Rate of Severe Reactions High in Kids With Food Allergies

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."