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Nearly 60% of children with asthma have at least one type of allergy
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VANCOUVER, British Columbia — More than half of children with asthma also have at least one type of allergy, and data indicate the trend has remained level from 2001 to 2012, according to research recently presented at the 2014 Pediatric Academic Societies Annual Meeting.
“Although trends in allergies among children with and without asthma are similar over the past decade, children with asthma have much higher rates of prevalence for each type of allergy, and are increasingly likely to have all three types compared to children without asthma,” Kenneth C. Schoendorf, MD, and Lara J. Akinbami, MD, of the National Center for Health Statistics in Hyattsville, Md., told Healio Allergy. “This trend may have implications for asthma management and health care use.”
Lara J. Akinbami
Data from the National Health Interview Survey (2001-2012) allowed researchers to determine the percentage of children (aged 0 to 17 years) with one, two or three types of allergy (respiratory, food and/or skin allergies). They found that the percentage of children with asthma with an at least one allergy remained stable at 57% in 2001 and in 2012. The percentage of children with asthma and respiratory allergies, however, appeared to decrease 1.5% annually from 51% in 2001 to 44% in 2012 (P<.05).
Additional findings showed that among children with asthma, food allergies increased 4% per year from 10% to 15% during the study period (P<.05); skin allergies increased by 3.4% annually from 17% to 26% for the same time (P<.05).
Children with asthma and with all three types of allergy, however, rose from 3% in 2001 to 6% in 2012 (P<.05). However, among children without asthma, the percent with all three types of allergies remained stable at approximately 0.5%.
Kenneth C. Schoendorf
“We did not expect such a big contrast in trends between children with and without asthma in the percent with all three allergic conditions given the pattern in trends for single allergies. The rates of growth in food allergies and skin allergies were similar between children with and without asthma,” Schoendorf and Akinbami wrote to Healio Allergy. “Furthermore, the percent of children with asthma who had a respiratory allergy declined while it stayed level among children without asthma. Finally, the trend in having any allergy increased among children without asthma compared to children with asthma. Nonetheless, the percent of children with all three allergies increased significantly among children with asthma but not in children without asthma.”
The researchers said the meaning of this trend isn’t clear but that follow-up is under way to analyze whether there are significant differences among age and race/ethnic subgroups. – by Samantha Costa
For more information:
Schoendorf KC. #4135.459. Presented at: PAS 2014; May 2-6; Vancouver, British Columbia.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Matthew Greenhawt, MD, MBA, MSc, FAAP
Schoendorf and colleagues detail their review of data taken from the NHIS that indicate nearly 60% of children have an allergy. It has been described that allergic conditions, most notably food allergy, have exploded in prevalence the past decade. However, in looking closer at the data source in this study, these authors use the NHIS, which details parent-reported data, and we must be very careful in how such reports are interpreted.
Unlike many other illnesses, allergy has inflated rates based on self-report, to the point that self-reported data are rarely considered reliable for publication in the allergy world. This is, in part, because allergy is strictly defined, despite commonly associated symptoms. Allergy technically implies development of typical symptoms characteristic of mast cell/basophil degranulation (eg, hives, itching, wheezing, colic, etc.) in the presence of a trigger to which the body is sensitized to make specific IgE against.
The balance between symptoms and sensitization is delicate — the presence of specific IgE alone is not the same as being allergic — both symptoms and sensitization are necessary. A number of conditions closely resemble allergic diseases — food intolerances, non-allergic rhinitis or irritation, cough/wheeze produced by paradoxical vocal fold motion, and viral urticaria are a few that come to mind. In a survey such as the NHIS, any of these entities could be reported as an “allergy” given their close resemblance to allergic conditions.
For example, clinical diagnosis of allergic rhinitis is common, but potentially inexact — being told by your primary care provider that you have seasonal allergies is not the same as having this confirmed by a board-certified allergist. However, both may be answered in an identical way on a survey such as the NHIS that does not specify how the diagnosis was made.
The NHIS does not track skin test or serologic parameters that would allow a true rate of allergy to be determined. The NHIS asks very basic questions concerning physician diagnoses of the allergic condition and cannot verify that all those reporting an allergic condition have IgE sensitization.
Therefore, at best, these data in this abstract indicate a 60% reported rate of allergies, which may not actually represent the true number of individuals meeting the definition of “allergic.” The increase in the report of allergies is not unimportant, but it cannot be mistaken to imply a 60% prevalence of disease, which translates to three out of five kids. Such a number would represent an alarming prevalence increase. The large, nationally representative databases, such as the NHIS and NHAHES, have known weakness in terms of their limited ability to tracking allergic disease because sensitization can’t be verified, or the symptoms can’t be verified to correlate with the sensitization.
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