title: A practical approach to vitamin and mineral supplementation in food allergic children.
abstract: BACKGROUND
  The management of food allergy in children requires elimination of the offending allergens, which significantly contribute to micronutrient intake. Vitamin and mineral supplementation are commonly suggested as part of dietary management. However a targeted supplementation regime requires a complete nutritional assessment, which includes food diaries. Ideally these should be analysed using a computerised program, but are very time consuming. We therefore set out to evaluate current practice of vitamin and mineral supplementation in a cohort of children with non-Immunoglobulin E (IgE) mediated food allergies.
  
  
  METHODS
  This prospective, observational study recruited children aged 4 weeks - 16 years, who required to follow an elimination diet for non-IgE mediated allergies. Only children that improved according to a symptom score and were on a vitamin and/or mineral supplement were included. A 3-day food diary including vitamin and mineral supplementation was recorded and analysed using Dietplan computer program. We assessed dietary adequacy with/without the supplement using the Dietary Reference Values.
  
  
  RESULTS
  One hundred-and-ten children had completed food diaries and of these 29% (32/110) were taking vitamin and/or mineral supplements. Children on hypoallergenic formulas were significantly (p = 0.007) less likely to be on supplements than those on alternative over-the-counter milks. Seventy-one percent had prescribable supplements, suggested by a dietitian/physician. Sixty percent of those without a vitamin supplement had a low vitamin D intake, but low zinc, calcium and selenium was also common. Of the supplemented cohort many continued to be either under or over-supplemented.
  
  
  CONCLUSIONS
  This study has raised the question for the first time, whether clinicians dealing with paediatric food allergies should consider routine vitamin and/or mineral supplements in the light of deficient intake being so common in addition to being so difficult to predict.
authors.affiliation: Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK.
authors.forename: Rosan
authors.initials: R
authors.lastname: Meyer
authors.affiliation: Department Nutrition and Dietetics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: De Koker
authors.affiliation: Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Dziubak
authors.affiliation: Department Nutrition and Dietetics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Ana-Kristina
authors.initials: AK
authors.lastname: Skrapac
authors.affiliation: Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Godwin
authors.affiliation: Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Reeve
authors.affiliation: Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK.
authors.forename: Adriana
authors.initials: A
authors.lastname: Chebar-Lozinsky
authors.affiliation: Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK ; Institute of Child Health, University College London, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Shah
keywords: Dietary adequacy; Elimination diet; Food diary; Non-IgE mediated allergy; Vitamin and mineral supplementation