Does providing written dietary advice improve the ingestion of non‐allergic nuts in children with existing nut allergies? – A randomized controlled trial. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Norman, M.; South, C.; Quinn, P.; Chan, D.; Palmer, S.; Netting, M.; Gold, M.
• Is Part Of: Clinical & experimental allergy. Volume 46:Issue 5(2016:May)
• Page Start: 741
• Page End: 748
• Publication Date: 2016-05
• Subjects: child -- diet -- food allergy -- non‐allergic -- nut -- parental burden -- quality of life; Allergy -- Periodicals; Immunology -- Periodicals; 616.97
• DOI: 10.1111/cea.12720
• Languages: English
• ISSNs: 0954-7894

Abstract

Summary: Background: Allergy to one or more nuts is common in children and often complete nut avoidance is advised. More recently, introduction of non‐allergic nuts into the diet is advised by some allergists. Objective: This study aims to determine whether the provision of additional written dietary advice increases the ingestion of non‐allergic nuts by children with nut allergy. Secondary aims include determining which factors facilitate or prevent successful inclusion of non‐allergic nuts in the diet, and how inclusion influences quality of life, sensitization and the rate of nut reactions. Methods: This is a randomized, double‐blinded, controlled trial of children with nut allergy who were asked to ingest one or more non‐allergic nuts. Participants were 75 children aged 2–16 years (Intervention=36, Control=39), recruited in Adelaide, Australia. Randomized participants were supplied with the intervention (recipe booklet and monthly reminder text messages) or provided standard verbal dietary advice. After 6 months participants were assessed by a blinded investigator with regard to nut ingestion, quality of life, sensitization and nut reactions. Results: The intervention did not increase the ingestion of non‐allergic nuts. A negative hospital challenge was a predictor of successful introduction. Parental report of child concern about a reaction was the greatest barrier. Ingestion of non‐allergic nuts did not improve quality of life or change nut sensitization. Few nut reactions occurred during the study. Conclusions and Clinical Relevance: Ingestion of non‐allergic nuts by children with nut allergy was not improved by additional dietary intervention. Selective introduction of non‐allergic nuts is difficult to achieve when the child is anxious about introduction and challenges cannot be done in a medically supervised setting. Capsule Summary: This dietary intervention did not improve non‐allergic nut ingestion by nut allergic children. Hospital challenge increased introduction rates, whilst parentally reported child concern about a reaction reduced success. Non‐allergic nut ingestion did not change quality of life or sensitization.