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Allergy study highlights risks for children

A lack of testing for food allergies is putting children's health at risk and could lead to life threatening reactions, a study has found. The study, Adverse reactions to food in New Zealand children age 0-5 years, was published in the New Zealand Medical Journal. It looked at a cross-section of 110 children who had attended Plunket clinics. It found 44 had experienced an adverse reaction to food, but only four had been clinically evaluated. Those children were found to have adverse reactions to food allergens, including a life threatening peanut allergy. Two others had been hospitalised with systemic symptoms, but neither had undergone testing for food allergy. “If these children have food allergies, they remain at risk for continued and possibly severe reactions,” the study said.

Parents modifying children's diets or breastfeeding mothers cutting out food without advice from a physician or dietician could also have adverse affects, it said. “Failure to thrive is commonly seen in children experiencing FA (food allergy) as a result of multiple foods being removed from their diet.” The data indicated adverse reactions to food were a public health concern and may be under investigated — even when symptoms were severe, the study said.

“There is an urgent need to investigate the epidemiology, diagnosis, and prevention of FA (food allergy) in New Zealand to reduce morbidity, improve child health, and reduce the burden to health costs.” Thirty-three of the children were reported to have eczema. Ten had worsening symptoms two hours after eating, the study said. Symptoms improved in six of them with dietary changes. Doctors had prescribed topical therapy for 18 of those children with eczema, but symptoms had persisted.

“One possible explanation for this observation is undiagnosed FA (food allergy). Without testing, allergic triggers for eczema could not be identified in these participants.” Further investigation of food allergy as the cause of eczema was warranted, the study said.

Adverse reactions to food worldwide in children was an increasing concern and food allergy was as common in New Zealand as in other countries, the study said. The study was conducted by the Auckland District Health Board and led by Associate Professor Rohan Ameratunga and lead researcher Dr Christine Crooks. Allergy New Zealand chief executive Penny Jorgensen said the study was “really disturbing” because it highlighted that many children were not being assessed for food allergy. The risk was the potential for life-threatening reactions, she said.

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Indications for Referral

There are many situations where referral may be indicated including:

  • a new diagnosis requiring specific dietary modification (eg. diabetes, food allergy, abnormal blood lipids)
  • poor understanding of dietary management (eg. a patient who has had diabetes for years but has poor blood glucose control)
  • significant unintentional weight change (either weight loss or gain)
  • evidence of recent poor food intake, poor appetite or difficulty preparing or eating food (eg. poor dentition or social isolation)
  • deterioration of symptoms or change in care needs (especially for cancer or HIV patients or the elderly)
  • any nutritional deficiencies (eg. anaemia or iodine deficiency)
  • changes in medication prescribed that may affect dietary intake
  • alternative methods of feeding (eg. enteral)
  • texture modified food (dysphagic patients)
  • periodic review for chronic conditions.

When referring, it is useful to include relevant medical history, recent biochemical and metabolic test results, and details of any medications currently prescribed.

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