Abstract
BackgroundThe management of food allergy in children requires elimination of the offending allergens, which significantly contribute to micronutrient intake. Vitamin and mineral supplementation are commonly suggested as part of dietary management. However a targeted supplementation regime requires a complete nutritional assessment, which includes food diaries. Ideally these should be analysed using a computerised program, but are very time consuming. We therefore set out to evaluate current practice of vitamin and mineral supplementation in a cohort of children with non-Immunoglobulin E (IgE) mediated food allergies.MethodsThis prospective, observational study recruited children aged 4 weeks – 16 years, who required to follow an elimination diet for non-IgE mediated allergies. Only children that improved according to a symptom score and were on a vitamin and/or mineral supplement were included. A 3-day food diary including vitamin and mineral supplementation was recorded and analysed using Dietplan computer program. We assessed dietary adequacy with/without the supplement using the Dietary Reference Values.ResultsOne hundred-and-ten children had completed food diaries and of these 29% (32/110) were taking vitamin and/or mineral supplements. Children on hypoallergenic formulas were significantly (p = 0.007) less likely to be on supplements than those on alternative over-the-counter milks. Seventy-one percent had prescribable supplements, suggested by a dietitian/physician. Sixty percent of those without a vitamin supplement had a low vitamin D intake, but low zinc, calcium and selenium was also common. Of the supplemented cohort many continued to be either under or over-supplemented.ConclusionThis study has raised the question for the first time, whether clinicians dealing with paediatric food allergies should consider routine vitamin and/or mineral supplements in the light of deficient intake being so common in addition to being so difficult to predict.
Highlights
Fundamental to the management of food allergy in early childhood is the total elimination of offending allergens [1]
We found that children on over-the-counter milk alternatives/no milk replacement were significantly more likely to be on supplements compared to those on a Hypoallergenic formula (HF) in the whole cohort (n = 110): 40.4% (23/57) vs. 17.0% (9/53), p = 0.007.The majority of children on supplements (68%, n = 22/32) had prescribable supplements, consisting of mainly multivitamins, calcium and vitamin D and in two cases an iron supplement
In 23/32 (71%) the suggestion for a vitamin and/or mineral supplement was made by the dietitian/ physician, in 6 cases both the dietitian and the parents were involved in choosing the supplement and in 3 children the parents started a supplement without dietetic input
Summary
Fundamental to the management of food allergy in early childhood is the total elimination of offending allergens [1] These often include cow’s milk, soya, hen’s egg, wheat, fish and nuts; foods which contribute significantly to dietary vitamin and mineral intake [2,3]. A dietary intake assessment can be very time consuming and is often limited to a 24-hour recall These dietary recall methods provide only a snap-shot of intake and are often biased [14,15], but are used in practice because they are quick and easy to do, and they provide the baseline for dietetic recommendations including supplementation of vitamin and/or minerals. The management of food allergy in children requires elimination of the offending allergens, which significantly contribute to micronutrient intake. A targeted supplementation regime requires a complete nutritional assessment, which includes food diaries These should be analysed using a computerised program, but are very time consuming. We set out to evaluate current practice of vitamin and mineral supplementation in a cohort of children with non-Immunoglobulin E (IgE) mediated food allergies
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