Food allergy associated with lung function deficits, asthma at age 6 years
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Key takeaways:
- Food allergy at age 1 year was independently associated with reduced FEV1 and with asthma at age 6 years.
- Children who avoid food due to allergy may benefit from seeing a dietician.
Infants with a food allergy experience a greater risk for deficits in lung function and for asthma at age 6 years, according to a study published in The Lancet Child & Adolescent Health.
These findings indicate that food allergy may be an important factor in the atopic march of childhood, Rachel L. Peters, PhD, associate professor, Murdoch Children’s Research Institute, and colleagues wrote.
“At the Murdoch Children’s Research Institute, we’ve been following 5,000 children since they were babies as part of the HealthNuts study to understand what causes infant food allergy and how it impacts their health as they grow up,” Peters told Healio.
Previous research has indicated a link between food allergy and asthma, sometimes called the atopic or allergic march, where infants with early allergies such as food allergy or eczema develop other allergies such as asthma and hay fever later in childhood, Peters continued.
“We are the first study to show an association between infant food allergy and later lung function and found that infants with food allergy had reduced lung function at 6 years of age,” Peters said.
“This relationship was independent of the association between food allergy and asthma, suggesting that the relationship between infant food allergy and reduced lung function was driven by pathways other than asthma,” she continued.
Study design, results
The current study included 3,233 children (51.4% boys) who participated in skin prick tests for egg, peanut, sesame and either shrimp or cow’s milk as well as an oral food challenge for egg, peanut and sesame at age 1 year.
At age 6 years, these children participated in SPTs for 10 different foods and eight aeroallergens in addition to OFCs and lung function testing via spirometry.
Food allergy at age 1 year was associated with reduced FEV1 (adjusted B = –0.19; 95% CI, –0.32 to –0.06) and forced vital capacity (FVC; aB = –0.17; 95% CI, –0.31 to –0.04) at age 6 years.
Compared with children who never had egg allergy, children with transient egg allergy also had reduced FEV1 (aB = –0.18; 95% CI, –0.33 to –0.03) and FVC (aB = –0.15; 95% CI, –0.31 to 0). But persistent egg allergy, the researchers noted, was not associated with reductions in FEV1 or FVC.
Reductions in FEV1 also were associated with transient (aB = –0.37; 95% CI, –0.79-0.04), persistent (aB = –0.3; 95% CI, –0.54 to –0.06) and late-onset (aB = –0.62; 95% CI, –0.6 to –0.18) peanut allergy.
Similarly, reductions in FVC were associated with transient (aB = –0.55; 95% CI, –0.98 to –0.12), persistent (aB = –0.3; –0.55 to –0.05) and late-onset (aB = –0.49; 95% CI, –0.96 to –0.03) peanut allergy.
Although estimates indicated an association between food-sensitized tolerance and reduced forced expiratory flow at 25% and 75% of pulmonary volume, the researchers said, some of these estimates were imprecise.
Also, the researchers said, there were no associations between FEV1/FVC ratio and any of the food allergy phenotypes, including food-sensitized tolerance or allergy, or ever, transient, persistent or late-onset food allergy.
The researchers additionally noted a possible association between late-onset peanut allergy and increased risk for bronchodilator responsiveness (adjusted OR = 2.95; 95% CI, 0.77-11.38).
Overall, 13.7% of the cohort was diagnosed with asthma before age 6 years (95% CI, 12.5-15). Food-sensitized tolerance at age 1 year was associated with increased risk for asthma at age 6 years (aOR = 1.97; 95% CI, 1.23-3.15), as was food allergy at age 1 year (aOR = 3.69; 95% CI, 2.81-4.85).
Adjusted odds ratios for asthma at age 6 years with food allergy between age 1 and 6 years also included 3.87 (95% CI, 2.39-6.26) for persistent peanut allergy and 5.06 (95% CI, 2.15-11.9) for late-onset peanut allergy, with no evidence for an association between asthma and transient peanut allergy, compared with children who never had a peanut allergy.
Transient egg allergy came with an adjusted odds ratio of 3.29 (95% CI; 2.37-4.56) and persistent egg allergy had an adjusted odds ratio of 5.33 (95% CI, 2.58-11) for asthma at age 6 years compared with children who never had an egg allergy.
Conclusions, next steps
Based on mediation analysis, the researchers said there was little evidence that lung function mediated the association between food allergy and asthma, indicating independent associations between food allergy and asthma and lung function.
“We found that even if babies outgrew their food allergies, they still had a higher risk of asthma and reduced lung function at age 6, compared to children who didn’t have food allergy as a baby,” Peters said.
With these findings, the researchers said, clinicians may be able to tailor individual treatment and exercise greater vigilance in monitoring the respiratory health of children who have food allergies due to their increased risk for adverse outcomes.
For example, Peters noted that lung development is related to children’s height and that children with food allergy may be shorter and lighter than peers who do not have food allergy. The lung function patterns the researchers saw, she continued, may be related to reduced growth.
“Children who are avoiding foods because of their food allergy may benefit from seeing a dietician so that nutrition can be catered to encourage healthy growth,” Peters said, adding that the similar immune mechanisms involved in the development of both food allergy and asthma likely explains this link.
The researchers also called for further research into the biological pathways behind these associations as well as into their potential modifiers.
“We are continuing to follow up with children in this study into adolescence to understand the impact that food allergy has on children’s health, including respiratory health, growth and mental health as they grow up,” Peters said.
“More research is needed to understand the mechanisms underlying these findings and to understand whether preventing food allergies can help prevent childhood asthma,” she said.
For more information:
Rachel L. Peters, PhD, can be reached at rachel.peters@mcri.edu.au.
Perspective
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These findings are significant but not surprising because they underscore what we already know about allergic conditions going hand in hand with one another. There is a progression of allergies early in life known as the allergic march that describes the progression from eczema early in life to food allergies and then asthma or hay fever.
We know that having one allergic condition early in life predisposes you to others. Therefore, the association between food allergy and lower lung function is also not surprising, as many of our food-allergic patients do develop asthma.
These findings also are very comparable with my day-to-day experience. Very rarely do I see a child with one isolated condition such as food allergy vs. asthma vs. eczema vs. allergic rhinitis. Children often will present with multiple findings, and they will continue to develop and evolve throughout life.
Doctors should be aware of these associations and have a lower threshold of screening for these associated conditions. For example, if a child with food allergy comes in coughing and wheezing, a doctor should be aggressive and prompt in diagnosis and treatment of potential asthma or reactive airway disease.
Next, research should strive to further sub-classify other factors or genes that may contribute to children with food allergies developing lung disorders vs. those who do not go on to develop lung disorders.
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