Food allergies in children are on the increase and the growing skeleton can be severely affected if there is inadequate supervision and assessment. Simple tools put into every day practice can help prevent bone and teeth problems in growing children with food allergies.
Food allergy in childhood is on the rise globally and is managed by omitting that particular food from the child’s diet. Peanuts, eggs, wheat and milk products in particular are common allergy triggers in children. A child with a food allergy is not only at risk of symptoms including eczema, asthma, itchy eyes or stomach upsets, bone health can suffer too. A holistic approach is warranted in order to prevent bone and teeth problems in this particular group of patients. To ensure a balanced diet and hence a normal growth, these children require regular supervision. However, there are recent cases where rickets has been diagnosed in this setting.
Children with food allergies avoid the food items that trigger their symptoms. To ensure a balanced diet and hence a normal growth, these children require regular supervision. However, there have been recent cases where rickets has been diagnosed in this setting. This disorder is characterized by the softening of bones, as a result of low calcium and/or vitamin D intake and minimal sun exposure. It leads to poor growth, bone deformities (e.g. bow legs, knock knees) and pain, and it also affects the teeth.
Risk factors predisposing to rickets in children with food allergies are: cow’s milk allergy or multiple food allergies (three or more food items), severe allergic symptoms, (e.g. difficult to control eczema or asthma) and coexistence of chronic conditions that are known to affect bone health, e.g. celiac disease, endocrinopathies, etc.
In a review that looks at bone health assessment of food allergic children published in the Journal of Pediatric Endocrinology and Metabolism, the authors show that a thorough history and clinical examination is usually all that is needed in order to identify the food allergic children are at risk of. This can be followed by routine laboratory investigations, which can help to set a diagnosis and proper supplementation to correct the nutritional deficiencies. An even smaller group of high-risk food-allergic patients, might also need measurement of bone mass with a special imaging technique (DXA scan) and more sophisticated blood and urine tests (metabolic bone markers), which are used mostly in research at present.
This category of food allergic children includes those with many fractures but no preceding serious trauma or with positive family history of early osteoporosis (< 50 years in men, before menopause in women) or with severe malnutrition (BMI<3rd centile).
In conclusion, by employing simple methods, it is possible to identify food allergic children at risk of poor skeletal health. As nutritional rickets is entirely preventable, it should not be overlooked. This is made possible through close dietary supervision and prompt supplementation with calcium and/or vitamin D, if symptoms are indicated.
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