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A nomogram for predicting food allergy in infants with feeding problems and malnutrition
Fan Yang1, Chunyan Zhou2, Luanluan Li1
1Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
A nomogram was developed to predict food allergy in infants with feeding problems. This tool helps identify infants needing further diagnosis for potential food allergies.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Diagnostics
- Nutritional Science
Background:
- Idiopathic feeding problems and malnutrition are common in infants.
- Oral food challenges (OFC) are not routinely feasible for all infants.
- Accurate diagnosis of food allergy is crucial for infant health.
Purpose of the Study:
- To construct a predictive nomogram for identifying food allergy in infants with idiopathic feeding problems and malnutrition.
- To provide a practical tool for clinicians to assess food allergy risk.
- To improve diagnostic efficiency in pediatric populations.
Main Methods:
- A cohort of 289 infants with idiopathic feeding problems and malnutrition was studied.
- Food allergy was diagnosed via skin prick tests or OFC and symptom improvement after food avoidance.
- Multivariable logistic regression was used to identify predictive factors for nomogram development.
Main Results:
- Food allergy was prevalent in 86.2% of the studied infants.
- Key predictors identified included feeding pattern, family history of allergy, Cow's Milk-related Symptom Scores (CoMiSS), and eosinophil percentage.
- The nomogram demonstrated good predictive performance with an AUC of 0.868.
Conclusions:
- Food allergy is a significant concern in infants presenting with idiopathic feeding problems and malnutrition.
- The developed nomogram serves as a valuable tool for early identification of food allergy.
- This nomogram can aid clinicians in prioritizing infants for further diagnostic evaluation.
Background And Objective:
As oral food challenge (OFC) cannot be performed routinely in the general outpatient, this study aimed to construct a nomogram to predict the odds of food allergy in infants with idiopathic feeding problems and malnutrition.
Methods:
From August 2018 to December 2021, 289 infants (median age, 6 months; P25-P75, 4-8) with idiopathic feeding problems and malnutrition were enrolled from seven hospitals in Shanghai, China. Food allergy was defined as a positive response to a skin prick test or OFC, with gastrointestinal, dermatologic, or respiratory symptom improvement after 4 weeks of avoidance of the suspected food. Demographic characteristics, Cow's Milk-related Symptom Scores (CoMiSS), and blood eosinophil amounts were evaluated for their associations with food allergy. Multivariable logistic regression analysis was used to identify variables to develop a nomogram model with the bootstrapped-concordance index as an assessment metric.
Results:
Totally 249 of 289 infants had food allergy (86.2%). After logistic regression analysis, the feeding pattern (odds ratio [OR] = 5.28, 95% confidence interval [CI]: 2.13-13.09), a family history of allergy (OR = 1.79, 95% CI: 0.71-4.51), CoMiSS (OR = 1.45, 95% CI: 1.19-1.77), and eosinophil percentage (OR = 1.33, 95% CI: 1.11-1.60) were used to develop the model, which had a good performance with an area under the curve of 0.868 (95% CI: 0.792-0.944) and a bootstrapped-concordance index of 0.868.
Conclusion:
Food allergy is common in infants with idiopathic feeding problems and malnutrition. The developed nomogram may help identify infants with food allergy for further diagnosis.
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