Egg Allergy in US Children

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Abstract

Egg allergy is common in young children (<5 years) and has significant negative impacts on quality of life. The objective of this study was to characterize egg allergy prevalence, severity, baked egg tolerance, and other associated factors in a large US cohort. A national cross-sectional survey was administered from October 2015-September 2016, resulting in complete parent-proxy responses for 38,408 children. Weighted proportions were estimated to compare egg allergy prevalence and characteristics between key subpopulations. Overall prevalence of current, convincingly egg allergy was 0.9% among all children and 1.3% among children <5 years. Black children were over-represented among children with egg allergy, accounting for 23.4% (95% CI: 13.1–38.4) of egg-allergic children despite comprising 13.2% (12.3-14-2) of the US pediatric population. Among children with egg allergy, 64.2% reported baked egg tolerance and 60.2% had allergy to other foods, with 29.3% having peanut allergy. Asthma was more prevalent in children with an egg allergy than children with other top 8 food allergies (46.5%, (35.8–57.4) vs 33.2% (29.6–37.0), p<0.05). Among children with current egg allergy, those with baked egg tolerance reported that their food allergy resulted in significantly reduced psychosocial burden, relative to their baked egg-allergic counterparts (M=3.1 (2.9–3.3) vs M=3.7 (3.5–3.9). Egg allergy is common amongst young children. Nearly two-thirds of children with egg allergy reported baked egg tolerance. Increased efforts are needed to ensure children with egg allergy are appropriately evaluated as many have comorbid allergic disease and determination of baked egg tolerance may improve QoL.

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The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States

Ruchi Gupta, Christopher M. Warren, Bridget M Smith … (2018)

A 2015–2016 population-based, cross-sectional survey was administered to a sample of US households to estimate current FA prevalence, severity, and health care use. Video Abstract BACKGROUND: Childhood food allergy (FA) is a life-threatening chronic condition that substantially impairs quality of life. This large, population-based survey estimates childhood FA prevalence and severity of all major allergenic foods. Detailed allergen-specific information was also collected regarding FA management and health care use. METHODS: A survey was administered to US households between 2015 and 2016, obtaining parent-proxy responses for 38 408 children. Prevalence estimates were based on responses from NORC at the University of Chicago’s nationally representative, probability-based AmeriSpeak Panel (51% completion rate), which were augmented by nonprobability-based responses via calibration weighting to increase precision. Prevalence was estimated via weighted proportions. Multiple logistic regression models were used to evaluate FA predictors. RESULTS: Overall, estimated current FA prevalence was 7.6% (95% confidence interval: 7.1%–8.1%) after excluding 4% of children whose parent-reported FA reaction history was inconsistent with immunoglobulin E–mediated FA. The most prevalent allergens were peanut (2.2%), milk (1.9%), shellfish (1.3%), and tree nut (1.2%). Among food-allergic children, 42.3% reported ≥1 severe FA and 39.9% reported multiple FA. Furthermore, 19.0% reported ≥1 FA-related emergency department visit in the previous year and 42.0% reported ≥1 lifetime FA-related emergency department visit, whereas 40.7% had a current epinephrine autoinjector prescription. Prevalence rates were higher among African American children and children with atopic comorbidities. CONCLUSIONS: FA is a major public health concern, affecting ∼8% of US children. However, >11% of children were perceived as food-allergic, suggesting that the perceived disease burden may be greater than previously acknowledged.

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The prevalence, severity, and distribution of childhood food allergy in the United States.

Jacqueline A. Pongracic, Subaschandrabose kumar, R. Gupta … (2011)

The goal of this study was to better estimate the prevalence and severity of childhood food allergy in the United States. A randomized, cross-sectional survey was administered electronically to a representative sample of US households with children from June 2009 to February 2010. Eligible participants included adults (aged 18 years or older) able to complete the survey in Spanish or English who resided in a household with at least 1 child younger than 18 years. Data were adjusted using both base and poststratification weights to account for potential biases from sampling design and nonresponse. Data were analyzed as weighted proportions to estimate prevalence and severity of food allergy. Multiple logistic regression models were constructed to identify characteristics significantly associated with outcomes. Data were collected for 40 104 children; incomplete responses for 1624 children were excluded, which yielded a final sample of 38 480. Food allergy prevalence was 8.0% (95% confidence interval [CI]: 7.6-8.3). Among children with food allergy, 38.7% had a history of severe reactions, and 30.4% had multiple food allergies. Prevalence according to allergen among food-allergic children was highest for peanut (25.2% [95% CI: 23.3-27.1]), followed by milk (21.1% [95% CI: 19.4-22.8]) and shellfish (17.2% [95% CI: 15.6-18.9]). Odds of food allergy were significantly associated with race, age, income, and geographic region. Disparities in food allergy diagnosis according to race and income were observed. Findings suggest that the prevalence and severity of childhood food allergy is greater than previously reported. Data suggest that disparities exist in the clinical diagnosis of disease. Copyright © 2011 by the American Academy of Pediatrics.

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Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants.

Nicholas J Osborne, Jennifer J. Koplin, Pamela E Martin … (2011)

Several indicators suggest that food allergy in infants is common and possibly increasing. Few studies have used oral food challenge to measure this phenomenon at the population level. To measure the prevalence of common IgE-mediated childhood food allergies in a population-based sample of 12-month-old infants by using predetermined food challenge criteria to measure outcomes. A sampling frame was used to select recruitment areas to attain a representative population base. Recruitment occurred at childhood immunization sessions in Melbourne, Australia. Infants underwent skin prick testing, and those with any sensitization (wheal size ≥ 1 mm) to 1 or more foods (raw egg, peanut, sesame, shellfish, or cow's milk) were invited to attend an allergy research clinic. Those who registered a wheal size ≥ 1 mm to raw egg, peanut, or sesame underwent oral food challenge. Amongst 2848 infants (73% participation rate), the prevalence of any sensitization to peanut was 8.9% (95% CI, 7.9-10.0); raw egg white, 16.5% (95% CI, 15.1-17.9); sesame, 2.5% (95% CI, 2.0-3.1); cow's milk, 5.6% (95% CI, 3.2-8.0); and shellfish, 0.9% (95% CI, 0.6-1.5). The prevalence of challenge-proven peanut allergy was 3.0% (95% CI, 2.4-3.8); raw egg allergy, 8.9% (95% CI, 7.8-10.0); and sesame allergy, 0.8% (95% CI, 0.5-1.1). Oral food challenges to cow's milk and shellfish were not performed. Of those with raw egg allergy, 80.3% could tolerate baked egg. More than 10% of 1-year-old infants had challenge-proven IgE-mediated food allergy to one of the common allergenic foods of infancy. The high prevalence of allergic disease in Australia requires further investigation and may be related to modifiable environmental factors. Copyright © 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.