Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

Author:

Fleischer David M.1,Perry Tamara T.2,Atkins Dan1,Wood Robert A.3,Burks A. Wesley4,Jones Stacie M.2,Henning Alice K.5,Stablein Donald5,Sampson Hugh A.6,Sicherer Scott H.6

Affiliation:

1. National Jewish Health, Denver, Colorado;

2. University of Arkansas for Medical Sciences, Little Rock, Arkansas;

3. Johns Hopkins University School of Medicine, Baltimore, Maryland;

4. Duke University Medical Center, Durham, North Carolina and University of North Carolina, Chapel Hill, North Carolina;

5. The EMMES Corporation, Rockville, Maryand; and the

6. Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, New York

Abstract

OBJECTIVE: To examine circumstances of allergic reactions to foods in a cohort of preschool-aged children. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

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