PURPOSE OF THE STUDY.
To examine the effects of food avoidance on the growth of children with food allergies.
A retrospective chart review was performed for children with and without food allergies followed at 2 New York City general pediatric practices. The practices differed by the primary type of insurance accepted without overlap, state insurance versus commercial insurance.
Charts were selected on the basis of codes from the International Classification of Diseases, 9th Revision, for well-child visit, food allergy, anaphylaxis, and/or epinephrine autoinjector prescriptions. Heights and weights were obtained to calculate BMI, height, and weight z scores.
Of the 9938 children seen, 439 (4.4%) were avoiding ≥1 foods. Of those with commercial insurance, children with food allergies were significantly shorter (mean height z score = 0.06; P = .01) and weighed less (mean weight z score −0.1; P = .006) than children without food allergies (mean height z score = 0.42; mean weight z score = 0.07). In contrast, children with food allergies and state insurance were not smaller in height or weight compared with children without food allergies. Among white subjects, there was a significant effect of food allergies on height and weight (analysis of variance for height P = .012, for weight P = .0036) that was not observed for Hispanic/Latino, black, or Asian subjects. Children with allergies to milk weighed significantly less than children without milk allergies (P = .0006).
Children with food allergies and commercial insurance have significant impairment in growth compared with those without food allergies. Additionally, children avoiding all forms of milk are shorter and weigh less than matched counterparts. Therefore, height and weight measurements should be assessed routinely in children with food allergies because there is risk for growth impairment in this population.
There were 2 interesting observations in this investigation, which apparently is the largest population of children to be studied for growth impairment as the result of avoidance diets for food allergy. First, although a difference in growth between children with and without food allergies was not seen in the overall population, patients with food allergies and commercial insurance compared with state insurance were found to be shorter and weigh less than patients without food allergies. I do not know how to completely explain this finding. Second, and as has been reported previously, children who were avoiding all forms of cow’s milk were significantly shorter and weighed less compared with healthy control children. As acknowledged by the authors, major limitations of this investigation included the following: (1) its retrospective design, (2) the reliance on physician diagnosis of food allergy without the use of specific IgE testing to foods (eg, prick skin test and/or serum IgE), and (3) no oral food challenges were performed to confirm the diagnosis. I think the real take-home message here should be that physicians caring for children with food allergies should be aware of the risk of growth impairment (ie, height and weight) from specific eliminations diets, and appropriate nutritional counseling should be provided to the families of these children to help prevent and avoid nutritional deficiencies.
- Copyright © 2015 by the American Academy of Pediatrics