Food Allergies Have No Negative Effect on School Performance

A recent study showed that food allergies have no negative effect on school performance.1

“We also found some statistically significant interactions with parental education, but not sex, although with no consistent pattern,” wrote investigators, led by Cecilia Lundholm, PhD, from the department of medical epidemiology and biostatistics at Karolinska Institutet in Sweden.

Research has shown that food allergies can negatively impact children’s mental health, leading to more internalizing problems, such as anxiety and depression, than their peers. In the past decade, psychology referrals dramatically increased for children with food allergies.2 Studies have also suggested that internalizing disorders in children are associated with school performance, so investigators theorized that food allergies may impact school performance.1

In their register-based cohort study, investigators sought to assess whether food allergies were linked to school performance. The sample included children in grades 7 – 9 (n = 456, 164) born in Sweden from 2001 – 2005 and had food allergy information based on hospital visits and prescriptions. Investigators collected data on grades and national test results from all Swedish schools to assess school performance.

The primary outcome was the total grades from children in year 9, and the secondary outcome was the total grades from younger children. On top of assessing children with food allergies, the study also included a sibling/twin control analysis (n = 31,609).

In adjusted and unadjusted analyses, children with severe food allergies appeared to have better total grades than children without food allergies (95% confidence interval [CI], 8.6 to 12.6). After adjusting for unmeasured confounders shared by siblings, the difference was close to null and nonsignificant (95% CI, -1.5 to 4.7; 95%; -2.2 to 2.1) for severe and non-severe food allergies, respectively.

Investigators found a significant association between food allergies and performance on the national English test in year 9 in sibling control analyses, though the effect was small. However, this was not replicated in the twin cohort.

These findings were similar to the results of trials on atopic diseases, atopic eczema, asthma, and rhinitis, indicating that children and adolescents with these diseases may perform as well or even better than their peers without those diseases.

“The difference between our results and those for severe eczema, asthma, and rhinitis may be explained by children with food allergy, successfully avoiding the allergens that causes reactions, do not need to take medication and may have as good somatic health as their peers without food allergy,” investigators wrote. “For the other atopic diseases, it may be more difficult to avoid the triggers of the disease and may therefore have worse somatic health or need medication that may have side effects.”

The team added that the results may be explained by the fact they accounted for familial factors that could affect a child’s health-seeking behavior and school performance.

Investigators wrote that the study’s primary limitation was the measurement of food allergy, as it relied on specialist care diagnoses and adrenaline autoinjector dispenses in the registers. This led to misclassification of undiagnosed primary care-diagnosed cases. Moreover, they added that the results could be limited by the inability to capture the temporary impacts of food allergy on school performance.

“Although significant associations were found in the cohort analyses adjusted for important measured confounders, indicating better school performance in children with food allergy compared to those without, the results did not hold when also accounting for unmeasured familial factors in the sibling control analyses,” investigators wrote.

References

1. Lundholm C, Karim H, Smew AI, Silverman M, Gong T, Brew BK, Almqvist C. Food allergy has no negative impact on children's school performance: A Swedish sibling and co-twin control study. J Allergy Clin Immunol Glob. 2024 Dec 4;4(1):100380. doi: 10.1016/j.jacig.2024.100380. PMID: 39844913; PMCID: PMC11750558.
2. Derman, C. Psychology Referrals Rose for Children with Food Allergies in the Past Decade. HCPLive. October 24, 2024. https://www.hcplive.com/view/psychology-referrals-rose-children-food-allergies-the-past-decade. Accessed January 27, 2025.