No associations between the number of food allergies and overall diet quality, adequacy, or balance emerged from a study of children published in the Journal of Allergy and Clinical Immunology. 

Led by Supinda Bunyavanich, MD, MPhil, MPH, a professor of allergy and systems biology and deputy director of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York City, the study found that the number of food allergies positively correlated with dietary alterations and negatively correlated with dietary variety. 

“Food allergy affects 8% of US children, and about a third of food-allergic children have more than one food allergy. These children have to alter their diets to avoid their allergens, so this changes their nutrition,” Bunyavanich told Medscape Medical News. “We were interested in studying how the number of food allergies that a child has affects diet quality.”

Her group hypothesized that a higher number of food allergies would be associated with poorer diet quality. “But we found that while children with more food allergies are less likely to have a highly varied diet, they do well at moderating their intake of foods that are high in fats, cholesterol, sodium, and other dietary components linked to poor health,” she said. 

While low diet quality has been associated with chronic disease in children, Bunyavanich and colleagues found the overall diet quality in children with multiple allergies reassuring. “They do well at choosing healthier alternatives, but our findings suggest that they could still benefit from counseling to increase the variety of foods they eat.” 

Dietary Assessment

The study looked at 195 pediatric patients aged 2-19, recruited from Mount Sinai Health System clinics from 2017 to 2024. Participants had 0-9 food allergies and completed food-frequency questionnaires along with their parents, who generally supervise the diets of younger children.

The study evaluated diet quality using the varied metrics of the Diet Quality Index-International (DQI-I) to nutritionally profile participants. The DQI-I measures dietary variety (eating one serving from each food group per day); moderation (eating fewer foods associated with disease such as those high in fats, cholesterol, or sodium); adequacy (meeting Recommended Daily Allowances of foods and nutrients); and balance (healthy ratios between macronutrients and fatty acids).

“We liked this model because it’s designed to compensate for non-Western diets, for instance treating beans as a calcium source,” Bunyavanich said.

The mean age in the cohort was 7.4 years, 49.7% were female, and 53% were White. Of the 195 participants, 117 (60%) were food allergic with a mean of 1.7 allergies. 

Specific allergies included the following foods: tree nuts (n = 85; 43.6%), peanut (n = 78; 40.0%), egg (n = 29; 14.9%), milk (n = 26; 13.3%), sesame (n = 44; 22.6%), fish (n = 11; 5.6%), shellfish (n = 15; 7.7%), wheat (n = 7; 3.6%), legumes (n = 6; 3.1%), soy (n = 5; 2.6%), and other (n = 21; 10.8%)

Covariate-adjusted models controlling for age, race, sex, and socioeconomic status found the number of food allergies was negatively associated with dietary variety (beta coefficient = -0.51; P = .036) and positively associated with dietary moderation (beta coefficient = 0.22; P = .002). There were no associations between number of food allergies and overall diet quality.

Offering a nonparticipant’s perspective on the study, Sara Anvari, MD, an associate professor in the Department of Pediatrics, Division of Allergy and Immunology, at Baylor College of Medicine/Texas Children’s Hospital in Houston, called the findings reassuring for families managing multiple food allergies. “Despite increased dietary restrictions, children generally maintain adequate nutrition and avoid excessive intake of harmful foods,” she told Medscape Medical News. 

Anvari added that, historically, nutritional adequacy has been a concern for food-allergic children, particularly those with multiple allergies. Since this study shows that “with appropriate guidance and careful food selection, most children achieve adequate nutrition. The focus should now shift toward strategies that safely expand dietary variety.”

To that end, Bunyavanich stressed the importance of helping food-allergic children and their families understand food choices and diet. “Navigating dietary choices can be tricky, but it’s possible to learn strategies for a high-quality diet that supports growth and nutrition.” 

This study was funded by the Icahn School of Medicine at Mount Sinai. The authors had no conflicts of interest to declare. Anvari reported research support from the National Institutes of Health/National Institute of Allergy and Infectious Disease, Regeneron, AstraZeneca, and DBV Technologies. She has served as a consultant for DBV Technologies, Genentech, and Food Allergy Research & Education. She serves in non-compensated roles as vice chair of the Adverse Reaction to Drug, Biologic, and Vaccines Committee, co-chair of the Non-IgE-Mediated Food Allergy Subcommittee of the American Academy of Allergy, Asthma and Immunology, and as a medical advisory board member for the International FPIES Association.