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Multicenter Study
. 2012 Jul;130(1):e25-32.
doi: 10.1542/peds.2011-1762. Epub 2012 Jun 25.

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

David M Fleischer  1 , Tamara T Perry, Dan Atkins, Robert A Wood, A Wesley Burks, Stacie M Jones, Alice K Henning, Donald Stablein, Hugh A Sampson, Scott H Sicherer
Affiliations
Multicenter Study

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

David M Fleischer et al. Pediatrics. 2012 Jul.

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.

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Figures

FIGURE 1
FIGURE 1
Allergic reactions per food allergen.
FIGURE 2
FIGURE 2
Allergic reactions per individual who provided the participant with the food.
FIGURE 3
FIGURE 3
Allergic reactions according to route of exposure. Other exposures included 3 allergic reactions with other combinations, 1 unknown exposure, and 4 by injection (egg in influenza vaccine).
See this image and copyright information in PMC

References

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