Nutritional Management of Children with Food Allergies

Abstract

Purpose of the Review The purpose of the review is to review the evidence for the nutritional management of paediatric food allergy and provide a practical approach for healthcare professionals working in this area. Recent Findings Dietary elimination remains the mainstay for management of food allergies in children. However, the elimination of food allergens increases the risk for growth faltering, micronutrient deficiencies and feeding difficulties. Breastmilk remains the ideal source of nutrition for infants, but when not available, the vast majority will tolerate an extensively hydrolysed formula, and rice hydrolysate has also been suggested as a suitable alternative. Only in severe cases, including anaphylaxis, eosinophilic oesophagitis and growth faltering, is an amino acid formula indicated. The early introduction of peanut and egg and avoiding the delay in the introduction of other allergens, when not already allergic, has been highlighted by recent studies. Summary Whilst the elimination of allergens increases the risk of developing poor growth, micronutrient deficiencies and feeding difficulties, optimal, early dietary input, including advice on active introduction of allergens and alternative feeds, ideally from a registered dietitian/nutritionist, may be prevent and improve outcomes.

Elimination diet in food allergy: friend or foe?

“…Most CM and egg allergies tolerate processed food associated with a wheat matrix and baked in high temperatures for a prolonged time (180°C for 25 to 30 minutes), which reduces the allergenicity of proteins by denaturing the conformational epitopes present in foods. 9 Once the tolerance to baked goods is confirmed through clinical history and/or oral food challenge, the allergens are allowed to be consumed in this way, respecting the conditions of preparation that guarantee their reduced allergenicity. It is noteworthy that not all processing decreases the allergenicity of food and that even some food sources, when processed, induce greater clinical reactivity.…”

“…A crucial topic in FA nutritional therapy is appropriate substitution based on the principles proposed by the Dietary Guides. 9 There are several publications suggesting substitute foods for the main food allergens. However, it is essential to differentiate between types of substitute foods, as they are not all the same.…”

“… 45 Multiple factors contribute to impaired growth and include the elimination diet itself, which impacts the intake of macro and micronutrients; coexistence with eating difficulties; the presence of comorbidities such as atopic dermatitis and asthma; persistent gastrointestinal inflammation affecting nutrient absorption 46 and the use of medications such as corticosteroids, which can also affect height growth, and proton pump inhibitors (PPIs). 9 PPIs, commonly used in EoE, can also affect micronutrient status. A reduction in gastric acid production potentially impacts the absorption of calcium, phosphorus, iron, and vitamin B12.…”

Nutritional Strategies for the Prevention and Management of Cow’s Milk Allergy in the Pediatric Age

“…In pediatric patients with a confirmed CMA diagnosis, international guidelines recommend a strict cow's milk protein elimination diet as the only therapeutic strategy to treat CMA. Obviously, the first aim of the elimination diet is to prevent an allergic reaction in CMA patients; but for specialists working in the FA field, avoiding nutritional deficit and ensuring optimal body growth are pivotal aspects that need to be considered [35][36][37][38]. In Table 1 are reported the nutritional intervention cornerstones in CMA pediatric patients.…”

Preparation of Hypoallergenic Whey Protein Hydrolysate by a Mixture of Alcalase and Prozyme and Evaluation of Its Digestibility and Immunoregulatory Properties

“…Whey protein (WP) not only boosts immunity due to the presence of β-lactoglobulin (β-LG), α-lactalbumin (αLA), bovine serum albumin, lactoferrin (LF), immunoglobulin (Ig), enzymes, and glycomacropeptide, and is also a source of essential amino acids (Marshall, 2004). Though it is obvious that WP is an excellent nutritive food, some of its components have been linked to allergic conditions in infants and young children (Jaiswal and Worku, 2022;Wright et al, 2022). Among the above mentioned proteins, the major antigens include casein, β-LG, and αLA, and it has been reported that most patients allergic to milk allergy have specific IgE antibodies against at least two antigens (Cohen et al, 2022;Savilahti and Kuitunen, 1992;Sicherer and Sampson, 1999).…”