Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study.
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.
National Jewish Health, Denver, Colorado 80206, USA. fleischerd@njhealth.org
David M
DM
Fleischer
Tamara T
TT
Perry
Dan
D
Atkins
Robert A
RA
Wood
A Wesley
AW
Burks
Stacie M
SM
Jones
Alice K
AK
Henning
Donald
D
Stablein
Hugh A
HA
Sampson
Scott H
SH
Sicherer
D003876:Dermatitis, Atopic / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D021181:Egg Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005512:Food Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D016269:Milk Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D021183:Peanut Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D016012:Poisson Distribution; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013566:Sympathomimetics / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D013566:Sympathomimetics; D004837:Epinephrine