Methods: The HealthNuts population-based cohort consists of 5300 children recruited at age 1 year. All infants underwent skin prick test to egg, peanut and sesame, and those sensitized had food challenges. At age 4 years, food challenges were repeated in those children previously identified as food allergic to determine persistence or resolution. Weight and height at 1 and 4 years were reported by parents from the child health record. Weight and height z-scores were determined from the World Health Organisation growth charts, standardised for age and sex. Multivariate linear regression models were fitted to examine the effect of food allergy and eczema at age 1 on weight and height z-scores at ages 1 and 4, adjusted for birthweight, prematurity, socioeconomic index, ethnicity and duration of breast feeding.
Results: Compared to children with no food allergy or eczema, children with both eczema and food allergy at age 1 had lower weight (β=-0.217, p<0.001) and height (β=-0.206, p=0.008) at age 1 and lower weight at age 4 (β=-0.159, p=0.026) after controlling for potential confounders. There was no difference in children with only food allergy or only eczema. At age 1 the height differences were greater in those with egg allergy and eczema (weight β=-0.240, p<0.001; height β=-0.215, p=0.009) than with peanut allergy and eczema (weight β=-0.292, p=0.011; height β=-0.145, p=0.281) compared to those with no eczema or food allergy. The differences continued at age 4 for children with egg allergy and eczema at age 1 (weight: β=-0.162, p=0.032 height: β=-0.120, p=0.234), particularly those who had persistent egg allergy and eczema at age 4 (weight β=-0.277, p=0.061; height β=-0.490, p=0.013). Peanut allergy, with or without eczema, at age 1 was not associated with differences in weight or height at age 4.
Conclusions: Children with IgE-mediated food allergy with eczema at age 1 have reduced growth parameters at age 1 and age 4, while eczema or food allergy alone was not associated with reduced growth. These results emphasise the need for adequate nutritional follow up in food allergic children in infancy, particularly those with eczema.