The Largest Nationwide Study Validates Pediatric Allergies

Children’s Hospital of Philadelphia (CHOP) researchers used electronic health record (EHR) data from more than 200,000 pediatric patients to describe patterns of pediatric allergies across the United States, validating an allergy development pattern known as the “allergic march,” in which allergies first manifest as eczema, followed by food allergies, asthma, and environmental allergies.

The researchers also discovered that a rare food allergy known as eosinophilic esophagitis (EoE), which was previously thought to affect mostly White males, is more common among non-White patients than previously reported.

The findings were published in Pediatrics.

“Allergic diseases are one of the most common causes of impaired quality of life in children, so to improve the diagnosis and care of children with these diseases, it is important that we have an accurate understanding of how widespread they are, and the risk factors that are associated with them,” said first author Stanislaw J. Gabryszewski, MD, Ph.D., a fellow in the Division of Allergy and Immunology at Children’s Hospital of Philadelphia.

“Prior studies have gauged the prevalence and patterns of allergies based on surveys completed by families. By using data from electronic health records, we were able to analyze data from medical providers, which allowed us to examine population-level patterns over time and in a way that minimizes reporting bias.”

The researchers used the Comparative Effectiveness Research through Collaborative Electronic Reporting (CER2) Consortium database, which contains data from more than 1 million children across multiple independent primary care practices and health systems in the United States, to uncover patterns and prevalence of allergic disease.

The study focused on five allergic diseases: eczema, also known as atopic dermatitis; IgE-mediated (anaphylactic) food allergy; asthma; allergic rhinitis, also known as hay fever; and EoE, a newer and less well-known non-anaphylactic food allergy that causes chronic esophageal symptoms. They determined the age at diagnosis and whether or not patients presented with other allergy diseases for each ailment.

They identified 218,485 children with allergies between the ages of infancy and 18 years old who were monitored for more than 5 years between 1999 and 2020. The average peak age of onset for eczema was 4 months, 13 months for anaphylactic food allergies, 13 months for asthma, 26 months for allergic rhinitis, and 35 months for EoE, according to the researchers.

Peanut (1.9%), egg (0.8%), and shellfish (0.6%) were the most commonly identified anaphylactic food allergies. They discovered that 13.4% of children had two allergic disorders, and patients with respiratory allergies such as asthma and allergic rhinitis were more likely to have both conditions as well as other allergic conditions.

The researchers also discovered that the prevalence of anaphylactic food allergies diagnosed by health care practitioners was 4%, which is roughly half the prevalence found in survey-based studies utilizing family-reported data, implying that past studies may have included non-anaphylactic food intolerances. According to the researchers, this disparity underlines the necessity of physicians and families working together to evaluate food allergies, as well as emphasizing that anaphylactic food allergies are frequently part of a larger allergic picture.

The researchers looked at demographic changes to look for non-biologic factors that may influence allergy susceptibility. In terms of race and ethnicity, Black children had a considerably larger representation among those with eczema and asthma, White children had a significantly higher representation for EoE, and Hispanic children had a significantly lower incidence of anaphylactic food allergies.

Notably, despite the fact that the majority of EoE patients were White males, the researchers discovered that roughly 40% of EoE patients in their cohort were non-White, which is far higher than previously recorded.

“This study provides an important overview of patterns and prevalence of allergic diseases in children, which is crucial as families and pediatricians observe symptoms that could be indicative of emerging allergies,” said senior author David A. Hill, MD, Ph.D., an attending physician with the Division of Allergy and Immunology at Children’s Hospital of Philadelphia. “Future studies should seek to define high-risk allergy populations who may benefit from screening and identify potentially modifiable disparities in disease outcomes.”

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