Department of Paediatrics, Imperial College, London, UK.
Pediatr Allergy Immunol. 2018 Nov;29(7):689-704. doi: 10.1111/pai.12960.
The elimination of food allergens that contribute essential nutrients in paediatrics may lead to the development of nutritional disorders. The most common nutritional disorders include poor growth, micronutrient deficiencies and feeding difficulties. Of the aforementioned, growth faltering has been well studied and is seen as a common presenting factor in paediatric food allergy. However, the use of different criteria and cut-off values makes it difficult to establish the overall effect. The impact of number and type of foods eliminated and comorbidities has yielded varying results, although there seems to be a trend towards worsening growth with atopic dermatitis and the avoidance of cow's milk. Low micronutrient intake is common in paediatric food allergy; however, a low intake does not necessarily translate into a deficiency as measured by biomarkers. Vitamin D and calcium have been well studied, and a long-lasting impact on bone mineral density has been found. However, other micronutrient deficiencies have also been found and should also be considered. Feeding difficulties is a common complaint in clinical practice, but limited data have been published in food allergy. Poor growth and reflux/vomiting have been shown to be associated with feeding difficulties, in particular in non-IgE-mediated food allergies. There seems to be a long-lasting effect on feeding, in particular in cow's milk allergy, which needs to be taken into account with dietary input. The interplay between growth, feeding difficulties and micronutrient deficiencies has been implied in some studies, but cause and effect is not well established and requires further research.
在儿科消除提供必需营养的食物过敏原可能导致营养障碍的发生。最常见的营养障碍包括生长不良、微量营养素缺乏和喂养困难。在上述所有问题中，生长迟缓已经得到了充分的研究，并且被视为儿科食物过敏的常见表现因素。然而，由于使用了不同的标准和截止值，因此很难确定整体效果。消除食物的数量和种类以及并存疾病的影响产生了不同的结果，尽管似乎存在特应性皮炎和避免牛奶时生长恶化的趋势。儿科食物过敏中普遍存在微量营养素摄入不足的情况；然而，由于生物标志物测量，低摄入量不一定转化为缺乏。维生素 D 和钙已经得到了充分的研究，并且发现它们对骨矿物质密度有持久的影响。然而，也发现了其他微量营养素缺乏，也应该考虑到这些缺乏。喂养困难是临床实践中的常见问题，但在食物过敏中发表的相关数据有限。生长不良和反流/呕吐已被证明与喂养困难有关，特别是在非 IgE 介导的食物过敏中。似乎对喂养有持久的影响，特别是在牛奶过敏中，这需要在饮食摄入方面加以考虑。在一些研究中已经暗示了生长、喂养困难和微量营养素缺乏之间的相互作用，但因果关系尚未得到很好的确立，需要进一步研究。
