Elimination diet in cow's milk allergy: Risk for impaired growth in young children,☆☆,,★★

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Abstract

Objective: The objective of this study was to evaluate the nutritional impact of therapeutic elimination diets and to identify risk factors predisposing infants with food allergy to poor growth. Study design: We studied 100 children (mean age 7 months) with atopic dermatitis and challenge-proven cow's milk allergy and evaluated their growth during the symptomatic period before diagnosis and during the therapeutic elimination diet. Results: Clinical control of symptoms was achieved in all patients. The mean length SD score and weight-for-length index of patients decreased compared with those in healthy age-matched children, p < 0.0001 and p = 0.03, respectively. Low serum albumin was present in 6% of the patients, 24% had an abnormal urea concentration, and 8% had a low serum phospholipid docosahexaenoic acid. The delay in growth was more pronounced in a subgroup of patients with early onset than in those with later of symptoms (F = 6.65, p < 0.0001). The duration of breast-feeding correlated positively with the sum of n-3 polyunsaturated fatty acids (r = 0.39, p = 0.001) and with the relative amount of docosahexaenoic acid (r = 0.36, p = 0.002). Conclusion: A delicate balance exists between the benefits and the risks of elimination diets. (J Pediatr 1998;132:1004-9.)

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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)

    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.

    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

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