title: Anaphylaxis to foods in a population of adolescents: incidence, characteristics and associated risks.
abstract: Information about severe reactions to foods in adolescence is limited.
  
  
  
  To describe reactions to foods, including anaphylaxis, with regard to incidence, characteristics and associated risks, among 16-year-olds (adolescents) in a large, population-based birth cohort.
  
  
  
  Parent-reported questionnaire data from ages 2-3 months, and 1, 2 and 16 years were used (N = 3153). Anaphylaxis at age 16 years was defined per NIAID/FAAN criteria. Immunoglobulin E (IgE) antibodies to 14 common food and inhalant allergens were analysed at ages 4 (n = 2283) and 16 years (n = 2510). Among adolescents with food-related symptoms (FRS) and for whom blood was available (n = 221), 25 additional food allergen extracts or allergen components were analysed. Associations between reactions to foods, and sensitization and allergic multimorbidity were investigated.
  
  
  
  In the 12 months prior to the 16-year assessment, 8.5% of adolescents had FRS. This included 0.8% (n = 24) adolescents who were classified as having anaphylaxis, yielding an incidence rate of 761/100 000 person-years. One-third of adolescents accessed health care during anaphylaxis. Allergic multimorbidity in infancy, as well as sensitization to foods and airborne allergens at age 4 years, was associated with an increased risk for FRS in adolescence. Peanuts and tree nuts were the most common culprit foods for anaphylaxis, and fruits and vegetables for non-anaphylactic reactions. Adolescents with anaphylaxis were significantly more likely to be sensitized to storage proteins (Ara h 2, Cor a 9, Cor a 14) and to be polysensitized to foods (P < 0.001 vs. non-anaphylactic reactions).
  
  
  
  The incidence of food-induced anaphylaxis during adolescence in our population-based birth cohort is higher than previously reported. Adolescents with anaphylaxis differ from adolescents with non-anaphylactic FRS with regard to culprit foods and sensitization. Adolescents with previous anaphylaxis are likely to be polysensitized to foods, particularly tree nut and peanut storage proteins, and which warrants consideration at follow-up.
authors: Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.|Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.|Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
authors: M
authors: M
authors: Vetander
authors: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.|Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
authors: J L P
authors: JL
authors: Protudjer
authors: Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.|Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.|Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
authors: G
authors: G
authors: Lilja
authors: Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.|Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.|Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
authors: I
authors: I
authors: Kull
authors: Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.|Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.|Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors: G
authors: G
authors: Hedlin
authors: Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.|Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
authors: M
authors: M
authors: van Hage
authors: Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.|Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.|Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
authors: E
authors: E
authors: Östblom
authors: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.|Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
authors: A
authors: A
authors: Bergström
authors: Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.|Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.|Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
authors: M
authors: M
authors: Wickman
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005502:Food / Q000009:adverse effects*; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000628:therapy; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D015994:Incidence; D007223:Infant; D008297:Male; D011159:Population Surveillance; D012306:Risk; D063189:Symptom Assessment
chemical_list: D007073:Immunoglobulin E; D004837:Epinephrine
keywords: allergen-specific immunoglobulin E; anaphylaxis; children; epidemiology; food allergy; food-related symptoms