PREVENTION PROGRAMS - A DIETETIC MINEFIELD

Food allergy and intolerance (FAI) is undoubtedly a controversial subj ect surrounded by a great deal of publicity. One of the most confusing issues arises when considering the value of allergy prevention progra mmes. Although prevention strategies have now been extensively studied the results are still inconclusive. In childhood, atopic disorders eg asthma, eczema, dermatitis, urticaria, rhinitis and gastrointestinal related symptoms are relatively common with estimates of their prevale nce ranging from two to 20 per cent (Mallet & Henocq, 1992), In additi on, the proportion of young children with allergies seems to be increa sing, although the extent to which food allergens contribute remains u nclear (Hide, 1991; Croner, 1992; DoH, 1994). In many of these cases, prevention of unpleasant, socially and psychologically disruptive and sometimes life threatening symptoms can be achieved by dietary modific ation. If atopic and gastrointestinal symptoms can be prevented growth failure may not be a problem, children may miss less schooling, and i f long term prevention is achieved there may be a substantial reductio n in the cost of medical care these children would otherwise require. Before prevention programmes are introduced, however, careful thought should be given to the implications of dietary treatment. The programm es are difficult to administrate in terms of both resources and expens e. Specifically, from a nutritional point of view, the diets employed are often socially disruptive which inevitably leads to problems with compliance. Nutritional adequacy may also be difficult to achieve unle ss there is close supervision by a dietitian who is experienced in the management of the complex dietary manipulations involved. Unfortunate ly the dietetic resources essential for the safety of the programmes m ay be lacking in many hospitals. Preventative practice may be aimed at either the general population or at specially identified group who ar e considered to be at a greater risk of developing atopic disorders. D ietary intervention studies looking at prevention in this 'at risk' gr oup have considered maternal dietary modification during pregnancy and lactation, the use of soya and hydrolysed protein feeds and the weani ng diet. The nutritional consequences of these methods of dietary mani pulation will be discussed in more detail.