Association of Iron Deficiency With Acute Exacerbations of Pediatric Atopic Diseases: A Cross-Sectional Study

Iron deficiency and allergic diseases are significant global health problems, particularly among children. Iron deficiency may contribute to immune dysregulation, which has been implicated in the pathogenesis and exacerbation of atopic diseases. This study examined the relationship between iron deficiency, as indicated by transferrin saturation (TSAT), and acute exacerbation of allergic diseases among children.

A cross-sectional observational study was conducted over a 24-month period (March 2023 to February 2025) at the Department of Pediatrics, KIMS, Bhubaneswar. A total of 240 children aged six months to 18 years were enrolled and divided into three groups (n = 80 each): Group 1 (atopic with acute exacerbation), Group 2 (atopic without exacerbation), and Group 3 (non-atopic controls). Hematological indices and iron profile parameters, including TSAT, were measured. TSAT <16% was defined as iron deficiency. Binary logistic regression analysis was performed, and predicted probabilities of acute exacerbation at varying TSAT thresholds were estimated.

Iron deficiency was highest in the exacerbation group (51.25%) compared with stable atopic children (42.5%) and controls (23.75%). Children with acute exacerbation experienced much lower mean TSAT (15.45 ± 4.47%) compared to those with no exacerbation (17.45 ± 4.18%) and controls (18.37 ± 4.68%) (p = 0.0002). Children with acute exacerbations were 3.38 times more likely to have iron deficiency than non-atopic controls (OR = 3.38; 95% CI: 1.72-6.64; p = 0.0004). Binary logistic regression identified TSAT as an important predictor of allergy flare-ups, with each 1% decrease linked to a 12% higher risk of exacerbation.

Iron deficiency, particularly low TSAT, is associated with acute allergic exacerbations in children. Routine TSAT screening in pediatric patients with atopic diseases may help identify children at increased risk of exacerbations and facilitate early intervention.