Over restrictive elimination of foods in children with food allergy

Background. Previous studies demonstrated critical deficits in diagnosis and management of childhood food allergy (FA), and recent developments in FA research support adopting a proactive approach in FA management. Our objective was to describe FA knowledge and management patterns of pediatricians. Method. We applied a 24-item survey to 170 general pediatricians, pediatric allergists and pediatric gastroenterologists practicing in Turkey. Results. Some IgE-mediated symptoms of FA such as cough, urticaria, wheezing and anaphylaxis were falsely recognized as symptoms of non-IgE-mediated FA by 30%, 29%, 25% and 19% of the participants, respectively. By contrast, 50% of the participants falsely recognized bloody stool, a finding of IgE-mediated FA. Most frequently and least frequently used diagnostic tools were specific IgE (30.5%) and oral food challenge test (1.7%), respectively. Maternal diet restrictions and infant diet restrictions were advised by 82% and 82%, respectively. Percentages of physicians eliminating only 1 food were 21%, 19%; 2 foods were 15%, 11%; 3 foods were 7%, 8%; 4-5 foods were 8%, 11%; 5 to 10 foods were 21%, 26%; and >10 foods were 28%, 25% from the maternal and infant diet, respectively. Cow’s milk, cheese, butter, yoghurt, baked milk products and hen’s egg were the most commonly restricted items. Conclusion. Overall, FA knowledge of pediatricians was fair. Pediatricians utilize an overly restrictive approach when advising diet eliminations in FA. Recent developments favor a more proactive approach to induce immune tolerance and need to be encouraged in pediatric clinical practice. Future educational efforts should focus on emphasizing the deleterious effects of injudicious and extensive eliminations.

___

1. Prescott SL, Pawankar R, Allen KJ, et al. A global survey of changing patterns of food allergy burden in children. World Allergy Organ J 2013; 6: 21.

2. Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics 2011; 128: e9-e17.

3. Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997-2011. NCHS Data Brief 2013; 121: 1-8.

4. Boyce JA, Assa’ad A, Burks AW, et al; NIAIDSponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010; 126(Suppl 6): S1-S58.

5. Mazzocchi A, Venter C, Maslin K, Agostoni C. The role of nutritional aspects in food allergy: prevention and management. Nutrients 2017; 9: 850.

6. Du Toit G, Roberts G, Sayre PH, et al; LEAP Study Team Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015; 372: 803-813.

7. Natsume O, Kabashima S, Nakazato J, et al; PETIT Study Team. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. Lancet 2017; 389: 276-286.

8. Meyer R, De Koker C, Dziubak R, et al. Malnutrition in children with food allergies in the UK. J Hum Nutr Diet 2014; 27: 227-235.

9. Christie L, Hine RJ, Parker JG, Burks W. Food allergies in children affect nutrient intake and growth. J Am Diet Assoc 2002; 102: 1648-1651.

10. Arik Yılmaz E, Cavkaytar O, Buyuktiryaki B, et al. Factors affecting food allergy-related quality of life from parents’ perception in Turkish children. Allergy Asthma Immunol Res 2018; 10: 379-386.

11. Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy 2010; 65: 933-945.

12. Yuce A, Dalgic B, Cullu-Cokugras F, et al. Cow’s milk protein allergy awareness and practice among Turkish pediatricians: a questionnaire-survey. Turk J Pediatr 2017; 59: 233-243.

13. Gupta RS, Springston EE, Kim JS, et al. Food allergy knowledge, attitudes, and beliefs of primary care physicians. Pediatrics 2010; 125: 126-132.

14. Morawetz DY, Hiscock H, Allen KJ, Davies S, Danchin MH. Management of food allergy: a survey of Australian paediatricians. J Paediatr Child Health 2014; 50: 432-437.

15. Baricic TV, Catipovic M, Cetinic EL, Krmek V, Horvat I. Parental perception, prevalence and primary care physicians’ knowledge on childhood food allergy in Croatia. Children (Basel) 2015; 2: 305-316.

16. Al-Herz W, Husain K, Al-Khabaz A, Moussa MA, Al-Refaee F. Awareness of food allergies: a survey of pediatricians in Kuwait. BMC Pediatr 2017; 17: 11.

17. Kaila M, Vanto T, Valovirta E, Koivikko A, JuntunenBackman K. Diagnosis of food allergy in Finland: survey of pediatric practices. Pediatr Allergy Immunol 2000; 11: 246-249.

18. Sackesen C, Suárez‐Fariñas M, Silva R, et al. A new luminex‐based peptide assay to identify reactivity to baked, fermented, and whole milk. Allergy 2019; 74: 327-336.

19. Tan-Lim CSC, Esteban-Ipac NAR. Probiotics as treatment for food allergies among pediatric patients: a meta-analysis. World Allergy Organ J 2018; 11: 25.

20. Meglio P, Giampietro PG, Carello R, Gabriele I, Avitabile S, Galli E. Oral food desensitization in children with IgE‐mediated hen’s egg allergy: a new protocol with raw hen’s egg. Pediatr Allergy Immunol 2013; 24: 75-83.

21. Yrjänä JMS, Bloigu R, Kulmala P. Parental confusion may result when primary health care professionals show heterogeneity in their knowledge, attitudes, and perceptions regarding infant nutrition, food allergy, and atopic dermatitis. Allergol Immunopathol (Madr) 2018; 46: 326-333.

22. Muraro A, Werfel T, Hoffmann‐Sommergruber K, et al; EAACI Food Allergy and Anaphylaxis Guidelines Group. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014; 69: 1008-1025.

23. Koletzko S, Niggemann B, Arato A, et al; European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr 2012; 55: 221-229.

24. Australasian Society of Clinical Immunology and Allergy. Nutritional Management of Food Allergy. https://www.allergy.org.au/images/ stories/pospapers/ASCIA_HPIP_food_allergy_ September_2013.pdf. (Accessed July 4, 2018).

25. Lack G. Epidemiologic risks for food allergy. J Allergy Clin Immunol 2008; 121: 1331-1336.

26. Perkin MR, Logan K, Marrs T, et al; EAT Study Team. Enquiring about tolerance (EAT) study: feasibility of an early allergenic food introduction regimen. J Allergy Clin Immunol 2016; 137: 1477-1486.e8.

27. Katz Y, Rajuan N, Goldberg MR, et al. Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy. J Allergy Clin Immunol 2010; 126: 77-82.e1.

28. Metcalfe JR, Marsh JA, D’Vaz N, et al. Effects of maternal dietary egg intake during early lactation on human milk ovalbumin concentration: a randomized controlled trial. Clin Exp Allergy 2016; 46: 1605-1613.

29. Sinai T, Goldberg MR, Nachshon L, et al. Reduced final height and inadequate nutritional intake in cow’s milk allergic young adults. J Allergy Clin Immunol Pract 2019; 7: 509-515.

30. Meyer R, Wright K, Vieira MC, et al. International survey on growth indices and impacting factors in children with food allergies. J Hum Nutr Diet 2019; 32: 175-184.

31. Greer FR, Sicherer SH, Burks AW, American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology.Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 121: 183-191.

32. Fiocchi A, Dahda L, Dupont C, Campoy C, Fierro V, Nieto A. Cow’s milk allergy: towards an update of DRACMA guidelines. World Allergy Organ J 2016; 9: 35.
Turkish Journal of Pediatrics-Cover
  • ISSN: 0041-4301
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 1958
  • Yayıncı: Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü
Sayıdaki Diğer Makaleler

The HLA groups and their relationship with clinical features in Turkish children and adolescents with celiac disease

Necati Balamtekin, Gökhan BAYSOY, Nuray USLU KIZILKAN, Hulya DEMIR, İnci Nur SALTIK TEMİZEL, HASAN ÖZEN, Aysel YÜCE, Figen GÜRAKAN, ÇAĞMAN TAN, İlhan TEZCAN

Screening traumatic life events in preschool aged children: cultural adaptation of Child and Adolescent Trauma Screen (CATS) Caregiver-report 3-6 years version

Pınar ZENGİN AKKUŞ, Esra SERDAROĞLU, Ayça KÖMÜRLÜOĞLU, Muhammet ASENA, Evin İLTER BAHADUR, Gökçenur ÖZDEMİR, Sevilay KARAHAN, Elif Nur ÖZMERT

The general movements assessment and effects of an early intervention in an infant with Cri du chat syndrome: a case report

Bilge Nur YARDIMCI LOKMANOĞLU, Akmer MUTLU, Ayşe LİVANELİOĞLU, Göknur HALİLOĞLU

Complicated pneumonia due to exogenous toxic substances in children

Ercan AYAZ, Berna OĞUZ, Mithat HALİLOĞLU, Dilber ADEMHAN TURAL, Ebru YALÇIN, Uğur ÖZÇELİK, Kübra YÜKSEL

Nasopharyngeal carcinoma in a child with Kartagener’s syndrome

Buket KARA, Yavuz KÖKSAL, Nusret SEHER, Mustafa KOÇAK, Meryem İlkay EREN KARANİS, Hasibe ARTAC, Mehmet KOÇ, Ahmet Okay ÇAĞLAYAN

Comparison of four different non-invasive respiratory support techniques as primary respiratory support in preterm infants

Ahmet ÖKTEM, Şule YİĞİT, HASAN TOLGA ÇELİK, Murat YURDAKOK

Practice, self-confidence and understanding of pediatric obstructive sleep apnea survey among pediatricians

Kantara SAELIM, Monthida UTHAIRAT, Kanokpan RUANGNAPA, Pharsai PRASERTSAN, Wanaporn ANUNTASEREE

Headache, cataract, and unilateral visual loss: unusual features of DARS2 variants in LBSL

Josef FINSTERER

Mucormycosis in a pediatric population: a review of 20 cases from southern Turkey

Derya ALABAZ, Gülsüm YILMAZ, Aysun UĞUZ, Süleyman ÖZDEMİR, Hatice Ilgen ŞAŞMAZ, İbrahim BAYRAM

Fecal elastase levels in children diagnosed with functional abdominal pain-not otherwise specified

Burcu GÜVEN, Nuriye Burçin TURAN, Ahmet Fayik ÖNER, Kamuran KARAMAN, Mecnun ÇETİN