Childhood food allergy results in significant direct medical costs for the US health care system and even larger costs for families with a food-allergic child.

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Although peanut allergy is among the most common food allergies, no study has comprehensively described the epidemiology of the condition among the general pediatric population. Our objective was to better characterize peanut allergy prevalence, diagnosis trends, and reaction history among affected children identified from a representative sample of United States households with children. A randomized, cross sectional survey was administered to parents from June 2009 to February 2010. Data from 38,480 parents were collected and analyzed in regard to demographics, allergic symptoms associated with food ingestion, and methods of food allergy diagnosis. Adjusted models were estimated to examine association of these characteristics with odds of peanut allergy. Of the 3218 children identified with food allergy, 754 (24.8%) were reported to have a peanut allergy. Peanut allergy was reported most often among 6- to 10-year-old children (25.5%), white children (47.7%), and children from households with an annual income of $50,000-$99,999 (41.7%). Although peanut allergy was diagnosed by a physician in 76% of cases, significantly more peanut allergy reactions were severe as compared with reactions to other foods (53.7% versus 41.0%, p < 0.001). Parents were significantly less likely to report tolerance to peanut as compared with the odds of tolerance reported for other foods (odds ratio 0.7, 95% confidence interval: 0.5-0.9). Childhood peanut allergy, which represents nearly a quarter of all food allergy, presents more severe reactions and is least likely to be outgrown. Although it is diagnosed by a physician in nearly three-fourths of all cases, socioeconomic disparities in regard to diagnosis persist.

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Food allergy is a growing public health concern in the United States that affects an estimated 8% of children. Food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a specific food. Nearly 40% of children with food allergy have a history of severe reactions that if not treated immediately with proper medication can lead to hospitalization or even death. The National Institute of Allergy and Infectious Diseases (NIAID) convened an expert panel in 2010 to develop guidelines outlining evidence-based practices in diagnosing and managing food allergy. The purpose of this review is to aid clinicians in translating the NIAID guidelines into primary care practice and includes the following content domains: (1) the definition and mechanism of childhood food allergy, (2) differences between food allergy and food intolerance, (3) the epidemiology of childhood food allergy in the United States, (4) best practices derived from the NIAID guidelines focused on primary care clinicians' management of childhood food allergy, (5) emerging food allergy treatments, and (6) future directions in food allergy research and practice. Articles focused on childhood food allergy were considered for inclusion in this review. Studies were restricted to the English language and to those published within the past 40 years. A cross-listed combination of the following words, phrases, and MeSH terms was searched in PubMed and Google Scholar to identify relevant articles: food allergy, food hypersensitivity, child, pediatric, prevalence, and epidemiology. Additional sources were identified through the bibliographies of the retrieved articles.

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Our goals were to (1) estimate the rates of parent-reported versus physician-diagnosed food allergy, (2) determine pediatrician adherence to national guidelines, and (3) obtain pediatricians' perspectives on guideline nonadherence. A mixed method approach was used, including survey, chart review, and qualitative methods. Overall, 10.9% of parents reported having a child with food allergy and two thirds of these cases were detected by the pediatrician. Chart reviews revealed high rates of guideline adherence with respect to allergist referral (67.3%), but less consistent adherence regarding documentation of reaction history (38.8%), appropriate use of diagnostic tests (34.7%), prescription of epinephrine autoinjectors (44.9%), and counseling families in food allergy management (24.5%). Pediatricians suggested that poor adherence was due to lack of documentation, familiarity with guidelines, and clarity regarding the pediatrician's role in managing food allergy. Findings emphasize the need to better establish the role of the pediatrician and to improve awareness and adherence to guidelines.