Veganism and paediatric food allergy: two increasingly prevalent dietary issues that are challenging when co-occurring

Abstract

Vegan dietsdefined as the exclusion of all foods of animal origin from the diet-are becoming popular. In recent years, the prevalence of food allergy has also increased, and disproportionately affects children. When vegan diets and food allergy co-occur, this combination can be challenging and pose risks of nutritional deficiencies, particularly during childhood. In this paper, we aim to summarise the major concerns regarding vegan diets and food allergy, review the literature on this topic, and provide some suggestions for healthcare providers, particularly dietitians and nutritionists, who work with food allergic, vegan patients and their family. When working with this patient population, a regular and complete medical nutrition history, including screening for any possible nutritional deficiencies, is warranted. Likewise, the routine tracking of serum markers (especially iodine, iron, zinc, calcium, Vitamins B12, D, B2, and A, selected n-3 fatty acids and protein, which are more abundant in animal vs. plant foods) and symptoms of co-morbid diseases, including asthma, is important, as comorbid diseases may increase energy and nutrient requirements. For infants and children, anthropometry ought to be tracked longitudinally at regular intervals to identify any deviations from the child's previous growth pattern, and to accommodate any increased requirements for growth and development. Correct diagnoses, education and allergy management must be disseminated to the family in a clear and appropriate manner. Children with allergy may have increased nutritional needs due to comorbidity. This is complicated by coincident food allergy and vegan diet as both impose diet restrictions (limiting sources of important nutrients, need for dietary variety and/or increased consumption due to reduced bioavaliability).

The Risk of Undeclared Allergens on Food Labels for Pediatric Patients in the European Union

“…On the other hand, vegan patterns have globally risen during the last several years, including in FA pediatric patients [31,32]. Among the different motivations of plant-based dieters, the aversion to animal products due to moral and ethical reasons is highlighted [33].…”

“…The management of food allergies and dietary avoidance presents several challenges for pediatric dietitians and other healthcare providers [43]. Health professionals who assess FA patients should include nutrition therapy to ensure the adequate intake of nutrients as well as nutritional education with comprehensive information about allergenic ingredients for their avoidance [31,44]. The American Academy of Pediatrics established as a critical issue the improving of the education and training of all stakeholders for recognizing and managing, as well as preventing, allergic reactions.…”

A Pilot Study to Evaluate the Dietary Intake of Adults Attending a Food Allergy Clinic, and Compare the Results Against the Final Diagnostic Outcome

“…There was a correlation between the number of foods excluded and the number of people with nutrient intakes below the reference range, but only for the group with no FA (Spearman r = 0.5074, p = 0.064). The challenge of ensuring dietary and nutritional needs are met in those with food allergy is exacerbated by increased exclusion of foods due to lifestyle choices such as vegetarianism and veganism ( 13 ). In the cohort studied, 9/29 (31%) were avoiding meat, two of whom were also avoiding fish.…”

“…However, many will also be avoiding multiple foods due to suspected or actual food intolerance, such as those diagnosed with Pollen Food Syndrome (PFS) or Oral Allergy Syndrome. The nutritional status of adults with food allergy or intolerance could be further compromised if those individuals are following a vegetarian or vegan lifestyle, as diets may be low in vitamin B12, vitamin D, zinc, calcium and iron ( 13 ). A study on the nutritional profile of children and adults with a milk allergy reported that there were nutritional deficiencies, especially if more than one food was being avoided ( 14 ).…”

Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects

“…Probably due to processed foods, industrial preparation procedures, pollution, and the introduction of food additives, FAs have seen a steady increase, particularly in developed countries [6][7][8][9][10][11][12][13]. As risk factors for food allergies, we also mention genetic predisposition, which is proven by the fact that FA is more common in people with atopy.…”