Could Folic Acid Fortification Improve Allergy Rates in Croatian Children?

Why It Matters

If folic‑acid supplementation can curb atopic disease, it offers a scalable public‑health tool to counter the sharp rise in childhood allergies and informs fortification policy decisions worldwide.

Key Takeaways

• 292 children studied; atopic group showed higher folate deficiency
• Deficiency correlated with elevated IgE and eosinophil counts
• Age‑adjusted analysis kept folate linked to atopy, not asthma
• Croatia lacks mandatory folic‑acid fortification unlike 60+ countries

Pulse Analysis

Allergy prevalence has surged in developed nations, prompting researchers to look beyond genetics toward diet‑driven epigenetic mechanisms. Folate, a key methyl donor for DNA methylation, influences immune gene regulation, making it a candidate factor in the rise of atopic conditions. While some studies suggest excess folic acid may exacerbate allergies, emerging evidence, including the Croatian cohort, points to deficiency as a potential driver of heightened immune reactivity.

The cross‑sectional study conducted between January 2024 and January 2025 enrolled 292 children from a university hospital and a primary‑care clinic in Split. Children with asthma, allergic rhinitis or atopic dermatitis displayed markedly lower serum folate than healthy peers, and this deficiency aligned with higher total IgE and eosinophil counts. After controlling for age—a strong confounder—the association remained significant for general atopic disease but not for asthma alone, underscoring the nuanced role folate may play across different allergic phenotypes. Limitations include the observational design and lack of dietary intake data, which preclude causal inference.

Globally, more than 60 countries mandate folic‑acid fortification to prevent neural‑tube defects, and the United Kingdom plans to join them in late 2026. Croatia’s absence of such a policy may contribute to the high deficiency rates observed. Policymakers and health professionals should weigh the dual benefits of fortification—neural‑tube defect prevention and potential allergy mitigation—while awaiting randomized trials that can confirm causality. Until then, clinicians might consider monitoring folate status in at‑risk pediatric patients as part of a broader strategy to manage rising allergy burdens.