Elimination diet in cow's milk allergy: Risk for impaired growth in young children☆,☆☆,★,★★
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Subjects and Study Design
The study involved 100 consecutive children aged 1 to 17 months (mean 7 months) who had been referred to the Tampere University Hospital Pediatric Department on the basis of suspected cow milk allergy. They fulfilled the Hanifin criteria13 of atopic dermatitis in children and the additional criteria of positive open or double-blind, placebo-controlled cow's milk challenge and no breastfeeding at the time of the study. Cow milk elimination diet was started in infants <12 months with either an
Clinical Characteristics at Diagnosis
The diagnosis of cow's milk allergy was made at 7 months (6 to 8 months) of age (mean 95% CI). The reactions involved pruritus, urticaria, morbilliform exanthema, or reactions of eczematous type. The reactions were confined to the skin in 80% of the patients. Vomiting, loose stools, and diarrhea occurred in 20% of the patients. Cow's milk–specific RAST was positive (≥0.4 kU/L) in 41%, and skin prick test for cow's milk was positive in 36%. Skin prick tests for egg, cereals (wheat, barley, rye,
DISCUSSION
The use of elimination diets has become an accepted adjunct in attempts at both prevention and treatment of allergy in early childhood. Despite the persuasive rationale of decreasing exposure to the most important source of antigens early in life, the results have been conflicting. Moreover, knowledge of the nutritional repercussions of exceptional diets is fragmentary. Our results substantiate a delicate balance between the benefits and risks. Therapeutic elimination diets resulted in clinical
Acknowledgements
We thank Eija-Liisa Ala-Laurila, MD, for help in evaluating the control patients, and Tuija Poussa, MSc, for able statistical consultations. We thank Ms. Kaarina Katajisto and Ms. Marjo Leponiemi for their assistance.
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Cited by (0)
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From the Department of Pediatrics, University of Turku and Medical School, University of Tampere, Finland.
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Supported by the Academy of Finland, the Jansson Foundation, and the Medical Research Fund of Tampere University Hospital.
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Reprint requests: Erika Isolauri, MD, Department of Pediatrics, University of Turku, 20520 Turku, Finland.
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0022-3476/98/$5.00 + 0 9/21/89122