A patient‐specific approach to develop an exclusion diet to manage food allergy in infants and children

Abstract

Food allergy is becoming increasingly common in infants and young children. This article set out to explain the different factors that should be taken into account during an individualized allergy consultation: Foods to avoid and degree of avoidance, suitable alternatives, self-management skills, co- and cross-reactive allergens and novel allergens alongside the role of the industry in allergen avoidance, importance of nutritional aspects of the diet and the future directions that nutritional guidance make take. Allergy management advice should be individualized to provide a patient-specific approach. Changes in the management of food allergies have in particular occurred in nut, milk and egg allergies over the past few years. There has also been a progressive increase in our understanding of cross-reactivity between different foods and also food and aero-allergens. A patient-specific approach of allergen avoidance should consider factors relating to industry and the environment such as food and nutrition literacy, threshold levels, cross-contact/contamination and safe eating away from home. Increasing migration and travel has also led to exposure of unfamiliar foods. As understanding improves on individual allergens and threshold levels, food labels and food labelling laws are affected. Allergy specialist dietitians should also keep up to date with the latest information on nutrition, the gut microbiome and the immune system to incorporate nutrition strategies in a dietetic consultation using an evidence-based approach.

Nutritional disorders resulting from food allergy in children

“…The management of food allergic disorders in children requires the avoidance of offending allergens . In early childhood, food allergic reactions are linked to eight major allergens including cow's milk, hen's egg, nuts (peanut and tree nuts), soya bean, wheat, fish and shellfish, with a total prevalence ranging between 2.1% and 4.2% in children between 0 and 3 years of age .…”

“…These allergens supply essential nutrients; in particular, cow's milk contributes indispensable macro‐ and micronutrients towards the infant's diet if breastmilk is not available. Significant advances have been made in food allergy management, and there is a drive towards individualized advice to avoid unnecessary dietary elimination, support the breastfeeding mother, assist in the choice of hypoallergenic formula and provide tailored advice to expand the infant's diet (including the active introduction of baked milk and egg when suitable) . In addition, guideline publications on food allergy highlight the importance of nutritional advice and ensuring dietary adequacy to avoid growth faltering or nutritional deficiencies .…”

Personalized Nutrition in Food Allergy: Tips for Clinical Practice

“…Until the last decade, the typical approach to children with tree nut or peanut allergy was exclusion from the diet of all types of nuts, in order to avoid risk of cross-reactivity or cross-contamination during processing (5). In 2014, the British Society for Allergy and Clinical Immunology (BSACI) recommended active inclusion in the diet of all types of tolerated nuts (6).…”

“…A strict egg or milk-free diet causes important dietary restrictions, including the need for careful reading of labels (ingredients, trace allergens, hidden allergens) and the exclusion of numerous packaged foods (5).…”

Personalized Nutrition Approach in Food Allergy: Is It Prime Time Yet?

“…Managing food allergies and avoiding food allergic reactions involves an individualized approach to food allergen avoidance while providing sufficient nutrition [33].…”