Children's Food Allergies Cause Nutrient Deficits

Managing children’s food allergies often starts with an elimination diet and then leads to lifetime avoidance of the offending foods, most frequently cow’s milk, hen’s eggs, wheat, fish, and nuts.

These ubiquitous foods in the average American’s diet represent primary sources of dietary micronutrient intake. As a result, many children who have food allergies develop micronutrient deficiencies.

Vitamin D, calcium, and omega-3 fatty acid intake is often an issue for those with food allergies mediated by immunoglobulin E (IgE), while minerals are more of a problem for children with non-IgE mediated allergies.

Concerned that supplementation recommendations might not be based on an individual child’s unique nutritional status, researchers recently evaluated current practices with respect to vitamin and mineral supplementation in children with non-IgE mediated food allergies.

The researchers designed a prospective, observational study that enrolled children aged 4 weeks to 16 years who followed elimination diets for non-IgE mediated allergies. All participants had symptom scores reflecting improvement, and either they or their parents completed a 3-day food diary that the researchers analyzed.

Of the 110 children who completed food diaries, 32 were taking vitamin and/or mineral supplements, and 71% of these children had been prescribed supplements by dietitians or physicians. Three-quarters of them avoided 2 or more food allergens, with cow’s milk and soya and a combination of cow’s milk, soya, egg, wheat, and other foods being the most common.

When cow’s milk allergy was identified, children on hypoallergenic formulas were significantly less likely to take supplements than those consuming OTC coconut, oat, or rice milks, the researchers noted.

Among children who were not taking a supplement, 61% had insufficient vitamin D intake. This is of concern in the United Kingdom because the incidence of rickets is climbing. Rickets is also re-emerging in the United States, although it is still rare.

Insufficient zinc, calcium, and selenium intake were also common among study participants.

Overall, children who received supplements were either under- or over-supplemented.

The researchers stressed that decisions about dietary supplementation in children with food allergies are complicated, and they recommended that clinicians use food diaries and computerized tools to assess children’s unique needs.

This study appeared in the March 2015 eCollection of Clinical and Translational Allergy.