A recent study conducted in Croatia delved into folate levels in children residing in the Mediterranean region, exploring their potential link to atopic diseases and asthma.
Atopic conditions such as asthma, eczema, and allergic rhinitis arise when the immune system reacts excessively to harmless agents like pollen and dust.
The researchers highlighted a marked increase in allergic diseases over the past few decades in developed nations. This sharp rise is too swift to be solely attributed to genetic changes, prompting a focus on environmental and epigenetic factors including allergens, infections, pollutants, dietary habits, stress, and immune responses.
Folic acid emerged as a key point of interest due to its role in providing methyl groups essential for DNA methylation, potentially influencing gene regulation associated with allergy development. However, its impact remains a subject of debate. Some studies suggest that fortifying with folic acid may correlate with heightened allergy rates, while others indicate that low folate levels could exacerbate inflammation and lead to increased atopy, suggesting that folate might protect against allergic conditions.
Folate Deficiency Linked to Elevated Immune Markers in Children
The research employed a cross-sectional design, assessing 292 children recruited from the University Hospital Split and a local pediatric clinic from January 2024 to January 2025. Participants included children diagnosed with atopic conditions such as asthma, allergic rhinitis, or atopic dermatitis, as well as healthy children serving as controls.
The study examined clinical histories, laboratory markers, lung function tests, skin prick tests, total IgE levels, eosinophil counts, vitamin B12 levels, and folate levels.
Findings revealed that children with atopic diseases or asthma exhibited higher rates of folic acid deficiency compared to the healthy control group. Folate deficiency appeared to correlate with older age, elevated eosinophil counts, and increased IgE levels, which remained linked to allergic inflammation. A deeper analysis confirmed that folic acid levels tended to diminish with age and were slightly lower in children exhibiting higher IgE levels, although no significant relationships with eosinophils or vitamin B12 were found.
After adjusting for age, the connection between folate and asthma diminished; however, the association with broader atopic disease persisted. This suggested that while age is a significant confounding factor, folate might still be relevant to overall allergic conditions.
Is Folic Acid Fortification Necessary?
The authors postulate that modern dietary shifts in Mediterranean populations, such as an increase in processed food consumption and a decrease in folate-rich foods, may play a role in the observed deficiency.
Currently, approximately 60 countries, including the United States, Canada, Australia, and certain regions in Latin America and Africa, require folic acid fortification. Recently, the UK announced plans to adopt similar measures by the latter half of 2026.
Dr. Harry Jarrett, director of science and research at the UK-based supplement company Heights, remarked to NutraIngredients that contemporary diets provide fewer micronutrients compared to prior generations. He emphasized the need for government guidelines to adapt to current dietary and food system realities.
The researchers noted, “Croatia does not mandate folic acid fortification in staple foods, which may help explain the high prevalence of deficiency observed in our cohort.”
It was further emphasized that folate is crucial for DNA methylation and immune function, implying that inadequate levels could affect immune development and heighten allergic sensitivity.
The researchers concluded that folate deficiency is prevalent in this population and is associated with markers of allergic disease. Nonetheless, establishing causality is challenging given the study design, prompting a call for further research that includes dietary assessments and intervention studies to determine if enhancing folate status can positively affect allergic disease outcomes in children.
Journal: Nutrients; “Folic Acid Level of Children with Atopy/Asthma and Children Without Chronic Allergic Disease—Should We Consider Nutritional Fortification?” doi: https://doi.org/10.3390/nu18091368 Authors: Rogulj, et al.
