Food Allergy in Children: A Public Health Concern
The most common food allergies identified in US children were peanut, milk, shellfish, tree nut, egg, and fin fish.
Food allergy in children has become a public health concern, as it affects approximately 8% of US children, resulting in a high rate of severe allergic reactions as well as emergency department use, according to a study published in Pediatrics.
In response to a survey administered in 2009 and 2010 on the prevalence of food allergies in children, researchers administered a follow-up, population-based survey between October 2015 and September 2016 to US households with children to gather data on the public health effects of childhood food allergies. Eligible participants included those aged 18 years and older who were able to complete the survey. Participants were recruited from NORC at the University of Chicago's AmeriSpeak Panel, where the survey completion rate was 51.2% (7218 responses from 14,095 invitees). Each child was assigned a base, study-specific sampling weight equal to their responding parent's nonresponse-adjusted AmeriSpeak sampling weight. To increase precision, data obtained from the responses were augmented with calibration-weighted, nonprobability-based responses from Survey Sampling International. The total number of responses from US households was 51,819.
The primary outcome measure was the prevalence of overall and food-specific convincing childhood food allergy. Convincing food allergies included those reported by parents if the most severe reaction to a specific food included symptoms affecting the skin and/or oral mucosa; respiratory, gastrointestinal, cardiovascular systems and/or heart; and certain mood disorders. Patient-reported allergies with reaction symptoms characterized by oral allergy syndrome and food intolerances were not considered convincing.
Parent-reported data were collected for 38,408 children after application of exclusion criteria. Approximately half (51.1%) were male and white (52.8%). The estimated prevalence of food allergy was 7.6%, with 40% of children with at least 1 food allergy. Peanut (2.2%) and milk (1.9%) allergies were the most common, followed by shellfish (1.3%), tree nut (1.2%), egg (0.9%), and fin fish (0.6%). An estimated 61.1% of children with convincing food allergies had at least 1 confirmed food allergy.
Among children with convincing food allergies, 42.3% were estimated to have reaction symptoms that indicated a severe food allergy; specifically, peanut (59.2%), tree nut (56.1%), and shellfish (48.7%). Among these children, 42% had been treated in the emergency department at some point in their life, with 19% treated in the emergency department within the past year. Only 40.7% of children, however, reported a current prescription of epinephrine autoinjector. The most common allergies associated with a prescription for epinephrine autoinjector were peanut (73.0%), tree nut (70.4%), and sesame (64.8%).
Differences by race were found in convincing food allergy, with non-Hispanic African American children at a significantly elevated risk relative to non-Hispanic white children (odds ratio [OR] 1.4). Children who had ever received a physician diagnosis of asthma (OR, 3.2), atopic dermatitis and/or eczema (OR, 1.9), allergic rhinitis (OR, 2.3), insect sting allergy (OR, 2.5), medication allergy (OR, 1.9), urticaria (OR, 2.9), or latex allergy (OR, 7.9) had increased odds of convincing food allergy.
Among children with 1 or more convincing food allergies, having multiple food allergies, a current epinephrine prescription, a history of 1 or more lifetime food allergy–related emergency department visits, a severe reaction history, and comorbid allergic rhinitis were each associated with the presence of 1 or more confirmed food allergies.
“These data suggest that childhood [food allergy] is a significant public health issue resulting in relatively high rates of severe allergic reactions and [emergency department] use,” the authors concluded.
Gupta RS, Warren CM, Smith BM, et al. The public health impact of parent-reported childhood food allergies in the United States. Pediatrics. 2018;142(6):e20181235.