Food anaphylaxis in children – are we flattening the curve?

Published: January 21, 2022

Community and hospital-based studies have shown that childhood food allergy and anaphylaxis have been increasing worldwide over the last 20 years. Amongst many possible factors, the timing of introduction of allergenic foods such as cow’s milk, egg and peanut plays an important role. Carefully controlled and supervised clinical trials have shown that earlier introduction of allergenic foods can reduce the risk of developing food allergy. Whether updated allergy prevention guidelines recommending earlier introduction of allergenic foods translate to reduced rates of food allergy or anaphylaxis in the real world is yet to be determined.

In a recent issue of the Journal of Allergy and Clinical Immunology (JACI), Mullins and colleagues examined whether updated Australian allergy prevention/feeding guidelines to recommend earlier introduction of allergenic foods had any impact on food anaphylaxis hospital admissions. Guidelines were updated in 2008 to remove earlier advice recommending delayed introduction of allergenic foods, and again in 2016 to actively recommend early introduction of allergenic foods. Food anaphylaxis admission rates over a 20-year period were compared across three time periods – 1999 to 2007 (delay introduction of allergenic foods), between 2008 and 2015 (not delay allergenic food introduction), and 2016 to 2019 (advice to introduce allergenic food early).

Hospital admissions for food anaphylaxis increased over the 20 years from 1998/1999. Changes to Australian allergy prevention/infant feeding guidelines were associated with reduced year on year rate increases in anaphylaxis admissions amongst children aged 1 to 4 years, 5 to 9 years and 10 to 14 years (all born after the 2008 feeding guideline changes), with each age group showed a flattening in the rate of increase of hospital admissions. For example, in children aged 1 to 4 years, the yearly rate of increase dropped from 17.6%/year between 1999 to 2007, to 6.2%/year in the second period and 3.9%/year since 2016. Conversely, year on year rates of admission for food anaphylaxis amongst children under one year of age increased markedly following the 2016 update which actively recommended early introduction of allergenic solids, likely due to earlier presentation of allergy in those who were already allergic to food. Year on year food anaphylaxis admission rates also continued to accelerate in those aged 15 years or above, born before the 2008 feeding guideline changes.

This Australian study presents the first real-world evidence that updates to allergy prevention and infant feeding guidelines are having a measurable impact on the population prevalence of food anaphylaxis.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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