In their article "Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder," Xu and colleagues 1 present new data that add to the growing body of literature supporting an immune-mediated subtype of autism spectrum disorder (ASD). The investigators analyzed data from the National Health Interview Survey, a continuous, ongoing, nationally representative annual health survey conducted in the United States since 1957. The National Health Interview Survey is the primary source of information on health conditions of the US population. Data from 1997 to 2016, collected via an in-person household interview, were used in this study. All children aged 3 to 17 years with available information about allergic conditions and ASD were included. Respondents were asked about the occurrence of a food or digestive allergy, any kind of respiratory allergy, or eczema or any kind of skin allergy during the past 12 months. Respondents were also asked whether the child received a diagnosis of ASD from a physician or other health professional. Among the 199 520 children in the analysis, 8734 had food allergy, 24 555 had respiratory allergy, and 19 399 had skin allergy. Health professional-diagnosed ASD was reported in 1868 children. Children with ASD were significantly more likely than those without ASD to have food allergy (11.25% vs 4.25%), respiratory allergy (18.73% vs 12.08%), and skin allergy (16.81% vs 9.84%). The likelihood of the child having ASD more than doubled among children with food allergy compared with those without food allergy; children with respiratory and skin allergy were also significantly more likely to have ASD, but at a lesser magnitude. While no sex difference was found for food allergy, boys with ASD were significantly more likely than girls with ASD to have respiratory and skin allergy.Previous studies have identified a positive association of respiratory allergy and skin allergy with ASD, as detailed in the current article. To my knowledge, the results of Xu et al 1 are the first to document the association of food allergy with ASD with confidence, in part based on the large sample size they accessed. The authors wonder whether this association may be related to gut-brainbehavior axis abnormalities that have been hypothesized to exist in a subset of individuals with ASD.Such an association has been reported in both patients with ASD and animal models of ASD, particularly those using the maternal immune activation model of ASD. 2 From a clinical perspective, patients with ASD who are minimally verbal to nonverbal may be unable to describe the pain and discomfort they experience secondary to food allergy and subsequent inflammation in the gastrointestinal (GI) tract. Instead, their physical distress may manifest as irritability, aggression, and/or self-injury. It is important to underscore the need for health care professionals to conduct a thorough history and physical examination to rule out identifiable medical causes of aberrant behavior, including food allergy and secondary ...