Growth improves with oral immunotherapy
September 08, 2025
3 min read
Key takeaways:
- Children with milk allergy had a lower baseline height-for-age z score.
- Baseline mean height-for-age z score grew from –0.19 to –0.1.
- Younger age and lower baseline height-for-age z score predicted improvement.
Oral immunotherapy for food allergy may improve growth, especially for younger children and for those with lower baseline height-for-age z scores, according to data published in The Journal of Allergy and Clinical Immunology: In Practice.
Previous studies have found that children with food allergies lag the general population in growth parameters, Matan Elkan, MD, allergy and immunology fellow at the Institute of Allergy, Asthma and Immunology at Shamir Medical Center, Zerifin, Israel, and colleagues wrote.
Children who began oral immunotherapy before age 6 years saw the greatest improvements in height-for-age Z scores. Image: Adobe Stock
The study included 458 children aged 3.9 to 16.2 years (median age, 8 years; 40.2% girls) with an IgE-mediated food allergy treated with OIT for a median of 12.2 months. Treatments included peanut (n = 136), walnut (n = 105), milk (n = 79), sesame (n = 67), cashew (n = 40), egg (n = 22), hazelnut (n = 8) and almond (n = 1).
Between baseline and follow-up (mean, 19.4 months), mean height-for-age z scores (HAZ) increased from –0.19 ± 1.05 to –0.1 ± 1.05, with a mean difference of 0.09 (95% CI, 0.05-0.13).
Height-for-age differences (HAD), representing the absolute difference between measured height and median height for age and sex based on growth standards, increased by 0.37 cm (95% CI, 0.12-0.62).
There also was a 0.23 increase (95% CI, 0.17-0.29) in mean weight-for-age and sex z scores (WAZ) and a 0.16 increase (95% CI, 0.11-0.22) increase in mean BMI for age and sex z scores (BAZ), with a positive correlation between mean changes in WAZ and HAZ between baseline and follow-up (R = 0.44; 95% CI, 0.34-0.53).
Short-stature status, defined as a HAZ of less than –2, improved for 11 children and worsened for three children (OR = 3.67; 95% CI, 1.02-13.14). Also, the researchers said, the slight right-skew in HAZ distribution relative to the WHO reference at baseline had a modest shift toward normalization at follow-up.
Among 113 patients with multiple OIT treatments with a median duration of 34 months who had an additional follow-up, this HAZ distribution shifted further toward a near-normal WHO reference distribution.
Improvements in this group included –0.28 ± 0.98 to 0.02 ± 1.02 with a mean difference of 0.3 (95% CI, 0.16-0.43) in mean HAZ; 2.02 cm (95% CI, 0.83-3.2) in HAD; 0.53 (95% CI, 0.37-0.7) in WAZ; and 0.23 (95% CI, 0.07-0.37) in BAZ.
Also, the researchers noted a positive correlation between mean change in WAZ between baseline and long-term follow-up and mean change in HAZ (R = 0.5; 95% CI, 0.27-0.67), as well as 11 children who improved and two who worsened in crossing the 10th percentile threshold (OR = 5.5; 95% CI, 1.22-24.81).
HAZ at baseline included –0.45 ± 0.91 for children with milk OIT and –0.14 ± 1.07 for children who were not receiving milk OIT (P = .016). Similarly, BAZ at baseline included –0.05 ± 1.11 for the milk OIT group and 0.25 ± 1.14 for those not receiving milk OIT (P = .037). The researchers attributed these effects to differences between the groups with milk and tree nut allergies.
Magnitude of HAZ change at follow-up was the lowest for the peanut group, the researchers added, but there were no significant differences between these changes at follow-up across all the allergen groups.
However, magnitudes of HAZ change at follow-up differed significantly by age group, including 0.16 ± 0.4 for age less than 6 years; 0.14 ± 0.43 for age between 6 and 7.9 years; 0.01 ± 0.4 for between age 8 and 9.9 years; 0.1 ± 0.47 for age between 10 and 11.9 years; and –0.11 ± 0.49 for age 12 years and older (P = .001).
The researchers further called baseline age (B = –0.02; 95% CI, –0.04 to –0.01) and baseline HAZ (B = 0.92; 95% CI, 0.89-0.96) and baseline HAZ significant predictors of HAZ at short-term follow-up based on a linear regression model.
Baseline age (B = –0.09; 95% CI, –0.15 to –0.03) and baseline HAZ (B = 0.83; 95% CI, 0.69-0.97) remained significant predictors in the model for long-term HAZ change, the researchers said.
Based on these findings, the researchers concluded that growth metrics among children with food allergy may benefit by completing OIT, with improvements most evident with long-term follow-up.
Also, younger age and lower baseline HAZ were most associated with increased HAZ, they said, indicating that OIT may facilitate catch-up growth, although even longer-term follow-up and additional research are necessary for a better understanding.
Perspective
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This study evaluates an important consideration of OIT’s effects on children, not previously studied with such a large group of patients. While the study is retrospective, it illustrates that OIT could have a beneficial impact on growth trajectory, particularly in those with lower baseline height, such as milk allergic children, and in younger patients who pursue OIT. Physicians can discuss this potential benefit with families considering pursuing OIT, with the important caveat that further study is needed. This should include evaluating children who participate in blinded clinical trials of OIT comparing growth trajectories of active vs. placebo groups. This could provide important data as to whether OIT could impact this important metric.
Jonathan A. Hemler, MD
Disclosures: Hemler reports no relevant financial disclosures.
Perspective
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I might have guessed that getting milk (in particular) into the diet of children with milk allergies through OIT could be associated with improved growth through improved nutrition. Indeed, limited prior studies suggest that.
On the other hand, I might have worried that since gastrointestinal inflammatory side effects of OIT can occur, we might be creating problems in this process that could adversely affect growth.
The results of the study are quite significant in providing both some reassurance and even an observed beneficial effect. The study is also significant in including a large group and addressing OIT to multiple food allergens.
Our research group pioneered adding milk to the diet of children who could tolerate this protein in baked foods and progressed to heated cheese and then whole milk. We recently reported better growth in the “milk adders” compared with avoiders. This approach is different from OIT, but the theme seems similar.
Meanwhile, this study provides important additional data to discuss with families when considering OIT, particularly in decision-making with younger children with milk allergy.
However, this was a retrospective study, with limited follow-up time, and they did not investigate the actual diets of the children. It is possible that nuances apart from the OIT itself, or dietary incorporation of the targeted food, were at play. Understanding this could be informative for management and validating the results. So, next steps may include prospective studies with tracking the diet in detail and longer-term monitoring.
Reference:
Wong LSY, et al. Allergy. 2025;doi:10.1111/all.16330.
Scott H. Sicherer, MD, FAAP
Disclosures: Sicherer reports holding a position as deputy editor of The Journal of Allergy and Clinical Immunology: In Practice.
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