Pediatric patients with both food allergies and atopic dermatitis in early life may be more likely to develop moderate-to-severe asthma, allergic rhinitis, and anaphylaxis by ages 5 to 11 years, according to a new study analyzing health records.
Investigators followed a birth cohort of 10,688 pediatric patients enrolled in a large Southern California health care system. All of them had a confirmed diagnosis of atopic dermatitis (AD) prior to 36 months of age. Among them, 2,273 had a diagnosis of food allergy, and 8,415 didn't. Outcomes were tracked through age 11 years.
The patients with food allergy were 42% more likely to develop moderate-to-severe asthma (adjusted risk ratio [RR] = 1.42, 99% confidence interval [CI] = 1.14–1.76), 34% more likely to develop allergic rhinitis (adjusted RR = 1.34, 99% CI = 1.19–1.51), and 69% more likely to experience anaphylaxis (adjusted RR = 1.69, 99% CI = 1.33–2.15) compared with those without food allergy. All differences were statistically significant (P < .001).
“Food allergy enhances the atopic march by increasing the risk for future moderate-severe asthma, allergic rhinitis, and anaphylaxis from ages 5 [to] 11 years,” the study authors wrote, referring to the progression of allergic diseases over time.
By age 11 years, the patients with food allergy had higher rates of asthma visits (47.0% vs 30.4%), greater use of controller medications such as inhaled corticosteroids (30.2% vs 17.0%), and more frequent systemic corticosteroid use (23.8% vs 13.9%). They also had more persistent moderate-to-severe asthma.
Allergic rhinitis diagnoses required both clinical coding and a positive aeroallergen test. food allergy–positive patients met these criteria more often (31.6% vs 13.2%).
Anaphylaxis occurred in 19.0% of those with food allergy vs 10.3% of those without. Autoinjectable epinephrine was prescribed to 65.3% of food allergy–positive patients compared with 9.7% of food allergy–negative patients.
Among those tested for sensitization between ages 5 and 11 years, 92.6% of the patients with food allergy had positive food allergen results compared with 72.8% without. Aeroallergen sensitization was also more frequent in the participants with food allergy.
The patients with food allergy were more likely to have elevated blood eosinophil counts and to be seen by allergists (47.5% vs 14.5%) or dermatologists (20.0% vs 13.3%).
The investigators used electronic health records and pharmacy data to follow clinical outcomes over time. Diagnoses were based on validated codes and laboratory tests. While the observational design didn't establish causality, the investigators cited the cohort’s size and data completeness as major strengths.
They concluded that early food allergy could increase the risk of later allergic conditions in pediatric patients with atopic dermatitis, highlighting the importance of early identification and monitoring.
Full disclosures can be found in the study.
Source: JACI in Practice
