Growth of children with food allergies in Singapore

Background: Although it is known that children with food allergies are at risk of impaired growth, this has not been well studied in South-East Asia. Objective: The aim of this cross-sectional study is to survey the growth of children with food allergies in Singapore and the factors impacting it. Methods: Anthropometric data, demographic data, type of food allergy, foods eliminated, and atopic comorbidities were recorded. Malnutrition was defined using World Health Organization standards <=-2 z-score for weight-for-height [WH], weight-for-age [WA], and height-for-age [HA]). Results: Seventy-four patients (51% male) were recruited over 1 month, with median age at diagnosis of 8 months (interquartile range [IQR], 4-13 months) and at data collection of 25 months (IQR, 14-48 months). Sixty-two (84%) had IgE-mediated allergy, 8 (11%) mixed IgE and non-IgE, and 4 (5%) non-IgE-mediated allergy. Food exclusions: 55% one food, 27% two foods, 8% three to four foods, and 10% >= 5 foods. Only 1% were underweight (WA <= -2 z-score) and 3% had WA >= +2 z-score. Having a mixed type food allergy significantly reduced WA (p = 0.023). WA was significantly lower for those referred to the dietitian (p = 0.027). 5.4% were stunted (HA <= -2 z-score). Factors significantly associated with stunting were underlying eczema (p= 0.03) and having an IgE-mediated (p= 0.03) or mixed type food allergy (p= 0.002). One point four percent (1.4%) were undernourished (WH <= -2 z-score) and 1.4% were overweight (WH >= +2 z-score). Multivariate regression analysis found that children with mixed type food allergies were significantly shorter (z-score -1 lower). Children had a lower WA if they had skin involvement as part of their symptom presentation. Conclusion: This is the first survey documenting growth in children with food allergy in Singapore. Eczema, IgE-mediated and mixed type allergies are associated with poorer growth rates in these children. Early, individualised nutritional intervention is recommended for all children with food allergy.