Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Cow's milk allergy in children: adherence to a therapeutic elimination diet and reintroduction of milk into the diet

European Journal of Clinical Nutrition volume 64, pages 1080–1085 (2010)Cite this article

Subjects

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

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

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.

    Article  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • Finnish Paediatric Association (2004). Food allergy among children. Duodecim 120, 1524–1538.

    Google Scholar 

  • Grimshaw KE (2006). Dietary management of food allergy in children. Proc Nutr Soc 65, 412–417.

    Article  CAS  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Hommel KA, Mackner LM, Denson LA, Crandall WV (2008). Treatment regimen adherence in pediatric gastroenterology. J Pediatr Gastroenterol Nutr 47, 526–543.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

Download references

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

Author notes

  1. T Klaukka: Deceased.

Authors and Affiliations

  1. Department of Public Health, University of Helsinki, Helsinki, Finland

    J Tuokkola

  2. Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland

    J Tuokkola, C Kronberg-Kippilä, H K Sinkko, P Pietinen & S M Virtanen

  3. Primary and Specialised Health and Social Services Unit, National Institute for Health and Welfare, Helsinki, Finland

    M Kaila

  4. Department of Pediatrics, Tampere University Hospital, Tampere, Finland

    M Kaila & M Knip

  5. Social Insurance Institution, Helsinki, Finland

    T Klaukka

  6. Department of Paediatrics, University of Oulu, Oulu, Finland

    R Veijola

  7. Department of Pediatrics, University of Turku, Turku, Finland

    O Simell

  8. Department of Clinical Microbiology, University of Kuopio, Kuopio, Finland

    J Ilonen

  9. Immunogenetics Laboratory, University of Turku, Turku, Finland

    J Ilonen

  10. Research Unit, Tampere University Hospital, Tampere, Finland

    M Knip & S M Virtanen

  11. Hospital for Children and Adolescents and Folkhälsan Research Institute, University of Helsinki, Helsinki, Finland

    M Knip

  12. Tampere School of Public Health, University of Tampere, Tampere, Finland

    S M Virtanen

Authors
  1. J Tuokkola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Kaila
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C Kronberg-Kippilä
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H K Sinkko
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T Klaukka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P Pietinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R Veijola
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. O Simell
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J Ilonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M Knip
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S M Virtanen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J Tuokkola.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2010.132

Keywords

This article is cited by

Search

Advanced search

Quick links