Reactions in Kids with Food Allergy Are Common
Nearly three-quarters (72%) of young children with food allergies had an allergic reaction through 3 years of follow-up, researchers found.
And a little more than half (52.5%) had at least two, David Fleischer, MD, of National Jewish Health in Denver, and colleagues reported online ahead of the July issue of Pediatrics.
Through a median follow-up of 3 years, there were 1,171 allergic reactions in 367 of the children, a reaction rate of 0.81 per year (95% CI 0.76 to 0.85). A higher number of food allergies (P<0.0001) and higher food-specific immunoglobulin E (P<0.0001) were associated with reactions.
The findings point to the need for increased education of parents and others who care for children with food allergies, according to the researchers.
"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," not just parents, they wrote.
Fleischer and colleagues looked at data from an ongoing prospective study of infants and young children, ages 3 to 15 months, with a documented or likely allergy to milk or egg.
The current analysis included 512 participants who met at least one of the following conditions:
- A convincing allergic reaction to milk, egg, or both coupled with a positive skin prick test to the trigger food
- Moderate to severe atopic dermatitis and a positive skin prick test to milk, egg, or both
Most of the reactions were caused by milk (42.3%), egg (21%), and peanut (7.9%).
The vast majority of reactions (87.4%) were from accidental exposures -- including unintentional ingestion by the child, label-reading errors, and cross-contamination -- but the rest resulted from purposeful exposures, which is a concern, according to the researchers.
"Reasons for these exposures need further exploration but may reflect parental testing for resolution of allergy," the authors wrote. "A preemptive discussion of the risks of purposeful exposure is advisable."
About one in every five reactions overall (21.3%) received no treatment. Epinephrine was administered in fewer than one-third of the reactions considered severe.
The problem of lack of treatment was underscored in the 11.4% of reactions considered severe, which are characterized by lower respiratory symptoms, cardiovascular symptoms, or a combination of skin, oral, upper respiratory, and gastrointestinal symptoms.
Despite the fact that all such reactions are candidates for epinephrine, the drug was administered in only 29.9% of cases. In about half of the severe reactions, the caretakers recognized that epinephrine was indicated but failed to administer it anyway.
The most common factors associated with not using epinephrine were lack of recognition of the severity of the reaction (47%), epinephrine not being available (23.1%), and fears about administering the drug (12.3%).
"Education about treatment and reassuring caretakers about the safety of administering epinephrine is indicated because some caretakers reported being afraid," the authors wrote.
They acknowledged that the study was limited by the possibility that not all reactions were captured, that the parental reports about the reactions contained inaccuracies, and that parents were reluctant to report reactions stemming from purposeful exposures.
The study was supported by the NIH-National Institute of Allergy and Infectious Diseases (NIAID). The project was also supported by grants from National Jewish Health, Mount Sinai School of Medicine, the University of Arkansas for Medical Sciences, Duke University Medical Center, and Johns Hopkins University School of Medicine from the National Center for Research Resources, a component of the NIH. Fleischer received grant support from the NIH-NIAID. His co-authors reported support from the National Heart, Lung, and Blood Institute, the Marion B. Lyon Award, the NIH, the Food Allergy & Anaphylaxis Network, the Wallace Research Foundation, the National Peanut Board, the NIH-NIAID, the Food Allergy Initiative, and Dyax Corp.
Fleischer and one of his co-authors are consultants for Sunovion. The other study authors reported relationships with the Asthma and Allergy Foundation of America, the Food Allergy & Anaphylaxis Network, ActoGeniX NV, Intelliject, McNeil Nutritionals, Novartis, Schering-Plough, Allertein, MastCell, Dannon Co. Probiotics, Nutricia, the American College of Allergy, Asthma, and Immunology, the NIH, the Journal of Allergy and Clinical Immunology, the FDA, sanofi-aventis, the Food Allergy Initiative, and Herb Springs.
Primary source: Pediatrics
Source reference:
Fleischer D, et al "Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study" Pediatrics 2012; DOI: 10.1542/peds.2011-1762.
Add Your Knowledge ™
Register Today
Earn Free CME Credits by reading the latest medical news
in your specialty.
Todd Neale
Senior Staff Writer
Todd Neale, MedPage Today Staff Writer, got his start in journalism at Audubon Magazine and made a stop in directory publishing before landing at MedPage Today. He received a B.S. in biology from the University of Massachusetts Amherst and an M.A. in journalism from the Science, Health, and Environmental Reporting program at New York University.