Dietary counselling of children with food allergy

Abstract

Background: The management of food allergy is challenging for children and their families. Several international guidelines recommend involving dietitians in the management; however, their tasks remain uncertain, and the effectiveness of dietary counselling has rarely been investigated. Therefore, the aim of this project was to evaluate the effectiveness of dietary counselling in children with food allergy regarding food allergy related quality of life (QoL), number of allergic reactions, and growth as indicator of nutritional status and diet diversity.

Methods: The project was guided by the Complex Intervention Model by the Medical Research Council. To reach the overall aim there needed to be a common understanding of how to counsel this patient group. Therefore, the first step was to develop a practice guideline for dietary counselling in collaboration with dietitians and other stakeholders. Furthermore, a valid instrument to measure QoL was required. For this purpose, a previously validated English questionnaire, the Food Allergy Quality of Life Questionnaire – Parent Form (FAQLQ-PF), was translated into German, adapted culturally, and validated. For the final evaluation study, a multi-centre non-randomised controlled study was conducted, in which children with food allergies were followed up from diagnosis over one year, comparing children who received dietary counselling (intervention) with those that did not (control). Outcomes were measured at baseline, after three, six and twelve months, with online questionnaires. In this thesis, only six months data is presented due to delay in recruitment and consequent follow up data collection.

Results: Results of this project include the practice guideline consisting of 25 recommendations for dietitians based on the Nutrition Care Process. A further result is a validated German version of the FAQLQ-PF. In the comparative study, 48 children were included, 29 with counselling and 19 without counselling. The most important finding was that children without counselling had a 2.65-fold higher risk of experiencing an allergic reaction in the first three months after diagnosis (Incident Rate Ratio=2.65 (unadjusted model), 95% CI: 1.12; 6.25. p = 0.026). The only other outcomes to differ were the number of allergic reactions after three and six months in the model adjusted to age, sex, and multiple food allergies. However, the median number of consultations with the dietitian was two and the guideline was incompletely implemented by the dietitians, thus, the full impact of dietary counselling may not be evident.

Conclusion: This data suggests that dietary counselling is an important element of the routine management of children with food allergy because it has the potential to reduce allergic reactions. Further evidence needs to underpin this preliminary finding and cost-effectiveness needs to be evaluated. The German version of the FAQLQ-PF tool was successfully used to assess QoL in this study (acceptable to participants and feasible in the study context) but lack sensitivity at already high QoL. The implementation of the practice guideline developed in this project needs to be further evaluated, and reasons for the failure to fully implement it into the work of dietitians identified.