Infectious Disease

New pediatric guidelines have slowed the rise in the rate of anaphylaxis from food allergies

February 03, 2022

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Source/Disclosures

Source:

Mullins RJ, et al. J Allergy Clinic Immunol. 2022;doi:10.1016/j.jaci.2021.12.795.

Disclosure:
The authors report no relevant financial information.

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Although cases of pediatric food allergy anaphylaxis have increased in Australia over the past two decades, the rate of increase has slowed following the release of new guidelines, according to data in the Journal of Allergy and Clinical Immunology.

Doctors have advised parents in the past not to introduce their infants to common allergenic foods to prevent food sensitization. But in 2009, the Australasian Society for Clinical Immunology and Allergy (ASCIA) advised against these delays.

Data were adapted from Mullins RJ, et al. J Allergy Clinic Immunol. 2021;doi:10.1016/j.jaci.2021.12.795.

Subsequent studies then found that introducing allergens to infants reduced the development of allergies, leading ASCIA to recommend the early introduction of several allergenic foods in 2016.

Raymond James Mullins, MBBS, PhD, FRACP, FRCPA, Consultant Clinical Immunology and Allergy at John James Medical Center in Deakin, Australia, and colleagues examined data from the Australian Institute of Health and Welfare to determine if the introduction of these guidelines affected was admission rates for food anaphylaxis.

Researchers compared intake rates for food anaphylaxis between 1998 and 1999 and 2006 and 2007, when delayed introduction of allergenic foods was recommended; between 2007-2008 and 2014-2015 when this Recommendation was withdrawn; and between 2015–2016 and 2018–2019, when early introduction of allergens was recommended.

Anaphylaxis admission rates increased in all age groups over the 20-year period, with the highest overall increase in children under 1 year increasing by a factor of five, from 14.8 per 105 population to 74.3 per 105 population. Intake rates for foodborne anaphylaxis increase by a factor of 7.6 for children ages 1 to 4, 15.1 for children ages 5 to 9, 14.6 for ages 9 to 14, and 14.6 for 15 to 19 year olds by 15.7.

However, children aged 1 to 4 years and 5 to 9 years showed a significant reduction in annual rates of increase in the intake of food anaphylaxis twice, the first when the recommendations for delayed introduction were withdrawn, and the second when an early introduction of allergens was recommended.

Across the three periods, annual growth rates slowed from 2007 to 2008 for children aged 1 to 4 years (17.6%, 6.2%, 3.9% per year) and 5 to 9 years (22%, 13.9%, -2.4%) and after 2015 to 2016 in children aged 10 to 14 years (17.5%, 18%, 10.8%).

However, children under 1 year experienced an acceleration in annual rates of increase (5.2%, 8%, 18%), as did all children over 15 years of age.

To determine whether the decrease in anaphylaxis admissions in 1- to 4-year-olds led to an increase in earlier introduction in infants, the researchers examined year-to-year changes for the combined 0- to 4-year-old age group. They found that after the 2006 and 2015 guideline updates, annual intake rates for foodborne anaphylaxis in children ages 0 to 4 years decreased overall, but there was an increase in intake rates for infants aged less than 1 year year-on-year.

“The Acceleration of Intake of Foodborne Anaphylaxis in Infants [younger than] The age of 1 year is also consistent with the timing of the 2016 guidelines to actively introduce allergenic solids in the first year of life, as this could lead to an earlier onset of food allergies in individuals who already have an allergy,” the researchers wrote. “It is important to examine whether accelerating the intake of food anaphylaxis in infants [younger than] 1 year old, which could be the result of earlier introduction of allergenic foods, may result in harm, particularly as this population may not have access to weight-appropriate epinephrine auto-injectors. Although deaths from anaphylaxis in infancy are rare, this should be closely monitored to assess potential risks associated with earlier introduction of allergenic foods.”

Overall, the researchers noted the correlation between these rate changes and the timing of guideline introduction. Although a causal relationship should not be assumed, the researchers continue, these results suggest that recommendations for early introduction of allergenic foods could slow the rate of childhood food allergies.

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Bruce Roberts, PhD)

Bruce Roberts, Ph.D

The results of this study are not surprising. There is a trend towards a reduced rate of anaphylactic reactions with a flattening of the curve. But before we can assess significance, we also need to see more data. Will the trend continue and prices diverge further?

Importantly, the authors point out that a true cause-and-effect relationship cannot be established. Therefore, we cannot categorically conclude that the introduction of guidelines is responsible for the trend towards reduced anaphylactic reactions.

Nevertheless, the data suggest, but do not prove, that early dietary introduction of allergens may be beneficial as measured by reduced rates of diet-induced anaphylactic reactions.

There is a need to continue educating parents about early nutritional counseling. In addition, the collection of more data will serve to determine whether rates of anaphylactic reactions will continue to decrease as more parents heed the advice on introducing allergens early in the diet.

The authors report an acceleration in the onset of food anaphylaxis in infants younger than 1 year and speculate that this may lead to an earlier onset of food allergy in infants who already have an allergy. In other words, as parents introduce more allergens into infant diets to prevent food allergies, they may discover that the child is already allergic.

Data from the Early Learning About Peanut Allergy study suggests that there may be a window for introducing allergens, and ideally they should be introduced when children are 4 to 6 months of age. So by the time a well-meaning parent introduces an allergen later – say between 8 and 12 months – the allergy may already have developed. Therefore, the child experiences a reaction.

The effects of timing of allergen introduction within the first year of life on allergy prevention and reduction in anaphylactic events warrant further investigation.

Bruce Roberts, Ph.D

Interim CEO, Food Allergy Research and Education

Disclosure: Roberts does not report relevant financial information.

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