Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Allergy Unit

Student research

The role of food intolerance in gastrointestinal symptoms in children

A retrospective survey

Ugur Murat
Master of Science (Nutrition and Dietetics), University of Wollongong
Supervisors: Anne Swain, Robert Loblay, Velencia Soutter
June 1998

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From 1995 to 1998, 750 children aged 3-12 years were seen at the Royal Prince Alfred Hospital (RPAH) Allergy Unit, for the investigation of suspected food allergy and/or intolerance. Of these, 223 children presented with gastrointestinal symptoms. The aims of this project were (1) to document the occurrence of food intolerances in this subgroup, (2) to determine the long-term outcome of dietary modification, and (3) to determine the nutritional adequacy of the diet after appropriate modification.

Clinical data on these 223 children was collected from the medical and dietetic notes at the RPAH Allergy Unit. Parents were sent a Follow Up Questionnaire and a Conner's Rating Scale for Parents on behalf of their child, to obtain information regarding the long term outcome of the Simplified Elimination Diet (SED), dietary modification and any changes in their child's symptoms. Ten volunteers were sent a Food Frequency Questionnaire to assess nutritional adequacy of dietary management of such children. All data was entered into a computerized database for analysis.

At presentation and on challenge the most common gastrointestinal symptoms were diarrhoea and abdominal pain, and the most common associated symptoms were hyperactivity, eczema and headaches. Eighty-three percent of respondents found that their gastrointestinal symptoms improved significantly when their diets were modified. Of these, 56% achieved this by dietary modification based on formal challenge testing, and 27% by a self modified diet based on information and advice received at the clinic. Dietary modification significantly improved behaviour and physical symptoms. Salicylates, amines, milk, wheat and additives were the common triggers and therefore the most restricted. Children on modified diets maintained their growth velocity but can have inadequate intake of vitamin A without supplementation. Dietary calcium intakes did not meet Recommended Daily Intake in those with milk exclusion without supplementation

Gastrointestinal symptoms were found to be associated with intolerance to salicylates, milk, wheat and amines. The SED protocol was a useful tool for the investigation of food intolerance in children, however many parents preferred to modify their child's diet empirically, based on the information received at the clinic, rather than going through the formal elimination and challenge protocol. Dietary modification requires monitoring by a dietitian to ensure adequate nutrition.