Management of food allergy: Nutritional issues
- Marion Groetch, MS, RD, CDN
Marion Groetch, MS, RD, CDN
- Director of Nutrition Services
- Jaffe Food Allergy Institute
- Icahn School of Medicine at Mount Sinai
The goals of nutritional intervention in patients with food allergy are twofold: prevent acute and chronic food allergic reactions through allergen elimination and ensure optimal nutrition within the context of the allergen-restricted diet.
Nutritional management of food allergy requires careful planning to ensure that the nutrients inherent in the eliminated food(s) are adequately replaced. Nutrient-dense alternative food sources should be recommended when elimination diets are initiated. Follow-up to ensure that the alternative nutrient sources have been accepted and incorporated into the diet is also recommended.
This topic will focus on the prevention of nutritional problems that can arise with food elimination diets. Food allergen avoidance is discussed separately. (See "Management of food allergy: Avoidance" and "Patient education: Food allergy treatment and avoidance (Beyond the Basics)".)
The indications for nutritional assessment, clinical features of nutrition disorders, measurements of growth, and laboratory evaluation of nutritional status are also discussed separately. (See "Indications for nutritional assessment in childhood" and "Measurement of growth in children" and "Laboratory and radiologic evaluation of nutritional status in children" and "Dietary assessment in adults".)
GENERAL NUTRITION AND FOOD ALLERGY
Dietary limitations secondary to food allergy can lead to failure to thrive and/or deficiencies in specific macro and micronutrients. Several studies have demonstrated that children with food allergies have lower intakes of total energy and macro/micronutrients than children without food allergy [1,2]. (See "Failure to thrive (undernutrition) in children younger than two years: Management" and "Poor weight gain in children older than two years of age" and "Failure to thrive (undernutrition) in children younger than two years: Etiology and evaluation", section on 'Etiology'.)
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- NIAID-Sponsored Expert Panel, Boyce JA, Assa'ad A, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010; 126:S1.
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- Taylor SL, Hefle SL, Bindslev-Jensen C, et al. Factors affecting the determination of threshold doses for allergenic foods: how much is too much? J Allergy Clin Immunol 2002; 109:24.
- Crevel RW, Kerkhoff MA, Koning MM. Allergenicity of refined vegetable oils. Food Chem Toxicol 2000; 38:385.
- GENERAL NUTRITION AND FOOD ALLERGY
- - Replacement
- MONITORING GROWTH
- FOOD ELIMINATION DIETS
- Cow's milk allergy
- - Breastfed infants
- - Formula-fed infants
- - Children >1 year old
- Wheat allergy
- Egg allergy
- Soybean allergy
- Peanut, tree nut, fish, and shellfish allergies
- INFORMATION FOR PATIENTS