FOOD SENSITIVITIES AND FOOD ALLERGIES
- Food Sensitivities and Food Allergie (Infants and nursing mothers)
- Food Sensitivities and Food Allergies (Children and adults)
Food Sensitivities and Food Allergie
Infants and nursing mothers
General information:
The attending physician and the dietician in charge advise about complete infant nutrition during the first 6 months and advise not to give any weaning foods to infants under the age of 5-6 months.
Best time to refer to the dietician:
Child
- when advice is needed on protein hydrolysate infant formula
- when advice is needed on a diagnostic elimination diet
- when weaning foods are started beginning at 6 months of age, in the case of food allergies
- when there are problems introducing weaning foods
- when there are doubts about the completeness of the current diet, both in the diagnostic and the therapeutic stage
Nursing mother
- when there are doubts about the completeness of the mother’s diet, both in the diagnostic and the therapeutic stage, such as when there is unwanted weight loss
- when an elimination diet has been followed for more than 4 weeks
- when there is a chance that breastfeeding might be discontinued because the diet appears to be too complex.
Relevant information for the dietician:
- Diagnosis: (suspected) food allergy/intolerance, with mention of (suspected) allergens/triggers, any comorbid conditions / differential diagnosis
- Symptoms:
- gastrointestinal tract: vomiting, gastroesophageal reflux, abdominal pain, diarrhea, constipation
- skin: eczema, urticaria, transient symptoms of exanthem
- airways: asthma, allergic conjunctivitis, allergic rhinitis
- Laboratory tests: (if taken) skin (prick) tests total IgE, RAST for food products and inhaled allergens
- Medication: antihistaminics, cromoglycate, corticosteroids, bronchodilators, adrenaline
- Other: height, (changes in) mother’s weight, infant’s growth, extent of family history or inheritance.
- Other: anaphylaxis, failure to thrive, food refusal, angioedema, fussing and inconsolable crying in combination with other symptoms
Aims of the diet:
- reduce symptoms
- maintain and/or achieve a complete and age-appropriate diet
- plan for structured (re)introduction or provocation of suspect foods
- to not limit food consumption unnecessarily
- instruct in the practical application of avoiding the relevant allergen
Characteristics of the diet:
Child
- elimination of (suspected) allergens
- for infant formula, an intensively hydrolyzed infant formula
- introduction of solid food beginning at 6 months of age, which is important for the development of taste and oral motor function. If necessary, weaning foods can be introduced in stages. The following applies to highly allergenic foods:
- beginning at 6 months: wheat
- beginning at 9 months: soy, fish, seeds, pits and where relevant, milk
- beginning at 12 months: eggs, nuts, peanuts, seafood and shellfish
Nursing mothers
- The first choice is breastfeeding, elimination of suspect allergens as needed unless this gets in the way of breastfeeding progress.
Treatment time:
- Care level 3, see “Dietician’s working methods.”
Specific remarks:
- Starting the infant on weaning foods at a later time (after 6 months) increases the risk of developing eating problems due to stagnating development of oral motor function. This can manifest, for example, in problems with accepting different food consistencies and new tastes.
- The specific history-taking process contributes to diagnosing food sensitivities. In order to devise a structured treatment, it is important to inventory the food being consumed in association with the symptoms. Questions should be asked concerning reasons for changing to a different diet or reasons for not (yet) introducing certain foods.
- A therapeutic elimination diet should be evaluated regularly, because allergic food sensitivities can be temporary.
References:
Aarsen CJE, Amstel-Visser S van, et al. Informatorium voor voeding en diëtetiek: Voedselovergevoeligheid bij zuigelingen, peuters and kleuters. 2008
Brand PLP, Kneepkens CMF et al, Werkboek Kinderallergologie, VU uitgeverij: 2006
Kneepkens F, Drongelen K van, Aarsen C. Landelijke Standaard Voedselallergie bij zuigelingen. Voedingscentrum: 2005
Food Sensitivities and Food Allergies in Infants and Nursing Mothers was updated by Sascha van Amstel-Visser, dietician at Diëtistenpraktijk Andermaal, and Irene Herpertz, dietician at Beatrix Pediatric Hospital at the Universitair Medisch Centrum Groningen (UMCG), also writing on behalf of Diëtist & VoedselOvergevoeligheid (D&VO) and the VoedselOvergevoeligheid Overleg Diëtisten Academische Ziekenhuizen (VOODAZ).
Food Sensitivities and Food Allergies
Children and adults
Best time to refer to the dietician:
- when adjustments to the diet need to be made
- when dietetic analysis is needed, especially with regard to the diagnosis. The main components of this are:
- assessment of the diet in terms of its completeness
- analyzing the relationship between the diet and the symptoms
- working up a diagnostic elimination diet
- counseling in the elimination-provocation procedure
- when there are problems with substitute foods and/or dietetic preparations
- when the patient has questions
Relevant information for the dietician:
- Diagnosis: (suspected) food allergy/sensitivity (food intolerance) with, if possible, listing of (suspected) allergens/triggers, any comorbid conditions/differential diagnosis
- Symptoms, including their severity and frequency (normally, more than 1 organ system is involved in the reaction)
- gastrointestinal symptoms such as vomiting, colic, abdominal pain, nausea, cramps, diarrhea and constipation, as well as the oral allergy syndrome
- dermatological symptoms such as aggravation of atopic eczema, urticaria, itching, exanthem (erythematous rash), angioedema
- respiratory symptoms such as asthma, allergic conjunctivitis, allergic rhinitis
- other symtpoms such as anaphylactic shock and food refusal or aversion
- Laboratory/immunological testing:
- blood tests: total IgE, specific IgE for foods, inhaled allergens such as pollen and latex (in connection with possible cross allergy)
- skin tests: prick tests (HEP and/or prick-to-prick), patch tests (SAFT)
- interpretation of the results for each allergen.
- Medication: antihistamines, cromoglycates, corticosteroids, bronchodilators and epinephrine (adrenaline)
- Other: risk profile (presence of an atopic condition in the past or present and/or one or more parents or siblings with an atopic condition).
Aims of the diet:
- contribute to the diagnosis of food sensitivities
- reduce symptoms
- to not limit food consumption unnecessarily, and if applicable plan for the reintroduction or provocation of suspected allergens/triggers
- learning to avoid the relevant allergen
- maintain/achieve a complete and age-appropriate diet.
Characteristics of the diet:
Diagnostic stage
- diagnostic elimination or restriction of suspected foods (allergens/triggers) from the diet, and if necessary introduce replacement foods and/or dietetic products
- provocation (open or double blind) and/or reintroduction (at once or in progressively greater amounts).
Treatment
- therapeutic elimination or restriction of allergens/triggers for which there is evidence of food sensitivity
- ensure a complete and age-appropriate diet (supplement vitamins, minerals and trace elements, as needed)
- information about food products that contain the relevant allergens/triggers and, if necessary, introduction of replacement dietetic products.
Treatment time:
- Care level 3, see “Dietician’s working methods.”
Specific remarks:
- A therapeutic elimination diet should be evaluated regularly, because allergic food sensitivities can be temporary. Furthermore, in children, the nutritional requirements change as children grow.
References:
Monchy JGR, Kaufmann HF. Allergologie. Utrecht: Bunge: 1994 Voedingscentrum. Diagnostisch onderzoek door diëtisten bij vermeende voedselovergevoeligheid. Den Haag: 2002
Gezondheidsraad. Voedselallergie. Den Haag: Gezondheidsraad, 2007; publicatienr. 2007/07. ISBN 978- 90- 5549- 645- 7
Voedselovergevoeligheid bij oudere kinderen en volwassenen, Informatorium voor Voeding en Diëtetiek: 2005
Food Sensitivities and Food Allergies in Children and Adults was updated by Berta Beusekamp, dietician at Universitair Medisch Centrum Groningen (UMCG), writing also on behalf of the Voedselovergevoeligheid Overleg Diëtisten Academische Ziekenhuizen (VOODAZ) and Eva Lincklaen Arriens-Heus, dietician at Dietistenpraktijk Lincklaen Arriens, writing also on behalf of Diëtist & VoedelOvergevoeligheid (D&VO).