Key Risk Factors for Development of Childhood Food Allergy: Details JAMA study
Canada: A recent meta-analysis has identified that the development of childhood food allergy is most strongly associated with a combination of major and minor risk factors. These include early allergic conditions related to the atopic march or diathesis, delayed introduction of allergenic foods, genetic predisposition, exposure to antibiotics, demographic influences, and various birth-related factors.
Published in JAMA Pediatrics, the systematic review and meta-analysis was conducted by Nazmul Islam from the Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada, along with colleagues. The study aimed to clarify the incidence of food allergy in early life and identify the most reliable risk factors contributing to its development, an area that has remained uncertain despite increasing global prevalence.
The researchers analyzed data from 190 studies across 40 countries, covering nearly 2.8 million children. Eligible studies included children younger than six years and assessed food allergy using food challenge testing or robust diagnostic criteria. The primary outcome was the development of food allergy by six years of age. Risk factors were evaluated using adjusted estimates from cohort, case-control, and cross-sectional studies, with evidence quality assessed using standardized tools.
The following findings were reported:
- Among studies confirming food allergy by food challenge testing, the overall incidence of childhood food allergy was estimated at 4.7%, with moderate certainty.
- Early allergic diseases were the strongest and most consistent risk factors for later food allergy development.
- Infants with eczema, allergic rhinitis, or wheezing had a markedly higher risk of developing food allergy during childhood.
- Greater severity of atopic dermatitis was associated with an additional increase in food allergy risk.
- Indicators of impaired skin barrier function, including increased transepidermal water loss, were strongly linked to higher susceptibility to food allergy.
- Genetic variations in the filaggrin gene were associated with an increased risk of developing food allergy.
- Delayed introduction of allergenic foods in infancy, particularly peanuts after 12 months of age, was associated with a significantly higher risk of food allergy.
- Early-life antibiotic exposure, including use during the first month or first year of life and during pregnancy, was linked to increased food allergy risk.
- Male sex, being a firstborn child, and a family history of food allergy in parents or siblings were associated with a higher risk.
- Additional associations were observed with parental migration, self-identification as Black, and cesarean delivery.
- Low birth weight, post-term birth, maternal diet, and prenatal stress were not significantly associated with the development of childhood food allergy.
The authors conclude that childhood food allergy arises from a complex interplay of early allergic disease, genetic susceptibility, feeding practices, antibiotic exposure, and demographic and birth-related factors. These findings may help inform targeted prevention strategies and guide clinical and public health efforts to reduce the burden of food allergy in children.
Reference:
Islam N, Chu AWL, Sheriff F, et al. Risk Factors for the Development of Food Allergy in Infants and Children: A Systematic Review and Meta-Analysis. JAMA Pediatr. Published online February 09, 2026. doi:10.1001/jamapediatrics.2025.6105
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