D2.229 - Food Allergy in Ukrainian Children: Risk Factors, Early Allergen Introduction and Natural History

The prevalence of food allergy (FA) has increased worldwide, with atopic dermatitis (AD) recognized as a major risk factor due to impaired skin barrier function. Early introduction of allergenic foods has been proposed as a preventive strategy, yet real-world practices and associated risk factors remain insufficiently characterized in Eastern Europe. This study aimed to evaluate the prevalence, risk factors, and natural history of food allergy in Ukrainian children and to assess the impact of early allergen introduction.

A cross-sectional survey of parents of 306 children was conducted between May 2025 and January 2026. Data collected included demographic characteristics, breastfeeding duration, parental atopy, presence and severity of AD, timing of allergen introduction, and reported food allergy outcomes. Early introduction was defined as ≤9 months of age. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess associations between risk factors and FA.

Among participants, 43.6% were girls and 56.4% boys; 38.6% had a positive parental atopic history. Most children (82.7%) were breastfed for ≥6 months, and 49% for more than one year. Mild AD was present in 57%, and severe AD in 7.5% of children.

Food allergy was reported in 23.3% of children. The most common allergens were cow’s milk (7%), egg (4%), tree nuts (3%), peanut (0.7%), soy (0.3%), seafood (0.3%), and multiple foods (8%). Among nut allergies, walnut was most frequent (42%).

AD was strongly associated with FA (OR 3.58; 95% CI 1.78–7.17; p=0.00016), with prevalence highest in severe AD (p=1.0×10⁻⁷). Parental atopy was not significantly associated with FA (OR 1.47; p=0.164). Early introduction of cow’s milk significantly reduced FA risk (OR 0.21; 95% CI 0.08–0.53; p=0.0012), while early egg introduction showed a borderline protective effect (OR 0.31; p=0.051). No significant associations were found for peanut or tree nuts.

At the time of the survey, 20% of children had developed tolerance, 37% were undergoing milk/egg ladder therapy, and 20% remained on elimination diets.

The feeding patterns observed in this Ukrainian cohort suggest potential regional differences compared to Western European countries, particularly regarding prolonged breastfeeding and cautious timing of allergen introduction. These national characteristics may partially shape food allergy epidemiology and should be considered when implementing international prevention guidelines.

Food allergy was common in this Ukrainian cohort and strongly associated with AD severity. Early introduction of milk, and possibly egg, demonstrated a protective effect, supporting current prevention strategies. These findings highlight the importance of early dietary interventions and targeted management in children with AD.