title: Incidence and risk factors for food hypersensitivity in UK infants: results from a birth cohort study.
abstract: BACKGROUND
  The prevalence of food hypersensitivity in the UK is still largely open to debate. Additionally its pathogenesis is also unclear although it is known that there are differing phenotypes. Determining its prevalence, along with identifying those factors associated with its development will help to assess its clinical importance within the national setting and also add to the debate on appropriate prevention strategies.
  
  
  METHODS
  A population based birth cohort study conducted in Hampshire, UK as part of the EuroPrevall birth cohort study. 1140 infants were recruited with 823 being followed up until 2 years of age. Infants with suspected food reactions were assessed including specific IgE measurement and skin prick testing. Diagnosis of food hypersensitivity was by positive double-blind, placebo-controlled food challenge (DBPCFC) where symptoms up to 48 h after the end of the food challenge were considered indicative of a food hypersensitivity. Factors associated with food hypersensitivity and its two phenotypes of IgE-mediated and non-IgE-mediated disease were modelled in a multivariable logistic regression analysis.
  
  
  RESULTS
  Cumulative incidence of food hypersensitivity by 2 years of age was 5.0 %. The cumulative incidence for individual food allergens were hens' egg 2.7 % (1.6-3.8); cows' milk 2.4 % (1.4-3.5); peanut 0.7 % (0.1-1.3); soy 0.4 % (0.0-0.8); wheat 0.2 % (0.0-0.5) and 0.1 % (0.0-0.32) for fish. The cumulative incidence of IgE-mediated food allergy was 2.6 % with 2.1 % reacting to hens' egg. For non-IgE-mediated food allergy the cumulative incidence was 2.4 % (cows' milk 1.7 %). Predictors for any food hypersensitivity were wheeze, maternal atopy, increasing gestational age, age at first solid food introduction and mean healthy dietary pattern score. Predictors for IgE mediated allergy were eczema, rhinitis and healthy dietary pattern score whereas for non-IgE-mediated food allergy the predictors were dog in the home, healthy dietary pattern score, maternal consumption of probiotics during breastfeeding and age at first solid food introduction.
  
  
  CONCLUSIONS
  Just under half the infants with confirmed food hypersensitivity had no demonstrable IgE. In an exploratory analysis, risk factors for this phenotype of food hypersensitivity differed from those for IgE-mediated food allergy except for a healthy infant diet which was associated with less risk for both phenotypes.
authors.affiliation: Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Mailpoint 803, Level F, South Academic Block, Southampton, SO16 6YD UK ; Department of Nutrition and Dietetics, Southampton Children's Hospital, Southampton, SO16 6YD UK.
authors.forename: Kate E C
authors.identifier: 0000-0003-3649-7963
authors.initials: KE
authors.lastname: Grimshaw
authors.affiliation: Primary Care and Population Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD UK.
authors.forename: Trevor
authors.initials: T
authors.lastname: Bryant
authors.affiliation: Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Mailpoint 803, Level F, South Academic Block, Southampton, SO16 6YD UK.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Oliver
authors.affiliation: NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Martin
authors.affiliation: Primary Care and Population Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD UK.
authors.forename: Joe
authors.initials: J
authors.lastname: Maskell
authors.affiliation: The Hampshire Hospitals Foundation Trust, Winchester, SO22 5DG UK.
authors.forename: Terri
authors.initials: T
authors.lastname: Kemp
authors.affiliation: Institute of Inflammation and Repair, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, The University of Manchester, Manchester, M1 7DN UK.
authors.forename: E N
authors.initials: EN
authors.lastname: Clare Mills
authors.affiliation: The Hampshire Hospitals Foundation Trust, Winchester, SO22 5DG UK.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Foote
authors.affiliation: Primary Care and Population Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD UK.
authors.forename: Barrie M
authors.initials: BM
authors.lastname: Margetts
authors.affiliation: Department of Paediatric Pneumology and Immunology, Charité University Medical Centre, Berlin, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Beyer
authors.affiliation: Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Mailpoint 803, Level F, South Academic Block, Southampton, SO16 6YD UK ; NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Roberts
keywords: Dietary pattern analysis; Epidemiology; EuroPrevall; Food allergy; Food hypersensitivity; Healthy eating; Incidence; Risk factors
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