Reduced Final Height and Inadequate Nutritional Intake in Cow's Milk-Allergic Young Adults.

BACKGROUND: Growth impairment was previously described in milk-allergic children but was not examined in adults on reaching final height. OBJECTIVES: To investigate the dietary intake and final stature of young adults with IgE-mediated cow's milk allergy (IgE-CMA) as compared with nonallergic controls. METHODS: Eighty-seven patients with IgE-CMA, median age 19.5 years (interquartile range [IQR], 17.3-22.7), and 36 control participants without food allergies, median age 22.7 years (IQR, 18.9-26.1), were studied. Anthropometric and nutritional data were collected. Age and gender z-scores were determined according to the Centers for Disease Control and Prevention growth charts. Nutrient intake assessment was based on dietary records. Individuals with conditions or treatments affecting bone metabolism or growth, other than asthma, were excluded. RESULTS: Mean values of height z-scores were significantly reduced in CMA subjects compared with controls (-0.64 ± 0.9 vs -0.04 ± 0.7, P = .001). In contrast, no differences were found between the 2 groups in weight and body mass index z-scores. Patients with CMA had significantly lower intake of protein, and several essential vitamins (A, B12, and riboflavin) and minerals (calcium, potassium, phosphorus, magnesium, and zinc) compared with controls (P < .05), but the intakes of calories, carbohydrate, and fat were not significantly different between the 2 groups. Differences between actual and expected (based on midparental height) height z-scores were comparable in CMA subjects with or without asthma and between those with and without additional food allergies. CONCLUSIONS: Young adults who have CMA from infancy are at risk of not reaching their growth potential. Growth and nutritional monitoring and appropriate dietary intervention are of particular importance in these at-risk individuals.

Decreased bone mineral density in young adult IgE-mediated cow's milk-allergic patients.

BACKGROUND: IgE-mediated cow's milk-allergic (IgE-CMA) patients provide a valuable model for studying the relationship between dairy intake and bone mineral density (BMD) because they are unable to consume even minor amounts of dairy foods. OBJECTIVE: To determine the effects of dairy restriction on BMD in young adult IgE-CMA patients. METHODS: A prospective observational study was conducted from July 2012 to June 2013 at the Allergy unit of the Assaf-Harofeh Medical Center. Densitometric measurements of postpubertal patients diagnosed with IgE-CMA (group I, n = 33) were compared with those of volunteers matched for age and sex without IgE-CMA (control group II, n = 24). In a second analysis, group I and II patients were compared with IgE-CMA patients who after desensitization consumed milk for 12 to 39 months before analysis (group III, n = 12). RESULTS: Densitometric measurements (average T scores and Z scores) of the hip, femoral neck, and lumbar spine of IgE-CMA patients were significantly lower than of those in the control group (P < .0001). A T score below -2.5 SD, identifying a risk for osteoporosis, was found in 27% of IgE-CMA patients but in none of the controls (P = .0071). Calcium intake was severely reduced in allergic patients than in controls (P < .0001). BMD measurements in group III were significantly greater than in group I (P < .0001) and unchanged from the control group. CONCLUSIONS: Patients with IgE-CMA have a significant risk of reduced BMD and early osteoporosis, which appears to be reversible on milk desensitization. Adequate calcium intake is not achieved while on a nondairy diet, requiring investigation into optimal nutritional protocols for these patients.