Food-Allergic Toddlers at Risk of Over-Restriction and Lower Diet Diversity

A new cross-sectional study from Poland is shedding light on how food allergies in toddlers can unintentionally lead to overly restrictive diets, even when those restrictions may not be clinically necessary. The research, published in Nutrients, found that children aged 13 to 36 months with food allergies had significantly lower diet diversity than their healthy peers, despite showing similar rates of undernutrition and feeding difficulties.

The study surveyed 388 children from urban nurseries, primarily in Warsaw and Olsztyn. Sixteen percent of the toddlers had physician-confirmed food allergies, but only about one-third had their diagnoses verified with an oral food challenge (OFC)—the gold standard for confirming food allergies. Most diagnoses were based on skin or blood tests, or clinical history, raising concerns about potential overdiagnosis and subsequent over-restriction.

Children with food allergies were found to consume fewer food groups overall and had a significantly lower intake of potentially allergenic foods such as cow’s milk, eggs, peanuts, tree nuts, and sesame. Yet, few of the children had confirmed allergies to these latter items. According to the study authors, this pattern suggests that parental caution—possibly driven by misinformation or lack of professional dietary guidance—may be limiting the children's dietary exposures more than necessary.

The differences in dietary exposure were statistically significant. Children with food allergies had lower median scores across several measures, including food group diversity, food item diversity, and allergen diversity. For example, only 72% of children with food allergies had been introduced to five or more common food allergens, compared to 85% in the control group. This matters, the authors argue, because early and diverse dietary exposure is linked to reduced allergy risk later in life.

While feeding difficulties were similarly prevalent in both groups (18% in the allergy group vs. 13.5% in the control group), the study raised concerns about inappropriate feeding practices among parents of food-allergic children. Nearly half of the allergic children consumed plant-based milk alternatives, such as oat or almond drinks. Yet, only about 40% of these beverages were fortified with calcium, which could pose long-term risks for bone health if not addressed.

Another area of concern was the lack of professional support. Most parents had not consulted a dietitian, even though dietary management of food allergy often requires careful planning to avoid nutrient gaps and ensure safe, timely reintroduction of allergens. Food ladders—stepwise reintroduction protocols for milk and egg—were underutilized or incompletely followed. Less than half of the children with cow’s milk or egg allergies had achieved tolerance to baked forms of these foods.

Despite the lower diet diversity, children with food allergies did not show higher rates of underweight or stunting, and the proportion of children with high weight-for-age was similar between groups. However, the authors caution that these findings might not hold in lower-income populations, as the study sample skewed toward higher socioeconomic status and was limited to large urban centers.

The authors concluded that while elimination diets are essential in confirmed cases of food allergy, overly cautious approaches—particularly without robust diagnostic confirmation or professional guidance—may carry unintended nutritional consequences. They advocate for wider access to dietetic counseling and improved implementation of reintroduction strategies.