Eliminating certain foods such as egg and milk from children’s diet due to IgE-mediated allergy may hinder growth, but oral immunotherapy helps improve growth trajectories, especially when initiated at a younger age, according to two studies.

Egg and milk avoidance

In the first study, children who avoided egg or milk, regardless of the reason, had lower growth parameters overall when compared with healthy children (control), reported lead author Dr Ozge Nur Aktas from the Children’s National Hospital in Washington, DC, US.

Specifically, children with egg allergy had significantly lower height-for-age z-score compared with those who had other food allergies and consumed egg (p=0.035), Aktas continued. This was also observed for children who avoided egg for nonallergic reason (p=0.015). [AAAAI 2025, abstract 769]

Children with milk allergy also had significantly lower height-for-age z-score (p=0.024) compared with those who had other food allergies and consumed milk. No significant differences were noted in weight-for-age z-score and BMI-for-age z-score.

According to Aktas, children with egg or milk allergy combined were shorter than those who had other food allergies (p=0.048) even after adjusting for parental height (p=0.005).

Meanwhile, children with other food allergies who consumed egg and milk had much higher height-for-age z-score (p=0.005),height-for-age z-score adjusted for mid-parental height (p<0.001), and weight-for-age z-score (p=0.013) relative to children who avoided egg or milk regardless of the reason.

“Egg and cow’s milk are major sources of nutrition,” and the findings indicate that the avoidance of such foods can impact the growth of children, Aktas noted. “Thus, it is vital to diagnose allergies correctly and prevent unnecessary avoidance.”

The analysis included 50 paediatric healthy controls and 121 children with at least one IgE-mediated food allergy.

Height gains

In a study conducted in Israel, oral immunotherapy appeared to enhance long-term growth in children with IgE-mediated food allergies.

Over a median treatment duration of 19.4 months, the deficit in height-for-age z-score decreased from a mean of ?0.19 at baseline to ?0.10 (p<0.001), reported first study author Dr Matan Elkan from the Shamir Medical Center in Be’er Ya’akov, Israel. [AAAAI 2025, abstract 452]

The largest gains in height-for-age z-score were seen in children who initiated oral immunotherapy before age 6 years (0.16), whereas a decrease was noted in those who started therapy after age 12 years (?0.11), Elkan added.

Among children who completed the 34-month follow-up, height-for-age z-score improved by 0.30 points (p<0.001).

Predictors of height gains with oral immunotherapy included younger age at baseline (p=0.002) and lower baseline height-for-age z-score (p<0.001).

The findings provide evidence on the benefit of oral immunotherapy on growth outcomes in the population of children with food allergies, Elkan said. “[However,] effects on their final stature remains to be determined.”

A total of 763 children (40.6 percent female) between 5 and 16.5 years of age (mean 8.0 years) who completed oral immunotherapy were included in the study. Of these, 29.7 percent were treated for peanut allergy, 22.9 percent for walnut allergy, 17.2 percent for milk allergy, and 14.6 percent for sesame allergy.