Infants with food allergies exhibit high rate of reactions over time

By Andrew Czyzewski

Infants with documented or likely milk or egg allergies experience a high number of reactions caused by accidental and nonaccidental exposure, results of a three-year observational study demonstrate.

In cases where the reactions were severe there was significant undertreatment with epinephrine, report David Fleischer (National Jewish Health, Denver, Colorado, USA) and colleagues.

"Areas for improved education include the need for constant vigilance, accurate label reading, avoidance of nonaccidental exposure, prevention of cross-contamination, appropriate epinephrine administration, and education of all caretakers," they comment in Pediatrics.

Allergic reactions to foods affect up to 8% of children and food allergy appears to be increasing in prevalence. Management requires avoidance of the trigger foods and treatment of anaphylaxis promptly with epinephrine.

"The primary aim of this study was to determine the frequency and circumstances of allergic reactions to foods, and treatment responses, in a prospective study of infants and preschool-aged children with likely egg or milk allergies," Fleischer et al comment.

They conducted a prospective, five-site observational study of 512 infants, aged 3 to 15 months, with documented or likely allergy to milk or egg, and collected data prospectively examining allergic reactions.

Over a median follow up of 36 months, there was a total of 1171 reactions reported by 367 (71.7%) infants. More than one reaction was reported by 269 participants (52.5%).

The annualized rates of reactions were 0.81 per year overall, with milk 0.34 per year, egg 0.17 per year, and peanut 0.06 per year.

Of the 834 reactions to milk, egg, or peanut, 729 (87.4%) were due to accidental exposures. Causes of accidental reactions included the following: unintentional ingestions (eg, purely accidental such as forgetfulness, reduced supervision, not checking a product, etc.); label reading error; cross-contamination; error in preparation; and manufacturer labeling error.

There were 93 nonaccidental exposures, examples of which included new onset reactions or reactions to foods containing larger allergen amounts than previously tolerated.

Fleischer et al say this is an "unexpected, worrisome finding" speculating that it "may reflect parental testing for resolution of allergy."

Of the 11.4% of reactions that were severe, 29.9% were treated with epinephrine. Factors resulting in undertreatment included lack of recognition of severity, epinephrine being unavailable, and fears about epinephrine administration

"With these data, the pediatrician can provide management instructions and anticipatory guidance with new insights on potential pitfalls," Fleischer et al comment.

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