Extensively hydrolyzed casein formulas and partially hydrolyzed whey formulas are appropriate alternatives to breast milk for allergy prevention in infants at risk. Because atopic disease in children cannot be predicted, the use of these formulas in the general population should be considered, and one must weigh cost, compliance, and long-term benefits.
When caring for patients with severe, multiple food allergies, special considerations are necessary for achieving the best quality of care. The most important consideration is to confirm all food allergies so that the patient does not unnecessarily restrict foods. Retest or challenge any foods with a questionable diagnosis. Second, because strict allergen avoidance remains the appropriate treatment for food allergy, provide the patient and family with adequate education about allergen avoidance and include plans for reintroduction of foods during follow-up care. Following a strict allergen avoidance diet often places the patient at nutrition risk. Another consideration includes conducting a complete nutrition assessment and monitoring for nutrient deficiencies on an ongoing basis. Food substitutions and hypoallergenic formulas and supplements are often required to meet the patient's needs. Last, consider evaluating medication ingredients as causes of persistent symptoms in extremely sensitive food allergic patients. Including the above considerations will result in food allergic patients enjoying the safest variety of foods and reaching their full growth potential.
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