Pre-Teen Growth May Be Affected by Cow's Milk Allergy

Persistent cow's milk allergy may negatively impact height, weight, and BMI through adolescence.

Corinne A. Keet, MD, PhD, MS

Longitudinal study data has revealed that persistent cow’s milk allergy may have a negative impact on the growth of children through the course of pre-adolescence.

Conducted by Karen A. Robbins, MD; Robert A. Wood, MD; and Corinne A. Keet, MD, PhD, MS, the team of investigators from Johns Hopkins University School of Medicine in Baltimore, Maryland, sought to collect data on the influence of allergy on growth, as the available data are limited—most are from cross-sectional studies in early childhood. They utilized a cohort of 191 children that were strictly avoiding consumption and exposure of cow’s milk (n = 111) and peanut/tree nuts (n = 80) due to Immunoglobulin E (IgE)-deliberated allergy.

All the patients in the study underwent at least 1 clinic visit between the ages of 2—4 years, 5–8 years, and 9–12 years, totaling to 1098 clinic visits. Robbins and colleagues also recorded and analyzed differences in height, weight, and body mass index (BMI)-z scores with generalized estimating equation regression models.

“Correspondingly, persistent milk allergy was associated with a greater decline in weight and also BMI from the baseline visit when the children were 2 to 4 years-old,” Keet said in a statement. “From our findings, this negative trend in growth appears to continue through pre-adolescence.”

Results showed that the group with cow’s milk allergy had a lower average weight (mean z-difference, 0.39; 95% CI, 0.13—0.66; P = .004) and height (mean z-difference, 0.39; 95% CI, 0.11—0.67; P = .006). Although, there was no significant difference for BMI-for-age (P = .11) z-scores when compared to their peanut/tree nut allergic counterparts.

The largest differences recorded for weight were within the 5- to 8-year-old range (mean z-difference, 0.43; 95% CI, 0.13—0.73; P =.004) and the 9- to 12-year-old range (mean z-difference, 0.52; 95% CI, 0.21—0.84; P = .001). Those same age groups did not observe a larger difference for height, however (P <.05 for interaction with age).

Incidence of persistent cow’s milk allergy was also found to be associated with a greater decline in weight (mean z-difference, 0.25; 95% CI, 0.06—0.43; P = .008) as well as BMI (mean z-difference, 0.34; 95% CI, 0.09–0.59; P = .007) z scores from baseline at 2—4 years of age.

Keet noted that height, weight, and BMI differences were persistent and more prominent for those patients with data from age 13 and older. Height and weight were unaffected by other atopic conditions, early-onset eczema, and inhaled corticosteroid use.

“Further study is needed to better understand the complex relationship between food allergy and childhood growth patterns,” Keet said. “Pediatricians and allergists need to work with their patients to ensure a diet that promotes healthy growth while acknowledging nutritional limitations due to allergy.”

The results of the study were presented at the 2018 American Academy of Allergy, Asthma, and Immunology/World Allergy Organization Joint Congress in Orlando, Florida.

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