Impact of food allergy on the growth of children with moderate-severe atopic dermatitis

Abstract

Summary Children with moderate-severe atopic dermatitis and food allergy (especially milk) exhibit reduced weight and height, while those with atopic dermatitis alone are often overweight or obese, and their body mass index correlates with eczema severity.

International survey on growth indices and impacting factors in children with food allergies

“…Brazil had the lowest BMI Z ‐score at −0.71, which was lower than the median BMI Z ‐score of 0.52 (0.44–0.61) taken from a household food insecurity study of Brazilian children aged <60 months in 2012 . For Spain, which had the lowest WH, there are no recent data available on the population prevalence of childhood undernutrition; however, all of the children from Spain had non‐IgE mediated or mixed IgE and non‐IgE mediated allergies, with cow's milk being the primary allergen, which may explain the lower growth parameters . Holland had the lowest HA, which was an unexpected finding, where stunting is documented only in 0.06% of cases .…”

The clinical and mechanistic intersection of primary atopic disorders and inborn errors of growth and metabolism

“…Expanding our field‐of‐view from cellular pathways to the level of the human organism, there is evidence to suggest that allergic diseases in general may be associated with altered metabolism. A number of allergic diseases including airway disease, atopic dermatitis, and food allergy have all been associated with impaired growth and delayed physical development during childhood . It is difficult to deconvolute the extrinsic effects of altered dietary intake, systemic corticosteroids, or other therapies that may negatively impact growth and development from inherent abnormalities.…”

“…A number of allergic diseases including airway disease, atopic dermatitis, and food allergy have all been associated with impaired growth and delayed physical development during childhood. [12][13][14] It is difficult to deconvolute the extrinsic effects of altered dietary intake, systemic corticosteroids, or other therapies that may negatively impact growth and development from inherent abnormalities. However, the few studies that have examined corticosteroid naive patients, or carefully controlled for dietary intake, have confirmed this clinical association and suggested that cell-or organism-intrinsic mechanisms may contribute to the observed association.…”

“…Likewise, patients presenting with parasitic infections that evoke strong Th2 responses often display disproportionate reductions in predicted height and weight relative to the estimated metabolic demands of their disease burden; a response that may actually be beneficial rather than pathogenic to the host in a number of disease processes . Furthermore, a number of allergic diseases also have been associated with reduced height and body mass …”

“…11 Furthermore, a number of allergic diseases also have been associated with reduced height and body mass. [12][13][14] The discovery of several monogenic diseases that result in discrete metabolic lesions and concomitant atopy now allow us to begin differentiating those metabolic derangements that intrinsically promote allergic disease from the secondary metabolic effects of allergic inflammation, and to decipher the specific contributions of altered metabolism on the atopic diathesis. This review will provide examples of this critical intersection, discuss the lessons learned from these patients, and propose how these metabolic pathways may be targeted with personalized therapeutic interventions for prevention of clinical allergic disease and reaction severity.…”