
For any kind of therapeutic intervention in allergic diseases such as environmental control, pharmacological, or immunomodulating treatment including educational programs, children are addressed separately from adults. Health authorities like the Food and Drug Administration in the United States of America or the European Medicine Agency in Europe request a specific 'Pediatric investigational plan' with studies addressing dose-response relationship, safety, and efficacy for infants, children, and adolescents. During the last 2 years, promising advances have been reported for the treatment of a variety of allergic and immunologic disorders. This review summarizes the progress in the treatment of pediatric asthma and allergic diseases, based on publications of approximately the last 2.5 years (end of 2013 until May 2016) in and beyond this journal. Meanwhile, it highlights areas with promising novel therapeutic approaches, which are likely to change treatment for allergic children in the near future.
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Affiliation(s)
- A F Wert
- Department of Paediatric Pneumology Allergy and Neonatology, Hannover Medical School, Hannover, Germany.
| | - D Posa
- Department of Paediatric Pneumology & Immunology, Charité Medical School, Berlin, Germany
| | - O Tsilochristou
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London & Guy's, St. Thomas'National Health Service Foundation Trust, London, UK
| | - N Schwerk
- Department of Paediatric Pneumology Allergy and Neonatology, Hannover Medical School, Hannover, Germany
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Erkkola M, Saloheimo T, Hauta-alus H, Kukkonen AK, Virta S, Kronberg-Kippilä C, Vaara E, Pelkonen AS, Fogelholm M, Mäkelä MJ. Burden of allergy diets in Finnish day care reduced by change in practices. Allergy 2016; 71:1453-60. [PMID: 27117067 DOI: 10.1111/all.12902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nonessential allergy diets in children with mild symptoms may harm the development of immunological tolerance and impose a burden on families and day care. We aimed to reduce the high prevalence of allergy diets in day care by reforming the practices for inquiring about need of special diets from parents. METHODS We developed a new special diet form and an information leaflet based on the new allergy guidelines. The new form was implemented into 40 Finnish day care centres in the capital region in 2013-2015. The questionnaires on practices concerning special diets in day care centres and allergy knowledge were collected from the personnel. RESULTS After 2 years, the new special diet form was used by 64% of families with food-allergic children, and the prevalence of allergy diets in day care centres decreased by 43% to 4.3% (IQ range 3.05-5.96). A significant decrease was found in the prevalence of all basic (milk, grains, egg) and most other allergy diets (P for trend < 0.01). The new practice was well accepted by day care and kitchen personnel. Lack of updated allergy knowledge was noted among day care personnel. CONCLUSIONS The burden of allergy diets in day care settings could be decreased by simple pragmatic changes based on current allergy guidelines. Old allergy attitudes persisted among day care personnel, indicating the need for continuous education.
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Affiliation(s)
- M. Erkkola
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - T. Saloheimo
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - H. Hauta-alus
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - A. K. Kukkonen
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - S. Virta
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - C. Kronberg-Kippilä
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - E. Vaara
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - A. S. Pelkonen
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. Fogelholm
- Division of Nutrition; Department of Food and Environmental Sciences; University of Helsinki; Helsinki Finland
| | - M. J. Mäkelä
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Maslin K, Dean T, Arshad SH, Venter C. Dietary variety and food group consumption in children consuming a cows' milk exclusion diet. Pediatr Allergy Immunol 2016; 27:471-7. [PMID: 27062104 DOI: 10.1111/pai.12573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dietary variety is defined as the number of different foods or food groups consumed over a given reference period, the consensus being that dietary variety and dietary quality are positively correlated. Recently there has been considerable interest in the association between infant dietary variety and atopic disease. METHODS This was a cross-sectional study of 8- to 27-month-old children from the Isle of Wight, UK, including two groups: a group of children consuming a cows' milk exclusion (CME) diet and a control group of children consuming an unrestricted diet. Parents completed a validated food frequency questionnaire, from which dietary variety and consumption of food groups were calculated. Growth measurements were recorded. RESULTS A total of 126 participants of mean age 13.0 months were recruited. In addition to the expected differences in dairy and soya consumption, the CME group consumed sweet foods 1.6 times less frequently, non-water drinks seven times less frequently (p < 0.05) and ready-made baby foods 15 times more frequently (p < 0.01) than the control group. Overall dietary variety was significantly lower in the CME group (p < 0.01) as was variety of meat and sweet foods consumed. There was a greater concern with healthy eating in the CME group (p < 0.05). CONCLUSIONS Children consuming an exclusion diet for cows' milk allergy have an overall less varied diet, including a less varied consumption of meat and sweet foods. Efforts should be made to ensure exclusion diets are as varied as possible to optimize nutritional intake.
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Affiliation(s)
- Kate Maslin
- School of Health Sciences & Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - Tara Dean
- School of Health Sciences & Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.,University of Southampton, Southampton, UK
| | - Carina Venter
- School of Health Sciences & Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
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Maslin K, Grimshaw K, Oliver E, Roberts G, Arshad SH, Dean T, Grundy J, Glasbey G, Venter C. Taste preference, food neophobia and nutritional intake in children consuming a cows' milk exclusion diet: a prospective study. J Hum Nutr Diet 2016; 29:786-796. [PMID: 27298213 DOI: 10.1111/jhn.12387] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Taste exposure in infancy is known to predict food preferences later in childhood. This is particularly relevant in children with cows' milk allergy who consume a substitute formula and/or a cows' milk exclusion (CME) diet early in life. This prospective study aimed to show whether there is a long-term effect of consuming a substitute formula and CME diet on taste preferences and dietary intake. METHODS Children were predominantly recruited from two large birth cohort studies in the UK. Two groups were recruited: an experimental group of children who had consumed a CME diet during infancy and a control group who had consumed an unrestricted diet during infancy. Parents completed a food neophobia questionnaire and an estimated prospective food diary. Children completed a taste preference test and their growth was assessed. RESULTS One hundred and one children with a mean age of 11.5 years were recruited (28 CME and 73 controls). Children in the CME group had a significantly higher preference for bitter taste than those in the control group (P < 0.05). There were significant differences between the groups with respect to the intake of some micronutrients, including riboflavin, iodine, sodium and selenium. Food neophobia did not differ between groups. Some 28% of the CME group were overweight/obese compared to 15% of the control group; however, this difference was not statistically significant. CONCLUSIONS Consuming a substitute formula and/or a CME diet in infancy has a long-term effect on the preference for bitter taste. Differences exist with respect to the intake of some micronutrients, but not macronutrients. There was a nonsignificant trend towards being overweight and obese in children in the CME group.
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Affiliation(s)
- K Maslin
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - K Grimshaw
- Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Nutrition and Dietetics, Southampton Children's Hospital, Southampton, UK
| | - E Oliver
- Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - G Roberts
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.,Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - S H Arshad
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - T Dean
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - J Grundy
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - G Glasbey
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - C Venter
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
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Maslin K, Oliver EM, Scally KS, Atkinson J, Foote K, Venter C, Roberts G, Grimshaw KEC. Nutritional adequacy of a cows' milk exclusion diet in infancy. Clin Transl Allergy 2016; 6:20. [PMID: 27257475 PMCID: PMC4890506 DOI: 10.1186/s13601-016-0109-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/23/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Infants with suspected cows' milk allergy are required to follow a strict milk exclusion diet which may lead to nutritional deficiencies, especially if not supervised by a healthcare professional. The aim of this study was to assess the nutritional adequacy of a cows' milk exclusion diet in a group of UK infants over a period of 6 months. METHODS Participants in this study are a subgroup of the Prevalence of Infant Food Allergy study, a prospective food allergy birth cohort study from the South of England. Each infant consuming a milk free diet, following advice from a specialist allergy dietitian, was matched to two control infants who were consuming an unrestricted diet, forming a nested matched case-control study. Detailed food diaries completed prospectively for 1 week per month over a 5 month period, were coded and analysed according to a standard protocol. RESULTS The diets of 39 infants (13 milk-free and 26 controls) were assessed. Mean age at diet commencement was 14 weeks. Two of the eleven infants started on an extensively hydrolysed formula did not tolerate it and required an amino acid formula for symptom resolution. All infants had mean intakes in excess of the estimated average requirement for energy and the recommended nutrient intake (RNI) for protein, calcium, iron, selenium, zinc, vitamins A, C and E. Vitamin D intake was in excess of the RNI at all time-points, except at 44 weeks of age. Across the study period, selenium intake was higher for infants consuming a milk free diet whilst vitamin C intake was higher for infants consuming an unrestricted diet. Differences were found between the two groups for protein, calcium, iron and vitamin E intakes at differing time points. CONCLUSION This study demonstrated that although infants consuming a milk-free diet have a nutritional intake that is significantly different to matched controls who are eating an unrestricted diet, this difference is not constant and it is not seen for all nutrients. Further research in infants without dietetic input is needed to explore the nutritional implications of unsupervised cows' milk exclusion diets.
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Affiliation(s)
- Kate Maslin
- />School of Health Science and Social Work, University of Portsmouth, Portsmouth, UK
| | - Erin M. Oliver
- />Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD UK
| | - Karen S. Scally
- />Faculty of Social and Human Sciences, 58/2113, University of Southampton, Highfield, Southampton, SO17 1BJ UK
| | | | - Keith Foote
- />Hampshire Hospitals Foundation Trust, Winchester, UK
| | - Carina Venter
- />Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC7028, Cincinnati, OH 45229 USA
| | - Graham Roberts
- />Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD UK
- />NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Kate E. C. Grimshaw
- />Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD UK
- />Department of Nutrition and Dietetics, Southampton Children’s Hospital, Southampton, SO16 6YD UK
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