Food allergy prevalence doubled in Japan from 2010 to 2019
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Key takeaways:
- High-risk patients suffered more anaphylaxis and severe allergic reactions compared with other patients.
- More than 80% of patients with food allergy were children and adolescents.
The prevalence of food allergy surged between 2010 and 2019 in Japan, increasing 1.7 times among children aged 6 years and younger, according to a study in Pediatric Allergy and Immunology.
The rise of food allergy has caused a substantial public health burden, Hajime Yoshisue, PhD, senior lead in real world evidence and evidence excellence at Novartis Pharma K.K. in Tokyo, and colleagues wrote.
Because of this burden, the epidemiological landscape including diet, culture and lifestyle changes should be evaluated, the researchers said.
Methods
This noninterventional, observational study used administrative claims data between January 2010 and December 2019 from the JMDC claims database. The number of participants increased from 1,048,594 in 2010 to 8,479,899 in 2019.
Participants were divided into six cohorts: prevalent, high-risk, low-risk, high risk with 1-year post-index, anaphylaxis and non-anaphylaxis.
The prevalent cohort consisted of all patients with at least one food allergy diagnosis. The high-risk cohort included patients from the prevalent cohort who had at least one adrenaline prescription. The low-risk cohort included patients from the prevalent cohort without an adrenaline prescription.
The 1-year post index cohort was made up of patients from the high-risk cohort with 1 year of data following adrenaline prescription. This group was further divided into the anaphylaxis and non-anaphylaxis cohorts.
Results
Within the prevalent cohort, the number of food allergy patients increased from 2,869 to 70,533 from 2010 to 2019. The prevalence rates increased from 0.47% (95% CI, 0.453%-0.488%) in 2010 to 1.031% (95% CI, 1.024%-1.039%) in 2019.
Among preschool and children/adolescent groups, the rate increased from 3.377% (95% CI, 3.229%-3.525%) and 0.729% (95% CI, 0.678%-0.78%) in 2010 to 5.726% (95% CI, 5.663%-5.789%) and 2.565% (95% CI, 2.536%-2.594%) in 2019, respectively. The rate also increased among adults from 0.056% (95% CI, 0.049%-0.063%) in 2010 to 0.224% (95% CI, 0.22%-0.228%) in 2019.
The mean age in the overall cohort was 7.1 ± 10.6 years in 2010 and 11.8 ± 14 years in 2019. There were more boys vs. girls in the preschool and child/adolescent groups and slightly more women vs. men in the adult group.
In the prevalent cohort, the mean number of days spent in food allergy outpatient visits per year was 5.9 days in 2010 and 5.2 days in 2019. The highest reported visits occurred in the anaphylaxis cohort at 9.1 days.
The proportion of patients hospitalized on account of food allergies was higher in the high-risk cohort (24.6%; 95% CI, 23.5%-25.7%), high-risk with 1-year post-index cohort (24.8%; 95% CI, 23.7%-25.9%) and the anaphylaxis cohort (30.4%; 95% CI, 29%-31.9%).
The percentage of patients who received adrenaline prescriptions saw an increase between 2010 (0.6%; 95% CI, 0.4%-0.9%) and 2019 (8.5%; 95% CI, 8.3%-8.7%). Researchers noted that adrenaline was most frequently prescribed in March, showing a seasonal trend.
Among the high-risk cohort, 70,085 anaphylaxis reports or severe allergic reaction reports were identified from 11,235,028 days of observation, showing an incidence rate of 227,689.91 (95% CI, 226,007.29-229,381.94) per 100,000 patient-years between 2010 and 2019.
The number of food allergy-related visits, hospitalizations and length of hospitalizations were higher in the anaphylaxis cohort by 2.08 (95% CI, 2.05-2.11), 1.25 (95% CI, 1.16-1.36), and 1.49 (95% CI, 1.4-1.6) times, respectively.
Adult and children/adolescent groups experienced fewer visits than the preschool group at 0.75 (95% CI, 0.74-0.76) times and 0.67 (95% CI, 0.65-0.67) times, respectively. The children/adolescent group had less hospitalizations at 0.79 times (95% CI, 0.64-0.97) but longer hospital stays at 1.58 times (95% CI, 1.4-1.79) vs. the preschool group.
Perspective
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I do not believe the findings of this study are necessarily surprising, because it has already been generally well recognized in the scientific community that there is an increasing prevalence of food allergies worldwide. It is thought that the prevalence increases are being driven by other variables to include genetic components, diagnostic methods and environmental factors.
In my practice, I mainly work with clients who have food-related allergies pertaining to gut health. Namely, allergies to gluten and/or dairy products are some of the main ones that come up. I think because individuals have become more attuned to the symptoms of food allergies, it does somewhat seem that this is part of the reason why there are more of these clients coming through my practice over the years. With food allergens such as gluten, there are known genetic components that over the years have likely compounded, also potentially explaining the prevalence increase.
I think some of the main contributing factors include a well-informed population with a generalized interest in wellness and nutrition, which prompts such individuals to know and more easily recognize food allergy symptoms. This is, of course, aside from severe allergic reaction symptoms such as anaphylactic shock. I also believe that food allergies are now more accurately diagnosed, with more people seeking answers and subsequent solutions, and thus prompting increased diagnosis. Lastly, I believe that external factors such as environmental exposures and genetic influences with relation to food allergies also play important roles in the compounding prevalence.
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