The prevalence of food allergy and other allergic diseases in early childhood in a population-based study: HealthNuts age 4-year follow-up.
TL;DR: The prevalence of food allergy decreased between age 1 year and age 4 years in this population‐based cohort, and the prevalence of any allergic disease among 4‐year‐old children in Melbourne, Australia, is remarkably high.
Abstract: Background The HealthNuts study previously reported interim prevalence data showing the highest prevalence of challenge-confirmed food allergy in infants internationally. However, population-derived prevalence data on challenge-confirmed food allergy and other allergic diseases in preschool-aged children remain sparse. Objective This study aimed to report the updated prevalence of food allergy at age 1 year from the whole cohort, and to report the prevalence of food allergy, asthma, eczema, and allergic rhinitis at age 4 years. Methods HealthNuts is a population-based cohort study with baseline recruitment of 5276 one-year-old children who underwent skin prick test (SPT) to 4 food allergens and those with detectable SPT results had formal food challenges. At age 4 years, parents completed a questionnaire (81.3% completed) and those who previously attended the HealthNuts clinic at age 1 year or reported symptoms of a new food allergy were invited for an assessment that included SPT and oral food challenges. Data on asthma, eczema, and allergic rhinitis were captured by validated International Study of Asthma and Allergies in Childhood questionnaires. Results The prevalence of challenge-confirmed food allergy at age 1 and 4 years was 11.0% and 3.8%, respectively. At age 4 years, peanut allergy prevalence was 1.9% (95% CI, 1.6% to 2.3%), egg allergy was 1.2% (95% CI, 0.9% to 1.6%), and sesame allergy was 0.4% (95% CI, 0.3% to 0.6%). Late-onset peanut allergy at age 4 years was rare (0.2%). The prevalence of current asthma was 10.8% (95% CI, 9.7% to 12.1%), current eczema was 16.0% (95% CI, 14.7% to 17.4%), and current allergic rhinitis was 8.3% (95% CI, 7.2% to 9.4%). Forty percent to 50% of this population-based cohort experienced symptoms of an allergic disease in the first 4 years of their life. Conclusions Although the prevalence of food allergy decreased between age 1 year and age 4 years in this population-based cohort, the prevalence of any allergic disease among 4-year-old children in Melbourne, Australia, is remarkably high.
Citations
More filters
TL;DR: This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis, and treatment that have occurred over the 4 years since the last comprehensive review.
Abstract: This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis, and treatment that have occurred over the 4 years since our last comprehensive review. Although firm prevalence data are lacking, there is a strong impression that food allergy has increased, and rates as high as approximately 10% have been documented. Genetic, epigenetic, and environmental risk factors are being elucidated increasingly, creating potential for improved prevention and treatment strategies targeted to those at risk. Insights on pathophysiology reveal a complex interplay of the epithelial barrier, mucosal and systemic immune response, route of exposure, and microbiome among other influences resulting in allergy or tolerance. The diagnosis of food allergy is largely reliant on medical history, tests for sensitization, and oral food challenges, but emerging use of component-resolved diagnostics is improving diagnostic accuracy. Additional novel diagnostics, such as basophil activation tests, determination of epitope binding, DNA methylation signatures, and bioinformatics approaches, will further change the landscape. A number of prevention strategies are under investigation, but early introduction of peanut has been advised as a public health measure based on existing data. Management remains largely based on allergen avoidance, but a panoply of promising treatment strategies are in phase 2 and 3 studies, providing immense hope that better treatment will be imminently and widely available, whereas numerous additional promising treatments are in the preclinical and clinical pipeline.
938 citations
Cites background from "The prevalence of food allergy and ..."
...%) and the lowest rates in Lithuania, Germany, and Greece (<0.3%).30 Some of the highest rates of food allergy are noted in Australia and are obtained from the population-based HealthNuts study, which recruited 5276 children at age 1 year and included OFCs.23,31 They reported an 11% age 1 prevalence of challenge-proved food allergy only considering 3 foods: peanut (3.0%; 95% CI, 2.4% to 3.8%), raw egg allergy (8.9%; 95% CI, 7.8% to 10.0%), and sesame allergy (0.8%; 95% CI, 0.5% to 1.1%).23 In follow-up at age 4 years,31 the overall allergy rate was 3.8%, with a peanut allergy prevalence of 1.9% (95% CI, 1.6% to 2.3%), egg allergy prevalence of 1.2% (95% CI, 0.9% to 1.6%), and sesame allergy prevalence of 0.4% (95% CI, 0.3% to 0.6%)....
[...]
...CRD has already improved the diagnostic armamentarium, and there are more sophisticated tests under development to hopefully improve the ability to predict prognosis and severity and reduce the need for OFCs....
[...]
...We have proposed a schematic diagnostic algorithm that considers the history, epidemiology, pathophysiology, and test results leading to a diagnosis, including identification of the trigger food or foods, as shown in Fig 1,1,89 and similar schematics have been proposed by others.5,90 Expert panels, practice parameters, systematic reviews, and guidelines have identified a number of recommended diagnostic modalities.3,5,7,17,79 These tests include medical history, physical examination, elimination diets, SPTs, sIgE tests, and OFCs....
[...]
...However, a stepped approach of testing peanut IgE followed by Ara h 2 would have reduced the need for OFCs to 32 and an SPT followed by Ara h 2 reduced the need to only 21 OFCs....
[...]
...Some of the highest rates of food allergy are noted in Australia and are obtained from the population-based HealthNuts study, which recruited 5276 children at age 1 year and included OFCs.(23,31) They reported an 11% age 1 prevalence of challenge-proved food allergy only considering 3 foods: peanut (3....
[...]
TL;DR: More robust studies investigating food allergy prevalence, particularly in Asia and the developing world, are necessary to understand the extent of the food allergy problem and identify preventive strategies to cope with the potential increase in these regions.
Abstract: There is a lack of high-quality evidence based on the gold standard of oral food challenges to determine food allergy prevalence. Nevertheless, studies using surrogate measures of food allergy, such as health service utilization and clinical history, together with allergen-specific immunoglobulin E (sIgE), provide compelling data that the prevalence of food allergy is increasing in both Western and developing countries. In Western countries, challenge-diagnosed food allergy has been reported to be as high as 10%, with the greatest prevalence noted among younger children. There is also growing evidence of increasing prevalence in developing countries, with rates of challenge-diagnosed food allergy in China and Africa reported to be similar to that in Western countries. An interesting observation is that children of East Asian or African descent born in a Western environment are at higher risk of food allergy compared to Caucasian children; this intriguing finding emphasizes the importance of genome-environment interactions and forecasts future increases in food allergy in Asia and Africa as economic growth continues in these regions. While cow's milk and egg allergy are two of the most common food allergies in most countries, diverse patterns of food allergy can be observed in individual geographic regions determined by each country's feeding patterns. More robust studies investigating food allergy prevalence, particularly in Asia and the developing world, are necessary to understand the extent of the food allergy problem and identify preventive strategies to cope with the potential increase in these regions.
277 citations
Cites background from "The prevalence of food allergy and ..."
...In Australia, it was noted that 12-month-old infants with parents of East Asian ethnicity had a three-fold higher risk of food allergy compared with infants of non-East Asian descent [42]....
[...]
...In Australia, a country with one of the highest rates of food allergy, a recent study evaluating 5016 adolescents aged 10 to 14 years reported an OFC-confirmed food allergy prevalence of 4.5% (95% CI, 3.9–5.1) [17]....
[...]
...A subsequent study using the same methodology to examine Australian hospital morbidity data showed that food-related anaphylaxis admission rates have continued to increase from 5.6 to 8.2 per 100,000 between 2005 and 2012 [21]....
[...]
...In Australia, admissions for anaphylaxis caused by food showed an average annual increase of 13.2% between 1994 and 2005....
[...]
...8% in Norway [11] and more than 10% at age 12 months and around 4% at age 4 years in Australia [2,12]....
[...]
TL;DR: There is compelling evidence that egg also contains many and still-unexplored bioactive compounds, which may be of high interest in preventing/curing diseases.
Abstract: Egg is an encapsulated source of macro and micronutrients that meet all requirements to support embryonic development until hatching. The perfect balance and diversity in its nutrients along with its high digestibility and its affordable price has put the egg in the spotlight as a basic food for humans. However, egg still has to face many years of nutritionist recommendations aiming at restricting egg consumption to limit cardiovascular diseases incidence. Most experimental, clinical, and epidemiologic studies concluded that there was no evidence of a correlation between dietary cholesterol brought by eggs and an increase in plasma total-cholesterol. Egg remains a food product of high nutritional quality for adults including elderly people and children and is extensively consumed worldwide. In parallel, there is compelling evidence that egg also contains many and still-unexplored bioactive compounds, which may be of high interest in preventing/curing diseases. This review will give an overview of (1) the main nutritional characteristics of chicken egg, (2) emerging data related to egg bioactive compounds, and (3) some factors affecting egg composition including a comparison of nutritional value between eggs from various domestic species.
227 citations
TL;DR: While it remains unclear how much of the current population-level burden of disease results from true, IgE-mediated allergy, it is clear that affected individuals suffer impairments in their quality of life and incur substantial economic costs—beyond the physical health burden imposed by anaphylaxis.
Abstract: In recent decades, food allergy has become an increasing concern for families, clinicians, and policymakers. This review aims to summarize what is currently known about the epidemiology and population-level burden of IgE-mediated food allergy, including its effects on quality of life. Prevalence surveys, healthcare utilization data, and findings from longitudinal cohort studies across the globe indicate that food allergy imposes a growing societal burden. Worryingly, recent data indicate that food allergies may be more prevalent among adult populations than previously acknowledged, with many reported cases of adult-onset allergies. While it remains unclear how much of the current population-level burden of disease results from true, IgE-mediated allergy, as much epidemiological data does not incorporate clinical confirmation of disease prevalence—it is clear that affected individuals suffer impairments in their quality of life and incur substantial economic costs—beyond the physical health burden imposed by anaphylaxis.
135 citations
TL;DR: To prevent peanut and/or egg allergy, both peanut and egg should be introduced around 6 months of life, but not before 4 months, and infants should be fed a diverse diet, because this may help foster prevention of food allergy.
124 citations
References
More filters
TL;DR: The rise in prevalence of symptoms in many centres is concerning, but the absence of increases in prevalence in asthma symptoms for centres with existing high prevalence in the older age-group is reassuring.
3,762 citations
TL;DR: Wide variations exist in the symptom prevalence of childhood asthma worldwide, and although asthma symptoms tend to be more prevalent in more affluent countries, they appear to beMore severe in less affluent countries.
Abstract: Background: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence and severity of asthma symptoms in children. Methods: A cross-sectional questionnaire survey of 798 685 children aged 13–14 years from 233 centres in 97 countries, and 388 811 children aged 6–7 years from 144 centres in 61 countries, was conducted between 2000 and 2003 in >90% of the centres. Results: The prevalence of wheeze in the past 12 months (current wheeze) ranged from 0.8% in Tibet (China) to 32.6% in Wellington (New Zealand) in the 13–14 year olds, and from 2.4% in Jodhpur (India) to 37.6% in Costa Rica in the 6–7 year olds. The prevalence of symptoms of severe asthma, defined as ⩾4 attacks of wheeze or ⩾1 night per week sleep disturbance from wheeze or wheeze affecting speech in the past 12 months, ranged from 0.1% in Pune (India) to 16% in Costa Rica in the 13–14 year olds and from 0% to 20.3% in the same two centres, respectively, in the 6–7 year olds. Ecological economic analyses revealed a significant trend towards a higher prevalence of current wheeze in centres in higher income countries in both age groups, but this trend was reversed for the prevalence of severe symptoms among current wheezers, especially in the older age group. Conclusion: Wide variations exist in the symptom prevalence of childhood asthma worldwide. Although asthma symptoms tend to be more prevalent in more affluent countries, they appear to be more severe in less affluent countries.
894 citations
"The prevalence of food allergy and ..." refers background in this paper
...0%.(24) The prevalence of current eczema in 6- to 7-year-old children was higher in Australia than the global estimate; 17....
[...]
TL;DR: In this paper, the authors measured the prevalence of common IgE-mediated childhood food allergies in a population-based sample of 12-month-old infants by using predetermined food challenge criteria to measure outcomes.
Abstract: Background: Several indicators suggest that food allergy in infants is common and possibly increasing. Few studies have used oral food challenge to measure this phenomenon at the population level. Objective: To measure the prevalence of common IgE-mediated childhood food allergies in a population-based sample of 12-month-old infants by using predetermined food challenge criteria to measure outcomes. Methods: A sampling frame was used to select recruitment areas to attain a representative population base. Recruitment occurred at childhood immunization sessions in Melbourne, Australia. Infants underwent skin prick testing, and those with any sensitization (wheal size ≥1 mm) to 1 or more foods (raw egg, peanut, sesame, shellfish, or cow's milk) were invited to attend an allergy research clinic. Those who registered a wheal size ≥1 mm to raw egg, peanut, or sesame underwent oral food challenge. Results: Amongst 2848 infants (73% participation rate), the prevalence of any sensitization to peanut was 8.9% (95% CI, 7.9-10.0); raw egg white, 16.5% (95% CI, 15.1-17.9); sesame, 2.5% (95% CI, 2.0-3.1); cow's milk, 5.6% (95% CI, 3.2-8.0); and shellfish, 0.9% (95% CI, 0.6-1.5). The prevalence of challenge-proven peanut allergy was 3.0% (95% CI, 2.4-3.8); raw egg allergy, 8.9% (95% CI, 7.8-10.0); and sesame allergy, 0.8% (95% CI, 0.5-1.1). Oral food challenges to cow's milk and shellfish were not performed. Of those with raw egg allergy, 80.3% could tolerate baked egg. Conclusion: More than 10% of 1-year-old infants had challenge-proven IgE-mediated food allergy to one of the common allergenic foods of infancy. The high prevalence of allergic disease in Australia requires further investigation and may be related to modifiable environmental factors.
866 citations
TL;DR: The trial did not show the efficacy of early introduction of allergenic foods in an intention-to-treat analysis, and the consumption of 2 g per week of peanut or egg-white protein was associated with a significantly lower prevalence of these respective allergies than was less consumption.
Abstract: BackgroundThe age at which allergenic foods should be introduced into the diet of breast-fed infants is uncertain. We evaluated whether the early introduction of allergenic foods in the diet of breast-fed infants would protect against the development of food allergy. MethodsWe recruited, from the general population, 1303 exclusively breast-fed infants who were 3 months of age and randomly assigned them to the early introduction of six allergenic foods (peanut, cooked egg, cow’s milk, sesame, whitefish, and wheat; early-introduction group) or to the current practice recommended in the United Kingdom of exclusive breast-feeding to approximately 6 months of age (standard-introduction group). The primary outcome was food allergy to one or more of the six foods between 1 year and 3 years of age. ResultsIn the intention-to-treat analysis, food allergy to one or more of the six intervention foods developed in 7.1% of the participants in the standard-introduction group (42 of 595 participants) and in 5.6% of thos...
626 citations
"The prevalence of food allergy and ..." refers methods in this paper
...These participants and methods have been described in detail previously.(11) §Participants were included in the numerator if they were allergic to 1 or more foods, including additional foods tested (see Table E2); participants were excluded from the...
[...]
TL;DR: The epidemic of eczema seems to be leveling or decreasing in some countries with previously high prevalence rates, with many formerly low-prevalence developing countries experiencing substantial increases, especially in the younger age group.
Abstract: Background It is unclear whether eczema prevalence is truly increasing worldwide Objective We sought to investigate worldwide secular trends in childhood eczema Methods Children (n = 302,159) aged 13 to 14 years in 105 centers from 55 countries and children aged 6 to 7 years (n = 187,943) in 64 centers from 35 countries were surveyed from the same study centers taking part in Phase One and Three of the International Study of Asthma and Allergies in Childhood by using identical validated and translated questionnaires Eczema was defined as an itchy, relapsing, flexural skin rash in the last 12 months, and it was termed severe eczema when it was associated with 1 or more disturbed nights per week Results Annual prevalence changes in relation to average prevalence across Phase One and Three were generally small and differed in direction according to the age of the participants and world region For children 13 to 14 years old, eczema symptom prevalence decreased in some previously high-prevalence centers from the developed world, such as the United Kingdom and New Zealand, whereas centers with previously high prevalence rates from developing countries continued to increase In the children 6 to 7 years old, most centers showed an increase in current eczema symptoms Similar patterns to these were present for severe eczema at both ages Conclusion The epidemic of eczema seems to be leveling or decreasing in some countries with previously high prevalence rates The picture elsewhere is mixed, with many formerly low-prevalence developing countries experiencing substantial increases, especially in the younger age group
481 citations