Q: My child has multiple food allergies including milk, eggs, and soy. With such a restricted diet, I am worried about his nutrition. Is he getting enough nutrients in his diet?
A: As we know, there is no cure for food allergies. The only way to manage them is by eliminating the specific allergen from the diet. Most food-allergic children are at an increased risk of nutritional deficiencies especially when they have allergies to commonly used allergens such as milk, soy, eggs, and wheat. Below is a table that highlights the important nutrients often found in these top allergens. These nutrients may be lacking in a child’s diet if they are avoiding these foods due to allergies.
Multiple studies have also found that children allergic to milk also have higher risk of poor bone growth and tend to be shorter in height versus children without food allergies.1,2 Children eliminating just milk from their diets have been shown to be lacking in vitamin D, calcium, and protein.1,3-4 The nutritional deficiency risk increases as the number of food allergies increase. These kiddos are at risk for malnutrition unless supplementation replaces the nutrients found in the offending allergen.1
Age-appropriate nutritional supplementation is vital for these children. A hypoallergenic supplement is highly recommended if the child is under two years old.5 Extensively hydrolyzed and amino acid-based formulas are often used to supplement a child’s diet when food allergies are evident. Keep in mind, while extensively hydrolyzed formulas (eHFs) are considered hypoallergenic, they still use cow milk protein as seen in the ingredients (casein and whey are milk proteins). Amino acid-based products, such as Neocate, are more hypoallergenic than eHFs and are 100% free from allergens. Amino acid-based products are often used if the child does not tolerate an eHF, which can occur in 10-30% of food allergic children.6-8Registered dietitians are important in evaluating your child’s diet. They can determine what percentage of the DRIs (Daily Recommended Intakes) of each vitamin and mineral your child is receiving and if changes need to be made in order to ensure your little one is getting 100% of their DRIs. With the help of your doctor and/or registered dietitian, you can find the right hypoallergenic product that will fit your child’s nutritional and developmental needs.
1. Henriksen C et al. Nutrient intake among two-year-old children on cows’ milk-restricted diets. Acta Paediatr. 2000;89:272-278.
2. Agostoni C et al. Growth of infants with IgE-mediated cow’s milk allergy fed different formulas in the complementary feeding period. Pediatr Allergy Immunol. 2007;18:599-606.
3. Levy Y et al. Nutritional rickets in children with cows’ milk allergy: calcium deﬁciency or vitamin D deﬁciency? Pediatr Allergy Immunol. 2005;16:553.
4. Fox AT et al. Food allergy as a risk factor for nutritional rickets. Pediatr Allergy Immunol. 2004;15:566-569.
5. Fiocchi A et al. Diagnosis and Rationale for Action Against Cow’s Milk Allergy (DRACMA): a summary report. J Allergy Clin Immunol. 2010;126(6):1119-28.
6. de Boissieu D et al. Allergy to extensively hydrolyzed cow’s milk proteins in infants; safety and duration of amino acid based formula. J Pediatr. 2002;141(2):271-273.
7. Latcham F et al. A consistent pattern of minor immunodeficiency and subtle enteropathy in children with multiple food allergies. J Pediatr. 2003;143:39-47.
8. Isolauri E et al. Efficacy and safety of hydrolyzed cow milk and amino acid-derived formulas in infants with cow milk allergy. J Pediatr.1995;127 :550-557.
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