Food Allergies Are More Common Than You Think!
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The topic of food allergy—and especially peanut allergy—is guaranteed to generate controversy. Schools, airplanes, and baseball stadiums have all established peanut-free zones. Is all this really necessary, or an overreaction? Are food allergies really that common among children?
Maybe so. Newly published survey data from almost 40,000 respondents throughout the United States suggest that among the children in your practice, 1 in 13 of them is likely to suffer from at least one food allergy, which is estimated to cause more than 200,000 visits to the emergency department each year.
The study surveyed a nationally representative sample of almost 40,000 U.S. adults who lived with a child under age 18. They filled out an online questionnaire about allergies based on a single child in their household, reporting whether or not the child had any signs and symptoms of a food allergy, had ever been diagnosed with an allergy by a doctor, and had ever had a severe allergic reaction to food.
Results from the survey, published in Pediatrics, found that 8% of children under age 18 had a food allergy, which translates to roughly 5.9 million children—or 1 in every 13 children. This figure is double the 3.9% prevalence rate previously reported by the U.S. Centers for Disease Control and Prevention in 2009.[1,3]
Even more striking is that among children with food allergies, about 30% were allergic to multiple foods and 39% had a history of severe reaction. For these children, accidental ingestion of an allergenic food could lead to anaphylaxis—a sharp drop in blood pressure, and even death. Anaphylactic-type reactions occurred in slightly more than half of all allergic reactions to peanuts and tree nuts; they were also common with shellfish (48.6%), soy (42.6%) and fin fish (40.6%). According to the authors, these reactions were twice as common in children ages 14 to 17, possibly because young kids with allergies are more likely to be monitored by parents to make sure they stay away from potential allergy triggers.
The most common food allergen was peanuts (25%), followed by milk (21%) and shellfish (17%). Black and Asian children were more likely to have a food allergy compared with white children; the likelihood of having severe allergies was greater in boys, in children with multiple allergies, in higher income households, and in older age groups.
The 2010 food allergy guidelines published by the National Institute of Allergy and Infectious Diseases recommend that you ask the following questions if you suspect a child of having a food allergy:
- What are your symptoms?
- What food causes your symptoms, and has this food caused these symptoms more than once?
- How much of the food did you eat when the symptoms occurred?
- Was the food cooked on the stovetop, baked in the oven, or raw?
- How long after you were exposed to the food did your symptoms occur?
- Have you ever eaten the food without these symptoms occurring?
- Were other factors involved, such as exercise, alcohol, or use of aspirin or nonsteroidal anti-inflammatory drugs?
- Have you had these symptoms other than after being exposed to the food?
- What treatment did you receive, and how long did the symptoms last?
The guidelines also include information about risk factors, immunologic diagnosis of food allergies, initiation of solid foods, and treatment recommendations; a consumer-friendly version of the guidelines was published in May 2011.
It’s important to let patients know that the most efficient way to manage a food allergy is to avoid foods that contain that food. In the United States, the Food and Drug Administration (FDA) requires food manufacturers to list the eight most common ingredients that trigger food allergies including—
- Tree nuts (such as almonds, cashews, walnuts)
- Fish (such as bass, cod, flounder)
- Shellfish (such as crab, lobster, shrimp)
The Food Allergen Labeling and Consumer Protection Act, which took effect January 1, 2006, mandates that the labels of processed foods containing these eight allergens declare the allergen in plain language, either in the ingredient list or via
- The word “contains” followed by the name of the major food allergen—for example, “contains milk, wheat”—or
- A parenthetical statement in the list of ingredients—for example, “albumin (egg)”
Such ingredients must be listed if they are present in any amount, even in colors, flavors, or spice blends. Additionally, manufacturers must list the specific nut or seafood that is used. Fresh produce, fresh meat, and certain highly refined oils don’t require listing on labels.
Some manufacturers voluntarily include a “may contain” statement on their labels when there is a chance that a food allergen could be present. A manufacturer might use the same equipment to make different products. Even after cleaning this equipment, a small amount of an allergen (such as peanuts) that was used to make one product (such as cookies) may become part of another product (such as crackers). In this case, the cracker label might state “may contain peanuts.” Because the “may contain” statement is voluntary, patients should still be encouraged to read the ingredient list to see if the product contains their allergen.
Jill Shuman, MS, ELS
Published on July 5, 2011
- Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011 Jul;128(1):e9-e17.
- Clark S, Espinola J, Rudders SA, et al. Frequency of US emergency department visits for food-related acute allergic reactions. J Allergy Clin Immunol. 2011;127(3):682-683.
- Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics 2009;124(6):1549-1555.