Synthetic Folic Acid Metabolites May Be Associated With Food Allergy in Children Interview with:
Emily Clarke McGowan, MD

Assistant Professor, Allergy/Clinical Immunology
Charlottesville, VA 22908-1355 What is the background for this study? What are the main findings?

Response: Folate (vitamin B9) is available in either the natural or synthetic forms and has been shown to reduce the risk of neural tube defects, like spina bifida, in newborns.  Folic acid, the synthetic form of folate, is widely consumed in the United States in infant formula, supplements, vitamins, and fortified grains.  When folic acid is consumed in high quantities, some of this folic acid does not undergo further metabolism and circulates in the blood as “unmetabolized folic acid” (UMFA).

In this study, we measured total folate, UMFA, and 5-methyltetrahydrofolate (5-MTHF), the main folate metabolite involved in biochemical processes in the body, in a subset of children from the Boston Birth Cohort.

While mean levels of total folate at birth were lower among those who developed food allergy, mean levels of the synthetic folic acid derivative, UMFA, were higher.  There was no association between total folate, 5-MTHF, or UMFA levels in early life and the development of food allergy. What should readers take away from your report? 

Response: Among children in the Boston Birth Cohort, higher levels of the synthetic folic acid derivative, UMFA, at birth was associated with the development of food allergy.  Whether this is due to increased exposure to synthetic folic acid exposure in utero or underlying genetic differences in folate metabolism is unknown. What recommendations do you have for future research as a result of this work?

Response: More research is needed to replicate these findings in a different population and determine whether certain individuals with genetic differences in folate metabolism may be more at risk.  Ultimately, more research is needed to conclude whether mothers should consider consuming alternate sources of folate, such as green leafy vegetables, beans, and lentils, instead of the synthetic form, folic acid. Is there anything else you would like to add? 

Response: While we found that higher levels of the synthetic folic acid derivative, UMFA, are associated with the development of food allergy in children, more research is clearly needed.  We do not currently endorse any changes to national recommendations regarding folate supplementation during pregnancy. 


AAAAI  2018 abstract:

The Association Between Folate/Folic Acid Metabolites and the Development of Food Allergy (FA) in Children

Emily C. McGowan, MD et al 2018 



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