Systematic Review of Nutrient Intake and Growth in Children with Multiple IgE-Mediated Food Allergies

Abstract

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.

Methods:
A systematic review of the literature was conducted and a workgroup was established to critically analyze each relevant article. The findings were summarized and a conclusion was generated.

Results:
Six studies were analyzed. One study found that children with food allergies are more likely to be malnourished than children without food allergies. Three studies found that children with multiple food allergies were shorter than children with 1 food allergy. Four studies assessed nutrient intake of children with multiple food allergies, but the inclusion and comparison criteria were different in each of the studies and the findings were conflicting. 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. Until more research is available, we recommend monitoring of nutrition and growth of children with multiple food allergies to prevent possible nutrient deficiencies and to optimize growth.

Full text

Nutrition in Clinical Practice
Volume 28 Number 6
December 2013 669 –675
© 2013 American Society
for Parenteral and Enteral Nutrition
DOI: 10.1177/0884533613505870
ncp.sagepub.com
hosted at
online.sagepub.com
Invited Review
Introduction
Food allergies affect up to 8% of American children younger
than 18 years, and the prevalence of food allergy appears to be
increasing.1 Eight foods account for more than 90% of food
allergies: milk, soy, wheat, eggs, peanuts, tree nuts, fish, and
shellfish,2 but more than 170 foods have been identified to
cause allergic reactions.3 Currently, the recommended treat-
ment for food allergies is strict elimination of the offending
allergens from the diet. Elimination of nutrient-dense foods
from the diet, however, may result in poor nutrient intake and
impaired growth in children.
The effect of eliminating milk from the diet on growth and
development has been clearly documented in the literature and
is well understood by many clinicians. Children following a
milk-free diet are more likely to consume less energy, fat, pro-
tein, calcium, riboflavin, and niacin than are milk consumers.4
Children with milk allergy are at increased risk of having
impaired growth compared to healthy children.5 Furthermore,
research has demonstrated that nutrition counseling and con-
sumption of an age-appropriate milk substitute led to improved
nutrient intake in children following a milk-free diet.6
Few studies have looked at the effect of a multiple-food-
elimination diet on nutrient intake and growth. The purpose of
this article is to critically analyze the current research on the
effect of a multiple-food-elimination diet on nutrient intake
and growth in children with multiple food allergies.
505870NCPXXX10.1177/0884533613505870Nutrition in Clinical PracticeSova et al
research-article2013
From 1Department of Clinical Nutrition, Children’s Hospital of
Wisconsin, Milwaukee, Wisconsin; 2Mount Mary College, Milwaukee,
Wisconsin; 3Department of Pediatrics, Division of Asthma, Allergy and
Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin;
4Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin,
Milwaukee, Wisconsin.
Financial disclosure: None declared.
This article originally appeared online on October 28, 2013.
Corresponding Author:
Cassandra Sova, MS, RD, CD, CNSC, Department of Clinical Nutrition,
Children’s Hospital of Wisconsin, P.O. Box 1997, MS B610, Milwaukee,
WI 53201-1997, USA.
Email: csova@chw.org.
Systematic Review of Nutrient Intake and Growth in
Children with Multiple IgE-Mediated Food Allergies
Cassandra Sova, MS, RD, CD, CNSC1; Mary Beth Feuling, MS, RD, CD, CSP1;
Megan Baumler, PhD, RD, CD2; Linda Gleason, MS, RD, CD2; Jonathan S. Tam, MD3;
Heidi Zafra, MD3; and Praveen S. Goday, MBBS, CNSC4
Abstract
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. Methods: A systematic review of the literature was conducted and a workgroup
was established to critically analyze each relevant article. The findings were summarized and a conclusion was generated. Results: Six
studies were analyzed. One study found that children with food allergies are more likely to be malnourished than children without food
allergies. Three studies found that children with multiple food allergies were shorter than children with 1 food allergy. Four studies
assessed nutrient intake of children with multiple food allergies, but the inclusion and comparison criteria were different in each of the
studies and the findings were conflicting. 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. Until more research
is available, we recommend monitoring of nutrition and growth of children with multiple food allergies to prevent possible nutrient
deficiencies and to optimize growth. (Nutr Clin Pract. 2013;28:669-675)
Keywords
food hypersensitivity; vitamin; micronutrient; soy foods; nutrition therapy

670 Nutrition in Clinical Practice 28(6)
Methods
We searched for primary research studies to answer the follow-
ing question: Are children with 2 or more food allergies at risk of
inadequate nutrient intake and impaired growth? We used strict
inclusion and exclusion criteria to search the PubMed and
CINAHL databases using the following MeSH terms: food
hypersensitivity and growth, food hypersensitivity and nutrition,
food hypersensitivity and micronutrient, food hypersensitivity
and vitamin, and food hypersensitivity and trace element. The
MeSH search term food hypersensitivity includes the top 8 food
allergens except soy. Therefore, the search was repeated with
soy hypersensitivity. Studies with only an abstract published
were excluded. We followed the Academy of Nutrition and
Dietetics’ (AND) Evidence Analysis Process to search for and
critically review relevant articles.7 Two different researchers
(PSG and CS) critically appraised each article using the AND’s
Quality Criteria Checklist: Primary Research. The results were
compared and discussed by the workgroup. A quality rating was
given to each article. Statistically significant findings related to
nutrition and growth of children with multiple food allergies
were extracted from all articles that met our inclusion criteria,
even when other outcomes were the primary focus of the study.
Inclusion Criteria for Systematic Review of
the Literature
 IgE-mediated food allergy proven by skin prick testing
or serum-specific IgE and/or food challenge
 Subjects with 2 or more food allergies
 Age 0–18 years
 Primary study
 Written in English
 Published 1990 or later
 Human research
Exclusion Criteria for Systematic Review of
the Literature
 Abstract only
 Medical conditions other than asthma, atopic dermati-
tis, and other atopic manifestations
Results
Nearly 900 studies were identified in the literature search.
Screening for duplications and eligibility greatly reduced the
number of articles to be critically analyzed to 6. The number of
studies screened, assessed, and reported in this review are
listed in Figure 1. A total of 6 studies with 415 subjects and 335
controls were included in this review. There were 3 cross-
sectional studies, 2 non-controlled studies, and a case series;
each was of neutral quality. Relevant findings of the studies are
summarized in Table 1.
Relationship of Multiple Food Allergies to
Growth
All of the studies reviewed reported on the growth status of
children with multiple food allergies. The World Health
Organization (WHO) defines malnutrition as a weight-for-age,
weight-for-length, or length-for-age z-score < –2.8 One cross-
sectional study found that children with food allergies were
more likely to be malnourished than controls as indicated by a
weight-for-age or height-for-age z-score < –2 (P < .05).9 The
same study also found that children with 3 or more food aller-
gies were more likely than children with 1 or 2 food allergies
to be malnourished as indicated by a weight-for-age or height-
for-age z-score < –2 (P < .05).9 All other studies found that
growth of children with multiple food allergies was within nor-
mal limits as defined by a z-score of 2 to –2 or 3rd to 97th
percentile on the growth chart.10-13 However, 4 of these studies
found differences between the growth of children with multi-
ple food allergies and the control group.9,10,11,14 Three studies
found that children with multiple food allergies were shorter
than children with 1 food allergy (P < .05),10,11,14 while a single
study found that weight-for-age z-scores decreased as the num-
ber of sensitized food allergens increased (P < .01).11
Relationship of Multiple Food Allergies to
Nutrient Intake
Four of the studies reviewed assessed nutrient intake. Two
studies found that children with food allergies consumed more
vitamin E than did controls (P < .05).9,10 Flammarion et al
reported that children with food allergies consumed more vita-
min A than did controls (P < .05).9 One study found that chil-
dren with food allergies who did not receive nutrition
counseling were more likely to have inadequate intake of cal-
cium and vitamin D (P < .05).10 This study also reported that
children with milk allergy were more likely to consume inad-
equate calcium than children with other allergies (P < .05).10
One study reported adequate protein intake in children with
multiple food allergies consuming amino-acid-based for-
mula,13 while another reported possible essential fatty acid
(EFA) deficiency in children with multiple food allergies [P <
.01 for the (ω3 + ω6) / (ω7 + ω9) ratio].12
Discussion
Eliminating multiple foods from the diet of growing children
may result in poor nutrient intake and poor growth. Our review
of the literature unveiled 6 studies of neutral quality related to
this topic. Limitations of this review include inconsistency of
methods and exclusion criteria among the studies. Some stud-
ies excluded specific comorbidities while others did not. In
addition, 1 study included all patients with food sensitizations
but did not specifically state if the sensitized allergens were
relevant food allergies or if the sensitized foods were actually

Sova et al 671
eliminated from the diet. Another limitation is that the studies
used different nutrition assessment methods and used different
nutrient intake standards. This led to inconsistent results that
did not prompt a clear conclusion.
Growth
Five of the 6 studies reported that the growth of children with
multiple food allergies was within normal limits.10-14 Only 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Based on the PRISMA flow
diagram.26

672
Table 1. Overview of Studies (n = 6).
Study, Design, Class/
Rating Subjects Comparison Group
Relationship of MFA to Growth
(Standard Used)
Relationship of MFA to Nutrient Intake
(Nutrition Assessment Method/Standard
Used) Limitations & Comments
Christie et al (2002),10
cross-sectional,
class D, rating Øa
consecutive
patients
with  1
FA (n =
98)
age-matched
controls without
FA (n = 99)
(CDC growth charts) (3-day food record/10th edition DRIs) used 25th percentile height-for-
age as indicator of potential
undernutrition
age 3.7 ± 2.3
years
age 4.1 ± 2.4 years  2 FA more likely to be < 25th
percentile height-for-age than 1
FAb (35% and 16%, respectively)
 1 FA more likely to consume > 100% DRI
for vitamin E than controlsb (78% and
92%, respectively)
did not report weight data
1 FA more likely to be > 75th
percentile height-for-age than  2
FAc (34% and 13%, respectively)
milk allergy more likely to consume
< 100% DRI for calcium than other
allergiesb (58% and 31%, respectively)
unknown time avoiding allergens
other allergies more likely to consume <
100% DRI vitamin E than milk allergyb
(90% and 62%, respectively)
FA without nutrition counseling more likely
to consume < 67% DRI for calcium and
vitamin D than those with counselinga
(calcium: 39% and 15%, respectively;
vitamin D: 55% and 29%, respectively)
Flammarion et al
(2011),9 cross-
sectional, class D,
rating Ø
children with
 1 FA (n
= 96)
age- and sex-
matched controls
(n = 95)
(Sempé reference values) (3-day food record/RDI for healthy children
in France)
88% of children with food
allergies received nutrition
counseling by a dietitian
age 4.6 ±
2.58 years
age 4.7 ± 2.7 years  3 FA more likely to have weight-
for-age and height-for-age z-score
< –2 than children with 1–2
FAb (weight: 14.5% and 1.8%,
respectively; height: 12.1% and
3.6%, respectively)
FA consumed more vitamins A and E than
controlsb (vitamin A: 95% RDA and 65%
RDA, respectively; vitamin E: 92% RDA
and 53% RDA, respectively)
avoiding allergens for  4 months
prior to study
FA more likely than controls to
have weight-for-age and height-
for-age z-scores < –2b (weight:
9.3% and 0%, respectively;
height: 7.2% and 2.7%,
respectively)
Cho et al (2011),11
case series, class D,
rating Ø
children
with atopic
dermatitis
(n = 165)
Korean Pediatric
Society growth
charts 2007
(Korean growth charts) unknown time avoiding allergens
classified
according
to #
sensitized
FA
weight-for-age z-score decreased as
# sensitized FA increasedc (–0.21
± 1.08, 0.02 ± 0.87, –0.14 ± 0.96,
and –0.57 ± 1.90 for 0, 1, 2, and 
3 sensitized FA, respectively)
did not state if they were actually
avoiding the sensitized FA
(continued)

673
Study, Design, Class/
Rating Subjects Comparison Group
Relationship of MFA to Growth
(Standard Used)
Relationship of MFA to Nutrient Intake
(Nutrition Assessment Method/Standard
Used) Limitations & Comments
age 16.00
± 10.93
months
 3 FA significantly shorter than
1 FAb (–0.50 ± 1.01 and 1.10 ±
0.90, respectively)
Aldámiz-Echevarría
et al (2008),12 cross-
sectional, class D,
rating Ø
children with
 2 FA (n
= 25)
healthy children (n
= 61)
WNL (no nutrition assessment measure used/no
nutrient intake standard used)
unknown time avoiding allergens
age 3.8 ± 1.6
years
age 5.1 ± 2.6 years EFA index [(ω3 + ω6) / (ω7 + ω9)] was
lower in FA than controlsc (1.5 and 1.9,
respectively)
diets of the control patients were
not described
DHA:DPA ratio was lower in FA than
controlsc (4.0 and 11.7, respectively)
lower percentage of α-linoleic acid in
FA than controlsb (27.4 and 30.7,
respectively)
Sicherer et al (2001),13
non-controlled trial,
class D, rating Ø
children
with milk
allergy (n
= 18)
NCHS z-scores,
RDA
(NCHS) (diet record/RDA) unknown time avoiding allergens
 16 had
multiple
food
allergies
weight-for-age, height-for-age, and
weight-for-height z-scores WNL
at entry, 1 month, 4 months (–0.8
± 0.2, –0.3 ± 0.2, and –0.6 ± 0.3,
respectively, at 4 months)
consumed 152 ± 12% RDA for protein from
formula at 4 months
unclear how many had 18 MFA
vs only milk allergy
age 6–210
months at
enrollment
no statistically significant
differences in z-scores between 0,
1, and 4 months
funded by formula manufacturer
primary purpose to test efficacy
of formula
many with allergic eosinophilic
gastroenteritis
Zeiger et al (1999),14
non-controlled trial,
class D, rating Ø
children with
allergy to
milk and
soy (n =
13)
children with milk
allergy but no soy
allergy (n = 80)
(NCHS) unknown time avoiding allergens
11 had
additional
allergies
children with milk and soy allergy
had lower height-for-age z-scores
than children with milk allergyb
(–0.73 ± 0.26 vs –0.09 ± 0.12)
purpose of study was to assess
prevalence of soy allergy in
children with milk allergy
age 23.4
± 2.5
months at
enrollment
age 18.4 ± 0.9
months
weight & height for milk and soy
allergic children measured only
1 time
CDC, Centers for Disease Control and Prevention; DHA, docosahexanoic acid; DPA, docosapentaenoic acid; DRI, dietary reference intake; EFA, essential fatty acid; FA, food allergy; MFA, multiple
food allergies; NCHS, National Center for Health Statistics; RDA, recommended daily allowance; RDI, reference daily intake; WNL, within normal limits.
aClass and rating were determined using the Academy of Nutrition and Dietetics’ Evidence Analysis Manual. Ø = neutral.
bP < .05.
cP < .01.
Table 1. (continued)

674 Nutrition in Clinical Practice 28(6)
study reported that children with 3 or more food allergies were
more likely to be malnourished than children with 1 or 2 food
allergies.9 This study was different from the others in 2 ways:
88% of the subjects received nutrition counseling from a trained
dietitian, and all subjects were avoiding the allergens for at least
4 months prior to the study visit. It is unclear when the dietitian
visit occurred. If the dietitian visit occurred at or close to the time
that anthropometric measurements were taken for the study, the
impact of nutrition counseling would not be seen in the anthropo-
metric measurements. It is most likely that Flammarion et al9
found a higher incidence of malnutrition than the other studies
because they were the only investigators who excluded patients
who eliminated offending foods for fewer than 4 months.
Four of the 6 studies found differences in the growth of chil-
dren with food allergies and controls. Three studies found that
children with food allergies were shorter than children without
food allergies. This may indicate potential undernutrition.
Since growth in early childhood affects overall adult stature,15
this is an important finding that may be clinically significant.
Previous studies have found that children with atopic der-
matitis, which is frequently associated with food allergies,
may have poor growth.16,17 These studies have found that chil-
dren with atopic dermatitis are shorter than controls. Studies
have also found that asthmatic children treated with inhaled
corticosteroids initially experience a decline in growth veloc-
ity that may contribute to shorter stature.18,19 This suggests
that there may be other mechanisms involved in the poor
growth of children with multiple food allergies besides food
exclusion alone.
Nutrient Intake
Four of the studies reported on nutrient intake. All of the stud-
ies used different nutrient intake standards, which makes it dif-
ficult to compare the studies to each other. Two studies found
that children with food allergies consumed more vitamin E
than did controls.9,10 More than 50% of the patients in both
studies received nutrition counseling. Nutrition counseling for
children with multiple food allergies often includes recom-
mending oil supplementation to increase calorie and fat intake.
The additional oil in their diets may have resulted in the
increased vitamin E intake reported. It is interesting that the
increased intake of vitamin E was the only consistent result
reported by the studies that measured nutrient intake.
One study found that children with milk allergies are more
likely to consume < 100% of the dietary reference intake (DRI)
for calcium than are children with other allergies.10 The effects
of milk allergy on nutrient intake and growth are well docu-
mented in the literature.4-6 However, these studies were done
prior to the widespread availability of amino-acid formulas.
Studies have documented improved growth since the introduc-
tion of amino-acid-based formulas.20 This improvement in
growth with amino-acid-based formulas is likely multifactorial.
In addition to symptom improvement that may improve nutrient
intake, these formulas probably result in reduction of inflammation,
which may in turn improve nutrient absorption and normaliza-
tion of cytokines positively impacting growth.
One study found that children who did not receive nutrition
counseling were more likely to consume < 67% DRI for cal-
cium and vitamin D than were children with nutrition counsel-
ing.10 This is an important finding, as it suggests that nutrition
counseling may improve calcium and vitamin D intake of chil-
dren with food allergies.
Children with food allergies who received nutrition coun-
seling consumed more calcium than did those who did not
receive nutrition counseling in the study by Christie et al.10 It is
unfortunate that nutrition counseling was poorly defined in this
study. Another study, in which 88% of the subjects received
nutrition counseling from a trained dietitian, found that nutri-
ent intake was similar in children with food allergies and con-
trols.9 The nutrition counseling may have influenced their food
choices and thus their nutrient intake.
A study from Spain reported that children with multiple
food allergies are more likely to have EFA deficiency than are
controls.12 In this study, the EFA index [(ω3 + ω6) / (ω7 + ω9)],
which can be an indicator of EFA status,21 was lower in the
children with food allergies. Docosapentaenoic acid (22:5ω6)
is produced when docosahexanoic acid (DHA) (22:6ω3) avail-
ability is marginal, and the ratio between DHA and docosapen-
taenoic acid can be used as an indicator of DHA status.22 In the
study by Aldámiz-Echevarría et al, children with food allergies
appear to have low DHA status. However, since the best bio-
markers of dietary fatty acids are those fatty acids that cannot
be synthesized endogenously, linoleic and α-linoleic acids may
be better indicators, as they tend to be less affected by dietary
intake.23 The children with food allergies had lower serum lin-
oleic acid concentrations, but their α-linoleic acid concentra-
tions were not different. The children in both groups did not
differ with regard to mead acid and arachidonic acid concentra-
tions, which are the numerator and denominator of the
triene:tetraene ratio, making it unlikely that any of the children
in either group were EFA deficient.
Future Research
Our review of the literature highlights the need for additional
research surrounding the growth and nutrition status of chil-
dren with multiple food allergies. The heterogeneity of this
population makes research difficult. Future studies could
include multicenter research so that sample sizes are adequate
to divide patients by specific allergies. We also speculate that
categorizing children by type of allergy may be superior to
dividing by number of food allergies since certain food aller-
gies or combinations of food allergies may be nutritionally
more important than others. For instance, in the Western world,
a combination of a cow’s milk and soy allergy in a toddler may
be more nutritionally relevant than an allergy to peanuts and
shellfish. However, nutritionally important allergies may differ
depending on the population that is studied and the usual diet
of that population. Many of the articles reviewed assessed

Sova et al 675
nutrient intake and growth only at a single point in time. Future
research should follow children with multiple food allergies
over a period of time to describe changes in nutrient intake and
growth in response to medical nutrition therapy. In addition,
future research should compare subjects with and without
nutrition intervention to assess the impact of nutrition interven-
tion on nutrient intake and growth.
The results of this systematic review suggest that children
with multiple food allergies following a multiple-food elimina-
tion diet may grow less well than children without food allergies.
Over the last few decades, eosinophilic gastrointestinal disease,
specifically eosinophilic esophagitis (EoE), has been increas-
ingly identified in the population of children with food allergies.24
EoE is associated with failure to thrive and feeding disorders.25
Future studies should determine the role of such disorders in chil-
dren with multiple food allergies who have poor growth.
Application to Practice
The available research specific to our research question is lim-
ited and the quality of the available studies is neutral. One study
found that children with 3 or more food allergies are more likely
to be malnourished than are children with 1 or 2 food allergies,1
while other studies found that children with multiple food aller-
gies grew less well than controls, but still within the normal
range. Our review of the literature shows that children with
multiple food allergies have a higher risk of impaired growth.
Regarding nutrient intake, 2 of the studies reviewed did not find
that children with multiple food allergies have inadequate nutri-
ent intake. However, 1 study found that children with milk
allergy consumed less calcium and vitamin D than did children
with other allergies and that children with food allergies who
received nutrition counseling were less likely to have inade-
quate calcium and vitamin D intake.10 Thus, we cannot rule out
that children with food allergies may be at risk of inadequate
nutrient intake. Reducing the risk of poor nutrition and poor
growth is especially important in childhood, as poor nutrition in
early childhood can affect growth and development throughout
the lifespan.15 Until more research is available, we recommend
ongoing nutrition and growth assessment of children with mul-
tiple food allergies to prevent possible nutrient deficiencies and
optimize growth and development. This is consistent with the
National Institutes of Allergy and Infectious Diseases guide-
lines, which recommend regular growth assessment and nutri-
tion counseling for children with food allergies.1
References
1. Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity,
and distribution of childhood food allergy in the United States. J Pediatr
Gastroenterol Nutr. 2011;128:9-17.
2. Branum AM, Lukacs SL. Food allergy among U.S. children: trends in
prevalence and hospitalizations. NCHS Data Brief. 2008;10:1-8.
3. National Institute of Allergy and Infectious Diseases. Guidelines for
the diagnosis and management of food allergy in the United States:
report of the NIAID-sponsored expert panel. J Allergy Clin Immunol.
2010;126(suppl 6):S1-S58.
4. Henriksen C, Eggesbo M, Halvorsen R, Botten G. Nutrient intake among
two-year-old children on cow’s milk-restricted diets. Acta Paediatr.
2000;89:272-278.
5. Isolauri E, Siitas Y, Salo MK, Isosomppi R, Kaila M. Elimination diet in
cow’s milk allergy: risk for impaired growth in young children. J Pediatr.
1998;132:1004-1009.
6. Madsen CD, Henderson RC. Calcium intake in children with positive IgG
RAST to cow’s milk. J Pediatr Child Health. 1997;33:209-212.
7. Academy of Nutrition and Dietetics. Evidence Analysis Manual: Steps
in the Academy Evidence Analysis Process. Chicago, IL: Academy of
Nutrition and Dietetics; 2012.
8. World Health Organization. Global database for child health and malnutri-
tion. http://www.who.int/nutgrowthdb/about/introduction/en/index5.html.
Accessed July 10, 2013.
9. Flammarion S, Santos C, Guimber D, et al. Diet and nutritional status of
children with food allergies. Pediatr Allergy Immunol. 2011;22:161-165.
10. Christie L, Hine RJ, Parker JG, et al. Food allergies in children affect
nutrient intake and growth. J Am Diet Assoc. 2002;102(11):1648-1651.
11. Cho HN, Hong S, Lee SH, Yum H. Nutritional status according to sen-
sitized food allergens in children with atopic dermatitis. Asthma Allergy
Immunol Res. 2011;3:53-57.
12. Aldámiz-Echevarría L, Bilbao A, Andrade F, Elorz J, Prieto JA, Rodriguez-
Soriano J. Fatty acid deficiency profile in children with food allergy man-
aged with elimination diets. Acta Paediatr. 2008;97:1572-1576.
13. Sicherer SH, Noone SA, Koerner CB, Christie L, Burks AW, Sampson
HA. Hypoallergenicity and efficacy of an amino acid-based formula in
children with cow’s milk and multiple food hypersensitivities. J Pediatr.
2001;138:688-693.
14. Zeiger RS, Sampson HA, Bock SA, et al. Soy allergy in infants and chil-
dren with IgE-associated cow’s milk allergy. J Pediatr. 1999;134:614-622.
15. Albertsson-Wikland K, Karlberg J. Postnatal growth of children born
small for gestational age. Acta Pediatr Suppl. 1997;423:193-195.
16. Dhar S, Mondal B, Malakar R, Ghosh A, Gupta AB. Correlation of the
severity of atopic dermatitis with growth retardation in pediatric age
group. Indian J Dermatol. 2005;50:125-128.
17. Palit A, Handa S, Bhalla AK, Kumar B. A mixed longitudinal study of
physical growth in children with atopic dermatitis. Indian J Dermatol
Venereol Leprol. 2007;73:171-175.
18. Pauwels RA, Pedersen S, Busse WW, et al. START Investigators Group.
Early intervention with budesonide in mild persistent asthma: a ran-
domised, double-blind trial. Lancet. 2003;361:1071-1076.
19. Turpeinen M, Nikander K, Pelkonen AS, et al. Daily versus as-needed
inhaled corticosteroid for mild persistent asthma (the Helsinki Early
Intervention Childhood Asthma Study). Arch Dis Child. 2008;93:654-659.
20. Niggemann B, Binder C, Dupont C, Hadji S, Arvola T, Isolauri E.
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. Pediatr Allergy Immunol. 2001;12:78-82.
21. Rump P, Mensink RP, Kester ADM, Hornstra G. Essential fatty acid com-
position of plasma phospholipids and birth weight: a study in term neo-
nates. Am J Clin Nutr. 2001;73:797-806.
22. Hoffman DR, Uauy R. Essentiality of dietary omega-3 fatty acids for pre-
mature infants; plasma and red blood cell fatty acid composition. Lipids.
1992;27:886-895.
23. Salo P, Viikari J, Rask-Nissilä L, et al. 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. Eur J Clin Nutr.
1999;53:927-932.
24. Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J
Med. 2004;351:940-941.
25. Liacouras CA, Spergel JM, Ruchelli E, et al. Eosinophilic esophagi-
tis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol.
2005;3:1198-1206.
26. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred
reporting items for systematic reviews and meta-analyses: the PRISMA
statement. PLoS Med. 2009;6:e1000097.