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

Abstract

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