Introduction Of Foods Research Articles

Parental food selection questionnaire - Infant version

PurposeComplementary feeding practices (CFPs) are associated with health outcomes (e.g., obesity and food allergies). Understanding how parents select foods for their infant is limited. This study's purpose was to develop a psychometrically sound measure of parents' food selection motives for their infant during the complementary feeding period. MethodsDevelopment and testing of the Parental Food Slection Questionnaire-Infant Version (PFSQ-I) occurred in three phases. English-speaking, U.S. mothers of healthy infants, aged 6–19 months old participated in a semi-structured, face-to-face interview (Phase 1) or a web-based survey (Phases 2 & 3). Phase 1 was a qualitative study of maternal beliefs and motives surrounding complementary feeding. Phase 2 involved adaptation and exploratory factor analysis of the original Food Choice Questionnaire (Steptoe et al., 1995). Phase 3 involved validity testing of the relationships among PFSQ-I factors and CFPs (timing/type of complementary food introduction, frequency of feeding method, usual texture intake, and allergenic food introduction) using bivariate analyses, and multiple linear and logistic regression analyses. ResultsMean maternal age was 30.4 years and infant age was 14.1 months (n = 381). The final structure of the PFSQ-I included 30 items and 7 factors: Behavioral Influence, Health Promotion, Ingredients, Affordability, Sensory Appeal, Convenience, and Perceived Threats (Cronbach's α = 0.68–0.83). Associations of factors with CFPs supported construct validity. DiscussionThe PFSQ-I demonstrated strong initial psychometric properties in a sample of mothers from the U.S. Mothers who rated Behavioral Influence as more important were more likely to report suboptimal CFPs (e.g., earlier than recommended complementary food introduction, delayed allergenic food introduction, and prolonged use of spoon-feeding). Additional psychometric testing in a larger, more heterogenous sample is needed, along with examination of relationships between PFSQ-I factors and health outcomes.

The Design of an Illustration Book 'Serba-Serbi Rasa Jawa Tengah' For Teenagers as an Introduction of Central Java's Traditional Food

The Design of an Illustration Book 'Serba-Serbi Rasa Jawa Tengah' For Teenagers as an Introduction of Central Java's Traditional Food

Skin care interventions and early complementary food introduction for the prevention of atopic dermatitis in infants

аtopic dermatitis and food allergy are common diseases that usually begin in early childhood and can occur together in the same individuals. The aim of this study was to assess the significance of interventions such as skin care products for the skin barrier improvement, breastfeeding and early complementary foods introduction for the primary prevention of atopic dermatitis and food allergy in infants by building logistic regression models. We performed a survey of 97 parents of children. The survey was conducted with the help of Google forms and distributed on the Internet. Method of building and analysing logistic regression models was used to analyse the association of the risk of atopic dermatitis in children with the factor characteristics. Characteristics were as follows: "Skin care 1: application moisturizers to the infant's skin", "Skin care 2: bathing infants with water containing moisturizing substances or moisturizing oils", "Skin care 3: usage of less soap, bathing the child less often", "paternal history of atopy", "duration of breastfeeding less than 1 year", "early introduction of supplementary food (up to the 6th month of life)". We obtained the following results: 42.2% of respondents reported about the application of moisturizing cream, parents of 16.5% of children were using moisturizing oil for bathing the child, 12.4% of parents used less soap and bathed the child less often, 28.9% reported that they were not using any interventions. It was established that when applying care method 1, namely applying moisturizing agents to the infant’s skin, the risk of developing atopic dermatitis increases, OR=12.8 (95% CI 3.89 - 42.3) (p<0.0001). When constructing a three-factor logistic regression model for predicting the risk of food allergy, no dependence was found between the development of food allergy and the presence of allergic diseases in parents, the period of introduction of complementary foods, and the duration of breastfeeding. Thus, this study did not reveal the protective role of skin care products, breastfeeding, and early introduction of complementary foods for the development of atopic dermatitis and food allergies in children. Multivariate analysis showed that atopic dermatitis is associated with emollients application to the infant’s skin. The use of moisturizing creams for the treatment of already existing atopic dermatitis or the path of percutaneous sensitization to allergens could have influenced the data.

Association of feeding patterns in infancy with later autism symptoms and neurodevelopment: a national multicentre survey

BackgroundWe aimed to compare differences in infant feeding patterns (breastfeeding and complementary food supplementation) between children with the autism spectrum disorder (ASD) and typically developing (TD) children through a multicentre study. The relationship between these patterns and later core symptoms and neurodevelopment in children with ASD was also investigated.MethodsWe analysed breastfeeding and complementary feeding patterns in 1389 children with ASD and 1190 TD children. The Children Neuropsychological and Behavior Scale-Revision 2016 (CNBS-R2016) was used to assess neurodevelopmental levels. The Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), Childhood Autism Rating Scale (CARS), and ASD Warning Behavior Subscale of the CNBS-R2016 were used to assess ASD symptoms.ResultsChildren with ASD had a shorter breastfeeding duration in infancy (8 (3–12) months vs. 10 (6–14) months, P < 0.001), later introduction of complementary foods (P < 0.001), and poorer acceptance of complementary foods (P < 0.001) than TD children. Total ABC and CARS scores were lower in the group of children with ASD who had been breastfed for 12 months or more than in the group who had been breastfed for less than 6 months. Children with ASD who were given complementary food after 6 months had lower general quotient (GQ), adaptive ability, fine motor and language scores than those who were given complementary food within 4–6 months. Children with ASD with poor acceptance of complementary foods had higher ABC and SRS scores and lower gross motor scores than those who had good acceptance.ConclusionsChildren with ASD have a shorter duration of breastfeeding, a later introduction of complementary foods, and poorer acceptance of complementary foods than TD children. These feeding patterns may be related to the symptoms and growth of children with ASD. The research suggests that continued breastfeeding for longer than 12 months may be beneficial in reducing ASD symptoms and that infants who have difficulty introducing complementary foods should be followed up for neurodevelopment.Trial registrationThe ethics committee of the Children’s Hospital of Chongqing Medical University approved the study. Approval Number: (2018) IRB (STUDY) NO. 121, and registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000031194, registered on 23/03/2020).

Impact of the Revision of European Food Hygiene Legislation and the Introduction of Convenience-based Food on Food Safety in the German Military

The implementation of the European Food Regulation in the German military started in 2003 and was fully implemented in 2006. In addition, in 2003 the German military introduced the concept of using convenience-based foods targeted to improve the safety of food served to the troops. The aim of this study was to evaluate the impact of these changes on food safety and the occurrence of food-borne disease outbreaks in the German military. For this purpose, data from a total of 517 food-borne outbreaks that occurred between 1995 and 2019 in the responsible areas of the German military both within the country and abroad were subjected to a retrospective analysis. As a result, a significant decrease (p = 2.47 × 10−5) in the number of the food-borne outbreak was observed in the second observation period (2003–2019) compared to the first period (1995–2002). Food groups often found contaminated with pathogens were desserts and prepared dishes (first period), fresh produce, soups, and sauces (second period). Bacillus cereus, Enterobacteriaceae, Salmonella spp., and Staphylococcus aureus were dominant pathogens isolated from suspected foods during disease outbreaks in both periods, however, the absolute number of isolates reduced significantly in the second period. Therefore it can be concluded that the implementation of European food hygiene regulations together with the introduction of convenience-based foods had a significant positive impact on food safety in the German military.

RISK FACTORS AND OUTCOMES OF ACUTE LOWER RESPIRATORY TRACT INFECTION IN CHILDREN AGED 2 MONTHS TO 5 YEARS

Background: Acute Lower Respiratory Tract Infection (ALRI) is the leading cause of under-5 childhood morbidity in the world, with nearly 156 million new episodes each year, of which India accounts for a bulk of 43 million. The mortality burden is 1.9 million per year, out of which India accounts for around four hundred thousand deaths per year. Objective: To study the various risk factors, clinical prole and outcome of acute lower respiratory tract infections (ALRI) in children aged 2 months to 5 years. Methods: 100 ALRI cases fullling WHO criteria for pneumonia, in the age group of 2 month to 5 years were evaluated for potential risk factors, clinical prole and outcome as per a predesigned proforma in a rural medical college. Results: Socio-demographic risk factors like parental illiteracy, overcrowding, partial immunization and low socioeconomic status were potential risk factors. Nutritional risk factors like early and late introduction of complementary foods, anemia and malnutrition were associated with ALRI. Environmental risk factors were use of biomass fuels, inadequate ventilation at home, and lack of separate kitchen. Conclusion: The present study has identied various socio-demographic, nutritional and environmental risk factors for ALRI which can be tackled by effective health education of the community and effective training of peripheral health personnel.

Introduction of Egg White and Yolk to Infant Diets and Early Childhood Atopic Dermatitis.

This study investigated whether the introduction of allergenic foods in infancy is associated with atopic dermatitis (AD) in early childhood. Information regarding parental allergic histories, the introduction of six possible allergenic foods (fruits, egg white, egg yolk, fish, shellfish, and peanuts), and physician-diagnosed AD was obtained using age-specific questionnaires (0-2 years). Immunoglobulin E, specific to 20 food allergens, was also quantified at 12 months of age. Logistic regression analyses were used to determine the association between individual food introduction and the outcomes of food sensitization and AD. We found AD development by 2 years of age was significantly related to a parental history of allergy (adjusted odds ratio (aOR) = 1.29) and not being introduced to egg white and yolk during infancy (aORs = 2.27 and 1.97, respectively). Stratified analyses revealed that the introduction of both egg white and yolk was negatively associated with AD by 2 years of age, especially for those children where both parents had allergic diseases (aOR = 0.10). In summary, the introduction of egg white and yolk to an infant's diet may be a modifiable factor in reducing the risk of physician-diagnosed AD by 2 years of age, which may be particularly important for infants where both parents have allergies.

Functional constipation symptoms and complementary feeding methods: A randomized clinical trial

IntroductionThe aim of the study was to investigate the impact of different complementary feeding methods on the prevalence of functional constipation symptoms in infants at 12 months of age. Material and methodsRandomized clinical trial in mother–infant dyads that underwent the intervention at 5.5 months post birth, randomly allocated to one of three complementary food introduction methods: PLW (parent-led weaning), Baby-led Introduction to SolidS (BLISS) and a mixed approach. The symptoms of constipation were assessed at 12 months with an online questionnaire based on the Rome IV diagnostic criteria and adapted to our sample. The data were summarised as absolute frequencies and percentages and compared by means of the χ2 test. The project was approved by the ethics committee of the Hospital de Clínicas de Porto Alegre under number 2019-0230. ResultsWe analysed data corresponding to 135 infants, 45 allocated to PLW, 48 to BLISS and 42 to the mixed approach. The prevalence of constipation symptoms was 49.6% in the overall sample (n = 67), 60% (n = 27) in the PLW group, 47.9% (n = 23) in the BLISS group and 40.5% (n = 17) in the mixed approach group. We found no association between functional constipation symptoms and the method used to introduce complementary foods (P = .183). ConclusionsThe prevalence of functional constipation symptoms was high in the study population. The presence of constipation symptoms was not associated with the complementary feeding approach.

Cohort profile: Celiac disease genomic, environmental, microbiome and metabolome study; a prospective longitudinal birth cohort study of children at-risk for celiac disease.

The Celiac Disease Genomic, Environmental, Microbiome and Metabolomic (CDGEMM) study is an international prospective birth cohort in children at-risk of developing celiac disease (CD). The CDGEMM study has been designed to take a multi-omic approach to predicting CD onset in at-risk individuals. Participants are required to have a first-degree family member with biopsy diagnosed CD and must be enrolled prior to the introduction of solid food. Participation involves providing blood and stool samples longitudinally over a period of five years as well as answering questionnaires related to the participant, their family, and environment. Recruitment and data collection have been ongoing since 2014. As of 2022 we have a total of 554 participants and the average age of the cohort is 56.4 months. A total of 54 participants have developed positive antibodies for CD and 31 have confirmed CD. Approximately 80% of the 54 participants with CD have developed it by 3 years of age. To date we have identified several microbial strains, pathways, and metabolites occurring in increased abundance and detected before CD onset, which have previously been linked to autoimmune and inflammatory conditions while others occurred in decreased abundance before CD onset and are known to have anti-inflammatory effects. Our ongoing analysis includes expanding our metagenomic and metabolomic analyses, evaluating environmental risk factors linked to CD onset, and mechanistic studies investigating how alterations in the microbiome and metabolites may protect against or contribute to CD development.

Temporal trends in anaphylaxis ED visits over the last decade and the effect of COVID-19 pandemic on these trends

ABSTRACT Background Anaphylaxis is an acute systemic and potentially fatal allergic reaction. We evaluated trends in yearly rates of anaphylaxis in a pediatric Emergency Department (ED) in Montreal, Canada. Methods A prospective and retrospective recruitment process was used to find families of children who had presented with anaphylaxis at the Montreal Children’s Hospital between April 2011 and April 2021. Using a uniform recruitment form, data were collected. Anaphylaxis patterns were compared to clinical triggers using descriptive analysis. Results Among 830,382 ED visits during the study period, 2726 (26% recruited prospectively) presented with anaphylaxis. The median age was 6 years (IQR: 0.2, 12.00), and 58.7% were males. The relative frequency of anaphylaxis cases doubled between 2011–2015, from 0.22% (95% CI, 0.19, 0.26) to 0.42 March 2020, the total absolute number of anaphylaxis cases and relative frequency declined by 24 cases per month (p < 0.05) and by 0.5% of ED visits (p < 0.05). Conclusions The rate of anaphylaxis has changed over the years, representing modifications in food introduction strategies or lifestyle changes. The decrease in the frequency of anaphylaxis presenting to the ED during the COVID pandemic may reflect decreased accidental exposures with reduced social gatherings, closed school, and reluctance to present to ED.

Food allergy prevention: Where are we in 2023?

Food allergy prevention involves recommendations to the maternal diet during pregnancy and breast feeding, early life feeding and introduction of solid foods. Pregnant and breastfeeding women are not recommended to exclude any food allergens from their diet, but data are lacking to support active consumption of food allergens for prevention of food allergy. Breastfeeding is recommended for the many health benefits to the mother and child but has not shown any association with reduction in childhood food allergies. There is currently no recommendation regarding the use of any infant formula for allergy prevention, including the use of partially or extensively hydrolyzed formulas. Once the introduction of solid food commences, based on randomized controlled trials, it is advised to actively introduce peanuts and egg early into the infant diet and continue with consumption of these. Although there are limited data with respect to other major food allergens and whether early introduction may prevent allergy development, there is no need to delay the introduction of these allergens into the infant diet. Interpreting food allergen consumption in the context of cultural food practices has not been studied, but it makes sense to introduce the infant to family foods by 1 year of age. Consumption of foods typical of the Western diet and foods high in advanced glycation end products may be associated with an increase in food allergies. Similarly, intake of micronutrients, such as vitamin D and omega-3 fatty acids in both the maternal and infant diet, needs further clarification in the context of food allergy prevention.

Delaying the Introduction of Complementary Food until 6 Months does not Affect Appetite or Mother's Report of Food Acceptance of Breast-Fed Infants from 6 to 12 Months in a Low Income, Honduran Population

Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to one of three groups: 1) continued exclusive breast-feeding to 6 mo (EBF), 2) introduction of complementary foods at 4 mo, with ad libitum nursing 4–6 mo (SF), and 3) introduction of complementary foods at 4 mo, with maintenance of base-line nursing frequency 4–6 mo (SF-M). After the intervention phase (4–6 mo; n = 141), home visits were conducted for a subsample at 9 (n = 60) and 12 (n = 123) mo. At each visit, an observer recorded infant food intake at the midday meal and interviewed the mother regarding usual feeding patterns and the infant's acceptance of 20 common food items. All but two infants (1.5%) were breast-fed to 9 mo and all but eight (6%) to 12 mo. There were no significant differences among groups in breast-feeding frequency, amount or number of foods consumed at the midday meal, percentage of food offered that was consumed, usual daily number of meals and snacks, number of food groups consumed, or overall food acceptance score. Frequency of consumption of foods from eight different food groups (dairy, meats, eggs, grains, beans, fruits, vegetables, tubers) was not significantly different among groups except that, at 9 mo only, the SF group (but not the SF-M group) consumed more vegetables than did the EBF group. These results indicate that delaying the introduction of complementary foods until 6 mo does not adversely affect appetite or food acceptance among breast-fed infants.

Faecal Short-chain Fatty Acid and Early Introduction of Foods in the First 200 Days of Infant’s Life in the District of Abidjan (Ivory Coast)

Dosage of short chain fatty acids (SCFAs) according to food diet showed that the content of acetate was high in newborn feaces. Infants receiving food supplements have a complex and diverse gut microbiota. Moreover, the results show that infants from poor districts have an abundant concentration of SCFAs in their faeces compared to those living in places with a relatively high standard of living. Among infants receiving milk, the highest proportion of SCFA is acetate in breastfed infants (BF) at a rate of 15.025 ± 2.23 μmol/g, followed by propionate in infants receiving mixed feeding (BF+FF), at a rate of 13.58 ± 1.03 μmol/g and butyrate in infants taking mixed feeding at a rate of 0.32 ± 0.72 μmol/g. However, among infants starting early diet diversification, acetate is higher in infants receiving milk formula and diet diversification (FF+FD) with a concentration of 25.4 ± 0 μmol/g, followed by propionate (2.36 ± 0 μmol/g) in infants receiving mixed feeding (BF+FF) and butyrate in those fed with (BF+FD). Partial breastfeeding is associated with a higher proportion of acetate, butyrate and propionate. The study of the correlation between the different SCFAs produced and the ASV (Variants of Microbial Amplicon Sequences) of the intestinal community of the child, shows that acetate is positively correlated with Bifidobacterium and negatively with Streptococcus and Escherichia-Shigella. Propionate is positively correlated with Bifido bacterium and negatively with Escherichia-Shigella. Similarly, butyrate is positively correlated with Bifidobacterium and negatively with Escherichia-Shigella.

A Peer-Led Integrated Nutrition Education Intervention through Care Groups Improved Complementary Feeding of Infants in Postemergency Settlements in the West-Nile Region in Uganda: A Cluster Randomized Trial

BackgroundComplementary feeding of infants in refugee settlements remains inadequate. Furthermore, there has been limited evaluation of interventions addressing these nutrition challenges. ObjectiveThis study examined the effects of a peer-led integrated nutrition education intervention on infant complementary feeding by South Sudanese refugee mothers in the West-Nile region in Uganda. MethodsA community-based randomized trial enrolled 390 pregnant women (during third trimester) as the baseline. Two arms [mothers-only and parents-combined (both mothers and fathers)] comprised treatments with a control. Infant feeding was assessed using WHO and UNICEF guidelines. Data were collected at Midline-II and Endline. The medical outcomes study (MOS) social support index was used to measure social support. An overall mean score of >4 was considered optimal social support, a score of ≤2 was none or little support. Adjusted multivariable logistic regression models determined the effects of the intervention on infant complementary feeding. ResultsAt the end of the study, infant complementary feeding improved significantly in both mothers-only and parents-combined arms. There was a positive effect on the introduction of solid, semisolid, and soft foods (ISSSF) in the mothers-only arm at both Midline-II {adjusted odds ratio (AOR) = 4.0]} and Endline (AOR = 3.8). Likewise, ISSSF was better for the parents-combined arm at both Midline-II (AOR = 4.5) and Endline (AOR = 3.4). Minimum dietary diversity (MDD) was significantly better at the Endline for the parents-combined arm (AOR = 3.0). Minimum acceptable diet (MAD) was significantly better at Endline for both mothers-only (AOR = 2.3) and parents-combined arms (AOR = 2.7). Infant consumption of eggs and flesh foods (EFF) was improved only in the parents-combined arm at both Midline-II (AOR = 3.3) and Endline (AOR = 2.4). Higher maternal social support was associated with better infant MDD (AOR = 3.3), MAD (AOR = 3.6), and EFF (AOR = 4.7). ConclusionEngaging both fathers and mothers in care groups benefited complementary feeding of infants. Overall, this peer-led integrated nutrition education intervention through care groups improved infant complementary feeding in the West-Nile postemergency settlements in Uganda.This trial was registered at clinicaltrials.gov as NCT05584969.

Effects of timing of complementary food introduction on childhood food allergy development: A modified role of ambient air pollution exposure

BackgroundFood allergy increased in the recent years causing heavy disease burden worldwide, yet the unique factors for the second-wave allergy epidemic since a rise of allergic diseases are unclear. ObjectiveTo examine the impact of introduction timing of complementary foods on childhood food allergy and whether ambient air pollution modify this association. MethodsA retrospective cohort study of 2,598 preschoolers was conducted at 36 kindergartens at Changsha of China during 2011–2012. A standard questionnaire was developed to survey each preschooler's introduction timing of complementary foods, food allergy, and home environments. Each subject's exposure to ambient air pollutants including PM10, SO2, and NO2 was estimated for pregnancy and postnatal period. Association between food allergy and introduction timing of complementary foods as well as its modification by ambient pollution were evaluated by multiple logistic regression model. ResultsChildhood total food allergy (14.6%) was significantly positively associated with early introduction to fruit or vegetable before 3 months with OR = 1.97 (1.25–3.11), especially for egg and milk allergies. Food allergy was also significantly associated with NO2 exposure in pregnancy especially during the 1st trimester with ORs (95% CI) = 1.24 (1.00–1.54) and 1.27 (1.03–1.58) and postnatal period with OR of 1.30 (1.01–1.66) respectively for per IQR increase in their exposure. We observed that living near traffic-main road and other areas significantly increased food allergy risk of early introduction of fruit and vegetable. We further detected that early introduction of milk powder or porridge significantly decreased the risk of food allergy at the condition of light outdoor air pollution exposure during postnatal period. Sensitivity analysis showed that children living at urban area, male sex, younger age, and having breast-feeding were more susceptible to the effect of early introduction of fruit and vegetable on food allergy. ConclusionOur study indicates that the role of introduction timing of complementary foods on food allergy could be adjusted by air pollution exposure level, which may partly explain the second-wave allergy epidemic and provide a potential preventive strategy.

Síntomas de estreñimiento funcional y métodos de alimentación complementaria: ensayo clínico aleatorizado

IntroductionThe aim of the study was to investigate the impact of different complementary feeding methods on the prevalence of functional constipation symptoms in infants at 12 months of age. Material and methodsRandomized clinical trial in mother–infant dyads that underwent the intervention at 5.5 months post birth, randomly allocated to one of three complementary food introduction methods: PLW (parent-led weaning), baby-led introduction to solids (BLISS) and a mixed approach. The symptoms of constipation were assessed at 12 months with an online questionnaire based on the Rome IV diagnostic criteria and adapted to our sample. The data were summarised as absolute frequencies and percentages and compared by means of the χ2 test. The project was approved by the ethics committee of the Hospital de Clínicas de Porto Alegre under number 2019-0230. ResultsWe analysed data corresponding to 135 infants, 45 allocated to PLW, 48 to BLISS and 42 to the mixed approach. The prevalence of constipation symptoms was 49.6% in the overall sample (n=67), 60% (n=27) in the PLW group, 47.9% (n=23) in the BLISS group and 40.5% (n=17) in the mixed approach group. We found no association between functional constipation symptoms and the method used to introduce complementary foods (P=.183). ConclusionsThe prevalence of functional constipation symptoms was high in the study population. The presence of constipation symptoms was not associated with the complementary feeding approach.

Resident perspectives on early allergenic food introduction

The changing guidelines on introduction of allergenic foods over the past decade have left some providers and trainees confused on how to best counsel patients. Much of this counseling occurs during pediatric well visits by primary care providers. We aimed to describe barriers that resident physicians in the primary care setting face in counseling patients on early allergenic food introduction.

Food-induced Anaphylaxis In Infants Following Early Introduction Guidelines And Recommendations

Guidelines for prevention of peanut allergy (i.e. early introduction of age-appropriate peanut-containing food) in US were published in January 2017 and soon followed by recommendations for early introduction of other foods also. We sought to determine changes in infant anaphylaxis thereafter.

Development of Home Food Introduction Pathway Through Epic My Chart

Food allergy prevalence has been increasing in the United States to 7.6% of children. Many foods can safely be introduced at home, and do not require monitored challenges. We developed protocols for safe home introduction of peanut, milk, and egg products, via Epic MyChart ® patient portal. Our objectives were developing tools to support patients and families in the safe home introduction of foods and providing Allergists and PCP's with a mechanism to monitor patient progress.

Prevalence and Characteristics of Subsequent Reactions after Initial FPIES Diagnosis

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated, immune-based food adverse reaction treated by trigger food avoidance and supportive care. The rate of additional or subsequent reactions after initial diagnosis during home food introduction and identity of such triggers is not fully known.