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Key takeaways:
- Children with a cow’s milk allergy had lower weight-for-length than children with other allergies.
- Children with multiple food allergies had lower weight-for-length than children with a single allergy.
Children with food protein-induced allergic proctocolitis experienced impaired growth during their first year of life, but this resolves as the disease resolves, according to a study published in Annals of Allergy, Asthma & Immunology.
Meanwhile, children with IgE-mediated food allergy (IgE-FA) experienced impaired growth after age 1 year, Rachael Rosow, BA, clinical research coordinator for pediatric food allergy at Massachusetts General Hospital at the time of the study and now a medical student at Frank H. Netter MD School of Medicine at Quinnipiac University, and colleagues wrote.
By recognizing the impact of food allergies on growth among infants, doctors can create interventions to maintain nutrition. Source: Adobe Stock
The 804 children followed from birth through age 2 years in the study included 134 (17%) who developed food protein-induced allergic proctocolitis (FPIAP), 50 (6%) who developed an IgE-FA and 15 (2%) who developed both.
The children with an IgE-FA included 32 (64%) who developed an allergy to one food, nine (18%) with a cow’s milk allergy and 18 (36%) with multiple food allergies and an average of 2.2 food allergens.
There were no significant differences in weight-for-length (WFL) between the children with FPIAP and unaffected controls between birth and age 2 years.
Between age 2 months and age 9 months, however, WFL was significantly lower among the children with FPIAP compared with the healthy controls (main effect: P = .007; disease-time interaction: P = .029).
This decrease in WFL among the children with FPIAP between age 2 months and age 9 months improved dramatically after age 1 year, the researchers said, when the disease typically resolves.
The children with IgE-FA experienced a trend toward lower WFL over time during their first 2 years compared with children who did not have an IgE-FA, the researchers continued, but the disease-time interaction between birth and age 2 years was not significant .
Noting that the median age of diagnosis of a first IgE-FA among these children was 11 months (interquartile range, 10-13 months), the researchers said the children with IgE-FA and the healthy children did not have any significant differences in WFL .
At approximately age 4 to 6 months, the WFL curves for the children with and without IgE-FA appeared to begin to diverge, the researchers said. Then between age 1 year and age 2 years, the children with IgE-FA trended toward lower WFL overall with a significantly lower WFL over time compared with the healthy controls (disease-time interaction: P = .001).
The children diagnosed with both FPIAP and IgE-FA did not show any differences in growth compared with the healthy controls, the researchers continued.
The nine children with a cow’s milk allergy had significantly lower WFL between birth and age 2 years compared with the healthy controls (disease-time interaction: P = .019), most prominently at age 2 to 12 months and after age 18 months, the researchers said.
The children with other IgE-FA outside of cow’s milk allergy had no significant differences in WFL compared with the healthy controls, the researchers said.
Also compared with the healthy controls, the researchers said that the children with multiple IgE-FAs had markedly lower WFL over time (disease-time interaction: P < .001), appearing to begin at approximately age 6 to 9 months with worsening over time .
Children with a single IgE-FA experienced a trend in lower growth between birth and age 2 years compared with the healthy controls as well, most particularly among children aged younger than 1 year (disease-time interaction effect: P = .049).
The groups of children with single and multiple IgE-FAs also both demonstrated significantly decreased WFL over time between age 1 year and age 2 years compared with the healthy controls (multiple disease-time interaction: P = .029; single IgE-FA disease- time interaction: P = .016).
Overall, the researchers concluded that the greatest decreases in growth occurred among children with FPIAP during their first year, with resolution as the disease resolves, and later among children with IgE-FA, corresponding with the onset of their allergy.
By improving recognition of the risks that food allergies may have in growth deficiency, the researchers said, clinicians can optimize nutrition and plan appropriate interventions for these populations to improve outcomes.
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Aikaterini (Katherine) Anagnostou, MD (Hons), MSc, PhD
This is an interesting study examining growth over time in an infant cohort of healthy controls and infants who develop IgE-mediated and non-IgE-mediated food allergies.
The observation that children with FPIAP had transiently delayed weight gain during active disease, whereas children with any IgE-mediated food allergy had a lower WFL after 1 year of age, is not unexpected, but it is certainly valuable in terms of the need and timing for intervention to mitigate the effects of the disease.
The finding that children with multiple food allergies had a significantly lower WFL over time compared with healthy controls also is not unexpected. Both allergic inflammation and many dietary limitations are likely responsible for the poor growth observed in these children.
A multi-disciplinary approach to food allergy management is required to address the needs of food-allergic children, and the role of a dietician is key. The study is limited by a small patient sample. Larger population samples, including diverse populations from a variety of settings, are required to validate these findings and further explore growth in food allergy.
Aikaterini (Katherine) Anagnostou, MD (Hons), MSc, PhD
Professor of Pediatrics, Division of Immunology, Allergy and Retrovirology, Baylor College of Medicine
Director, Food Immunotherapy Program and Food Challenge Program; Co-director, Food Allergy Program; and Lead for Adolescent Transition for Allergy at Texas Children’s Hospital
Vice Chair, American College of Allergy, Asthma & Immunology Food Allergy Committee
Disclosures: Anagnostou reports serving as a researcher for Aimmune Therapeutics, a consultant for ALK and an advisor for DBV Technologies.
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