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J Allergy Clin Immunol. 2015 Jan;135(1):171-8. doi: 10.1016/j.jaci.2014.06.033. Epub 2014 Aug 13.

Influence of early-life exposures on food sensitization and food allergy in an inner-city birth cohort.

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Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, and the Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo.
National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md.
Rho, Inc, Chapel Hill, NC.
Department of Medicine, Division of Pediatric Primary Care, Boston University School of Medicine, Boston, Mass.
Department of Medicine, Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Mass.
Department of Pediatrics, Division of Pediatric Pulmonology, New York Presbyterian/Columbia University Medical Center, New York, NY.
Department of Pediatrics, Division of Allergy and Immunology, University of Wisconsin School of Medicine, Madison, Wis.
Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Md. Electronic address:



Previous data suggest that food allergy (FA) might be more common in inner-city children; however, these studies have not collected data on both sensitization and clinical reactivity or early-life exposures.


Children in the Urban Environment and Childhood Asthma birth cohort were followed through age 5 years. Household exposures, diet, clinical history, and physical examinations were assessed yearly; levels of specific IgE to milk, egg, and peanut were measured at 1, 2, 3, and 5 years of age. On the basis of sensitization (IgE ≥0.35 kU/L) and clinical history over the 5-year period, children were classified as having FA or being possibly allergic, sensitized but tolerant, or not allergic/not sensitized.


Five hundred sixteen children were included. Overall, 55.4% were sensitized (milk, 46.7%; egg, 31.0%; and peanut, 20.9%), whereas 9.9% were categorized as having FA (peanut, 6.0%; egg, 4.3%; and milk, 2.7%; 2.5% to >1 food). The remaining children were categorized as possibly allergic (17.0%), sensitized but tolerant (28.5%), and not sensitized (44.6%). Eighteen (3.5%) reported reactions to foods for which IgE levels were not measured. Food-specific IgE levels were similar in children with FA versus sensitized but tolerant children, except for egg, levels of which were higher in patients with FA at ages 1 and 2 years. FA was associated with recurrent wheeze, eczema, aeroallergen sensitization, male sex, breast-feeding, and lower endotoxin exposure in year 1 but not with race/ethnicity, income, tobacco exposure, maternal stress, or early introduction of solid foods.


Even given that this was designed to be a high-risk cohort, the cumulative incidence of FA is extremely high, especially considering the strict definition of FA that was applied and that only 3 common allergens were included.


Food allergy; Urban Environment and Childhood Asthma cohort; inner city; specific IgE

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