title: Soy allergy in infants and children with IgE-associated cow's milk allergy. Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial Effect of low-saturated fat, low-cholesterol dietary intervention on fatty acid compositions in serum lipid fractions in 5-year-old children. The STRIP project Prospective, controlled, multi-center study on the effect of an amino-acid-based formula in infants with cow's milk allergy/intolerance and atopic dermatitis. Hypoallergenicity and efficacy of an amino acid-based formula in children with cow's milk and multiple food hypersensitivities. Calcium intake in children with positive IgG RAST to cow's milk. Eosinophilic esophagitis: a 10-year experience in 381 children.
abstract: OBJECTIVES To determine the prevalence of soy allergy in IgE-associated cow 's milk allergy ( CMA ) . STUDY DESIGN Children < 3.5 years with documented IgE-associated CMA ( n = 93 ) were evaluated for soy allergy by double-blind , placebo-controlled food challenge , open challenge , or convincing previous history of an anaphylactic reaction to soy .  Children tolerant to soy at entry received soy formula and were followed up for 1 year . RESULTS Of this IgE-associated CMA cohort ( ages 3 to 41 months ) , 14 % ( 95 % CI = 7 . 7%-22.7 % ) were determined to have soy allergy , 12 definitely at entry and 1 possibly after 1 year of soy ingestion . The latter child experienced severe failure to thrive at enrollment and exhibited improved growth while receiving soy during follow-up but was diagnosed with eosinophilic esophagitis at study completion . Improved growth ( P < .05 ) occurred in the non-soy-allergic cohort ingesting soy formula ( 579 31 mL/d ) during the year of follow-up . CONCLUSIONS Soy allergy occurs in only a small minority of young children with IgE-associated CMA . As such , soy formula may provide a safe and growth-promoting alternative for the majority of children with IgE-associated CMA shown to be soy tolerant at the time of introduction of soy formula BACKGROUND Although inhaled glucocorticosteroids are recommended for persistent asthma , their long-term effect on recent onset , mild , persistent asthma has yet to be established . METHODS We did a r and omised , double-blind clinical trial in 7241 patients in 32 countries to assess the effects of budesonide  in patients who had had mild persistent asthma for less than 2 years and who had not had previous regular treatment with glucocorticosteroids . Patients aged 5 - 66 years received either budesonide or placebo once daily for 3 years in addition to their usual asthma medications . The daily budesonide dose was 400 microg , or 200 microg for children younger than 11 years . The primary outcome was time to first severe asthma-related event , and analysis was by intention to treat . FINDINGS 198 of 3568 patients on placebo and 117 of 3597 on budesonide had at least one severe asthma exacerbation ; hazard ratio 0.56 ( 95 % CI 0.45 - 0.71 , p<0.0001 ) . Patients on budesonide had fewer courses of systemic corticosteroids and more symptom-free days than did those on placebo . Compared with placebo , budesonide increased postbronchodilator forced expiratory volume in 1 s ( FEV1 ) from baseline by 1.48 % ( p<0.0001 ) after 1 year and by 0.88 % ( p=0.0005 ) after 3 years ( expressed as percent of the predicted value ) . The corresponding increase in prebronchodilator FEV1 was 2.24 % after 1 year and 1.71 % after 3 years ( p<0.0001 at both timepoints ) . The effect of treatment on all outcome variables was independent of the baseline lung function ( prebronchodilator or postbronchodilator ) or baseline medication . In children younger than 11 years , 3-year growth was reduced in the budesonide group by 1.34 cm . The reduction was greatest in the first year of treatment ( 0.58 cm ) than years 2 and 3 ( 0.43 cm and 0.33 cm , respectively ) . INTERPRETATION Long-term , once-daily treatment with low-dose budesonide decreases the risk of severe exacerbations and improves asthma control in patients with mild persistent asthma of recent onset Objective : To evaluate the effect of dietary low-saturated fat , low-cholesterol intervention on fat intake and fatty acid compositions in serum cholesterol ester ( CE ) , phospholipid ( PL ) and triglyceride ( TG ) fractions in five-year-old children . Design and subjects : The STRIP project is a prospect i ve , r and omised intervention project in which 1062 seven-month-old infants were recruited from the well-baby clinics . 764 children participated in the 5-year follow-up ; 202 of them were r and omly selected for this study .  Diet was assessed with 4-d dietary records . Serum CE , PL and TG fatty acid compositions were analysed with gas-liquid chromatography . Results : Saturated fat intake of intervention children ( mean ( confidence interval ) ) ( girls 11.9 ( 11.2–12.6 ) % of energy intake ( E% ) ; boys 12.5 ( 11.9–13.1 ) ) was lower than that of the control children ( girls 14.4 ( 13.7–15.2 ) E% ; boys 15.0 ( 14.3–15.8 ) E% ) ( P=0.0001 for the difference between intervention and control groups ) . The intake of unsaturated fat differed only slightly . Dietary ratios of polyunsaturated to saturated fatty acids ( PS ratios ) of the intervention and control diets were 0.44 and 0.33 , respectively ( P=0.0001 ) . Furthermore , serum cholesterol concentrations of the intervention and control children differed ( 4.28 ( 4.13–4.43 ) mmol/L vs 4.49 ( 4.35–4.63 ) mmol/L ; P=0.04 ) . Relative proportion of saturated fatty acids in serum TG was lower ( 34.9 % vs 36.3 % ; P=0.04 ) and that of n-6 polyunsaturated fatty acids higher ( 13.9 % vs 12.4 % ; P=0.0004 ) in the intervention than in the control children , whereas serum CE and PL fatty acid compositions of intervention and control groups were closely similar . However , intake of linoleic acid correlated better with serum linoleic acid relative content in the CE fraction ( r=0.36 ; P=0.0001 ) than in the PL ( r=0.27 ; P=0.0002 ) or in the TG ( r=0.23 ; P=0.0016 ) fraction Conclusions : Intervention result ed in decreased intake of saturated fatty acids and lowered serum total and LDL cholesterol concentrations . Of serum lipid fractions , TG fatty acid composition was the most sensitive and parallelled the findings in dietary food records Cow 's milk allergy/intolerance is treated by complete avoidance of cow 's milk proteins . Because cow 's milk is an important food for infants , its avoidance may lead to an increased risk of growth impairment . Whilst there is evidence for the beneficial effects of extensively hydrolyzed cow 's milk formulate ( eHF ) in infants with cow 's milk allergy/intolerance , little is known about the effects of amino-acid-based formulae ( AA ) in such infants . We therefore performed a prospect i ve , controlled , multi-center trial to study the efficacy of AA in comparison with eHF , on the growth and clinical symptoms of 73 infants ( median age 5.7 months ) with cow 's milk allergy/intolerance and atopic dermatitis . Cow 's milk allergy/intolerance was proven in all infants by double-blind , placebo-controlled food-challenge . We observed a significant improvement in the SCORAD index in both groups , from a mean of 24.6 , at entry , to a mean of 10.7 ( p < 0.0001 ) after 6 months . In the AA group there was a significant increase in the length st and ard deviation score ( p < 0.04 ) , whilst there was no difference in the eHF group . The weight-for-length values were stable in both groups . The energy intake during the study was similar in both groups . Both an AA and eHF result ed in a significant clinical improvement in infants with an early onset of symptoms of cow 's milk allergy/intolerance . Feeding an AA result ed in improved growth compared with feeding eHF , despite similar dietary intakes , and may therefore be considered as a beneficial alternative in infants with severe cow 's milk allergy intolerance OBJECTIVE To determine the hypoallergenicity and efficacy of a pediatric amino acid-based formula ( AAF ) , EleCare , for children with cow 's milk allergy ( CMA ) and multiple food allergies ( MFA ) . STUDY DESIGN Hypoallergenicity was determined by performing blinded oral food challenges in 31 consecutive children with documented CMA .  Growth , tolerance , and biochemical response were evaluated during a nonr and omized feeding study with each child serving as his or her own control . RESULTS Thirty-one children ( median age , 23.3 months ; range , 6 months to 17.5 years ) were recruited ; 29 had MFA , 17 had acute reactions and cow 's milk-specific IgE antibody , and 14 had allergic eosinophilic gastroenteritis . At study entry , 23 were receiving another AAF ;  13 had not tolerated extensively hydrolyzed formula .  Eighteen subjects with allergic eosinophilic gastroenteritis and /or MFA were followed up while receiving AAF for a median of 21 months ( range , 7 to 40 months ) , with biochemical analysis performed at 4 months . No statistically significant differences were observed in the change in weight or height National Center for Health Statistics z scores from entry ; the percent of expected growth exceeded 90 % . There was a small decline in percent eosinophils and increase in hemoglobin , hematocrit , and serum ferritin level ( P < .05 ) . Except for small increases in plasma leucine and valine levels ( P < or = .006 ) , the remaining biochemical markers were unchanged . CONCLUSIONS The AAF was hypoallergenic and effective in maintaining normal growth for children with CMA and MFA OBJECTIVE This study was made to : ( i ) identify the prevalence of low calcium intakes in a paediatric population with loosely defined ' milk allergy ' ; and ( ii ) assess long-term ( mean 21 months later ) changes in calcium intake following a single nutrition counselling session with those patients initially found to have a low intake . METHODOLOGY Calcium intake was assessed in a cross-sectional study of 58 patients ages 5 - 16 years ( mean 9.9 years ) with IgG radioallergosorbent test ( RAST ) class II or higher for cow 's milk protein . Those 31 patients found to have a low calcium intake were prospect ively re-evaluated 12 - 30 months later following a single nutrition counselling session . RESULTS  Calcium intake was < recommended dietary allowance ( RDA ) for 31 of 58 ( 53 % ) patients . The patient 's perception of their intake was unreliable ; 44 % of those who rated their calcium intake fair or good did not meet their RDA . Taking a calcium supplement did not ensure adequate intake ; 21 % of those taking supplements still did not meet their RDA . Milk intake predicted calcium intake ; 8 % of those who did not drink milk vs 68 % of those who did drink at least some milk met their RDA without supplementation . The 31 patients with low intakes received counselling and were re-evaluated at an average follow-up of nearly 2 years . Calcium intake was increased a mean of 360 mg/day and use of supplements increased from 10 to 52 % of the group . Despite these positive changes , 48 % still did not meet their RDA . CONCLUSION Limited milk intake is likely to be associated with suboptimal calcium intake . Efforts should be made to educate the family about the importance of calcium and its non-dairy sources . With many families repeated discussion s of this issue may be necessary to influence calcium intake BACKGROUND & AIMS Eosinophilic esophagitis ( EoE ) is a disorder characterized by a severe , isolated eosinophilic infiltration of the esophagus unresponsive to aggressive acid blockade but responsive to the removal of dietary antigens . We present information relating to our 10-year experience in children diagnosed with EoE. METHODS We conducted a retrospective study between January 1 , 1994 , and January 1 , 2004 , to evaluate all patients diagnosed with EoE. Clinical symptoms , demographic data , endoscopic findings , and the results of various treatment regimens were collected and evaluated . RESULTS A total of 381 patients ( 66 % male , age 9.1 + /- 3.1 years ) were diagnosed with EoE : 312 presented with symptoms of gastroesophageal reflux ; 69 presented with dysphagia . Endoscopically , 68 % of patients had a visually abnormal esophagus ; 32 % had a normal-appearing esophagus despite a severe histologic esophageal eosinophilia . The average number of esophageal eosinophils ( per 400 x high power field ) proximally and distally were 23.3 + /- 10.5 and 38.7 + /- 13.3 , respectively . Corticosteroids significantly improved clinical symptoms and esophageal histology ; however , upon their withdrawal , the symptoms and esophageal eosinophilia recurred . Dietary restriction or complete dietary elimination using an amino acid-based formula significantly improved both the clinical symptoms and esophageal histology in 75 and 172 patients , respectively . CONCLUSIONS Medications such as corticosteroids are effective ; however , upon withdrawal , EoE recurs . The removal of dietary antigens significantly improved clinical symptoms and esophageal histology in 98 % of patients
target: One study found that children with food allergies who did not receive nutrition counseling were more likely to have inadequate intake of calcium and vitamin D.  CONCLUSION Children with multiple food allergies have a higher risk of impaired growth and may have a higher risk of inadequate nutrient intake than children without food allergies .
background: BACKGROUND Food allergies affect up to 8 % of American children .
  The current recommended treatment for food allergies is strict elimination of the allergens from the diet .
  Dietary elimination of nutrient-dense foods may result in inadequate nutrient intake and impaired growth .
  The purpose of this review was to critically analyze available research on the effect of an elimination diet on nutrient intake and growth in children with multiple food allergies .