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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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Parrish CP. A review of food allergy panels and their consequences. Ann Allergy Asthma Immunol 2023; 131:421-426. [PMID: 37098403 DOI: 10.1016/j.anai.2023.04.011] [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: 01/24/2023] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 04/27/2023]
Abstract
Serum immunoglobulin E (IgE) assays to food specific IgE (s-IgE) are useful tools for the confirmation of clinical suspicion of food allergy. However, the specificity of these assays is poor given that sensitization is much more common than clinical food allergy. Therefore, the use of broad panels to assess sensitization to multiple foods often leads to overdiagnosis and unnecessary food avoidance. Unintended consequences that may occur as a result include physical harm, psychological harm, financial cost, opportunity cost, and even worsening of existing health care disparities. Although current guidelines recommend against the use of s-IgE food panel testing, these tests are widely available and frequently used. To limit the negative impacts of s-IgE food panel testing, further work is needed to effectively spread the message that these food panels may cause unintended harm to patients and families.
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Affiliation(s)
- Christopher P Parrish
- Division of Allergy and Immunology, Departments of Pediatrics and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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3
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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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Low DW, Jamil A, Md Nor N, Kader Ibrahim SB, Poh BK. Food restriction, nutrition status, and growth in toddlers with atopic dermatitis. Pediatr Dermatol 2020; 37:69-77. [PMID: 31667896 DOI: 10.1111/pde.14004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple factors affect growth in children with atopic dermatitis (AD). We investigated food restriction practice, nutrition, and growth in children with AD. Food restriction is defined as restriction ≥3 types of food due to AD or food allergy. METHODS A cross-sectional study was performed in 150 children aged 12-36 months. EXCLUSION CRITERIA recurrent infections, moderate to severe asthma, recent systemic steroid, other diseases affecting growth/nutrition. Growth parameters, SCORing Atopic Dermatitis (SCORAD), hemoglobin, hematocrit, sodium, potassium, albumin, protein, calcium, phosphate, B12, iron, and folate values were determined. Parents completed a 3-day food diary. RESULTS The prevalence of food restriction was 60.7%. Commonly restricted foods were shellfish 62.7%, nuts 53.3%, egg 50%, dairy 29.3%, and cow's milk 28.7%. Food-restricted children have significantly lower calorie, protein, fat, riboflavin, vitamin B12, calcium, phosphorus and iron intakes and lower serum iron, protein and albumin values. Z scores of weight-for-age (-1.38 ± 1.02 vs -0.59 ± 0.96, P = .00), height-for-age (-1.34 ± 1.36 vs -0.51 ± 1.22, P = .00), head circumference-for-age (-1.37 ± 0.90 vs -0.90 ± 0.81, P = .00), mid-upper arm circumference (MUAC)-for-age (-0.71 ± 0.90 vs -0.22 ± 0.88, P = .00), and BMI-for-age (-0.79 ± 1.15 vs -0.42 ± 0.99, P = .04) were significantly lower in food-restricted compared to non-food-restricted children. More food-restricted children were stunted, underweight with lower head circumference and MUAC. Severe disease was an independent risk factor for food restriction with OR 5.352; 95% CI, 2.26-12.68. CONCLUSION Food restriction is common in children with AD. It is associated with lower Z scores for weight, height, head circumference, MUAC, and BMI. Severe disease is an independent risk factor for food restriction.
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Affiliation(s)
- Dy-Win Low
- Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Adawiyah Jamil
- Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Norazirah Md Nor
- Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | | | - Bee Koon Poh
- Nutritional Sciences Programme & Centre for Community Health, Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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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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6
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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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7
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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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Early Infant Feeding Practices as Possible Risk Factors for Immunoglobulin E-Mediated Food Allergies in Kuwait. Int J Pediatr 2018; 2018:1701903. [PMID: 29971112 PMCID: PMC6008860 DOI: 10.1155/2018/1701903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/13/2018] [Accepted: 04/22/2018] [Indexed: 11/17/2022] Open
Abstract
Objective Early feeding and infant exposures have been suggested as potential risk factors for immunoglobulin E- (IgE-) mediated food allergy (FA). We aimed to evaluate the association between IgE-mediated FA in children and early exposures including the child's nutritional status, breastfeeding and its duration, the age at which the solid food was first introduced, antibiotic exposure during the first year of life, and the child's vitamin D status during infancy. Design A case-control study. Setting and Subjects Children aged 0–13 years were recruited from pediatric allergy and immunology clinics (PAICs) located at major government hospitals in Kuwait (total FA cases: n = 100; boys = 67%), and healthy controls (n = 100, boys 55%) were recruited from various vaccination units at primary healthcare centers. Results Cow's milk allergy was the most common type of FA. FA status was independently associated with the early exposures of exclusive breastfeeding (aOR = 15.55 (3.26–74.19), p = 0.001), vitamin D deficiency or insufficiency during infancy (aOR = 5.42 (1.92–15.30), p = 0.001), and antibiotic exposure during the first year of life (aOR = 5.00 (1.58–15.84), p = 0.006). Conclusions FA is highly prevalent among children in Kuwait, and our data indicate that early nutrition-related and antibiotic exposures are associated with FA risk.
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Jhamnani RD, Levin S, Rasooly M, Stone KD, Milner JD, Nelson C, DiMaggio T, Jones N, Guerrerio AL, Frischmeyer-Guerrerio PA. Impact of food allergy on the growth of children with moderate-severe atopic dermatitis. J Allergy Clin Immunol 2018; 141:1526-1529.e4. [PMID: 29378286 PMCID: PMC5889954 DOI: 10.1016/j.jaci.2017.11.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/27/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
Children with moderate-severe atopic dermatitis and food allergy (especially milk) exhibit reduced weight and height, while those with atopic dermatitis alone are often overweight or obese, and their body mass index correlates with eczema severity.
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Affiliation(s)
- Rekha D Jhamnani
- Laboratory of Allergic Diseases, National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Samara Levin
- Laboratory of Allergic Diseases, National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Marjohn Rasooly
- Laboratory of Allergic Diseases, National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Kelly D Stone
- Laboratory of Allergic Diseases, National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Joshua D Milner
- Laboratory of Allergic Diseases, National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Celeste Nelson
- Laboratory of Allergic Diseases, National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Tom DiMaggio
- Laboratory of Allergic Diseases, National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Nina Jones
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc, Frederick, Md
| | - Anthony L Guerrerio
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University, Baltimore, Md
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10
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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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12
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Luo WY, Xu ZM, Hong L, Wu QY, Zhang YY. Nutritional outcomes in infants with food allergy after cardiac surgery. CONGENIT HEART DIS 2017; 12:777-782. [PMID: 28598588 DOI: 10.1111/chd.12489] [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: 03/05/2017] [Revised: 04/13/2017] [Accepted: 04/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Food allergy is a rapidly growing public health concern because of its increasing prevalence, as well as life-threatening potential. There is limited knowledge on the nutritional status for the pediatric congenital heart disease (CHD) patients with food allergy. OBJECTIVE This study investigated both clinical and nutritional outcomes according to the CHD infants with food allergy. METHODS Forty CHD infants with food allergy and 39 controls were recruited in Shanghai, China. The height and weight for age and weight for height were converted to z-scores to evaluate their effects on nutritional status before and after CHD operation. RESULTS Cow's milk showed the most frequently sensitized food allergen. The WHZ in the ≥2 allergen group was different before operation and after operation (P = .040). The number of sensitized food allergens significantly correlated with the WHZ (r = -0.431, P = .001), WAZ (r = -0.465, P = .000), and HAZ (r = -0.287, P = .025). Infection and NT-BNP showing negative correlation with WHZ and WAZ of infants with food allergy. CONCLUSIONS The increased number of sensitized food allergens is associated with negative effects on both short-term and long-term nutritional status in infants with CHD. Therefore, the meticulous and continuous evaluation and management of both growth and nutritional status should be considered in CHD patients with a high number of sensitized food allergens.
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Affiliation(s)
- Wen-Yi Luo
- Cardiovascular Intensive Care Unit, Shanghai Children's Medical Center, Shanghai, China
| | - Zhuo-Ming Xu
- Cardiovascular Intensive Care Unit, Shanghai Children's Medical Center, Shanghai, China
| | - Li Hong
- Nutrition Department, Shanghai Children's Medical Center, Shanghai, China
| | - Qian-Yue Wu
- Cardiovascular Intensive Care Unit, Shanghai Children's Medical Center, Shanghai, China
| | - Yue-Yue Zhang
- Cardiovascular Intensive Care Unit, Shanghai Children's Medical Center, Shanghai, China
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Abstract
OBJECTIVES The aim of the present article was to investigate iodine status and growth in cow's milk protein allergic infants and to identify potential predictors of iodine status and growth. METHODS Fifty-seven infants under 2 years of age were included in an observational cross-sectional study. Two spot urine samples were collected and analyzed for iodine, together with a 3-day food record and a food frequency questionnaire. Urine iodine concentrations were compared with the WHO cut-off values for iodine deficiency. Measurements of weight, length, and head circumference at birth and study inclusion were converted to standard deviation scores. Subgroup analyses were performed on different feeding patterns, according to weaning status. RESULTS Median age was 9 months. Median urinary iodine concentration was 159 ug/L. One third of the children had urine iodine concentrations indicating iodine deficiency. Infants who were mainly breastfed were at highest risk and 58% were classified as deficient. Dietary factors positively associated with iodine excretion were intake of enriched baby cereals and meeting the dietary requirement for iodine. Stunting was present in 5%. Underweight and wasting was frequent at 11% and this was associated with food refusal and poor appetite, but not with iodine status. Growth failure was detected among boys. CONCLUSIONS The present study suggests that cow's milk protein allergy children have high prevalence of iodine deficiency and poor growth, however the 2 conditions were not associated. The subgroup of mainly breastfed infants was at higher risk of iodine deficiency compared to weaned infants. Subjects with feeding problems had increased risk of malnutrition.
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Daza W, Dadán S, Higuera M. Síntomas gastrointestinales en pediatría ¿conducen siempre al verdadero diagnóstico? REVISTA DE LA FACULTAD DE MEDICINA 2016. [DOI: 10.15446/revfacmed.v64n1.51379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>Antecedentes. Los síntomas gastrointestinales son motivo frecuente de consulta pediátrica. Escasos estudios abordan la relación entre motivos de consulta (MC) y enfermedades gastrointestinales. Objetivos. Relacionar motivos de consulta con diagnósticos gastrointestinales definitivos (DGID) en pacientes pediátricos que acuden a una unidad de gastroenterología. Materiales y métodos. Estudio retrospectivo realizado entre enero del 2009 y diciembre del 2013. Se evaluó la relación entre los 10 principales MC con sus cinco primeros DGID bajo la prueba de ji cuadrado y la prueba exacta de Fisher. Resultados. Se reunieron 1171 pacientes. Los tres principales MC fueron dolor abdominal (DA) (12,3%), estreñimiento (12,1%) y reflujo gastroesofágico (8,4%). El Estreñimiento crónico funcional (ECF) (33,9%), la alergia alimentaria (AA), (17,3%) y la sospecha de AA (6,2%) constituyeron cerca del 50% de los DGID. El dolor abdominal, como motivo de consulta, se asoció con el diagnóstico de ECF, enfermedad ácido péptica (EAP) y AA; mientras que el estreñimiento como motivo de consulta se asoció con el diagnóstico de ECF, AA, sospecha AA e inercia colónica. Conclusión. El estreñimiento se ubica entre los primeros motivos de consulta y es el primer diagnóstico gastrointestinal directo con una asociación significativa entre ambos. Los profesionales de la salud deben estar atentos para detectar y diagnosticar esta entidad.</p>
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Beck C, Koplin J, Dharmage S, Wake M, Gurrin L, McWilliam V, Tang M, Sun C, Foskey R, Allen KJ, Robertson C, Hill D, Vuillermin P, Osborne N, Mathers M, Peters R, Dang T, Tey D, Robinson M, Zurzolo G, Thiele L, Czech H, Shaw H, Anderson D, Eckert J, Bertalli N, Sanjeevan J, Tan T, Martin P, Garner C, Trembath K, Crawford H, Suaini N, Ferreira M, Martino D, Saffery R, Ellis J, Saffery R, Molloy J, Brewerton M, Licciardi P, Tilbrook K, Chhabra S. Persistent Food Allergy and Food Allergy Coexistent with Eczema Is Associated with Reduced Growth in the First 4 Years of Life. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:248-56.e3. [DOI: 10.1016/j.jaip.2015.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/07/2015] [Accepted: 08/27/2015] [Indexed: 11/29/2022]
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An extensively hydrolysed casein-based formula for infants with cows' milk protein allergy: tolerance/hypo-allergenicity and growth catch-up. Br J Nutr 2015; 113:1102-12. [PMID: 25781481 DOI: 10.1017/s000711451500015x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Children with cows' milk protein allergy (CMPA) are at risk of insufficient length and weight gain, and the nutritional efficacy of hypo-allergenic formulas should be carefully assessed. In 2008, a trial assessed the impact of probiotic supplementation of an extensively hydrolysed casein-based formula (eHCF) on acquisition of tolerance in 119 infants with CMPA. First analysis of the study results showed that the studied formula allowed improvement of food-related symptoms. The scoring of atopic dermatitis (SCORAD) index was assessed at randomisation and after 6 months of feeding. A post hoc analysis was performed using WHO growth software's nutritional survey module (WHO Anthro version 3.2.2). All infants who were fed the study formula tolerated it well. The SCORAD index significantly improved from randomisation to 6 months of feeding with the study formula. Anthropometric data indicated a significant improvement in the weight-for-age, length-for-age and weight-for-length z scores, as well as in the restoration of normal BMI. The probiotic supplementation did not show any impact on these parameters. The present data showed that this eHCF was clinically tolerated and significantly improved the SCORAD index and growth indices.
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Berry MJ, Adams J, Voutilainen H, Feustel PJ, Celestin J, Järvinen KM. Impact of elimination diets on growth and nutritional status in children with multiple food allergies. Pediatr Allergy Immunol 2015; 26:133-8. [PMID: 25640977 DOI: 10.1111/pai.12348] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Impairment of growth has been reported in food-allergic children. It is not known whether this is related to the extent of food allergies. We sought to compare growth, nutritional status, and nutrient intake in children with food allergy either avoiding cow's milk or avoiding cow's milk and wheat, which are staples of the diet in young children. METHODS Infants and young children with challenge-proven allergy were recruited to this prospective study. They were strictly avoiding their allergic food triggers, either cow's milk, or cow's milk and wheat. They were counseled by a dietitian specialized in food allergies on food avoidance diets and nutritionally adequate supplementation at regular intervals. A 3-day food diary was kept. Children's height, weight, and laboratory data for nutritional parameters were monitored at 8-month intervals. RESULTS A total of 18 patients avoiding milk and 28 patients avoiding milk and wheat were evaluated at an average of 12, 21, and 28 months of age. During the follow-up, the markers of nutritional status, nutrient intake or height for age, and weight for height were comparable between the two groups, although the means for anthropometric measures were below the average for age in both groups. CONCLUSIONS The extent of food elimination diet has no impact on growth or nutritional status of food-allergic children, when diet is adequately supplemented. Close physician and dietitian follow-up are essential for food-allergic children when avoiding one or more foods, which are staples of the diet.
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Affiliation(s)
- Melissa J Berry
- Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Navarrete-Rodríguez EM, Del Río-Navarro BE, García-Aranda JA, Medeiros M, Enciso Peláez S, García Hernández HR, Pozo Beltrán CF. [Nutritional implications of elimination diets]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:112-117. [PMID: 29425990 DOI: 10.1016/j.bmhimx.2015.04.002] [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: 02/11/2015] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The backbone of food allergy treatment is the restriction of causative foods. These interventions have shown that children who restrict the consumption of basic foods have a higher risk of malnutrition. The aim of the study was to identify the nutritional status of patients with elimination diet, characterizing their anthropometric indexes and identifying the percentage of patients in the group with true food allergies. METHODS A cross-sectional study was carried out from January to October 2014 at the Hospital Infantil de Mexico Federico Gomez. Patients 1 to 11 years of age with a history of elimination of at least one of five foods (eggs, milk, wheat, corn, soybeans) for a minimum of 6 months were included. Full nutritional assessment was performed by comparing the anthropometric indexes to z score for age. Data analysis used descriptive statistics. Kruskal-Wallis and Spearman correlation were performed. RESULTS The most frequent eliminated foods were milk, soy, eggs, corn, and wheat. Comparing the number of foods eliminated with different anthropometric indexes, with a greater amount of eliminated food, the z-score of weight/age (W/A), height/age (H/A) and weight/height (W/H) were lower and the most affected index was fat reserve. Only in 5% of children was food allergy confirmed. CONCLUSIONS The study confirms the need for nutrition counseling for patients who have elimination diets and overdiagnosis of food allergy.
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Affiliation(s)
- Elsy M Navarrete-Rodríguez
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Infantil de México Federico Gómez, México D.F., México
| | - Blanca Estela Del Río-Navarro
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Infantil de México Federico Gómez, México D.F., México.
| | - José A García-Aranda
- Dirección General, Hospital Infantil de México Federico Gómez, México D.F., México
| | - Mara Medeiros
- Laboratorio de Investigación en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, México D.F., México
| | - Sandra Enciso Peláez
- Laboratorio de Investigación en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, México D.F., México
| | - Héctor Rodrigo García Hernández
- Laboratorio de Investigación en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, México D.F., México
| | - César Fireth Pozo Beltrán
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Infantil de México Federico Gómez, México D.F., México
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Growth parameters impairment in patients with food allergies. J Allergy (Cairo) 2014; 2014:980735. [PMID: 24949021 PMCID: PMC4052520 DOI: 10.1155/2014/980735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/10/2014] [Accepted: 05/02/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Aims. Food allergy (FA) is a common disease that is rapidly increasing in prevalence for reasons that remain unknown. Objective. The aim of this study was to analyze the clinical characteristics and anthropometric data of patients with food allergies followed in a tertiary centre of allergy and immunology. Methods. A retrospective study was performed that assessed the data records of patients with food allergy diagnosis, covering a period from February 2009 to February 2012. Results. 354 patients were evaluated in the period; 228 (69.1%) patients had a confirmed FA diagnosis. The z-scores for weight-for-age, height-for-age, and body mass indices-for-age showed lower significant values in the FA group compared with the non-FA group by Mann-Whitney test, with significance values of P = 0.0005, P = 0.0030, and P = 0.0066, respectively. There were no statistical differences in sex, gestational age, birth type, breastfeeding period, and age of introduction of complementary formulas based on cow milk protein between groups. Conclusion. FA patients had a lower growth rate in comparison with patients without FA. The early recognition of food allergies with the establishment of protein-implicated diet exclusion, in association with an adequate nutrient replenishment, is important to reduce the nutritional impact of food allergies.
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Patelis A, Janson C, Borres MP, Nordvall L, Alving K, Malinovschi A. Aeroallergen and food IgE sensitization and local and systemic inflammation in asthma. Allergy 2014; 69:380-7. [PMID: 24397423 DOI: 10.1111/all.12345] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND We recently reported an independent association between IgE sensitization to food allergens and increased airway inflammation, assessed by fraction of exhaled nitric oxide (FeNO), in a population-based study (J Allergy Clin Immunol, 130, 2012, 397). Similar studies have not been performed in populations with asthma. The aim of the present study was to investigate the allergic sensitization profile in asthmatics and examine FeNO, airway responsiveness and blood eosinophilia in relation to type and degree of IgE sensitization. METHOD FeNO, airway responsiveness, blood eosinophil count (B-Eos) and IgE sensitization to food allergens and aeroallergens were determined in 408 subjects with asthma, aged 10-34 years. RESULTS Asthmatics had higher prevalence of IgE sensitization against all allergens than controls (P < 0.001). Mite, pollen, furry animal, mould and food sensitizations were each associated with increased FeNO, airway responsiveness and B-Eos in asthmatics. IgE sensitization to mould, furry animals and food allergens was independently related to FeNO (all P < 0.05) after adjustment for age, sex, height, smoking history and medication. IgE sensitization to mould (P < 0.001) and furry animals (P = 0.02) was related to airway responsiveness in a similar model. Finally, IgE sensitization to mould (P = 0.001), furry animals (P < 0.001) and food allergens (P < 0.001) was independently related to B-Eos. CONCLUSION Independent effects of IgE sensitization to aeroallergens (furry animals and mould) and food allergens were found on both local and systemic markers of inflammation in asthma. The finding regarding food IgE sensitization is novel, and a clinical implication might be that even food sensitization must be assessed to fully understand inflammation patterns in asthma.
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Affiliation(s)
- A. Patelis
- Department of Medical Sciences, Respiratory Medicine & Allergology; Uppsala University; Uppsala Sweden
| | - C. Janson
- Department of Medical Sciences, Respiratory Medicine & Allergology; Uppsala University; Uppsala Sweden
| | - M. P. Borres
- Immunodiagnostics; Thermo Fischer Scientific; Uppsala Sweden
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - L. Nordvall
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - K. Alving
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - A. Malinovschi
- Department of Medical Sciences, Clinical Physiology; Uppsala University; Uppsala Sweden
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Sova C, Feuling MB, Baumler M, Gleason L, Tam JS, Zafra H, Goday PS. Systematic review of nutrient intake and growth in children with multiple IgE-mediated food allergies. Nutr Clin Pract 2013; 28:669-75. [PMID: 24166727 DOI: 10.1177/0884533613505870] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Food allergies affect up to 8% of American children. The current recommended treatment for food allergies is strict elimination of the allergens from the diet. Dietary elimination of nutrient-dense foods may result in inadequate nutrient intake and impaired growth. The purpose of this review was to critically analyze available research on the effect of an elimination diet on nutrient intake and growth in children with multiple food allergies. METHODS A systematic review of the literature was conducted and a workgroup was established to critically analyze each relevant article. The findings were summarized and a conclusion was generated. RESULTS Six studies were analyzed. One study found that children with food allergies are more likely to be malnourished than children without food allergies. Three studies found that children with multiple food allergies were shorter than children with 1 food allergy. Four studies assessed nutrient intake of children with multiple food allergies, but the inclusion and comparison criteria were different in each of the studies and the findings were conflicting. One study found that children with food allergies who did not receive nutrition counseling were more likely to have inadequate intake of calcium and vitamin D. CONCLUSION Children with multiple food allergies have a higher risk of impaired growth and may have a higher risk of inadequate nutrient intake than children without food allergies. Until more research is available, we recommend monitoring of nutrition and growth of children with multiple food allergies to prevent possible nutrient deficiencies and to optimize growth.
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Affiliation(s)
- Cassandra Sova
- Cassandra Sova, CD, CNSC, Department of Clinical Nutrition, Children's Hospital of Wisconsin, P.O. Box 1997, MS B610, Milwaukee, WI 53201-1997, USA.
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Pasha I, Saeed F, Sultan MT, Batool R, Aziz M, Ahmed W. Wheat Allergy and Intolerence; Recent Updates and Perspectives. Crit Rev Food Sci Nutr 2013; 56:13-24. [DOI: 10.1080/10408398.2012.659818] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Meyer R, De Koker C, Dziubak R, Venter C, Dominguez-Ortega G, Cutts R, Yerlett N, Skrapak AK, Fox AT, Shah N. Malnutrition in children with food allergies in the UK. J Hum Nutr Diet 2013; 27:227-35. [DOI: 10.1111/jhn.12149] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R. Meyer
- Department of Gastroenterology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - C. De Koker
- Department of Gastroenterology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - R. Dziubak
- Department of Gastroenterology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - C. Venter
- The David Hide Asthma and Allergy Research Centre; University of Portsmouth; Portsmouth UK
| | - G. Dominguez-Ortega
- Department of Gastroenterology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - R. Cutts
- University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - N. Yerlett
- Department of Gastroenterology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - A.-K. Skrapak
- Department of Gastroenterology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - A. T. Fox
- King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; Division of Asthma, Allergy and Lung Biology; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - N. Shah
- Department of Gastroenterology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
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Nutritional aspects in diagnosis and management of food hypersensitivity-the dietitians role. J Allergy (Cairo) 2012; 2012:269376. [PMID: 23150738 PMCID: PMC3485989 DOI: 10.1155/2012/269376] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 04/20/2012] [Indexed: 11/18/2022] Open
Abstract
Many common foods including cow's milk, hen's egg, soya, peanut, tree nuts, fish, shellfish, and wheat may cause food allergies. The prevalence of these immune-mediated adverse reactions to foods ranges from 0.5% to 9% in different populations. In simple terms, the cornerstone of managing food allergy is to avoid consumption of foods causing symptoms and to replace them with nutritionally equivalent foods. If poorly managed, food allergy impairs quality of life more than necessary, affects normal growth in children, and causes an additional economic burden to society. Delay in diagnosis may be a further incremental factor. Thus, an increased awareness of the appropriate procedures for both diagnosis and management is of importance. This paper sets out to present principles for taking an allergy-focused diet history as part of the diagnostic work-up of food allergy. A short overview of guidelines and principles for dietary management of food allergy is discussed focusing on the nutritional management of food allergies and the particular role of the dietitian in this process.
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Sohn MH, Kim KE. Use of intravenous immunoglobulin in the treatment of childhood atopic dermatitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 3:65-6. [PMID: 21461243 PMCID: PMC3062797 DOI: 10.4168/aair.2011.3.2.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 03/14/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Myung Hyun Sohn
- Department of Pediatrics and Institute of Allergy, BK 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
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