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.

ImportanceCataract surgery in the US is routinely performed with anesthesia care, whereas anesthesia care for other elective, low-risk, outpatient procedures is applied more selectively.ObjectiveTo identify predictors of anesthesia care in Medicare beneficiaries undergoing cataract surgery and evaluate anesthesia care for cataract surgery compared with other elective, low-risk, outpatient procedures.Design, Setting, and ParticipantsThis population-based, retrospective observational cohort study included Medicare beneficiaries 66 years or older who underwent cataract surgery in 2017. The data were analyzed from August 2020 through May 2021.Interventions (for clinical trials) or Exposures (for observational studies)Anesthesia care during elective, low-risk, outpatient procedures.Main Outcomes and MeasuresPrevalence of anesthesia care during cataract surgery compared with other low-risk procedures; association of anesthesia care with patient, clinician, and health system characteristics; and proportion of patients experiencing a systemic complication within 7 days of cataract surgery compared with patients undergoing other low-risk procedures.ResultsAmong 36 652 cataract surgery patients, the mean (SD) age was 74.7 (6.1) years; 21 690 (59.2%) were female; 2200 (6.6%) were Black and 32 049 (87.4%) were White. Anesthesia care was more common among patients undergoing cataract surgery compared with patients undergoing other low-risk procedures (89.8% vs range of &amp;lt;1% to 70.2%). Neither the patient’s age (adjusted odds ratio, 1.01; 95% CI, 1.00-1.02; P = .01) nor Charlson Comorbidity Index (CCI) score (CCI of ≥3: adjusted odds ratio, 1.06; 95% CI, 0.95-1.18; P = .28; reference, CCI score of 0-1) was strongly associated with anesthesia care for cataract surgery, but a model comprising a single variable identifying the ophthalmologist predicted anesthesia care with a C statistic of 0.96. Approximately 6.0% of ophthalmologists never used anesthesia care, 76.6% always used anesthesia care, and 17.4% used it for only a subset of patients. Fewer cataract surgery patients experienced systemic complications within 7 days (2833 [7.7%]), even when limited to patients of ophthalmologists who never used anesthesia care (108 [7.4%]), than patients undergoing other low-risk procedures (range, 13.2%-52.2%).Conclusions and RelevanceThe results of this cohort study suggest that systemic complications occurred less frequently after cataract surgery compared with other elective, low-risk, outpatient procedures during which anesthesia care was less commonly used. Anesthesia care was not associated with patient characteristics, such as older age or worse health status, but with the ophthalmologists’ usual approach to cataract surgery sedation. The study findings suggest an opportunity to use anesthesia care more selectively in patients undergoing cataract surgery.

COMMENT & RESPONSEIn Reply We thank Drs Nemet and Tuuminen and Dr Dalia and colleagues for their interest in our article. 1 Drs Nemet and Tuuminen's experiences in Finland add to the growing body of literature suggesting that complications after cataract surgery are exceedingly rare, even though anesthesia care for cataract surgery is used much more selectively at their institution than it is in the US. This approach to cataract surgery sedation is also the prevailing practice throughout the UK, 2 as well as at other dedicated eye care centers, 3,4 and has been shown to be safe and acceptable to patients in these settings.We agree with Dr Dalia and colleagues that undergoing an ambulatory procedure or a procedure performed outside the operating room does not automatically mean that these procedures should be considered low risk. 5 As the authors mentioned, some of the procedures we included, 1 such as cardiac catheterization and percutaneous coronary interventions (PCIs), are inherently higher risk than cataract surgery. 6 Yet our data showed 1 that although most cataract surgical procedures (lower risk) occurred with anesthesia care, almost all cardiac catheterizations and PCIs (higher risk) were being performed without anesthesia care. Our results raise the question of whether anesthesia care is being overused in cataract surgery while simultaneously being underused in cardiac catheterization and PCIs.Lastly, Dr Dalia and colleagues assert that the model results we shared in the online supplement 1 cannot account for all factors that affect the assignment of anesthesia care and/or the risk of developing perioperative complications. We agree that observational studies can only account for measured confounders. However, the reports of Drs Nemet and Tuuminen and others 2-4 support our study's conclusion that anesthesia care may be overused for cataract surgery. 1 Therefore, a pro-spective interventional trial is warranted to evaluate whether most cataract surgical procedures can be safely performed in the US without routine anesthesia care.