The Prevalence of Food Sensitization Appears Not to Have Changed between 2 Melbourne Cohorts of High-Risk Infants Recruited 15 Years Apart

doi:10.1016/j.jaip.2017.11.018

The Journal of Allergy and Clinical Immunology: In Practice

Volume 6, Issue 2, March–April 2018, Pages 440-448.e2

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Background

Although food allergy has probably risen over recent decades, recent reports suggest that the prevalence of food sensitization in the general population has not changed. However, this has not been analyzed in infants at high risk of food allergy.

Objective

The objective of this study was to compare the prevalence of food sensitization in high-risk infants from 2 cohorts recruited 15 years apart in the same region.

Methods

This study includes 620 high-risk infants with a family history of allergy (Melbourne Atopy Cohort Study [MACS]) born 1990-1994, and a subgroup of high-risk infants from the population-based HealthNuts study (n = 3,661/5,276), born 2006-2010. Both studies undertook skin prick tests (SPT) to peanut, egg, and milk at age 12 months. A logistic regression model generated adjusted prevalences to account for differences in sampling frame. SPT ≥ 95% positive predictive values (PPVs) for food allergy were used as proxies for food allergy.

Results

The adjusted prevalence of sensitization in MACS was similar to the observed prevalence of sensitization in the high-risk subgroup of HealthNuts: 7.9% (95% confidence interval 6.8-8.9) and 7.9% (7.0-8.8) respectively for peanut, 15.0% (13.4-16.6) and 14.5% (13.4-15.7) respectively for egg, and 2.4% (1.6-3.1) and 2.6% (2.0-3.4) respectively for cow's milk. The prevalence of SPT ≥ 95% PPVs was similar between the 2 studies.

Conclusions

The prevalence of food sensitization among high-risk infants has remained stable in Australia since the 1990s, despite the reported increase in food-related anaphylaxis in the same period. This discrepancy could be due to increased food allergy in the low-risk population, increased conversion of food sensitization to allergy, or increased number of high-risk infants. Alternatively, increased awareness or severity of reactions may have led to an apparent increase in food allergy.

Section snippets

Methods

Data used in the present analysis include 620 infants with a family history of allergy from the Melbourne Atopy Cohort Study (MACS) recruited between 1990 and 1994, and 5,276 infants from the population-based HealthNuts study, born in 2006-2010 and recruited at age 12 months (2007-2011). Both studies undertook skin prick tests (SPT) to common food allergens (egg, peanut, and milk) at 12 months of age using the same lancet device.15, 16 Sensitization was defined at SPT ≥ 2 mm and the 95%

Results

Participation in MACS and HealthNuts has been described in detail previously.15, 16 As expected, a higher proportion of maternal and paternal history of allergy was observed in the MACS high-risk cohort compared with the HealthNuts population-based cohort (see Table E2 in this article's Online Repository at www.jaci-inpractice.org). All MACS participants were classified as high-risk with 1 or more first degree family members having a history of allergic disease, whereas 69.4% (3,661/5,276) of

Discussion

The prevalence of food sensitization among high-risk infants with a family history of allergic disease has not changed significantly over the last 2 decades in Melbourne, Australia. In addition, we found that the proportion of high-risk infants with a proxy for clinical food allergy (SPT ≥ 95% PPVs) also remained stable during this period. These findings are surprising given the increased anaphylaxis admission rates and increased reported diagnoses of food allergy in Australia and

Acknowledgments

The HealthNuts study thanks the children and parents who participated in the HealthNuts study as well as the staff of Melbourne's Local Government Areas for providing access to community immunization clinics. We thank ALK-Abello SA, Madrid, Spain, for supplying the skin prick testing reagents; and the HealthNuts safety committee comprising Associate Professor Noel Cranswick (Australian Paediatric Pharmacology Research Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia),

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: The last two authors share senior authorship.

: The HealthNuts study 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. Allen, L. C. Gurrin, A. J. Lowe, J. J. Koplin, and S. C. Dharmage hold NHMRC awards. M. Wake was supported by an NHMRC award and Cure Kids New Zealand. The first 6 years of the Melbourne Atopy Cohort Study (MACS) was funded (study formula and staff) by Nestec Ltd, a subsidiary of Nestlé Australia. The 12-year follow-up was supported by Victorian Asthma Foundation and 18-year and 25-year follow-ups have been funded by NHMRC. All bodies that have funded aspects of the MACS have had no role in interpretation or publication of study findings.

: Conflicts of interest: A. J. Lowe has received research support from the National Health and Medical Research Council. M. L. K. Tang is on the Nestle Nutrition Institute Medical Advisory Board Oceania; is a past member of the Danone Nutricia Global Scientific Advisory Board; has received consultancy fees from Deerfield Consulting, GLG Consulting, and Bayer; is employed by and has stock/stock options in ProTA Therapeutics; has received research support from the National Health and medical Research Council Australia and ProTA Therapeutics; has received lecture fees from Danone Nutricia and Nestle Health Sciences; has a patent owned by Murdoch Children's Research Institute; received royalties from Wilkinson Publishing; and has received payment for developing educational presentations from MD Linx. M. Wake has received research support from the Australian National Health & Medical Research Council, NZ Ministry of Business, Innovation & Employment, and Cure Kids/A Better Start; has received a fellowship from Australian National Health & Medical Research Council; has received sitting fees from the Australian Government; and has received support to present at a symposium from Sandoz. M. J. Abramson has received research support from Pfizer and Boehringer Ingelheim; and has received travel support from Sanofi. The rest of the authors declare that they have no relevant conflicts of interest.

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Original ArticleThe Prevalence of Food Sensitization Appears Not to Have Changed between 2 Melbourne Cohorts of High-Risk Infants Recruited 15 Years Apart

Background

Objective

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgments

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol Pract

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Environ Toxicol Pharmacol

Food allergy: riding the second wave of the allergy epidemic

Pediatr Allergy Immunol

Food allergy: temporal trends and determinants

Curr Allergy Asthma Rep

Paediatric food allergy trends in a community-based specialist allergy practice, 1995-2006

Med J Aust

Time trends in the prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK

Allergy

Original Article
The Prevalence of Food Sensitization Appears Not to Have Changed between 2 Melbourne Cohorts of High-Risk Infants Recruited 15 Years Apart