Abstract
Background/Objectives:
The basic treatment for cow's milk allergy (CMA) is the elimination of all cow's milk proteins (CMP) from the diet. This study aimed at characterizing the diet of children with a diagnosis of CMA, to assess the degree of adherence to the elimination diet and to evaluate the factors associated with the adherence and age of recovery.
Subjects/Methods:
From a birth cohort study, food records of 267 children diagnosed with CMA were studied to define how strictly the elimination diet was adhered to. Subsequent food records were studied to assess the age at reintroduction of milk products in the child's diet.
Results:
The families adhered to the elimination diet of the child with extreme accuracy in 85% of the cases. Older and monosensitized children had more often small amounts of CMP in their diet, possibly because of the absence of nutritional information by a dietitian/nutritionist. Adherence to the diet was neither related to any other sociodemographic factor studied nor to the age at reintroduction of milk products into the diet.
Conclusions:
The therapeutic elimination diet of children diagnosed with CMA was well adhered to. Low intakes of vitamin D, calcium, and riboflavin are of concern in children who follow or have followed a cow's milk-free diet.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Allen CW, Kemp AS, Campbell DE (2009). Dietary advice, dietary adherence and the acquisition of tolerance in egg-allergic children: a 5-yr follow-up. Pediatr Allergy Immunol 20, 213–218.
Eggesbo M, Botten G, Stigum H (2001). Restricted diets in children with reactions to milk and egg perceived by their parents. J Pediatr 139, 583–587.
Finnish Paediatric Association (2004). Food allergy among children. Duodecim 120, 1524–1538.
Grimshaw KE (2006). Dietary management of food allergy in children. Proc Nutr Soc 65, 412–417.
Hidvegi E, Arato A, Cserhati E, Horvath C, Szabo A, Szabo A (2003). Slight decrease in bone mineralization in cow milk-sensitive children. J Pediatr Gastroenterol Nutr 36, 44–49.
Hommel KA, Mackner LM, Denson LA, Crandall WV (2008). Treatment regimen adherence in pediatric gastroenterology. J Pediatr Gastroenterol Nutr 47, 526–543.
Jensen VB, Jorgensen IM, Rasmussen KB, Molgaard C, Prahl P (2004). Bone mineral status in children with cow milk allergy. Pediatr Allergy Immunol 15, 562–565.
Kupila A, Muona P, Simell T, Arvilommi P, Savolainen H, Hamalainen AM et al. (2001). Feasibility of genetic and immunological prediction of type I diabetes in a population-based birth cohort. Diabetologia 44, 290–297.
Kyttälä P, Erkkola M, Ovaskainen ML, Kronberg-Kippila C, Tapanainen H, Veijola R et al. (2010). Food consumption and nutrient intake in Finnish 1-6-year-old children. Public Health Nutr 13 (6A), 947–956.
National Institute for Health and Welfare (2009). Fineli—Finnish Food Composition Database. http://www.Fineli.Fi.
Ovaskainen ML, Paturi M, Reinivuo H, Hannila ML, Sinkko H, Lehtisalo J et al. (2008). Accuracy in the estimation of food servings against the portions in food photographs. Eur J Clin Nutr 62, 674–681.
Paturi M, Nieminen R, Reinivuo H, Ovaskainen ML (2006). Picture book of food portion sizes, Edita Prima Oy, Helsinki.
Rockell JE, Williams SM, Taylor RW, Grant AM, Jones IE, Goulding A (2005). Two-year changes in bone and body composition in young children with a history of prolonged milk avoidance. Osteoporos Int 16, 1016–1023.
Skripak JM, Matsui EC, Muud K, Wood RA (2007). The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol 120, 1172–1177.
Tuokkola J, Kaila M, Pietinen P, Simell O, Knip M, Virtanen SM (2008). Agreement between parental reports and patient records in food allergies among infants and young children in Finland. J Eval Clin Pract 14, 984–989.
Vandenplas Y, Brueton M, Dupont C, Hill D, Isolauri E, Koletzko S et al. (2007). Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Arch Dis Child 92, 902–908.
Vanto T, Helppila S, Juntunen-Backman K, Kalimo K, Klemola T, Korpela R et al. (2004). Prediction of the development of tolerance to milk in children with cow's milk hypersensitivity. J Pediatr 144, 218–222.
Vlieg-Boerstra BJ, van der Heide S, Bijleveld CM, Kukler J, Duiverman EJ, Wolt-Plompen SA et al. (2006). Dietary assessment in children adhering to a food allergen avoidance diet for allergy prevention. Eur J Clin Nutr 60, 1384–1390.
Acknowledgements
We are extremely grateful to all the families who took part in this study. We also acknowledge the excellent collaboration of the DIPP research nurses, doctors, nutritionists, and laboratory staff over the years. The study was financially supported by the Academy of Finland (grants 63672, 79685, 79686, 80846, 201988, 210632, 129492, 126813), the Finnish Paediatric Research Foundation, the Juho Vainio Foundation, the Yrjö Jahnsson Foundation, Medical Research Funds of Turku, Oulu and Tampere University Hospitals, the Juvenile Diabetes Research Foundation (grants 197032, 4-1998-274, 4-1999-731, 4-2001-435), the Novo Nordisk Foundation and EU Biomed 2 (BMH4-CT98-3314), Doctoral Programs for Public Health, Foundation for Allergy Research, Research Foundation of Orion Corporation, Tampere Tuberculosis Foundation, and the Jalmari and Rauha Ahokas Foundation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Tuokkola, J., Kaila, M., Kronberg-Kippilä, C. et al. Cow's milk allergy in children: adherence to a therapeutic elimination diet and reintroduction of milk into the diet. Eur J Clin Nutr 64, 1080–1085 (2010). https://doi.org/10.1038/ejcn.2010.132
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ejcn.2010.132
Keywords
This article is cited by
-
Bone metabolism in cow milk allergic children
Indian Pediatrics (2013)