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Cows’ milk allergy (CMA) requires a strict exclusion diet, usually for the first year of life. This exclusion of a main food group occurs at a critical time in the development of food preferences and eating habits. It is known that infants are born with an innate predisposition to prefer sweet tastes and reject bitter and sour tastes. However, these innate preferences can be altered with exposure to (and exclusion of) different foods. The usual natural history of CMA therefore provides an opportunity to explore the effect of dietary exclusion in infancy on later eating habits.

For this study, Maslin et al. 1 collected data from 28 children who had consumed a cows’ milk exclusion diet during infancy and compared them to 73 control children. The study population were from two birth cohorts, meaning prospective infant feeding data were available. Children in the exclusion group had significantly higher levels of avoidant eating behaviour and a lower preference for dairy products than the control group, several years after cows’ milk had been reintroduced. The number of foods excluded and symptoms were associated with higher levels of avoidant eating behaviour.

This research has identified some novel findings, which have implications for health professionals working in food allergy and childhood nutrition. While adhering to an exclusion diet is essential for symptomatic relief in the management of CMA, it is clear that it can have secondary effects on fussy eating and food preferences that can persist into adolescence. It therefore underlines the importance of ensuring exclusion diets for food allergy are not initiated unnecessarily or implemented for longer than necessary. The diagnosis of CMA needs to be robust, with regular monitoring of exclusion diets.