![]() ![]() Interestingly, casein and gluten molecules are highly linked to mucosal barrier absorption and to digestive flora, and even induce an intestinal hyperpermeability. Gastrointestinal disorders, including food allergy, are widely reported in patients with ASD and different mechanisms may interfere in the gut-brain axis, but one of the commonest pathogenetic factors in ASD and allergic disturbances is the so-called leaky gut (intestinal hyperpermeability). I would emphasize the crucial role of the digestive microbiome and the intestinal hyperpermeability in both conditions (i.e. exploring the association of food allergy and other allergic conditions with autism in a pediatric population. I read with great interest the recent article published in JAMA Network Open by Xu et al. Washington, DC: The National Academies Press 2017.ġ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SwedenĢ Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipegģ Section of Allergy/Immunology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado FindingĪ Path to Safety in Food Allergy: Assessment of Global Burden, Causes, Prevention, Management, and Public Policy. National Academies of Sciences, Engineering, and Medicine. Eating behaviors, diet quality, and gastrointestinal symptoms in children with autism spectrum disorders: a brief review. Kral TV, Eriksen WT, Souders MC, Pinto-Martin JA. Association of food allergy and other allergic conditions with autism spectrum disorder in children. As a result, we question this study’s conclusions until the results can been replicated using a more accurate measure of food allergy.ġ.Xu G, Snetsalaar LG, Jing J. The methodologic limitations of this question and of self-reported food allergy in general are well-documented as poorly representative measures of food allergy prevalence, as noted in the recent National Academies of Sciences, Engineering and Medicine 2016 report.(3) Thus, any associations between food allergy as an outcome determined by this measure and other pediatric health states (including autism) would be flawed. ![]() It would have been interesting to see the annual prevalence for, and associations between autism spectrum disorder and food allergy, particularly as the questions used to capture autism spectrum disorder changed during the course of the study period. Yet, similar results for their own analysis were not presented. Parents may describe these behaviours as “food allergies” but without a clinical diagnosis.(2) Taken in combination with a poorly operationalised outcome, we cannot dismiss the possibility of excess parent-perceived food allergy (which is not necessarily clinical food allergy), and which contributes to serious concerns about differential misclassification of the outcome.įinally, the authors cite several studies that report an increase of both conditions. Moreover, compared to other children, children with autism spectrum disorder often exhibit ‘picky’ food habits, including limited food variety and heightened focus on sensory qualities of food (e.g. Similarly, no consideration was given to testing for food-specific Immunuglobulin E, used to confirm immunologic recognition of the culprit food, epinephrine auto-injector prescription or food allergic reactions as proxies to validate the outcome, or reports of consumption or avoidance of the food(s) to which respondents believe the children are allergic. The authors operationalised food allergy based on parental responses to the question, “During the past 12 months, has your child had any kind of food or digestive allergy?” This parent-reported outcome does not account for healthcare access, parent-diagnosis, or responder misperception of the child’s health experience. ![]() We find Xu et al’s article describing an association between allergic conditions, food allergy in particular, and autism spectrum disorder(1) to be a potentially flawed, as the exposure is based on a single, parent-reported outcome to define food allergy.
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