Food allergy in children: Prevalence, natural history, and monitoring for resolution

INTRODUCTION

Understanding the natural history of food allergy in childhood is essential in managing patients with these disorders. The natural history of a food allergy includes information on the acquisition of the allergy, the likelihood that it will be outgrown, and its usual duration.

Food allergy most often begins in the first two years of life. Certain food allergies, such as those to cow's milk and hen's egg, are usually outgrown during childhood or adolescence, whereas peanut and tree nut allergies are more likely to persist into adulthood.

This topic review provides an overview of the natural history of food allergy in children. The clinical manifestations and treatment of food allergy are discussed separately. (See "Clinical manifestations of food allergy: An overview".)

DEFINITION OF FOOD ALLERGY

In this section, the terms "allergy" and "hypersensitivity" are used interchangeably to refer to an abnormal immunologic reaction to food. Such reactions can be mediated by IgE molecules directed against specific food proteins that activate mast cells and basophils, or can arise from other cellular processes involving eosinophils or T cells. (See "Clinical manifestations of food allergy: An overview".)

PREVALENCE OF CHILDHOOD FOOD ALLERGY

Most food allergy is acquired in the first or second year of life. The peak prevalence of food allergy is approximately 6 to 8 percent at one year of age, although rates as high as 10 percent have been reported [1-4]. It then falls progressively until late childhood, after which the prevalence remains stable at about 3 to 4 percent. The prevalence of food allergy in children (aged 0 to 17 years) has slowly increased in the United States, from 3.4 percent in 1997 to 1999 to 5.1 percent in 2009 to 2011 [5].

                                     

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2014. | This topic last updated: Oct 29, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Osborne NJ, Koplin JJ, Martin PE, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol 2011; 127:668.
  2. Sicherer SH, Sampson HA. 9. Food allergy. J Allergy Clin Immunol 2006; 117:S470.
  3. Liu AH, Jaramillo R, Sicherer SH, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol 2010; 126:798.
  4. Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics 2009; 124:1549.
  5. Trends in Allergic Conditions Among Children: United States, 1997–2011. http://www.cdc.gov/nchs/data/databriefs/db121.pdf (Accessed on June 20, 2013).
  6. Eggesbø M, Halvorsen R, Tambs K, Botten G. Prevalence of parentally perceived adverse reactions to food in young children. Pediatr Allergy Immunol 1999; 10:122.
  7. Eggesbø M, Botten G, Halvorsen R, Magnus P. The prevalence of CMA/CMPI in young children: the validity of parentally perceived reactions in a population-based study. Allergy 2001; 56:393.
  8. Venter C, Pereira B, Grundy J, et al. Incidence of parentally reported and clinically diagnosed food hypersensitivity in the first year of life. J Allergy Clin Immunol 2006; 117:1118.
  9. Pyrhönen K, Näyhä S, Kaila M, et al. Occurrence of parent-reported food hypersensitivities and food allergies among children aged 1-4 yr. Pediatr Allergy Immunol 2009; 20:328.
  10. Leung TF, Yung E, Wong YS, et al. Parent-reported adverse food reactions in Hong Kong Chinese pre-schoolers: epidemiology, clinical spectrum and risk factors. Pediatr Allergy Immunol 2009; 20:339.
  11. McBride D, Keil T, Grabenhenrich L, et al. The EuroPrevall birth cohort study on food allergy: baseline characteristics of 12,000 newborns and their families from nine European countries. Pediatr Allergy Immunol 2012; 23:230.
  12. Eggesbø M, Botten G, Halvorsen R, Magnus P. The prevalence of allergy to egg: a population-based study in young children. Allergy 2001; 56:403.
  13. Nickel R, Kulig M, Forster J, et al. Sensitization to hen's egg at the age of twelve months is predictive for allergic sensitization to common indoor and outdoor allergens at the age of three years. J Allergy Clin Immunol 1997; 99:613.
  14. Kulig M, Bergmann R, Niggemann B, et al. Prediction of sensitization to inhalant allergens in childhood: evaluating family history, atopic dermatitis and sensitization to food allergens. The MAS Study Group. Multicentre Allergy Study. Clin Exp Allergy 1998; 28:1397.
  15. Kulig M, Bergmann R, Klettke U, et al. Natural course of sensitization to food and inhalant allergens during the first 6 years of life. J Allergy Clin Immunol 1999; 103:1173.
  16. Høst A, Halken S. A prospective study of cow milk allergy in Danish infants during the first 3 years of life. Clinical course in relation to clinical and immunological type of hypersensitivity reaction. Allergy 1990; 45:587.
  17. Hattevig G, Kjellman B, Johansson SG, Björkstén B. Clinical symptoms and IgE responses to common food proteins in atopic and healthy children. Clin Allergy 1984; 14:551.
  18. Sigurs N, Hattevig G, Kjellman B, et al. Appearance of atopic disease in relation to serum IgE antibodies in children followed up from birth for 4 to 15 years. J Allergy Clin Immunol 1994; 94:757.
  19. Dannaeus A, Inganäs M. A follow-up study of children with food allergy. Clinical course in relation to serum IgE- and IgG-antibody levels to milk, egg and fish. Clin Allergy 1981; 11:533.
  20. Sampson HA, Scanlon SM. Natural history of food hypersensitivity in children with atopic dermatitis. J Pediatr 1989; 115:23.
  21. James JM, Sampson HA. Immunologic changes associated with the development of tolerance in children with cow milk allergy. J Pediatr 1992; 121:371.
  22. Pastorello EA, Stocchi L, Pravettoni V, et al. Role of the elimination diet in adults with food allergy. J Allergy Clin Immunol 1989; 84:475.
  23. Allen CW, Kemp AS, Campbell DE. Dietary advice, dietary adherence and the acquisition of tolerance in egg-allergic children: a 5-yr follow-up. Pediatr Allergy Immunol 2009; 20:213.
  24. Taylor SL, Hefle SL, Bindslev-Jensen C, et al. A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much? Clin Exp Allergy 2004; 34:689.
  25. Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol 2007; 120:1413.
  26. Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol 2007; 120:1172.
  27. Lieberman JA, Huang FR, Sampson HA, Nowak-Węgrzyn A. Outcomes of 100 consecutive open, baked-egg oral food challenges in the allergy office. J Allergy Clin Immunol 2012; 129:1682.
  28. Larramendi CH, Martín Esteban M, Pascual Marcos C, et al. Possible consequences of elimination diets in asymptomatic immediate hypersensitivity to fish. Allergy 1992; 47:490.
  29. Flinterman AE, Knulst AC, Meijer Y, et al. Acute allergic reactions in children with AEDS after prolonged cow's milk elimination diets. Allergy 2006; 61:370.
  30. David TJ. Anaphylactic shock during elimination diets for severe atopic eczema. Arch Dis Child 1984; 59:983.
  31. Hill DJ, Firer MA, Ball G, Hosking CS. Natural history of cows' milk allergy in children: immunological outcome over 2 years. Clin Exp Allergy 1993; 23:124.
  32. Perry TT, Matsui EC, Kay Conover-Walker M, Wood RA. The relationship of allergen-specific IgE levels and oral food challenge outcome. J Allergy Clin Immunol 2004; 114:144.
  33. Diéguez MC, Cerecedo I, Muriel A, et al. Utility of diagnostic tests in the follow-up of egg-allergic children. Clin Exp Allergy 2009; 39:1575.
  34. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997; 100:444.
  35. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107:891.
  36. Keet CA, Matsui EC, Dhillon G, et al. The natural history of wheat allergy. Ann Allergy Asthma Immunol 2009; 102:410.
  37. Høst A. Frequency of cow's milk allergy in childhood. Ann Allergy Asthma Immunol 2002; 89:33.
  38. Elizur A, Rajuan N, Goldberg MR, et al. Natural course and risk factors for persistence of IgE-mediated cow's milk allergy. J Pediatr 2012; 161:482.
  39. Wood RA, Sicherer SH, Vickery BP, et al. The natural history of milk allergy in an observational cohort. J Allergy Clin Immunol 2013; 131:805.
  40. Santos A, Dias A, Pinheiro JA. Predictive factors for the persistence of cow's milk allergy. Pediatr Allergy Immunol 2010; 21:1127.
  41. Levy Y, Segal N, Garty B, Danon YL. Lessons from the clinical course of IgE-mediated cow milk allergy in Israel. Pediatr Allergy Immunol 2007; 18:589.
  42. Shek LP, Soderstrom L, Ahlstedt S, et al. Determination of food specific IgE levels over time can predict the development of tolerance in cow's milk and hen's egg allergy. J Allergy Clin Immunol 2004; 114:387.
  43. Chatchatee P, Järvinen KM, Bardina L, et al. Identification of IgE- and IgG-binding epitopes on alpha(s1)-casein: differences in patients with persistent and transient cow's milk allergy. J Allergy Clin Immunol 2001; 107:379.
  44. Chatchatee P, Järvinen KM, Bardina L, et al. Identification of IgE and IgG binding epitopes on beta- and kappa-casein in cow's milk allergic patients. Clin Exp Allergy 2001; 31:1256.
  45. Vila L, Beyer K, Järvinen KM, et al. Role of conformational and linear epitopes in the achievement of tolerance in cow's milk allergy. Clin Exp Allergy 2001; 31:1599.
  46. Järvinen KM, Beyer K, Vila L, et al. B-cell epitopes as a screening instrument for persistent cow's milk allergy. J Allergy Clin Immunol 2002; 110:293.
  47. Ricci G, Patrizi A, Baldi E, et al. Long-term follow-up of atopic dermatitis: retrospective analysis of related risk factors and association with concomitant allergic diseases. J Am Acad Dermatol 2006; 55:765.
  48. Ford RP, Taylor B. Natural history of egg hypersensitivity. Arch Dis Child 1982; 57:649.
  49. Boyano-Martínez T, García-Ara C, Díaz-Pena JM, Martín-Esteban M. Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy. J Allergy Clin Immunol 2002; 110:304.
  50. Des Roches A, Nguyen M, Paradis L, et al. Tolerance to cooked egg in an egg allergic population. Allergy 2006; 61:900.
  51. Konstantinou GN, Giavi S, Kalobatsou A, et al. Consumption of heat-treated egg by children allergic or sensitized to egg can affect the natural course of egg allergy: hypothesis-generating observations. J Allergy Clin Immunol 2008; 122:414.
  52. Clark A, Islam S, King Y, et al. A longitudinal study of resolution of allergy to well-cooked and uncooked egg. Clin Exp Allergy 2011; 41:706.
  53. Sicherer SH, Muñoz-Furlong A, Burks AW, Sampson HA. Prevalence of peanut and tree nut allergy in the US determined by a random digit dial telephone survey. J Allergy Clin Immunol 1999; 103:559.
  54. Sicherer SH, Muñoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol 2003; 112:1203.
  55. Skolnick HS, Conover-Walker MK, Koerner CB, et al. The natural history of peanut allergy. J Allergy Clin Immunol 2001; 107:367.
  56. Emmett SE, Angus FJ, Fry JS, Lee PN. Perceived prevalence of peanut allergy in Great Britain and its association with other atopic conditions and with peanut allergy in other household members. Allergy 1999; 54:380.
  57. Fleischer DM, Conover-Walker MK, Christie L, et al. The natural progression of peanut allergy: Resolution and the possibility of recurrence. J Allergy Clin Immunol 2003; 112:183.
  58. Grundy J, Matthews S, Bateman B, et al. Rising prevalence of allergy to peanut in children: Data from 2 sequential cohorts. J Allergy Clin Immunol 2002; 110:784.
  59. Kagan RS, Joseph L, Dufresne C, et al. Prevalence of peanut allergy in primary-school children in Montreal, Canada. J Allergy Clin Immunol 2003; 112:1223.
  60. Tariq SM, Stevens M, Matthews S, et al. Cohort study of peanut and tree nut sensitisation by age of 4 years. BMJ 1996; 313:514.
  61. Hourihane JO, Aiken R, Briggs R, et al. The impact of government advice to pregnant mothers regarding peanut avoidance on the prevalence of peanut allergy in United Kingdom children at school entry. J Allergy Clin Immunol 2007; 119:1197.
  62. Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 2010; 125:1322.
  63. Green TD, LaBelle VS, Steele PH, et al. Clinical characteristics of peanut-allergic children: recent changes. Pediatrics 2007; 120:1304.
  64. Bock SA, Atkins FM. The natural history of peanut allergy. J Allergy Clin Immunol 1989; 83:900.
  65. Hourihane JO, Roberts SA, Warner JO. Resolution of peanut allergy: case-control study. BMJ 1998; 316:1271.
  66. Ho MH, Wong WH, Heine RG, et al. Early clinical predictors of remission of peanut allergy in children. J Allergy Clin Immunol 2008; 121:731.
  67. Begin P, Paradis L, Paradis J, et al. Natural resolution of peanut allergy: A 12-year longitudinal follow-up study. Journal of Allergy and Clinical Immunology: In Practice 2013; 1:528.
  68. Fleischer DM, Conover-Walker MK, Matsui EC, Wood RA. The natural history of tree nut allergy. J Allergy Clin Immunol 2005; 116:1087.
  69. Beausoleil JL, Spergel JM. Late diagnosis of tree nut and sesame allergy in patients previously sensitized but tolerant to peanut. Ann Allergy Asthma Immunol 2006; 97:443.
  70. Fleischer DM, Conover-Walker MK, Christie L, et al. Peanut allergy: recurrence and its management. J Allergy Clin Immunol 2004; 114:1195.
  71. Busse PJ, Nowak-Wegrzyn AH, Noone SA, et al. Recurrent peanut allergy. N Engl J Med 2002; 347:1535.
  72. Lack G. Clinical practice. Food allergy. N Engl J Med 2008; 359:1252.
  73. Kotaniemi-Syrjänen A, Palosuo K, Jartti T, et al. The prognosis of wheat hypersensitivity in children. Pediatr Allergy Immunol 2010; 21:e421.
  74. Poole JA, Barriga K, Leung DY, et al. Timing of initial exposure to cereal grains and the risk of wheat allergy. Pediatrics 2006; 117:2175.
  75. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr 1985; 107:669.
  76. Bock SA. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics 1987; 79:683.
  77. Savage JH, Kaeding AJ, Matsui EC, Wood RA. The natural history of soy allergy. J Allergy Clin Immunol 2010; 125:683.
  78. Cohen A, Goldberg M, Levy B, et al. Sesame food allergy and sensitization in children: the natural history and long-term follow-up. Pediatr Allergy Immunol 2007; 18:217.
  79. Aaronov D, Tasher D, Levine A, et al. Natural history of food allergy in infants and children in Israel. Ann Allergy Asthma Immunol 2008; 101:637.
  80. Agne PS, Bidat E, Agne PS, et al. Sesame seed allergy in children. Eur Ann Allergy Clin Immunol 2004; 36:300.
  81. Yavuz ST, Sahiner UM, Buyuktiryaki B, et al. Role of specific IgE in predicting the clinical course of lentil allergy in children. Pediatr Allergy Immunol 2013; 24:382.
  82. Kajosaari M. Food allergy in Finnish children aged 1 to 6 years. Acta Paediatr Scand 1982; 71:815.