Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study

• Published in: Pediatrics (Evanston) Vol. 130; no. 1; p. e25
• Main Authors: Fleischer, David M, Perry, Tamara T, Atkins, Dan, Wood, Robert A, Burks, A Wesley, Jones, Stacie M, Henning, Alice K, Stablein, Donald, Sampson, Hugh A, Sicherer, Scott H
• Format: Journal Article
• Language: English
• Published: United States 01.07.2012
• Subjects: Dermatitis, Atopic - drug therapy; Dermatitis, Atopic - epidemiology; Dermatitis, Atopic - etiology; Egg Hypersensitivity - drug therapy; Egg Hypersensitivity - epidemiology; Egg Hypersensitivity - etiology; Epinephrine - therapeutic use; Female; Follow-Up Studies; Food Hypersensitivity - drug therapy; Food Hypersensitivity - epidemiology; Food Hypersensitivity - etiology; Health Surveys; Humans; Infant; Male; Milk Hypersensitivity - drug therapy; Milk Hypersensitivity - epidemiology; Milk Hypersensitivity - etiology; Peanut Hypersensitivity - drug therapy; Peanut Hypersensitivity - epidemiology; Peanut Hypersensitivity - etiology; Poisson Distribution; Prospective Studies; Regression Analysis; Severity of Illness Index; Surveys and Questionnaires; Sympathomimetics - therapeutic use; United States - epidemiology; United States
• DOI: 10.1542/peds.2011-1762

To examine circumstances of allergic reactions to foods in a cohort of preschool-aged children. We conducted a prospective, 5-site observational study of 512 infants aged 3 to 15 months with documented or likely allergy to milk or egg, and collected data prospectively examining allergic reactions. Over a median follow-up of 36 months (range: 0-48.4), the annualized reaction rate was 0.81 per year (367/512 subjects reporting 1171 reactions [95% confidence interval: 0.76-0.85]). Overall, 269/512 (52.5%) reported >1 reaction. The majority of reactions (71.2%) were triggered by milk (495 [42.3%]), egg (246 [21.0%]), and peanut (93 [7.9%]), with accidental exposures attributed to unintentional ingestion, label-reading errors, and cross-contact. Foods were provided by persons other than parents in 50.6% of reactions. Of 834 reactions to milk, egg, or peanut, 93 (11.2%) were attributed to purposeful exposures to these avoided foods. A higher number of food allergies (P < .0001) and higher food-specific immunoglobulin E (P < .0001) were associated with reactions. Of the 11.4% of reactions (n = 134) that were severe, 29.9% were treated with epinephrine. Factors resulting in undertreatment included lack of recognition of severity, epinephrine being unavailable, and fears about epinephrine administration. There was a high frequency of reactions caused by accidental and nonaccidental exposures. Undertreatment of severe reactions with epinephrine was a substantial problem. Areas for improved education include the need for constant vigilance, accurate label reading, avoidance of nonaccidental exposure, prevention of cross-contamination, appropriate epinephrine administration, and education of all caretakers.