Date of Award

Spring 5-1-2023

Document Type



College of Arts and Sciences

Degree Program

Human Nutrition

Degree Name

Master of Science

Thesis Advisor

Hope Lima, Ph.D.

Committee Member

Ashley Licata, Ph.D.

Committee Member

Jessie Hoffman, Ph.D.


Non-IgE-Mediated Allergies, Maternal Elimination Diets, Cow's Milk Allergy, Food Protein-Induced Allergic Proctocolitis

Committee Member

Raquel Durban, M.S.


Background: Non-IgE (immunoglobulin E)-mediated food allergies (FA) present diagnostic and management challenges despite guidelines due to knowledge gaps amongst clinicians. Given that 60% of food protein-induced allergic proctocolitis (FPIAP) cases occur in breast-fed infants, maternal elimination diets are routinely prescribed to manage allergy symptoms. The implications of maternal dietary eliminations extend beyond maternal nutrition to consideration of infant nutrition and feeding skill acquisition.

Methods: A survey-based retrospective, cross-sectional study sought to identify dietary triggers and symptom management techniques practiced by (n=59) lactating mothers of infants with confirmed and suspected cases of non-IgE FA in the United States. Statistical significance was set at p <0.05 and correlations were performed using SPSS statistical software version 29.0.

Results: Cow’s milk followed by soy represented the most common dietary antigens at 96.6% and 22.0% respectively of those surveyed. Of these, 88% reported maternal elimination of cow’s milk and 35.6% reported elimination of milk and soy. Only 14.3% of respondents received a referral to a dietitian. Among infants with confirmed or suspected non-IgE FA (n=59), 72.9% (n=43) continued breastfeeding during maternal elimination, 13.5% (n=8) transitioned to a hypoallergenic formula, and the other 5.1% (n=3) were fed a combination of breast milk and formula. The predominant symptoms reported were abdominal pain (59.3%), feeding difficulties (59.3%), and colic (50.8%). Conclusion: Based on the number of lactating mothers practicing cow’s milk avoidance, there are nutritional concerns for mothers and infants experiencing non-IgE FA. Dietitians can play a crucial role in supporting the breastfeeding mother through dietary eliminations for the management of non-IgE FA in their infant.

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