Elimination Diets-FYI

[Guest guest]

Good article , and a good reason why all kids with allergies should be

referred to an RD with expertise in IgE allergies. (I'm NOT an expert, but

know a thing or two.)

One: This article says SPT (Skin prick tests) were negative to cow's milk

allergy - Well, this is a perfectly reasonable expectation if the child had been

diary free for 6 months - but a SPT cannot be interpreted on it's own, it

must be combined with history, symptoms and the results of other SPT results.

_http://allergyadvisor.com/Educational/April04.htm_

(http://allergyadvisor.com/Educational/April04.htm) for a nice case study on

the subject.

The second child - RAST tested, should NOT Just had blanket elimination of

all those foods, and a decent allergist/RD allergy expert should have known

that. They should have been retested in a safe clinical environment in time,

but, as we all know, sometimes patients/their parents don't return as instructed

either.

Just a couple of comments. Thanks for sharing this!

Jan Patenaude

Delayed Food sensitivity, IBS, migraine, fibromyalgia expert - Not an IgE

allergy expert!

In a message dated 11/13/2006 5:40:38 A.M. Mountain Standard Time,

nrord@... writes:

Infants who are put on food-elimination diets to avoid allergens could be

inadvertently robbed of the proteins and nutrients they need to grow,

researchers warned here.

_http://www.medpagethttp://wwhttp://www.medpahttp://wwwhttp://_

(http://www.medpagetoday.com/AllergyImmunology/Allergy/dh/4487)

Action Points

a.. Explain to patients that when children, particularly infants and

toddlers, are put on allergen-avoidance diets, they need other sources of

protein

and essential nutrients that would otherwise have been provided by the

eliminated foods.

b.. Offer nutritional consultation to parents or caregivers of children on

allergen-avoidance diets.

c.. This study was published as an abstract and presented at a conference.

These data and conclusions should be considered to be preliminary as they have

not yet been reviewed and published in a peer-reviewed publication.

Children taking allergen avoidance diets may develop malnutrition due to the

severe protein and caloric restrictions involved, said B. Levy,

M.D., of the Medical College of Wisconsin, and colleagues.

In a presentation at the American College of Allergy, Asthma, and Immunology

meeting, the investigators reported on two patients in which the diets

robbed the children of so many calories and nutrients that they developed

failure

to thrive.

" Intensive nutritional assessment and management should be included

following the institution of restrictive allergen free diets, " the Milwaukee

researchers urged.

The first case was that of an 18-month-old boy who was admitted with diffuse

rash, failure to thrive, diffuse edema, and irritability. He had previously

been diagnosed with milk-protein sensitivity, and so had been switched to

enriched rice milk six months before his admission. The rice milk comprised 75%

of the boy's total calories.

His weight on admission was 10.40 kg (22.9 lbs), putting him in the 11th

percentile for his age. On examination, he was found to have peripheral edema

and a diffuse dry, erythematous rash.

Laboratory studies showed that he was suffering from iron deficiency anemia,

an albumin level of 1.9 g/dL, and both selenium and zinc deficiency. He was

also assumed to suffer from an essential fatty acid deficiency.

But when they performed a skin prick test for food sensitivity, they found

that the tests were negative.

The investigators started the child on a nutritional rehabilitation program

with a nasogastric feedings of a hydrolysate formula, with re-feeding

syndrome addressed as needed according to daily lab values.

He was discharged after 17 days in the hospital, weighing 10.96 kg (24.1

lbs) or 5%, shooting him up from the 11th to the 31st percentile.

The second case was that of a 13-month-old girl who was admitted to the

hospital secondary to severe atopic dermatitis, failure to thrive, cellulitis,

and multiple food allergies.

The child had undergone Radioallergosorbent Testing (RAST) at eight months,

which showed the she was sensitive to milk, wheat, egg, corn, soy and peanut.

The girl was then put on a diet that eliminated those foods, but she was not

started on nutritional supplementation, and was getting from 50% to 75% of

her calories from fruit juice, the investigators reported.

At admission she weighed just 7.4 kg (16.28 lbs), and was below the first

percentile.

Her albumin and zinc levels were normal, but physical examination showed

that she had eczematous skin lesions and left arm cellulitis.

She was started on elemental formula, a high-calorie diet, and her

caregivers were instructed in allergen substitution. After four days in the

hospital

her weight had increased 2%, to 7.63 kg (16.79 lbs).

The authors cautioned that " fruit juice and milk substitutes composed of

rice, oat, hazelnut, or almond contain very little protein and will result in

protein energy malnutrition when utilized as the primary calories source by

infants and young children. "

Additional Allergy Coverage

Primary source: The American College of Allergy, Asthma & Immunology

Source reference:

Preston MB et al. " Presentation of Failure to Thrive in Children with Food

Allergies. " Poster 144, presented Nov. 11.

Check Nutrition at my site:

Nutrition.teach-Nutrition.

Ortiz, RD

_nrord@..._ (mailto:nrord@...)

" The belly rules the mind. "

Jan Patenaude, RD

Director of Medical Nutrition

Signet Diagnostic Corporation

_www.nowleap.com_ (http://www.nowleap.com/)

(Mountain Time)

(toll free)

Fax:

DineRight4@...

Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

Syndrome, Migraine, Fibromyalgia and more, caused by food sensitivity

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[Guest guest]

Infants who are put on food-elimination diets to avoid allergens could be

inadvertently robbed of the proteins and nutrients they need to grow,

researchers warned here.

http://www.medpagetoday.com/AllergyImmunology/Allergy/dh/4487

Action Points

a.. Explain to patients that when children, particularly infants and toddlers,

are put on allergen-avoidance diets, they need other sources of protein and

essential nutrients that would otherwise have been provided by the eliminated

foods.

b.. Offer nutritional consultation to parents or caregivers of children on

allergen-avoidance diets.

c.. This study was published as an abstract and presented at a conference.

These data and conclusions should be considered to be preliminary as they have

not yet been reviewed and published in a peer-reviewed publication.

Children taking allergen avoidance diets may develop malnutrition due to the

severe protein and caloric restrictions involved, said B. Levy, M.D., of

the Medical College of Wisconsin, and colleagues.

In a presentation at the American College of Allergy, Asthma, and Immunology

meeting, the investigators reported on two patients in which the diets robbed

the children of so many calories and nutrients that they developed failure to

thrive.

" Intensive nutritional assessment and management should be included following

the institution of restrictive allergen free diets, " the Milwaukee researchers

urged.

The first case was that of an 18-month-old boy who was admitted with diffuse

rash, failure to thrive, diffuse edema, and irritability. He had previously been

diagnosed with milk-protein sensitivity, and so had been switched to enriched

rice milk six months before his admission. The rice milk comprised 75% of the

boy's total calories.

His weight on admission was 10.40 kg (22.9 lbs), putting him in the 11th

percentile for his age. On examination, he was found to have peripheral edema

and a diffuse dry, erythematous rash.

Laboratory studies showed that he was suffering from iron deficiency anemia, an

albumin level of 1.9 g/dL, and both selenium and zinc deficiency. He was also

assumed to suffer from an essential fatty acid deficiency.

But when they performed a skin prick test for food sensitivity, they found that

the tests were negative.

The investigators started the child on a nutritional rehabilitation program with

a nasogastric feedings of a hydrolysate formula, with re-feeding syndrome

addressed as needed according to daily lab values.

He was discharged after 17 days in the hospital, weighing 10.96 kg (24.1 lbs) or

5%, shooting him up from the 11th to the 31st percentile.

The second case was that of a 13-month-old girl who was admitted to the hospital

secondary to severe atopic dermatitis, failure to thrive, cellulitis, and

multiple food allergies.

The child had undergone Radioallergosorbent Testing (RAST) at eight months,

which showed the she was sensitive to milk, wheat, egg, corn, soy and peanut.

The girl was then put on a diet that eliminated those foods, but she was not

started on nutritional supplementation, and was getting from 50% to 75% of her

calories from fruit juice, the investigators reported.

At admission she weighed just 7.4 kg (16.28 lbs), and was below the first

percentile.

Her albumin and zinc levels were normal, but physical examination showed that

she had eczematous skin lesions and left arm cellulitis.

She was started on elemental formula, a high-calorie diet, and her caregivers

were instructed in allergen substitution. After four days in the hospital her

weight had increased 2%, to 7.63 kg (16.79 lbs).

The authors cautioned that " fruit juice and milk substitutes composed of rice,

oat, hazelnut, or almond contain very little protein and will result in protein

energy malnutrition when utilized as the primary calories source by infants and

young children. "

Additional Allergy Coverage

Primary source: The American College of Allergy, Asthma & Immunology

Source reference:

Preston MB et al. " Presentation of Failure to Thrive in Children with Food

Allergies. " Poster 144, presented Nov. 11.

Check Nutrition at my site:

Nutrition.teach-nology.com

Ortiz, RD

nrord@...

" The belly rules the mind. "