Asthma, respiratory allergy rates show decreasing trend among US children
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Rates of asthma and respiratory allergy among children decreased from 2007 to 2018, with variations based on race, ethnicity, income level and other demographics, according to a study published in Annals of Allergy, Asthma & Immunology.
Further, the study showed that children with allergies were significantly more likely to also have asthma.
These findings could assist in the clinical management of asthma, allocation of public health resources and implementation of tailored implementation strategies, the researchers wrote in the study.
“The purpose of the study was to document asthma status among children with allergies using national surveillance data from the National Health Interview Survey (NHIS),” Cynthia A. Pate, MPH, epidemiologist with the Asthma & Community Health Branch of the Division of Environmental Health Science and Practice, National Center for Environmental Health at the CDC, told Healio.
According to 2007 to 2018 data from the NHIS, approximately 26.4% of children in the United States aged 0 to 17 years had at least one allergy. The most common allergies included respiratory (14.7%), skin (12.7%) and food (6.4%), with 1.1% of children having all three types of allergies.
Also, 8.1% of all children and 18.1% of those who had allergy had current asthma. Children with allergy were two to eight times more likely to have current asthma than those without allergy depending on the type and number of allergies, with those reporting all three allergies at highest risk (adjusted prevalence ratios [aPR] = 7.99; 95% CI, 6.48-9.85).
“Having any allergy was significantly associated with having current asthma. However, the strength of association varied (two to eight times) by type and number of allergies,” Pate said.
Between 2010 and 2018, the prevalence of respiratory allergy significantly fell from 17.2% to 14% (P < .001). However, food allergy prevalence increased from 3.9% to 6.5% from 2007 to 2018 (P < .001).
Current asthma prevalence fell from 9.1% to 7.5% (P < .001) among all children and from 20.7% to 16.4% (P = .002) among children with allergy from 2007 to 2018. However, when looking at children from different racial and ethnic groups, the association only remained significant among white children with allergy (P = .03).
The researchers further found significant associations between prevalence of any allergy with age group (P < .001), sex (P = .03), race and ethnicity (P < .001) and family income (P < .001).
Specifically, allergy appeared more common among children aged 5 years and older (5-11 years, 26.8%; 12-17 years, 28.6% vs. 0-4 years, 23.1%), boys vs. girls (27.1% vs. 25.7%), multiracial children vs. white children (34.7% vs. 27.7%) and children living in families with higher incomes ( 450% of federal poverty level [FPL], 29.7% vs. < 100% of FPL, 25.2%; 100% to < 250% of FPL, 24.4%; 250% to < 450% of FPL, 26.6%).
Rates of respiratory allergy also increased with increasing age, among boys and among multiracial children, whereas skin allergy was more common among younger, Black and multiracial children. Food allergy prevalence appeared greater among multiracial children and white children and those with families of higher income.
Among children with allergy, the researchers also found greater prevalence of current asthma among children aged 5 years and older (5-11 years, 20.1%; 12-17 years, 21.2%) than among children aged 0 to 4 years (10.1%).
Current asthma prevalence among children with allergy similarly appeared more common among boys than girls (19.5% vs. 16.6%); among Black (27%), multiracial (23.8%) and Hispanic children (18.2%) than white children (15.4%); and among those living in families with lower incomes (< 100% of FPL, 22.6%; 100% to 250% of FPL, 20.4% vs. 450% of FPL, 15%).
The researchers also found higher current asthma prevalence among children with allergy in the Northeast (20.8%) and the Midwest (18.6%) vs. the West (14.8%).
Finally, the researchers found significant associations between missed school days (aPR = 1.33; 95% CI, 1.03-1.72) and daily preventive medication usage (aPR = 1.89; 95% CI, 1.32-2.71) among children with current allergy.
The researchers concluded that a significant association exists between asthma and any type of allergy, and the strength of this association varies based on the type and number of allergies. Demographics and income impact these associations as well.
“This is a population-based observational study. The findings are to increase the awareness but not necessarily provide recommendations for clinical care of patients with allergies and asthma,” Pate said.
For more information:
Cynthia A. Pate, MPH, can be reached at yvx0@cdc.gov.
Perspective
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Angela Duff Hogan, MD, FAAAAI, FACAAI, FAAP
This paper presents important epidemiological information from the CDC’s National Health Interview Survey from 2007 to 2018 on the prevalence of allergic disease in children. Currently, 26% of all U.S. children aged 0 to 17 years are atopic. The most reported types of allergies were allergic rhinitis/hay fever at 14.7%, skin allergy at 12.7% and food allergy at 6.4%.
Of the nearly 5 million children diagnosed with asthma, 60% of them are atopic. Children with any reported allergy were two to eight times more likely to have current asthma than children without allergies. This information suggests a low threshold for asthma screening in children with mild or intermittent respiratory symptoms.
Physicians should also discuss with parents that a prolonged cough in an atopic child may not just be postnasal drip but possibly asthma. With such a high prevalence of atopy in pediatric asthmatics, it is still essential to evaluate these patients for allergies, not only to implement environmental control measures and consider disease-modifying treatments such as immunotherapy, but also to understand asthma endotype presentations, which would help in selecting biologicals for severe asthmatics.
It was encouraging news that the current prevalence of asthma has decreased among children from 9.1% in 2007 to 7.5% in 2018. Perhaps this is based on improved asthma diagnosis and management strategies. It also fits with the decreasing rates of asthma mortality seen over the last few years, suggesting the asthma prevalence wave is decreasing as the food allergy wave seems to be increasing. Food allergy prevalence increased from 3.9% in 2007 to 6.5% in 2018.
Several risk profiles were presented in this data set. For example, skin allergy was more prevalent among Black and multiracial children aged 0 to 4 years. Food allergy was higher in multiracial children and in children living in higher socioeconomic environments. Asthma was more prevalent in the 12- to 17-year age group, boys, Black and multiracial children, and among families whose income was less than 250% of the FPL. Understanding the relationships among these risk factors could help develop intervention strategies to reduce the burden of atopic disease.
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