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

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 allergenspecific 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.

A Model for Improving Diet Quality within Child Nutrition Programs: The U.S. Army’s Child and Youth Services Healthy Menu Initiative

“…This CYS figure is consistent with the estimated prevalence of childhood food allergies in the United States, which is at roughly 8.0% [18,19]. This figure is also consistent with the estimated prevalence of parent-reported childhood food allergies, which, at 11%, is higher owing to the inclusion of reaction histories inconsistent with immunoglobulin E-mediated food allergy [19]. The relatively large proportion of children with special diet requirements adds significantly to the responsibility and workload of the CYS staff, as well as that of other child nutrition professionals.…”

“…However, site visits conducted during the implementation phase suggest that between 8% and 16% of CYS children require meal modifications for numerous reasons (e.g., allergies, religious accommodations). This CYS figure is consistent with the estimated prevalence of childhood food allergies in the United States, which is at roughly 8.0% [18,19]. This figure is also consistent with the estimated prevalence of parent-reported childhood food allergies, which, at 11%, is higher owing to the inclusion of reaction histories inconsistent with immunoglobulin E-mediated food allergy [19].…”

Food protein–induced enterocolitis syndrome in the US population–based study

“…Methodological details about survey development, complex survey sampling, and weighting have been previously described. [7][8][9] The outcome measure of interest was the lifetime prevalence of physician-diagnosed FPIES. Participants were asked: ''Have you/ Has your child ever been diagnosed by a physician with food protein-induced enterocolitis syndrome (FPIES)?…”

“…In addition, we analyzed the reported physician-diagnosed food allergy (IgE-mediated, IgE-food allergy), asthma, atopic dermatitis, and allergic rhinitis as per the definitions published previously. [7][8][9] Eligible study participants included adults (> _18 years) able to complete the survey in English or Spanish via web or telephone, who resided in a US household. Point prevalence estimates were based on participants recruited from the National Opinion Research Center at the University of Chicago's probability-based AmeriSpeak Panel, with a survey completion rate of 51.2%.…”

Allergen components in diagnosing childhood hazelnut allergy: Systematic literature review and meta‐analysis

“…Tree nut allergies affect 1.2% of children and adults, and hazelnut allergy is among the most common of these allergies. Symptoms range from mild oral symptoms to severe systemic reactions .…”