Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Food allergy · Lactose intolerance · Enteropathy,

food protein-induced · Enterocolitis syndrome,

food protein-induced · Proctocolitis, food

protein-induced · Elimination diet · Hypoallergenic

formula · Amino acid-based formula · Hydrolyzed

formula · Soy formula

Key Messages

• Food allergy is an immune-mediated reaction
  against food proteins, whereas food intolerances
  can be caused by any food constituent and do not
  involve immunological mechanisms


• Treatment of food allergies involves strict avoid-
  ance of the offending food allergen, either by use of
  a hypoallergenic infant formula or a specific elimi-
  nation diet. By contrast, patients with food intoler-
  ances generally tolerate small quantities of the of-
  fending food ingredient (dose-response relation-
  ship)


• Infants and young children with gastrointestinal
  food allergies and persistent vomiting or diarrhea
  are at high risk of failure to thrive, particularly if
  there are associated feeding difficulties


• Correct identification of food allergies and intoler-
  ances in infancy and childhood is important in or-
  der to prevent growth impairment and nutritional
  deficiency states
  
  
  • Close monitoring of dietary intake and growth pa-
    rameters, regular reassessment of persistent aller-
    gies and dietary introduction of tolerated food pro-
    teins are essential steps in the nutritional manage-
    ment of children with food allergies
    © 2015 S. Karger AG, Basel
  
  
  
  

Introduction

Food allergy is defined as a reproducible, T helper

lymphocyte type 2-mediated reaction to food

proteins. Over the past decades, the prevalence of

food allergy has increased dramatically in many

developed countries. Cow’s milk, egg, soy, wheat,

peanuts, tree nuts, fish and shellfish cause more

than 90% of food allergies [1]. A recent popula-

tion-based study in Australia demonstrated chal-

lenge-proven, immunoglobulin E (IgE)-mediat-

ed food allergy in more than 10% of 12-month-

old infants [2]. Possible reasons for the increased

prevalence of food allergy in children include ge-

netic factors, epigenetic dysregulation of gene ex-

pression, exposure to toxins and pollutants (e.g.

tobacco smoke), dietary factors, reduced environ-

mental microbial exposure and reduced fecal mi-

crobial diversity [3, 4].

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 195–202
DOI: 10.1159/000360340

3.11 Food Intolerance and Allergy

Ralf G. Heine

3