A nomogram for predicting food allergy in infants with feeding problems and malnutrition

Abstract Background and Objective As oral food challenge (OFC) cannot be performed routinely in the general outpatient, this study aimed to construct a nomogram to predict the odds of food allergy in infants with idiopathic feeding problems and malnutrition. Methods From August 2018 to December 2021, 289 infants (median age, 6 months; P25–P75, 4–8) with idiopathic feeding problems and malnutrition were enrolled from seven hospitals in Shanghai, China. Food allergy was defined as a positive response to a skin prick test or OFC, with gastrointestinal, dermatologic, or respiratory symptom improvement after 4 weeks of avoidance of the suspected food. Demographic characteristics, Cow's Milk‐related Symptom Scores (CoMiSS), and blood eosinophil amounts were evaluated for their associations with food allergy. Multivariable logistic regression analysis was used to identify variables to develop a nomogram model with the bootstrapped‐concordance index as an assessment metric. Results Totally 249 of 289 infants had food allergy (86.2%). After logistic regression analysis, the feeding pattern (odds ratio [OR] = 5.28, 95% confidence interval [CI]: 2.13–13.09), a family history of allergy (OR = 1.79, 95% CI: 0.71–4.51), CoMiSS (OR = 1.45, 95% CI: 1.19–1.77), and eosinophil percentage (OR = 1.33, 95% CI: 1.11–1.60) were used to develop the model, which had a good performance with an area under the curve of 0.868 (95% CI: 0.792–0.944) and a bootstrapped‐concordance index of 0.868. Conclusion Food allergy is common in infants with idiopathic feeding problems and malnutrition. The developed nomogram may help identify infants with food allergy for further diagnosis.