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Children allergic to cow’s milk smaller and lighter

little girl drinking milk

Children allergic to cow’s milk are smaller and weigh less, according to the first published study to characterize growth trajectories from early childhood to adolescence in children with persistent food allergies.

Children who are allergic to cow’s milk are smaller and weigh less than peers who have allergies to peanuts or tree nuts, and these findings persist into early adolescence. The results from the longitudinal study – believed to be the first to characterize growth patterns from early childhood to adolescence in children with persistent food allergies – was published online in The Journal of Allergy and Clinical Immunology.

“Published data about growth trajectories for kids with ongoing food allergies is scarce,” says Karen A. Robbins, M.D.,* lead study author and an allergist in the Division of Allergy and Immunology at Children’s National Hospital when the study was conducted. “It remains unclear how these growth trends ultimately influence how tall these children will become and how much they’ll weigh as adults. However, our findings align with recent research that suggests young adults with persistent cow’s milk allergy may not reach their full growth potential,” Dr. Robbins says.

According to the Centers for Disease Control and Prevention, 1 in 13 U.S. children has a food allergy with milk, eggs, fish, shellfish, wheat, soy, peanuts and tree nuts accounting for the most serious allergic reactions. Because there is no cure and such allergies can be life-threatening, most people eliminate one or more major allergen from their diets.

The multi-institutional research team reviewed the charts of pediatric patients diagnosed with persistent immunoglobulin E-mediated allergy to cow’s milk, peanuts or tree nuts based on their clinical symptoms, food-specific immunoglobulin levels, skin prick tests and food challenges. To be included in the study, the children had to have at least one clinical visit during three defined time frames from the time they were age 2 to age 12. During those visits, their height and weight had to be measured with complete data from their visit available to the research team. The children allergic to cow’s milk had to eliminate it completely from their diets, even extensively heated milk.

From November 1994 to March 2015, 191 children were enrolled in the study, 111 with cow’s milk allergies and 80 with nut allergies. All told, they had 1,186 clinical visits between the ages of 2 to 12. Sixty-one percent of children with cow’s milk allergies were boys, while 51.3% of children with peanut/tree nut allergies were boys.

In addition to children allergic to cow’s milk being shorter, the height discrepancy was more pronounced by ages 5 to 8 and ages 9 to 12. And, for the 53 teens who had clinical data gathered after age 13, differences in their weight and height were even more notable.

“As these children often have multiple food allergies and other conditions, such as asthma, there are likely factors besides simply avoiding cow’s milk that may contribute to these findings. These children also tend to restrict foods beyond cow’s milk,” she adds.

The way such food allergies are handled continues to evolve with more previously allergic children now introducing cow’s milk via baked goods, a wider selection of allergen-free foods being available, and an improving understanding of the nutritional concerns related to food allergy.

Dr. Robbins cautions that while most children outgrow cow’s milk allergies in early childhood, children who do not may be at risk for growth discrepancies. Future research should focus on improving understanding of this phenomenon.

In addition to Dr. Robbins, the research team includes co-author Robert A. Wood, M.D., and senior author Corinne A. Keet, M.D., Ph.D., both of Johns Hopkins University School of Medicine.

*Dec. 18, 2019 update: After leaving full-time employment at Children’s National Hospital, Dr. Robbins became an AstraZeneca employee, working on immuno-oncology safety.

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Newborns with suspected food allergies breastfed significantly longer

toddler nursing

Mothers whose newborns had suspected food allergies reported breastfeeding them significantly longer than women whose infants had no adverse reactions after food exposure, according to preliminary research led by Karen A. Robbins, M.D., and presented during the American Academy of Allergy, Asthma & Immunology 2019 Annual Meeting.

According to the Centers for Disease Control and Prevention (CDC), food allergies affect 4 to 6 percent of U.S. children, making such allergies a growing public health concern. Researchers are attempting to learn more about the interplay between food allergies and what, when and how children eat to inform allergy-prevention efforts. Little is known about the association between perceived food allergies, intolerance or hypersensitivity among babies eating their first bites of solid food and how long they’re breastfed.

Dr. Robbins and colleagues analyzed data gathered through a longitudinal study led by the Food and Drug Administration (FDA) and the CDC from 2005 to 2007. The Infant Feeding Practices Study II tracked diet and feeding practices of about 2,000 women late in their pregnancies and followed their babies’ diets through the first year of life.

Some 2,586 breastfeeding mothers in the study completed surveys when their infants were 4, 9 and 12 months old. The women were asked whether there were problems caused by food, such as an allergic reaction, sensitivity or intolerance. The majority of these infants (84.6 percent) had no suspected allergic reaction to either food they ate on their own or to food they were exposed to via breastmilk. The mothers reported that nearly 11 percent of infants reacted to something they ate; 2.4 percent reacted to food products they were exposed to via breastmilk; and 2.4 percent reacted to both food they consumed directly or were exposed to via breastfeeding. They also found:

  • Infants with suspected food allergies after exposure to food their mothers ate were breastfed a mean of 45.8 weeks.
  • Infants with food intolerance after both exposure to food their mother consumed and food they ate themselves were breastfed a mean of 40.2 weeks.

That contrasts with infants with no concern for food reactions, who were breastfed a mean of 32 weeks.

“Breastfeeding a newborn for the first few months of life helps their developing immune system become more robust, may affect the microbiome, and could influence or prevent development of allergy later in life,” says Dr. Robbins, an allergist at Children’s National Health System and lead author of the research. “However, mothers’ perceptions of their newborns’ adverse reactions to food appears to factor into how long they breastfeed.”

One potential concern is that extended breastfeeding can impact solid food introduction practices.

“Gradually transitioning to solid food gives infants an opportunity to sample an array of foods, nibble by nibble, including food allergens like peanut and eggs. We know from previously published research that introducing high-risk babies to a food allergen like peanuts early in life appropriately primes their immune system and dramatically decreases how often these children actually develop peanut allergies,” Dr. Robbins adds. “The relationship between breastfeeding and allergy development is complex, so understanding mothers’ practices is important. We also do not know how often these early reactions result in true food allergy, compared with transient food intolerance.”

American Academy of Allergy, Asthma & Immunology 2019 Annual Meeting presentation

  • “Perceived food allergy, sensitivity or intolerance and its impact on breastfeeding practices.”

Monday, Feb. 25, 2019, 9:45-10:45 a.m. (PST)

Karen A. Robbins M.D., lead author; Marni Jacobs, Ph.D., co-author; Ashley Ramos Ph.D., co-author; Daniel V. DiGiacomo, M.D., co-author; Katherine M. Balas BS, co-author; and Linda Herbert, Ph.D., director of Children’s Division of Allergy and Immunology’s psychosocial clinical program and senior author.