The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States
Ruchi S Gupta, Christopher M Warren, Bridget M Smith, Jesse A Blumenstock, Jialing Jiang, Matthew M Davis, Kari C Nadeau, Ruchi S Gupta, Christopher M Warren, Bridget M Smith, Jesse A Blumenstock, Jialing Jiang, Matthew M Davis, Kari C Nadeau
Abstract
: media-1vid110.1542/5840360268001PEDS-VA_2018-1235Video Abstract BACKGROUND: Childhood food allergy (FA) is a life-threatening chronic condition that substantially impairs quality of life. This large, population-based survey estimates childhood FA prevalence and severity of all major allergenic foods. Detailed allergen-specific information was also collected regarding FA management and health care use.
Methods: A survey was administered to US households between 2015 and 2016, obtaining parent-proxy responses for 38 408 children. Prevalence estimates were based on responses from NORC at the University of Chicago's nationally representative, probability-based AmeriSpeak Panel (51% completion rate), which were augmented by nonprobability-based responses via calibration weighting to increase precision. Prevalence was estimated via weighted proportions. Multiple logistic regression models were used to evaluate FA predictors.
Results: Overall, estimated current FA prevalence was 7.6% (95% confidence interval: 7.1%-8.1%) after excluding 4% of children whose parent-reported FA reaction history was inconsistent with immunoglobulin E-mediated FA. The most prevalent allergens were peanut (2.2%), milk (1.9%), shellfish (1.3%), and tree nut (1.2%). Among food-allergic children, 42.3% reported ≥1 severe FA and 39.9% reported multiple FA. Furthermore, 19.0% reported ≥1 FA-related emergency department visit in the previous year and 42.0% reported ≥1 lifetime FA-related emergency department visit, whereas 40.7% had a current epinephrine autoinjector prescription. Prevalence rates were higher among African American children and children with atopic comorbidities.
Conclusions: FA is a major public health concern, affecting ∼8% of US children. However, >11% of children were perceived as food-allergic, suggesting that the perceived disease burden may be greater than previously acknowledged.
Conflict of interest statement
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
Copyright © 2018 by the American Academy of Pediatrics.
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References
- Rudders SA, Arias SA, Camargo CA Jr. Trends in hospitalizations for food-induced anaphylaxis in US children, 2000-2009. J Allergy Clin Immunol. 2014;134(4):960–962.e3
- Jones SM, Burks AW. Food allergy. N Engl J Med. 2017;377(12):1168–1176
- Bock SA, Muñoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. 2007;119(4):1016–1018
- Warren CM, Otto AK, Walkner MM, Gupta RS. Quality of life among food allergic patients and their caregivers. Curr Allergy Asthma Rep. 2016;16(5):38.
- Gupta R, Holdford D, Bilaver L, Dyer A, Holl JL, Meltzer D. The economic impact of childhood food allergy in the United States [published correction appears in JAMA Pediatr. 2013;167(11):1083]. JAMA Pediatr. 2013;167(11):1026–1031
- Gupta RS, Springston EE, Warrier MR, et al. . The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128(1). Available at:
- Sampson HA. Food allergy: past, present and future. Allergol Int. 2016;65(4):363–369
- Tang ML, Mullins RJ. Food allergy: is prevalence increasing? Intern Med J. 2017;47(3):256–261
- Sicherer SH, Sampson HA. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141(1):41–58
- Keet CA, Savage JH, Seopaul S, Peng RD, Wood RA, Matsui EC. Temporal trends and racial/ethnic disparity in self-reported pediatric food allergy in the United States. Ann Allergy Asthma Immunol. 2014;112(3):222–229.e3
- Stallings VA, Oria MP, eds; National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Food Allergies: Global Burden, Causes, Treatment, Prevention, and Public Policy . Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: National Academies Press (US); 2017
- Motosue MS, Bellolio MF, Van Houten HK, Shah ND, Campbell RL. Increasing emergency department visits for anaphylaxis, 2005-2014. J Allergy Clin Immunol Pract. 2017;5(1):171–175.e3
- Du Toit G, Roberts G, Sayre PH, et al. ; LEAP Study Team . Randomized trial of peanut consumption in infants at risk for peanut allergy [published correction appears in N Engl J Med. 2016;375(4);398]. N Engl J Med. 2015;372(9):803–813
- Jones SM, Beyer K, Burks AW, et al. . Efficacy and safety of AR101 in peanut allergy: results from a phase 3, randomized, double-blind, placebo-controlled trial (PALISADE). J Allergy Clin Immunol. 2018;141(2):AB400
- Gupta RS, Kim JS, Springston EE, Pongracic JA, Wang X, Holl J. Development of the Chicago Food Allergy Research Surveys: assessing knowledge, attitudes, and beliefs of parents, physicians, and the general public. BMC Health Serv Res. 2009;9:142.
- Fahimi M, Barlas FM, Thomas RK, Buttermore N. Scientific surveys based on incomplete sampling frames and high rates of nonresponse. Surv Pract. 2015;8(6):1–13
- DiSogra C, Cobb C, Chan E, Dennis JM. Calibrating nonprobability Internet samples with probability samples using early adopter characteristics. In: Proceedings of the American Statistical Association, Section on Survey Research. Joint Statistical Meetings (JSM); August 3, 2011; Miami Beach, FL
- Sicherer SH, Muñoz-Furlong A, Sampson HA. Prevalence of seafood allergy in the United States determined by a random telephone survey. J Allergy Clin Immunol. 2004;114(1):159–165
- Moonesinghe H, Mackenzie H, Venter C, et al. . Prevalence of fish and shellfish allergy: a systematic review. Ann Allergy Asthma Immunol. 2016;117(3):264–272.e4
- Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol. 2010;125(6):1322–1326
- McWilliam V, Koplin J, Lodge C, Tang M, Dharmage S, Allen K. The prevalence of tree nut allergy: a systematic review. Curr Allergy Asthma Rep. 2015;15(9):54.
- Weinberger T, Sicherer S. Current perspectives on tree nut allergy: a review. J Asthma Allergy. 2018;11:41–51
- Ben-Shoshan M, Harrington DW, Soller L, et al. . A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada [published correction appears in J Allergy Clin Immunol. 2011;127(3):840]. J Allergy Clin Immunol. 2010;125(6):1327–1335
- Soller L, Ben-Shoshan M, Harrington DW, et al. . Adjusting for nonresponse bias corrects overestimates of food allergy prevalence. J Allergy Clin Immunol Pract. 2015;3(2):291–293.e2
- Sampson HA, Aceves S, Bock SA, et al. ; Joint Task Force on Practice Parameters; Practice Parameter Workgroup . Food allergy: a practice parameter update-2014. J Allergy Clin Immunol. 2014;134(5):1016–1025.e43
- McGowan EC, Peng RD, Salo PM, Zeldin DC, Keet CA. Changes in food-specific IgE over time in the National Health and Nutrition Examination Survey (NHANES). J Allergy Clin Immunol Pract. 2016;4(4):713–720
- Dyer AA, Lau CH, Smith TL, Smith BM, Gupta RS. Pediatric emergency department visits and hospitalizations due to food-induced anaphylaxis in Illinois [published correction appears in Ann Allergy Asthma Immunol. 2015;115(5):458]. Ann Allergy Asthma Immunol. 2015;115(1):56–62
- Liew WK, Williamson E, Tang ML. Anaphylaxis fatalities and admissions in Australia. J Allergy Clin Immunol. 2009;123(2):434–442
- Waserman S, Avilla E, Ben-Shoshan M, Rosenfield L, Adcock AB, Greenhawt M. Epinephrine autoinjectors: new data, new problems. J Allergy Clin Immunol Pract. 2017;5(5):1180–1191
- Kaplan MS, Jung SY, Chiang ML. Epinephrine autoinjector refill history in an HMO. Curr Allergy Asthma Rep. 2011;11(1):65–70
- Song TT, Worm M, Lieberman P. Anaphylaxis treatment: current barriers to adrenaline auto-injector use. Allergy. 2014;69(8):983–991
- Liu AH, Jaramillo R, Sicherer SH, et al. . National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010;126(4):798–806.e13
- Mahdavinia M, Fox SR, Smith BM, et al. . Racial differences in food allergy phenotype and health care utilization among US children. J Allergy Clin Immunol Pract. 2017;5(2):352–357.e1
- Bunyavanich S, Rifas-Shiman SL, Platts-Mills TAE, et al. . Peanut allergy prevalence among school-age children in a US cohort not selected for any disease. J Allergy Clin Immunol. 2014;134(3):753–755
- Togias A, Cooper SF, Acebal ML, et al. . Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017;139(1):29–44
Source: PubMed