Lynn Christie

Food allergies in children affect nutrient intake and growth.

OBJECTIVES To identify if specific food allergies, elimination diets, or other variables associated with food allergies have an impact on the growth and nutrient intake of children with food allergies. DESIGN Measurements of height, weight, and body mass index were used to determine potential growth problems. Estimates of energy and nutrient intakes were based on 3-day diet records. A questionnaire was used to determine number of food allergies and other variables. SUBJECTS Ninety-eight children with food allergies (subjects, mean age 3.7 +/- 2.3 years) and 99 children without food allergies (controls, mean age 4.1 +/- 2.4 years) participated in this age-matched, consecutive sampling, cross-sectional study. STATISTICAL ANALYSIS PERFORMED Cochran-Mantel-Haenszel statistics using general association and Fisher Exact Test, with 2-sided probability, were conducted. RESULTS Children with two or more food allergies were shorter, based on height-for-age percentiles, than those with one food allergy (P<.05). More than 25% of children in both groups consumed less than 67% of the DRI (RDA or AI) for calcium, vitamin D, and vitamin E. More children with cows milk allergy or multiple food allergies consumed dietary calcium less than age- and gender-specific recommendations compared with children without cows milk allergy and/or one food allergy. The possibility of consuming a less than recommended intake of calcium and vitamin D in children with food allergy was less if the child received nutrition counseling (P<.05) or consumed a safe infant/toddler formula or fortified soy beverage. APPLICATIONS/CONCLUSIONS Children diagnosed with food allergies need an annual nutrition assessment to prevent growth problems or inadequate nutrient intake. Children with milk allergies or multiple food allergies are at greater risk. Nutrition education needs to address how to avoid all forms of the allergen and incorporate alternative nutrient-dense foods. This population would benefit from the development and validation of a medical nutrition therapy protocol.

Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy

BACKGROUND Although peanut oral immunotherapy (OIT) has been conclusively shown to cause desensitization, it is currently unknown whether clinical protection persists after stopping therapy. OBJECTIVE Our primary objective was to determine whether peanut OIT can induce sustained unresponsiveness after withdrawal of OIT. METHODS We conducted a pilot clinical trial of peanut OIT at 2 US centers. Subjects age 1 to 16 years were recruited and treated for up to 5 years with peanut OIT. The protocol was modified over time to permit dose increases to a maximum of 4000 mg/d peanut protein. Blood was collected at multiple time points. Clinical end points were measured with 5000-mg double-blinded, placebo-controlled food challenges once specific criteria were met. RESULTS Of the 39 subjects originally enrolled, 24 completed the protocol and had evaluable outcomes. Twelve (50%) of 24 successfully passed a challenge 1 month after stopping OIT and achieved sustained unresponsiveness. Peanut was added to the diet. At baseline and the time of challenge, such subjects had smaller skin test results, as well as lower IgE levels specific for peanut, Ara h 1, and Ara h 2 and lower ratios of peanut-specific IgE/total IgE compared with subjects not passing. There were no differences in peanut IgG₄ levels or functional activity at the end of the study. CONCLUSIONS This is the first demonstration of sustained unresponsiveness after peanut OIT, occurring in half of subjects treated for up to 5 years. OIT favorably modified the peanut-specific immune response in all subjects completing the protocol. Smaller skin test results and lower allergen-specific IgE levels were predictive of successful outcome.

Developing A Food Allergy Curriculum for Parents

To cite this article: Vargas PA, Sicherer SH, Christie L, Keaveny M, Noone S, Watkins D, Carlisle SK, Jones SM, CoFAR. Developing a food allergy curriculum for parents. Pediatric Allergy Immunology 2011; 22: 575–582.

265 THE NATURAL HISTORY OF FOOD ALLERGIES IN CHILDREN: AN EVALUATION OF CLINICAL TOLERANCE AND SEVERITY OF REACTIONS TO FOOD CHALLENGES

Purpose To compare food-specific IgE levels and age of passed or failed oral food challenges (FC) and examine the severity of failed FC. Methods We performed a retrospective review of food allergic patients who underwent milk, egg, soy, wheat, and peanut FC (January 2000-June 2004) based on known predictive IgE levels. Food-specific IgE and age were determined for those who passed or failed challenges. System involvement and treatment of failed challenges were analyzed. Results One hundred sixty-three FC were performed in 106 patients (67% male; 83% Caucasian; 66% atopic comorbidities). 56% of FC were blinded, 43% open. Negative challenges occurred in 97/163 (60%) - milk 47%, egg 61%, peanut 66%, soy 61%, and wheat 63%. Median age (years) of those passing challenges was: milk 3.2; egg 4.5; peanut 5.1; soy 2.3; wheat 3.6. For failed challenges median age was milk 2.0; egg 4.4; peanut 4.0; soy 4.6; and wheat 4.0. Median food-specific IgE levels (kUA/L) for passed FC were milk 1.6; egg 0.7; peanut 0.7; soy 0.7; and wheat 6.7. IgE levels for failed challenges were milk 4.5; egg 0.7; peanut 1.4; soy 20; and wheat 7.5. For failed challenges, 80% had cutaneous involvement, 32% upper respiratory, 23% lower respiratory, and 32% gastrointestinal. Positive challenges were successfully treated with antihistamines (80%), bronchodilators (8%), charcoal (2%), epinephrine (11%), and fluids/corticosteroids (2%), while 8% required no treatment. Conclusions For patients with low food-specific IgE levels approaching 95th% negative predictive value, FC can be performed safely, with minimal symptoms and with the majority of patients showing clinical tolerance.

Growth After Pediatric Heart Transplant

Abstract LEARNING OUTCOME: To investigate the effect of nutrition intervention on growth after pediatric heart transplant. The incidence of delayed growth in children with congenital heart disease has been indicated in numerous studies. Studies have shown that nutrition intervention can play an important role in the early prevention of malnutrition. A retrospective chart review was conducted to examine growth during the year following transplantation. The National Center for Health Statistics (NCHS) growth chart was used to evaluate growth. Seventeen pediatric heart transplant patients under the age of six at the time of transplant were studied. Chi Square and Pearsons Correlation were performed using Statistical Analysis Systems (SAS) to analyze the data. Because of the small sample size, and numerous nutrition intervention encounters, the data indicated only a slight correlation between growth and nutrition intervention. However, each subject received different types of nutrition intervention, and the effectiveness of each type is variable. The mean increase in growth was 22% on the growth curve with a mean of 14 nutrition intervention encounters per subject. The researchers conclude that it is the responsibility of the dietitian to determine the most appropriate medical nutrition therapy for optimal growth of each individual patient. In addition, physicians should recognize the benefits of nutrition intervention for pediatric cardiac patients and enable the dietitians to provide the needed services through consultation and support of their recommendations.