Study population
The study population was collected from three Pediatric allergy (Koc University, Mersin City Hospital, Bakirkoy Dr. Sadi Konuk Research and Training Hospital) and one Pediatric Gastroenterology (Koc University Pediatric Gastroenterology) centers from Turkey. The study population consisted of breastfeeding mothers who were on an elimination diet due to a diagnosis of FA in their children aged 1-to-12 months. The breast-feeding mothers presented to the study centers who were willing to participate in the study were included, consecutively. Food allergy was classified as IgE-mediated (IgE), non-IgE-mediated (Non-IgE) and mixed (both IgE- and non-IgE-mediated FA) FA. The diagnosis of IgE-mediated FA was established according to the following criteria: 1. A consistent and clear-cut history of FA-related symptoms that developed within minutes to hours following the ingestion of food, 2. Positive serum levels of sIgE (> 0.35 kUA/L) for the specific food, 3. Positive skin prick test (SPT) for the specific food (a wheal diameter of 3 mm or greater than the negative control).The diagnosis of non-IgE mediated FA was established according to the following criteria: 1. The presence of blood in the stool after in otherwise healthy infants and the disappearance of blood with the elimination of the suspected food(s) from maternal diet within 1 week, 2. The presence of isolated gastrointestinal symptoms, such as repetitive-to-profuse emesis and vomiting with diarrhea, which can lead to dehydration, lethargy, hypotension, or shock, 1–3 hours after the ingestion of the suspected food or with persistence of these symptoms for 2 weeks without any other cause and also with resolution of symptoms after the removal of the causative food(s) from the diet, with a recurrence of symptoms when reintroducing the causative food(s).The mothers on dietary elimination whose infants had a diagnosis of FA according to the criteria specified above were called as FA.
The mothers following an elimination diet with the thought of FA in their children despite the absence of diagnostic criteria and laboratory findings consistent with FA in their children were called as “Indecisive symptoms for food allergy”. The considerations regarded as Indecisive symptoms for food allergy were as follows: 1. Mucous but no blood in stool, 2. Colic, sleep problems, irritability but no vomiting, diarrhea, loss of weight and percentiles for height & weight were in normal range and gain of weight were within normal limits.
The control group involved breastfeeding mothers of healthy children at the same age range having no allergic, chronic or systemic disease who were admitted to well-child care outpatient clinic at the study centers. This group was called as “Healthy” or “Healthy controls” throughout the study. The Koc University Ethics Committee approved the study and written informed consent were obtained from all participants.