Food allergy and gastrointestinal disease
The prevalence of food allergy and other allergic diseases in early childhood in a population-based study: HealthNuts age 4-year follow-up

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Background

The HealthNuts study previously reported interim prevalence data showing the highest prevalence of challenge-confirmed food allergy in infants internationally. However, population-derived prevalence data on challenge-confirmed food allergy and other allergic diseases in preschool-aged children remain sparse.

Objective

This study aimed to report the updated prevalence of food allergy at age 1 year from the whole cohort, and to report the prevalence of food allergy, asthma, eczema, and allergic rhinitis at age 4 years.

Methods

HealthNuts is a population-based cohort study with baseline recruitment of 5276 one-year-old children who underwent skin prick test (SPT) to 4 food allergens and those with detectable SPT results had formal food challenges. At age 4 years, parents completed a questionnaire (81.3% completed) and those who previously attended the HealthNuts clinic at age 1 year or reported symptoms of a new food allergy were invited for an assessment that included SPT and oral food challenges. Data on asthma, eczema, and allergic rhinitis were captured by validated International Study of Asthma and Allergies in Childhood questionnaires.

Results

The prevalence of challenge-confirmed food allergy at age 1 and 4 years was 11.0% and 3.8%, respectively. At age 4 years, peanut allergy prevalence was 1.9% (95% CI, 1.6% to 2.3%), egg allergy was 1.2% (95% CI, 0.9% to 1.6%), and sesame allergy was 0.4% (95% CI, 0.3% to 0.6%). Late-onset peanut allergy at age 4 years was rare (0.2%). The prevalence of current asthma was 10.8% (95% CI, 9.7% to 12.1%), current eczema was 16.0% (95% CI, 14.7% to 17.4%), and current allergic rhinitis was 8.3% (95% CI, 7.2% to 9.4%). Forty percent to 50% of this population-based cohort experienced symptoms of an allergic disease in the first 4 years of their life.

Conclusions

Although the prevalence of food allergy decreased between age 1 year and age 4 years in this population-based cohort, the prevalence of any allergic disease among 4-year-old children in Melbourne, Australia, is remarkably high.

Section snippets

Recruitment

The HealthNuts study is a population-based, longitudinal food allergy study undertaken in Melbourne, Australia. The recruitment methods have been described in detail previously.12, 13 Briefly, 5276 twelve-month-old infants were recruited (74% participation) from council-run immunization sessions where they underwent SPT screening to 4 common food allergens: egg, peanut, sesame, and either cow's milk or shrimp. Any infant with a detectable SPT wheal (≥1 mm) was invited for a food challenge at

Participation

Participation in the HealthNuts study at age 1 year has been described in detail previously; therefore, Fig 1 describes participation in the age 4-year follow-up.5, 12, 13, 16 At age 4 years, 81.3% of parents completed a questionnaire (n = 4291); of these, 73% completed the full questionnaire and 27% completed a short telephone questionnaire. Among children who were food allergic at age 1 year (n = 539), 89% completed a questionnaire and of these, 65% attended the HealthNuts study clinic for

Discussion

In this longitudinal population-based cohort, the prevalence of food allergy fell by two-thirds from 11% at age 1 year to 3.8% at age 4 years, with resolution of egg allergy being the main driver of this change, dropping from 9.5% to 1.2%. The prevalence of peanut allergy also fell between 1 and 4 years, dropping from 3.1% to 1.9%. Despite this drop, peanut allergy was the most prevalent food allergy in 4-year-old children. The prevalence of parent-reported doctor-diagnosed eczema was stable,

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  • Cited by (0)

    This work was supported by funding from the National Health & Medical Research Council (NHMRC) of Australia, Ilhan Food Allergy Foundation, AnaphylaxiStop, the Charles and Sylvia Viertel Medical Research Foundation, the Victorian Government's Operational Infrastructure Support Program, and the NHMRC Centre for Food and Allergy Research. K.J.A., L.C.G., A.J.L., M.W., J.J.K., and S.C.D. hold NHMRC awards.

    Disclosure of potential conflict of interest: M. Wake receives grant support from the National Health and Medical Research Council (NHMRC), the Australian National Health & Medical Research Council, and the Foundation for Children; serves as a consultant for Longitudinal Study of Australian Children; received payment for lectures from Sandoz; and received travel support from Victorian State Government, Australia. A.-L. Ponsonby receives grant support from the NHMRC. M. L. K. Tang serves on the board for Nestle Nutrition Institute and Danone Nutricia; serves as a consultant for GLG Consultant and DeerField; received payments for lectures from Danone Nutricia and MD Linx; holds patents with Murdoch Childrens Research Institute; and receives royalties from Wiley. A. J. Lowe receives grant support from the NHMRC. K. J. Allen serves as a consultant for Nestle, ThermoFisher, AspenCare, Before Brands, and Nutricia. The rest of the authors declare that they have no relevant conflicts of interest.

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