THERAPEUTIC NUTRITION IN FOOD ALLERGY: NOT THAT SIMPLE

Abstract

Purpose of the study. To assess the effectiveness of elimination diet therapy using therapeutic formulas in children with cow's milk protein allergy according to a 5-year follow-up. Materials and methods. A prospective, single-center, open, uncontrolled study was conducted. We observed 99 children with atopic dermatitis and allergy to cow's milk protein (CMP), the average age at the beginning of the study was 4.6 ± 0.8 months. The results of clinical observation, clinical assessment of the function of the digestive organs, and the level of the IgE to CMP were used as control methods. The selection of formulas for clinical nutrition at the stage of elimination diet therapy was carried out differentially, depending on the severity of the skin syndrome and gastrointestinal manifestations. The follow-up period was 5 years. Results. Food allergy manifested itself in 34 (34.3%) children only as a skin syndrome (atopic dermatitis), in 65 (65.7%) children as a skin syndrome in combination with gastrointestinal symptoms. In 67.7% of children, the use of therapeutic formulas based on highly hydrolyzed cow's milk protein and amino acids led to the normalization of the level of specific IgE. In mild atopic dermatitis, the average duration of the elimination period was 9.43 ± 2.7 months, in moderate atopic dermatitis, 19.3 ± 9.0 months, and in severe, 35.5 ± 14.8 months (p < 0.05). The number of patients with an exacerbation of an allergic disease with of the introduction of dairy products in mild, moderate and severe form of atopic dermatitis constituted 2 of 7, 6 of 48 (12.5%), 6 of 12 (50.0%) respectively (p < 0.05). Conclusion. In children with atopic dermatitis caused by food allergy to cow's milk proteins, the elimination diet in most cases (67.7%) leads to the normalization of the level of specific IgE, which makes it possible to start expanding the diet by introducing dairy products. The duration of the elimination period depends on the clinical manifestations of the allergic disease and the level of sensitization. When expanding the diet, patients should be provided with careful clinical and laboratory monitoring, including the determination of specific IgE to CMP. The high probability of persistent sensitization to CMP must be taken into account when prescribing elimination measures and drawing up rehabilitation programs for children with allergic diseases.