Beyond desensitization: growth promoting effects of oral immunotherapy in food allergic children
Published online August 26, 2025
In addition to the risk of severe allergic reactions, food allergies can also impact children’s nutrition and growth. Children with food allergies often have low intake of essential micronutrients, with deficiencies in vitamin D being most common, as well as reduced levels of zinc, iron, B vitamins, and other micronutrients. This is especially evident in cow’s milk allergy (CMA), where insufficient calcium intake has been linked to lower bone mineral density and reduced growth parameters. Studies have also shown that children with CMA often achieve a lower final height, frequently failing to reach mid-parental height. Oral immunotherapy (OIT) is increasingly used worldwide to desensitize children with food allergies and improve their quality of life. Emerging evidence suggests that reintroducing milk after successful OIT may help improve bone density and support normal growth, though larger studies across different food allergens are needed to confirm these effects.
In a retrospective cohort study published in The Journal of Allergy and Clinical Immunology: In Practice, Elkan et al. examined 458 children aged 4-15 [female] and 4-16.5 [males] years who successfully completed OIT for a variety of foods including tree nut (33.4%), peanut (29.7%), milk (17.2%), sesame (14.6%), and egg (4.8%). Baseline and follow-up height-for-age (HAZ) and weight-for-age (WAZ) z-scores were calculated based on World Health Organization growth standards, which allow comparison of each child’s growth relative to age- and sex-matched reference populations. In a subset of 113 patients, long term (median, 34 month) height and weight measurement were available.
Over an average follow-up of 19 months, children who completed OIT showed significant improvements in growth. Their height and weight increased compared to standard growth charts, with small but meaningful gains in both HAZ and WAZ scores. In a smaller group followed for about three years, these improvements were even more pronounced, with children moving closer to normal growth patterns for their age. In contrast, children who did not complete OIT showed no meaningful growth changes over a similar period. Younger children benefited the most, showing greater height gains than older ones. Overall, younger age and a lower starting HAZ were the strongest predictors of improvement, while gender, asthma, and the type of food allergen treated did not significantly influence growth outcomes.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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