title: Does providing written dietary advice improve the ingestion of non-allergic nuts in children with existing nut allergies? - A randomized controlled trial.
abstract: Allergy to one or more nuts is common in children and often complete nut avoidance is advised. More recently, introduction of non-allergic nuts into the diet is advised by some allergists.
  
  
  
  This study aims to determine whether the provision of additional written dietary advice increases the ingestion of non-allergic nuts by children with nut allergy. Secondary aims include determining which factors facilitate or prevent successful inclusion of non-allergic nuts in the diet, and how inclusion influences quality of life, sensitization and the rate of nut reactions.
  
  
  
  This is a randomized, double-blinded, controlled trial of children with nut allergy who were asked to ingest one or more non-allergic nuts. Participants were 75 children aged 2-16 years (Intervention=36, Control=39), recruited in Adelaide, Australia. Randomized participants were supplied with the intervention (recipe booklet and monthly reminder text messages) or provided standard verbal dietary advice. After 6 months participants were assessed by a blinded investigator with regard to nut ingestion, quality of life, sensitization and nut reactions.
  
  
  
  The intervention did not increase the ingestion of non-allergic nuts. A negative hospital challenge was a predictor of successful introduction. Parental report of child concern about a reaction was the greatest barrier. Ingestion of non-allergic nuts did not improve quality of life or change nut sensitization. Few nut reactions occurred during the study.
  
  
  
  Ingestion of non-allergic nuts by children with nut allergy was not improved by additional dietary intervention. Selective introduction of non-allergic nuts is difficult to achieve when the child is anxious about introduction and challenges cannot be done in a medically supervised setting.
  
  
  
  This dietary intervention did not improve non-allergic nut ingestion by nut allergic children. Hospital challenge increased introduction rates, whilst parentally reported child concern about a reaction reduced success. Non-allergic nut ingestion did not change quality of life or sensitization.
authors.affiliation: Department of Paediatric Allergy and Immunology, Women's and Children's Health Network, Adelaide, SA, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Norman
authors.affiliation: Department of Nutrition and Food Services, Women's and Children's Health Network, Adelaide, SA, Australia.
authors.forename: C
authors.initials: C
authors.lastname: South
authors.affiliation: Department of Paediatric Allergy and Immunology, Women's and Children's Health Network, Adelaide, SA, Australia.|Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Quinn
authors.affiliation: Department of Paediatric Allergy and Immunology, Women's and Children's Health Network, Adelaide, SA, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Chan
authors.affiliation: Department of Paediatric Allergy and Immunology, Women's and Children's Health Network, Adelaide, SA, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Palmer
authors.affiliation: Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia.|Child Nutrition Research Centre, South Australian Health and Medical Research Institute Adelaide, SA, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Netting
authors.affiliation: Department of Paediatric Allergy and Immunology, Women's and Children's Health Network, Adelaide, SA, Australia.|Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Gold
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000276:immunology*; D001315:Australia; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003376:Counseling / Q000379:methods; D004032:Diet; D005260:Female; D006801:Humans; D008297:Male; D021184:Nut Hypersensitivity / Q000175:diagnosis / Q000276:immunology* / Q000517:prevention & control*; D009754:Nuts / Q000009:adverse effects*; D011788:Quality of Life; D012307:Risk Factors; D063189:Symptom Assessment
chemical_list: D000485:Allergens
keywords: child; diet; food allergy; non-allergic; nut; parental burden; quality of life