Patients with multiple food allergies face greater physical, psychosocial burdens
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The burden of multiple food allergies was high among both children and adults in the United States, with four major phenotypes among these patients, according to a study published in Annals of Allergy, Asthma & Immunology.
These burdens include increased health care utilization and greater perceived psychosocial stressors, Christopher M. Warren, PhD, assistant professor of preventive medicine and director of population health research at Center for Food Allergy & Asthma Research, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, and colleagues wrote.
The researchers obtained survey results for 38,408 children (mean age, 8.7 years; 95% CI, 8.5-8.8) and 40,443 adults (mean age, 46.8 years; 95% CI, 46.3-47.2). The researchers distinguished between participants who reported food allergies and those whose allergies were “convincing,” meaning the most severe reaction included at least one symptom on a list of stringent symptoms developed by an expert panel.
Multiple food allergy prevalence
The survey found one or more current food allergies among 11.4% (95% CI, 10.8%-12%) of children regardless of clinical history, with 45% of these children reporting multiple current food allergies.
Similarly, 7.6% (95% CI, 7.1%-8.1%) of children had one or more convincingly IgE-mediated food allergies, 40% of whom reported multiple current IgE-mediated food allergies.
Based on the “convincing” definition of food allergy, 4.6% (95% CI, 4.2%-5%) of children had a single convincing food allergy, 1.8% (95% CI, 1.6%-2.1%) had two or three and 1.2% (95% CI, 1%-1.4%) had more than three.
Also, 10.8% (95% CI, 10.4%-11.1%) of adults reported one or more current convincingly IgE-mediated food allergies, with 46% having multiple.
Regarding convincing food allergies, 5.9% (95% CI, 5.6%-6.2%) of adults reported one, 3.1% (95% CI, 2.9%-3.3%) reported two or three and 1.7% (95% CI, 1.6%-1.9%) reported more than three.
Multi-allergy burdens
The survey revealed an association between the number of current convincing food allergies and the number of ED visits related to food allergy in the previous 12 and over the respondent’s lifetime months (P < .001 for both), with an association between a greater number of food allergies and greater odds for ED visits.
The likelihood for a severe food allergy reaction and history of epinephrine autoinjector use increased with the number of current convincing food allergies as well (P < .001). Additionally, current prescriptions for epinephrine autoinjectors were associated with greater numbers of current convincing food allergies (2-3 food allergies, OR = 2.1; 95% CI, 1.6-2.6; 3 food allergies, OR = 3; 95% CI, 2.3-3.9).
As patients reported greater numbers of current convincing food allergies, the prevalence of lifetime reported physician-diagnosed comorbidities such as asthma, atopic dermatitis, environmental allergies and gastrointestinal disease also increased significantly (P < .001).
The researchers further found an association between a greater number of convincing food allergies and greater perceived food allergy severity and corresponding psychosocial burden related to food allergy based on responses to the food allergy independent measure (FAIM) forms for children and adults.
Four phenotypes
The researchers found four patterns among patients with multiple food allergies:
- class 1 (5% of food-allergic children; 4% of food-allergic adults): broadly multi-food allergic with elevated probabilities for allergy to each of the top nine allergen categories;
- class 2 (28% of children; 17% of adults): elevated probability for peanut and tree nut allergies;
- class 3 (16% of children, 24% of adults): elevated probabilities for shellfish and fin fish allergies;
- class 4 (51% of children, 55% of adults): elevated probabilities for milk allergy and, to a lesser degree, egg allergy.
Patients in class 1 had the greatest psychosocial burdens, followed by those in class 2. Children in class 3 had the lowest perceived risk for accidental exposure, whereas children in both class 3 and 4 had comparable scores in terms of dietary and social limitations.
Among the adults, those in class 3 had the lowest perceived risk for accidental exposure and the lowest dietary and social limitations.
Overall, these findings could be used to identify patients with elevated risk for more severe outcomes while informing diagnostic testing in clinical practice and future treatment strategies targeted to minimize physical and psychosocial burdens, the researchers wrote.
Perspective
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Jennifer Bufford, MS, CRQM, CCRP, CCRC
Smaller studies have documented a high rate of patients with multiple food allergies, but this is a robust, large-scale study of 38,408 children and 40,443 adults. It found that approximately 40% of children and nearly 50% of adults with food allergies reported multiple food allergies. The Food Allergy Research & Education Patient Registry, which comprises some 14,000 participants, shows that up to 84% of children and adults with food allergy have more than one food allergy.
Researchers observed significant differences in multi vs. mono food allergies across racial/ethnic strata for both children and adults, with non-Hispanic white children and adults less likely to have multiple food allergies than their non-Hispanic Black counterparts.
Furthermore, the study found that individuals with multiple food allergies report a greater number of atopic comorbidities such as asthma, atopic dermatitis and allergic rhinitis.
This study also found that patients with multiple food allergies are at greater risk for an accidental allergen exposure necessitating the need for emergency room care and/or epinephrine administration.
Thus, this study may help clinicians identify patients at an elevated risk for more severe reactions as well as those likely to suffer from a comorbid condition or carry a higher psychosocial burden.
Additionally, the study found that individuals with multiple food allergies experience greater physical and psychosocial burden, illuminating the importance of accurate food allergy diagnosis so patients are not unnecessarily avoiding foods to which they are not allergic.
Finally, this study indicated that there are specific patterns of multiple food allergies with four major phenotype clusters, including milk/egg dominant, seafood dominant, peanut/tree nut dominant, and a broadly multi-food allergic group.
Further research to understand multi-food allergy phenotypes and the patterns observed in this study is suggested. Also, additional research to understand progression of the so-called atopic march in single vs. multiple food allergy is warranted.
Reference:
FARE Patient Registry, unpublished data. Date: Feb. 7, 2023.
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