Allergy to cow's milk negatively impacts pediatric weight, height

Karen A. Robbins

Children who experience a persistent allergy to cow’s milk are more likely to have a lower weight and height than children with peanut and tree nut allergies, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology.

“We have an incomplete understanding of the impact of food allergies on childhood growth patterns, but an emerging body of evidence suggests that some children with food allergy are at risk for decreased growth,” Karen A. Robbins, MD, pediatric allergist and immunologist at Children’s National Health System, told Infectious Diseases in Children. “Not all children with food allergies are small, so it is important to better understand what may explain the growth differences.”

“Children with cow’s milk allergy appeared to be at increased risk [of lower weight and height],” she continued. “However, it is possible that children with other food allergies could also be affected, especially if they have multiple food allergies and restrict many foods.”

To assess longitudinal data available on children who experience persistent cow’s milk, peanut or tree nut allergy, the researchers conducted a retrospective chart review for 191 children who were strictly avoiding cow’s milk (n = 111) and peanuts or tree nuts (n = 80) because of an IgE-mediated allergy. All children had visited a clinic at least once within specific age ranges, including 2 to 4 years, 5 to 8 years and 9 to 12 years.

Robbins and colleagues also analyzed differences in height, weight and BMI z scores using generalized estimating equation regression models. Data were collected from 1,098 clinic visits.

When compared with children with peanut and tree nut allergies, the researchers observed that children who had an allergy to cow’s milk weighed less (mean z difference: 0.39; 95% CI, 0.13-0.66) and were shorter (mean z difference: 0.39; 95% CI, 0.11-0.67) for their age; however, BMIs for children with cow’s milk allergy were not lower for their age.

The difference in weight was most evident when children did not experience other atopic conditions, early-onset eczema or use inhaled corticosteroids and were between the ages of 5 and 8 years (mean z difference: 0.43; 95% CI, 0.13-0.73) and in children between the ages of 9 and 12 years (mean z difference: 0.52; 95% CI, 0.21-0.84). These factors and age groups did not affect height.

Furthermore, children who had continuing cow’s milk allergy were likely to have a more significant decline of weight and BMI z scores between the ages of 2 and 4 years (weight: mean z difference, 0.25; 95% CI, 0.06-0.43; P = .008; BMI: mean z difference, 0.34; 95% CI, 0.09-.59).

“It is important to pay increased attention to the growth and nutrition of children with food allergy, especially those with cow’s milk allergy,” Robbins said. “While pediatricians are skilled at addressing these topics, early involvement of a registered dietician also can be helpful in ensuring that appropriate dietary guidance and food replacements are communicated.”

“However, one should consider that multiple factors could negatively impact a child’s growth,” she continued. “The differences that we see could be a combination of factors that go beyond nutritional intake like concurrent eczema, asthma and other food avoidances.” – by Katherine Bortz

Reference:

Robbins KA, et al. Abstract 477. Presented at: American Academy of Allergy, Asthma & Immunology Annual Meeting; March 2-5, 2017; Orlando.

Disclosure: Infectious Diseases in Children was unable to confirm relevant financial disclosures prior to publication.