Experiences and attitudes of parents of children with cow’s milk and other food-allergy

Main Article Content

Tuba Karakurt
Hayrunnisa Bekis Bozkurt
Fatih Kaplan
Anıl Akşit
Özlem Cavkaytar
Erdem Topal
Mustafa Arga

Keywords

food allergy, parents experience, cow’s milk protein, hypoallergenic formula

Abstract

Introduction and objective: The attitude and behaviors of parents are important in the management of children with food allergy (FA). The aim of this study is to evaluate the experiences and attitudes of parents of children with allergy to cow’s milk and other FA.


Materials and methods: The parents of children with FA were asked to complete an 18-item questionnaire to evaluate the FA history and experiences during diagnosis, treatment, and follow up.


Results: The data from 558 (91.2%) survey questionnaire that were filled completely were analyzed. The mean age of the parents was 33.4+4.9. It was found that most common food allergen was cow’s milk (85.3%). The mean time to diagnosis from the onset of symptoms was 10.9±18.4 months. Around 229 parents (41.6%) admitted to at least four different physicians and 68 (12.3%) parents admitted to at least five different physicians before diagnosis. The median time to diagnosis from the onset of symptoms was five (1-108) months in the patients admitted to four or more physicians, but it was one (1-48) month in the patients that admitted to less physicians (p˂0.001). The most common symptoms were dermatitis and mucus-bloody stool, the least common ones were cardiovascular symptoms. Only 21.1% of the patients were able to use hypoallergenic formulas (HAF) in accordance with the recommendation of the physician.


Conclusions: Delayed diagnosis of FA is a major concern, and during this period the patients admit many physicians. A majority of the patients with CMPA experience difficulties while using HAFs, and only one-fifth of them is able to use formula regularly.

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References

1. Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141(1):41-58. 10.1016/j.jaci.2017.11.003

2. Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128:e9–17. 10.1542/peds.2011-0204

3. Rudders SA, Banerji A, Clark S, Camargo CA Jr. Age-related differences in the clinical presentation of food-induced anaphylaxis. J Pediatr 2011;158:326-8. 10.1016/j.jpeds.2010.10.017

4. Kahveci M, Koken G, Şahiner ÜM, Soyer Ö, Şekerel BE. Immunoglobulin E-mediated food allergies differ in east mediterranean children aged 0-2 years. Int Arch Allergy Immunol. 2020;181(5):365-74. 10.1159/000505996

5. Meyer R, De Koker C, Dziubak R, Godwin H, Dominguez-Ortega G, Lozinsky AC et al. The impact of the elimination diet on growth and nutrient intake in children with food protein induced gastrointestinal allergies. Clin Transl Allergy. 2016;6:25. 10.1186/s13601-016-0115-x

6. Meyer R, Wright K, Vieira MC, Chong KW, Chatchatee P, Vlieg-Boerstra BJ, et al. International survey on growth indices and impacting factors in children with food allergies. J Hum Nutr Diet. 2019;32(2):175-84. 10.1111/jhn.12610

7. Mousan G, Kamat D. Cow's Milk Protein Allergy. Clin Pediatr (Phila). 2016;55(11):1054-63. 10.1177/0009922816664512

8. Prescott S, Allen KJ. Food allergy: riding the second wave of the allergy epidemic. Pediatr Allergy Immunol. 2011;22 (2):155-60. 10.1111/j.1399-3038.2011.01145.x

9. Warren CM, Jiang J, Gupta RS. Epidemiology and burden of food allergy. Curr Allergy Asthma Rep. 2020;20(2):6. 10.1007/s11882-020-0898-7

10. Fiocchi A, Brozek J, Schünemann H, et al. World Allergy Organization (WAO) Special Committee on Food Allergy. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. Pediatr Allergy Immunol. 2010;21(21):1-125. 10.1111/j.1399-3038.2010.01068.x

11. Ebisawa M, Ito K, Fujisawa T. Committee for Japanese Pediatric Guideline for Food Allergy, The Japanese Society of Pediatric Allergy and Clinical Immunology, The Japanese Society of Allergology. Japanese guidelines for food allergy 2017. Allergol Int. 2017;66(2):248-64. 10.1016/j.alit.2017.02.001

12. Fox A, Brown T, Walsh J, Venter C, Meyer R, Nowak-Wegrzyn A, et al. An update to the milk allergy in primary care guideline. Clin Transl Allergy. 2019;9:40. 10.1186/s13601-019-0281-8

13. Altuntaş DU, Büyüktiryaki B, Ayvaz D, Babayiğit Hocaoğlu A, Bingöl A, Bingöl G et al. Food Allergy: Turkish National Guideline 2017. Asthma Allergy Immunol. 2017;15:1-140, (Supplement 1). 10.21911/aai.2017.1

14. Aydoğan M, Topal E, Uysal P, et al. Proven food-induced acute urticaria and predictive factors for definitive diagnosis in childhood. Int Arch Allergy Immunol. 2021;18:1-8. 10.1159/000513267

15. Ngamphaiboon J, Chatchatee P, Thongkaew T. Cow's milk allergy in Thai children. Asian Pac J Allergy Immunol. 2008; 26(4):199-204.

16. Ludman S, Harmon M, Whiting D, du Toit G. Clinical presentation and referral characteristics of food protein-induced enterocolitis syndrome in the United Kingdom. Ann Allergy Asthma Immunol. 2014;113(3):290-4. 10.1016/j.anai.2014.06.020

17. Azzano P, Villard Truc F, Collardeau-Frachon S, Lachaux A. Children with eosinophilic esophagitis in real life: 10 years' experience with a focus on allergic management. Allergol Immunopathol (Madr). 2020;48(3):244-50. 10.1016/j.aller.2019.07.013

18. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI Food Allergy and Anaphylaxis Guidelines Group. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69(8):1008-25. 10.1111/all.12429

19. Ruffner MA, Wang KY, Dudley JW, Cianferoni A, Grundmeier RW, Spergel JM, et al. Elevated atopic comorbidity in patients with food protein-induced enterocolitis. J Allergy Clin Immunol Pract. 2020;8(3):1039-46. 10.1016/j.jaip.2019.10.047

20. Meyer R, Fox AT, Chebar Lozinsky A, Michaelis LJ, Shah N. Non-IgE-mediated gastrointestinal allergies-Do they have a place in a new model of the Allergic March. Pediatr Allergy Immunol. 2019;30(2):149-58. 10.1111/pai.13000

21. Devdas JM, Mckie C, Fox AT, Ratageri VH. Food allergy in children: An Overview. Indian J Pediatr. 2018;85(5):369-74. 10.1007/s12098-017-2535-6

22. Doğruel D, Bingöl G, Altıntaş DU, Yılmaz M, Güneşer Kendirli S. Clinical features of food allergy during the 1st year of life: The ADAPAR birth cohort study. Int Arch Allergy Immunol. 2016;169(3):171-80. 10.1159/000444639

23. Kahveci M, Akarsu A, Koken G, Sahiner UM, Soyer O, Sekerel BE. Food-induced anaphylaxis in infants, as compared to toddlers and preschool children in Turkey. Pediatr Allergy Immunol. 2020;31(8):954-61. 10.1111/pai.13320

24. Cetinkaya PG, Ocak M, Sahiner UM, Sekerel BE, Soyer O. Food protein-induced allergic proctocolitis may have distinct phenotypes. Ann Allergy Asthma Immunol. 2021;126(1):75-82. 10.1016/j.anai.2020.08.021

25. Grenov B, Michaelsen KF. Growth Components of cow's milk: emphasis on effects in undernourished children. Food Nutr Bull. 2018;39(2): S45-S53. 10.1177/0379572118772766

26. Meyer R, Groetch M, Venter C. When should infants with cow's milk protein allergy use an amino acid formula? A practical guide. J Allergy Clin Immunol Pract. 2018;6(2):383-99. 10.1016/j.jaip.2017.09.003