Results of a new National of Institute of Health (NIH) study
reveal many young kids who are allergic to milk, eggs and peanuts have serious
reactions after accidental exposures caused by misread labels, cross
contamination between foods or mistakes in food preparation. The findings
reinforce the importance of caregivers working closely with their doctors to
understand how to effectively manage a child's food allergy.
The study was published online in the June 25 issue of the
journal Pediatrics and are the latest findings from the Consortium of Food
Allergy Research (CoFAR), a network established by NIAID to conduct clinical
trials, observational studies and basic research to better understand and treat
food allergy.
The “Big Eight" allergens—tree nuts, peanuts, soy, fish,
shellfish, dairy, egg and wheat—account for 90% of all food allergies, and
children are most at-risk because they usually are not the ones preparing foods
or reading labels.
Almost 90% of allergic reactions to egg, milk or peanut occurred
after a child accidentally ate the food. The reasons for the accidental
exposures included caregivers misreading food labels, not checking a food for
an allergen, and unintentionally allowing a food allergen to come into contact
with other foods. The study also found that approximately 11% of allergic
reactions to egg, milk or peanut occurred after a caregiver—most often a
parent—provided a child the allergenic food intentionally.
"Intentional exposures to allergenic food are typically
reported in teenagers, who tend to take more risks or who might be embarrassed
about their food allergy," says David Fleischer, M.D., the lead study
author. "What is troubling is that in this study we found that a
significant number of young children received allergenic foods from parents who
were aware of the allergy."
The study also found that severe and potentially
life-threatening reactions in a significant number of these children occur and
that some caregivers are hesitant to give such children epinephrine, a
medication that reverses the symptoms of such reactions and can save lives.
"This study reinforces the importance of doctors, parents
and other caregivers working together to be even more vigilant in managing food
allergy in children," said Anthony S. Fauci, M.D., director of the
National Institute of Allergy and Infectious Diseases (NIAID), part of the
National Institutes of Health.
The research is part of an ongoing CoFAR observational study
that enrolled 512 infants aged 3 to 15 months who at study entry were allergic
to milk or egg, or who were likely to be allergic, based on a positive skin
test and the presence of moderate-to-severe eczema, a chronic skin condition.
The investigators are carefully following these children to see whether their
allergies resolve or if new allergies, particularly peanut allergy, develop.
The study is ongoing at research hospitals in Baltimore ;
Denver ; Durham , N.C. ; Little Rock , Ark. ; and New
York City .
CoFAR investigators advised parents and caregivers to avoid
giving their children foods that could cause an allergic reaction. Study
participants also received an emergency action plan, describing the symptoms of
a severe allergic reaction to food and what to do if a child has one, along
with a prescription and instructions on how to give epinephrine if a severe
reaction occurred.
Data compiled from patient questionnaires and clinic visits over
three years showed 72% of the children had a food-allergic reaction, and 53% of
the children had more than one reaction, with the majority of reactions being
to milk, egg or peanut. This translated into a rate of nearly one food-allergic
reaction per child per year. Approximately 11% of the reactions were classified
as severe and included symptoms, such as swelling in the throat, difficulty
breathing, a sudden drop in blood pressure, dizziness or fainting. Almost all
of the severe reactions were caused by ingestion of the allergen rather than
inhalation or skin contact.
In only 30% of the severe reactions did caregivers administer
epinephrine as an emergency protocol. Investigators found that caregivers did
not give children epinephrine for a number of reasons including, the drug was
not available, they were too afraid to administer it, they did not recognize
the symptoms as those of an allergic reaction, or they did not recognize the
reaction as severe.
"This study documenting the natural history of allergic
reactions to three of the major food allergens in preschool children provides
important new information for parents, caregivers and health care workers
because of the large number of children involved and the rigorous follow-up,"
said Daniel Rotrosen, M.D., director of the NIAID Division of Allergy,
Immunology and Transplantation, which oversees CoFAR. "The findings not
only reveal that food-allergic reactions occur at a much higher rate in young
children than we thought, they also suggest that more vigilance and increased
use of epinephrine is needed."