Food, drug, insect sting allergy, and anaphylaxis
National prevalence and risk factors for food allergy and relationship to asthma: Results from the National Health and Nutrition Examination Survey 2005-2006

https://doi.org/10.1016/j.jaci.2010.07.026Get rights and content

Background

The national prevalence and patterns of food allergy (FA) in the United States are not well understood.

Objective

We developed nationally representative estimates of the prevalence of and demographic risk factors for FA and investigated associations of FA with asthma, hay fever, and eczema.

Methods

A total of 8203 participants in the National Health and Nutrition Examination Survey 2005-2006 had food-specific serum IgE measured to peanut, cow's milk, egg white, and shrimp. Food-specific IgE and age-based criteria were used to define likely FA (LFA), possible FA, and unlikely FA and to develop estimates of clinical FA. Self-reported data were used to evaluate demographic risk factors and associations with asthma and related conditions.

Results

In the United States, the estimated prevalence of clinical FA was 2.5% (peanut, 1.3%; milk, 0.4%; egg, 0.2%; shrimp, 1.0%; not mutually exclusive). Risk of possible FA/LFA was increased in non-Hispanic blacks (odds ratio, 3.06; 95% CI, 2.14-4.36), males (1.87; 1.32-2.66), and children (2.04; 1.42-2.93). Study participants with doctor-diagnosed asthma (vs no asthma) exhibited increased risk of all measures of food sensitization. Moreover, in those with LFA, the adjusted odds ratio for current asthma (3.8; 1.5-10.7) and an emergency department visit for asthma in the past year (6.9; 2.4-19.7) were both notably increased.

Conclusion

Population-based serologic data on 4 foods indicate an estimated 2.5% of the US population has FA, and increased risk was found for black subjects, male subjects, and children. In addition, FA could be an under-recognized risk factor for problematic asthma.

Section snippets

The NHANES 2005-2006 study cohort

The NHANES is a Centers for Disease Control and Prevention, National Center for Health Statistics program, designed to assess the health and nutritional status of adults and children in the United States, that began in the early 1960s. NHANES 2005-2006 was the seventh nationally representative NHANES survey and included 10,348 participants from 30 sites across the continental United States.8 The NHANES 2005-2006 protocol was approved by the National Center for Health Statistics, Centers for

Study population characteristics

The study population was demographically diverse and representative of the US population (Table I). Allergic sensitization (ie, serum allergen-specific IgE level ≥ 0.35 kU/L) was common: 16.8% were sensitized to at least 1 food, 41.3% to at least 1 inhalant allergen, and 13.9% to at least 1 food and 1 inhalant allergen. Self-reported doctor-diagnosed asthma (14.6%), hay fever (10.8%), and eczema (9.1%) were also common. Of those with diagnosed asthma, 9.6% reported an ED or urgent care visit

Discussion

This study found that the prevalence estimate of clinical allergy to peanut, milk, egg, and/or shrimp was 2.5% and was associated with childhood, male sex, and non-Hispanic black race/ethnicity. We also found an association of LFA with current asthma and ED visits for asthma in the previous year.

For the first time in a US nationally representative sample, specific serum IgE levels were used to quantify allergic sensitization to common foods. This is important because clinical studies have

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Supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences.

Disclosure of potential conflict of interest: S. H. Sicherer is a consultant for the Food Allergy Initiative and has received research support from NIH/NIAID, Food Allergy Initiative, and FAAN. R. A. Wood has received research support from the NIH and is on the medical advisory board for FAAN. S. A. Bock has received research support from National Jewish Health. A. W. Burks is a consultant for ActoGeniX NV, Intelliject, McNeil Nutritionals, and Novartis; is a minority stockholder for Allertein and MastCell Inc; is on the advisory board for Dannon CO Probiotics; is on the expert panel for Nutricia; has received research support from the National Institutes of Health, the Food Allergy and the Anaphylaxis Network, and the Wallace Research Foundation; has served as an expert witness on the topic of food allergies; is on the medical board of directors for FAAN; is on the Dermatological Allergy Committee for the ACAAI; is a Study Section Member for the NIH/HAI; and is on the reviewer board for the Journal of Allergy and Clinical Immunology and the FDA. The rest of the authors have declared that they have no conflict of interest.

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