Factitious food allergy and failure to thrive

To examine the relationship between parental beliefs about factitious food allergies and failure to thrive in their children.

Retrospective case review.

Tertiary care referral center in Denver, Colo.

A consecutive sample of more than 700 patients referred for evaluation of food allergies was screened for age; negative results to double-blind, placebo-controlled food challenges; and failure to thrive.

After identifying two probands, we identified nine additional children with failure to thrive in the context of parents' beliefs in allergic reactions to multiple foods. The results of puncture skin tests conducted for foods suspected of causing allergic reactions were negative for seven (64%) of the 11 children. There were no allergic reactions to open challenges (ie, children, staff, and parents knew which food was being tested). Only two patients reacted during double-blind, placebo-controlled food challenges. One reacted to milk (one of 14 suspected foods) and the other reacted to eggs and milk (two of 15 suspected foods).

Parental beliefs about food allergies can lead to dietary restrictions severe enough to cause failure to thrive in their children. Because of the wide-spread belief by parents that children are allergic to food, pediatricians are frequently faced with the question of whether to subject children to food restrictions. Their collaboration with unsubstantiated parental beliefs can have long-term, deleterious consequences.