Improving Nutrient Intake and Growth in Children With Multiple Food Allergies
Condition: Food Allergy
MeSH terms: Hypersensitivity; Food Hypersensitivity
Study type: Observational

Summary: 
      -  Hypothesis 1: Food allergies are associated with poor growth which can be corrected with
           nutrition intervention.

             -  More than 10% of children with multiple food allergies will have a weight-for-age
                z-score less than - 2 at diagnosis. The z-score is a measure of the distance from
                the mean value, or 50th percentile on the growth chart. A z-score of less than - 2
                indicates that the child is underweight.

             -  Growth parameters of children with multiple food allergies will improve after
                intervention by a team that includes a dietitian and an allergist.

        -  Hypothesis 2: Food allergies are associated with low micronutrient intake which can be
           corrected with nutrition intervention.

           o More than 30% of children with multiple food allergies will consume less than 67% of
           the Dietary Reference Intake for at least one macronutrient or micronutrient at
           diagnosis.

        -  Macronutrient and micronutrient intake will increase after intervention by a team that
           includes a dietitian and an allergist.

      o

      • Hypothesis 3: Food allergies are related to behavioral feeding problems which can be
      corrected with nutrition intervention.

        -  At least 25% of children with multiple food allergies will have behavioral feeding
           problems at diagnosis.

        -  Prevalence of behavioral feeding problems will decrease after nutrition intervention.
    

Detailed description: 
      This is a prospective observational study with repeated measure design. All participants aged
      6 months to 6 years diagnosed with two or more food allergies will be invited to participate
      in the research study. At least one of the two food allergies must be milk, egg, wheat, or
      soy, which are nutritionally important food allergies. Inclusion criteria include diagnosis
      of two or more food allergies confirmed with skin prick testing or serum specific IgE
      (SIgE)testing. Participants aged 12 months or older will be invited to participate in the
      Mealtime Behavior Questionnaire (MBQ) and Feeding Strategies Questionnaire (FSQ).
      Participants with developmental delay, genetic syndromes or other chronic medical conditions
      will be excluded from the study. Participants with two or more food allergies that do not
      have at least one nutritionally important food allergy (milk, egg, wheat, soy) will not be
      invited to participate in the study. We will also exclude participants with a history of
      digestive surgery, non English-speaking patients, and patients currently receiving nutrition
      support (enteral or parenteral nutrition). Patients will be excluded if they received greater
      than one week of oral steroids in the previous three months. Exclusively breastfed infants
      will be excluded from the study as their nutrient intake cannot accurately assessed (must
      consume at least some foods or formulas). We will include patients if they have asthma,
      eczema, or both. There will be no control group recruited for the study as comparisons will
      be made within the study population.

      Subjects will be recruited from the Asthma, Allergy, & Immunology Clinic at the main campus
      of Children's Hospital of Wisconsin. At the first visit with the dietitian, subjects will be
      enrolled and consent will be obtained. Height, weight, and head circumference (until 2 YO)
      will be measured and recorded using standard procedures. The Mealtime Behavior Questionnaire
      (MBQ) and Feeding Strategies Questionnaire (FSQ) will be filled out by the parent or
      guardian. Demographic data and medical history will be obtained. Height/length, weight, and
      head circumference from the first allergist visit will be obtained from the medical record
      and recorded for use in the study. A multiple-pass 24-hour recall will be completed. In
      addition, they will receive standardized nutrition intervention to include nutrition
      assessment, food allergy education, and general nutrition education.

      The participant will attend a second visit with the dietitian. Height, weight, and head
      circumference will be measured and recorded using standard procedures. A multiple-pass
      24-hour recall will be completed. The participant's parent or guardian will complete the MBQ
      and FSQ. Follow-up nutrition intervention will include nutrition reassessment, food allergy
      education as needed, and general nutrition education as needed.

      All aspects of this study, with the exception of MBQ, and FSQ, are the current standard of
      care in the Asthma, Allergy, and Immunology clinic for patients with multiple food allergies.
    

Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        New patients to the Allergy & Immunology outpatient clinic at Children's Hospital of
        Wisconsin (CHW).
      
Keywords: food allergy; nutrient intake; growth