Infant Food Allergy Phenotypes and Association With Lung Function Deficits and Asthma at Age 6 Years: A Population-Based, Prospective Cohort Study in Australia

To examine the relationship between food allergy (FA) phenotypes and lung function and asthma in childhood.Australia’s HealthNuts cohort between 2007 and 2011. There were 3233 of 5276 participants included at age 1 year who completed the full assessment at 6 years.This is a prospective, population-based study. Skin prick testing, oral food challenge, and questionnaires evaluating allergy history and environmental exposures were performed at 1 and 6 years of age. Spirometry was performed at 6 years.Of the population, 13.7% were diagnosed with asthma before 6 years. Factors identified at 1 year associated with increased risk of asthma diagnosis at 6 years included the following: (1) both food-sensitized tolerance and confirmed FA, (2) peanut-sensitized tolerance and persistent or late-onset peanut allergy, and (3) egg allergy (both transient and persistent). Reduced forced expiratory volume in 1 second and/or forced vital capacity at 6 years were noted in the following: (1) infants with challenge-proven FA at 1 year; (2) transient egg allergy compared with never having egg allergy; (3) peanut sensitized tolerance and transient, persistent, or late-onset peanut allergy. In general, the magnitude of these associations was larger in children with persistent and late-onset food allergy (compared with transient allergy or sensitized tolerance), except for spirometry defects noted in egg allergy participants, perhaps because of the small number of patients with persistent egg allergy.This study demonstrates an association between challenge-confirmed FA in infancy and children’s respiratory health at age 6 years, regardless of whether the FA resolves or not.FA is an important factor in the atopic march and may be an important marker for future asthma development. Pediatricians should be mindful that it is especially prudent to monitor the respiratory health of children with FA closely, given that poorly controlled asthma is a risk factor for severe food-induced allergic reactions. Further studies are needed to understand the biological basis of the relationships demonstrated in this study.