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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.

Author information

1
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.
2
Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo.
3
National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md.
4
Rho, Inc, Chapel Hill, NC.
5
Department of Medicine, Division of Pediatric Primary Care, Boston University School of Medicine, Boston, Mass.
6
Department of Medicine, Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Mass.
7
Department of Pediatrics, Division of Pediatric Pulmonology, New York Presbyterian/Columbia University Medical Center, New York, NY.
8
Department of Pediatrics, Division of Allergy and Immunology, University of Wisconsin School of Medicine, Madison, Wis.
9
Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Md. Electronic address: rwood@jhmi.edu.

Abstract

OBJECTIVE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

PMID:
25129677
PMCID:
PMC4440482
DOI:
10.1016/j.jaci.2014.06.033
[Indexed for MEDLINE]
Free PMC Article

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