New Associations Found Between Pediatric Food Allergies, Sensitizations and Allergic Airway Disease in Adulthood

Professor Hasan Arshad, DM, and fellow researchers from the David Hide Allergy and Asthma Research Centre in the United Kingdom recently reported associations between food allergy (FA), food allergy sensitization (FAS) and allergic airway diseases (AAD) in adulthood.

Research also suggested that childhood food allergy and FAS increased the risk of asthma in adulthood by nearly 3-fold. However, neither were associated with rhinitis in adulthood.

Arshad and colleagues noted that AAD has continued to be a global major health crisis, resulting in morbidity, impaired quality-of-life and economic burden.

However, prior to the study little evidence on the association of childhood conditions such as food allergy and FAS and ADD was available, which prompted the investigative team to conduct a longitudinal study on the subject.

Data was collected on the 1536 children who were enrolled in the Isle of Wight (IOW) cohort study at birth, of which 1456 were available for subsequent assessments.

Initially, the parents of the participating children were approached between January 1, 1990-February 28, 1990. Follow-ups occurred at ages 1 (94.4%), 2 (84.5%), 4 (83.6%), 10 (94.3%), 18 years (90.2%), and 26 years (70.9%).

Clinical definitions of food allergy, FAS, aeroallergen sensitization, asthma and rhinitis were established prior to the study. Persistent asthma was defined at 2 time-points: ages 18 and 26 years.

Additionally, the investigators adjusted the study based on a myriad of covariates including sex, history of asthma, rhinitis, eczema or food allergy, cord Immunoglobulin E (IgE) (>0.5kU/L, dichotomous), maternal smoking, eczema, and more.

Retention rates remained high throughout the study, though a drop-off did occur later. Despite this, researchers had ample data to find an association between childhood food allergy/FAS and ADD.

“Based on results from multivariable logistic regressions, FA at 4 years was significantly associated with asthma at both 18 and 26 years,” they wrote. “Additionally, FA at 1 or 2 years was also associated with asthma at age 26 years.”

Stronger associations between childhood FAS and adult asthma were also recorded, while FAS in patients ages 4 and 10 was associated with increased offs of adult asthma at 18 and 26.

However, pediatric food allergy was not associated at all with rhinitis at 18 and 26 years despite stronger associations. There were also no statistically significant associations between childhood food allergy and FAS with asthma persistence.

Associations between childhood food allergy and FAS and aeroallergen sensitization were more complex.

The investigators noted that food allergy was not associated with aeroallergen sensitization at 18 years and only food allergy at 1 or 2 years was significantly associated with aeroallergen sensitization at 26 years.

However, FAS at ages 4 and 10 were associated with aeroallergen sensitization at 18 years and 26 years.

Results were similar among infants at age 1 or 2 years with symptoms of possible food allergy, as FAS was also associated with an increased odds of aeroallergen sensitization at ages 18 and 26 years.

Arshad and colleagues attributed the success of their study to a variety of factors. In addition to being the first longitudinal study to investigate such associations, the study used prospective data, had high retention rates, and had repeated collection of information.

However, limitations were also noted.

The investigators called for greater surveillance of patients, which they believed could detect early development of asthma. Early treatment was also recommended, as well as guidance that could be offered to children who do not fully understand their disease as they transition to adult clinic care.

They added that further assessment will need to investigate the immunologic pathways linking food allergy/FAS and AAD.

“Furthermore, primary and secondary preventive strategies have been described to reduce the incidence of food allergy,” they concluded. “Given our findings, it would be valuable to follow up those study participants to ascertain whether these strategies have any long-term impact on AAD.”

The study, “Childhood food allergy and food allergen sensitization are associated with adult airways disease: a birth cohort study,” was published online in Pediatric Allergy and Immunology.