The epidemiology of multifood allergy in the United States: A population-based study

Abstract

Background: Immunoglobulin E (IgE)-mediated food allergies (FAs) are increasingly common among US children and adults. Not only can living with FA impose considerable physical health impacts, but it also imposes economic burden and can negatively affect quality of life. Limited data indicate that allergy to multiple foods (multi-FA) also may be common, but much remains unknown about its distribution and determinants.

Objective: To characterize the prevalence, characteristics, determinants, psychosocial burden, and distribution of multi-FA among a large, nationally representative sample of US children and adults.

Methods: A US population-based survey was administered. Estimates of multi-FA prevalence, conditional frequencies of multi-FA combinations, and associated factors were derived. Latent class analyses were conducted using 9 dichotomized indicators of specific FA prevalence, which were used to determine factors associated with latent class membership and characterize FA-related psychosocial burden within each class.

Results: Surveys were completed for 38,408 children and 40,443 adults. Among children and adults meeting established symptom-report criteria for FA, an estimated 40% and 48% had multi-FA, respectively. Among pediatric and adult populations with convincing FAs, the lifetime reported prevalence of physician-diagnosed atopic comorbidities increased significantly as the number of reported current convincing FAs increased, as did the proportion reporting multi-FA-related health care utilization and higher perceived psychosocial burden. Latent class analyses suggested the existence of the following 4 key latent phenotypes of multi-FA: milk and egg-dominant, seafood-dominant, peanut and tree nut-dominant, and broadly multi-food allergic.

Conclusion: The US population-level burden of multi-FA is high among both children and adults, and data indicate the presence of 4 major phenotypes of multi-FA in both populations.

Figure 1.

Bivariate conditional frequencies of specific Convincingly IgE-mediated Multifood Allergies Among US Children. Conditional formatting is applied to each matrix such that higher rates of comorbidity are indicated with red, moderate rates of comorbidity are indicated with yellow shading and low rates of comorbidity are indicated with green. The data are presented as conditional frequencies (from 0-100%) of individuals with particular column food allergies who also have specific row food allergies. For example 8% of children with a tree nut allergy also have a sesame allergy. Figure 1a. Bivariate conditional frequencies of specific Convincingly IgE-mediated Multifood Allergies Among US Children Conditional probabilities of individuals with food allergies labeled within each column, who are also allergic to the specific food listed in the corresponding row. For example, 61% of children with a tree nut allergy are also allergic to peanut, while 33% of children who are allergic to peanut are also allergic to tree nut. Figure 1b. Bivariate conditional frequencies of specific Convincingly IgE-mediated Multifood Allergies Among US Adults Conditional probabilities of individuals with food allergies labeled within each column, who are also allergic to the specific food listed in the corresponding row. For example, 50% of adults with a tree nut allergy are also allergic to peanut, while 33% of adults who are allergic to peanut are also allergic to tree nut.

Figure 1.

Bivariate conditional frequencies of specific Convincingly IgE-mediated Multifood Allergies Among US Children. Conditional formatting is applied to each matrix such that higher rates of comorbidity are indicated with red, moderate rates of comorbidity are indicated with yellow shading and low rates of comorbidity are indicated with green. The data are presented as conditional frequencies (from 0-100%) of individuals with particular column food allergies who also have specific row food allergies. For example 8% of children with a tree nut allergy also have a sesame allergy. Figure 1a. Bivariate conditional frequencies of specific Convincingly IgE-mediated Multifood Allergies Among US Children Conditional probabilities of individuals with food allergies labeled within each column, who are also allergic to the specific food listed in the corresponding row. For example, 61% of children with a tree nut allergy are also allergic to peanut, while 33% of children who are allergic to peanut are also allergic to tree nut. Figure 1b. Bivariate conditional frequencies of specific Convincingly IgE-mediated Multifood Allergies Among US Adults Conditional probabilities of individuals with food allergies labeled within each column, who are also allergic to the specific food listed in the corresponding row. For example, 50% of adults with a tree nut allergy are also allergic to peanut, while 33% of adults who are allergic to peanut are also allergic to tree nut.

Figure 2.. Estimated Latent Classes of Multi-food allergy among children and adults with at least one convincingly IgE-mediated food allergy

Line graphs of convincingly IgE-mfood allergen-specific probabilities within 4 latent classes of multi food allergy, stratified by pediatric (0-17 years) and adult (>17 years) respondents

Figure 3.. Differences in Pediatric and Adult FAIM Scores by latent multi-food allergy class

Bar graphs demonstrating mean item-specific FAIM scores estimated for each of the 4 estimated latent multi-food allergy classes stratified by pediatric (0-17 years) and adult (>17 years) respondents