Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Infants and children with diagnosed food allergy are at risk for acute, potentially life-threatening symptoms. Limited data are available on the frequency, severity, and circumstances of reactions and caretaker medical response. WHAT THIS STUDY ADDS:This study describes food allergy reaction frequency, circumstances, and response. Pitfalls that may inform improved anticipatory guidance included lack of vigilance, misreading ingredient labels, allergen cross-contact, nonaccidental allergen feeding, and underutilization of epinephrine for severe reactions. abstract OBJECTIVE: To examine circumstances of allergic reactions to foods in a cohort of preschool-aged children. METHODS:We conducted a prospective, 5-site observational study of 512 infants aged 3 to 15 months with documented or likely allergy to milk or egg, and collected data prospectively examining allergic reactions. , with accidental exposures attributed to unintentional ingestion, label-reading errors, and cross-contact. Foods were provided by persons other than parents in 50.6% of reactions. Of 834 reactions to milk, egg, or peanut, 93 (11.2%) were attributed to purposeful exposures to these avoided foods. A higher number of food allergies (P , .0001) and higher foodspecific immunoglobulin E (P , .0001) were associated with reactions. Of the 11.4% of reactions (n = 134) that were severe, 29.9% were treated with epinephrine. Factors resulting in undertreatment included lack of recognition of severity, epinephrine being unavailable, and fears about epinephrine administration. RESULTS:CONCLUSIONS: There was a high frequency of reactions caused by accidental and nonaccidental exposures. Undertreatment of severe reactions with epinephrine was a substantial problem. Areas for improved education include the need for constant vigilance, accurate label reading, avoidance of nonaccidental exposure, prevention of cross-contamination, appropriate epinephrine administration, and education of all caretakers. Pediatrics 2012;130:e25-e32 AUTHORS:

Epinephrine for First-aid Management of Anaphylaxis

“…1,3,8,35 Many patients and caregivers fail to carry EAs consistently or to use them when anaphylaxis occurs, even for severe symptoms, including throat tightness, difficulty breathing, wheezing, and loss of consciousness. 41,45,46 People may have different reasons for not using EAs, including failure to recognize anaphylaxis symptoms, spontaneous recovery from a previous anaphylactic episode and the assumption that this will happen in every episode, reliance on oral H 1 -antihistamines and/ or inhaled bronchodilators, no EA available, fear of needles, and concerns about epinephrine adverse effects. 41, 45 -48 Many parents fear using an EA because they worry about hurting or injuring their child or a bad outcome.…”

“…41, 45 -48 Many parents fear using an EA because they worry about hurting or injuring their child or a bad outcome. 46,47 Unintentional injections into digits and other body parts, with or without injuries, 48 and lacerations incurred when an inadequately restrained child moves during the injection are reported from pen-type EAs. 49 Teenagers are at increased risk of death in anaphylaxis 16 -18 because of high-risk behaviors, including ethanol and/or recreational drug use, failure to recognize triggers, denial of symptoms, and failure to carry their EAs and inject epinephrine promptly when anaphylaxis occurs.…”

Emerging therapies for food allergy

“…While much childhood food allergy is outgrown, a substantial proportion of even milk and egg allergy persists into adulthood, and some food allergies, such as peanut, tree nuts, and shellfish, are usually persistent (1). Reported rates of reaction due to accidental exposure vary widely, from 5% per year to 58% per five years for peanut (2,3) and up to 80% per year for milk (4). Although mortality from food-related anaphylaxis is rare, estimated to be approximately 1.8 per million person-years among foodallergic subjects (5), fear of accidental reactions and social effects of avoidance diets contribute to significantly impaired quality of life for food-allergic children and their caregivers (6).…”

Sublingual Immunotherapy for Peanut Allergy: A Randomized, Double-Blind, Placebo-Controlled Multicenter Trial

“…(1) Peanuts and tree nuts are the most common triggers of severe and fatal food-induced anaphylactic reactions, (2;3) and peanut allergy is less commonly outgrown than allergy to other major food allergens; thus significant, lifelong changes in dietary habits are required. Given the ever-present fear of severe allergic reactions from accidental ingestions and food product contamination, (4)(5)(6) the potential for severe or fatal reactions, (3;7) the need for strict elimination diets and difficulty interpreting food labels, (8;9) a diagnosis of food allergy has significant medical, nutritional and psychosocial implications for affected individuals and families. (10)(11)(12)(13)(14) Additionally, there is a substantial economic impact, as investigators have also reported increased health care expenditures associated with food allergy.…”