Effects of Oral Immunotherapy on the Growth Trajectories of Food-Allergic Children.

Abstract

Background: Children with IgE-mediated food allergies, particularly milk, are at risk for hampered growth. Limited data are available regarding the benefit of oral immunotherapy (OIT) on growth outcomes.

Objective: To evaluate the impact of OIT on growth metrics in this population.

Methods: We retrospectively analyzed data from patients (aged 4-15 [females] and 4-16.5 [males] years) who successfully completed OIT. Pre- and post-OIT height-for-age and weight-for-age z-scores (HAZ and WAZ, respectively) were calculated using World Health Organization standards.

Results: Patients (n = 458, mean age 8.0 ± 2.7 years) successfully treated for tree nut (33.4%), peanut (29.7%), milk (17.2%), sesame (14.6%), and egg (4.8%) allergy were analyzed. Baseline mean HAZ -0.19 ± 1.05 improved to -0.10 ± 1.05 (P < .001) after OIT (median duration, 19.4 months). This was positively correlated with the mean change in WAZ (r = 0.44, P < .001). Milk-allergic patients had lower baseline HAZ than non-milk-allergic patients (-0.45 ± 0.91 vs -0.14 ± 1.07, P = .016). Patients beginning OIT before age 6 had the greatest HAZ improvement (0.16 ± 0.42), whereas those starting after age 12 experienced a decrease (-0.11 ± 0.49). In 113 patients with a median 34-month follow-up, HAZ improved by 0.30 ± 0.73 (P < .001). This effect was not observed at long-term follow-up in a group of patients who did not achieve successful OIT (n = 21). Using a linear regression model, significant predictors of follow-up HAZ were younger age at baseline (B = -0.09, 95% confidence interval [CI] [-0.15, -0.03], P = .002) and lower baseline HAZ (B = 0.83, 95% CI [0.69, 0.97], P < .001).

Conclusions: OIT may enhance long-term growth in allergic children, especially in younger patients and those with a lower baseline HAZ. Effects on their final stature remain to be determined.