Special section: Food allergy
Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants

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Background

Several indicators suggest that food allergy in infants is common and possibly increasing. Few studies have used oral food challenge to measure this phenomenon at the population level.

Objective

To measure the prevalence of common IgE-mediated childhood food allergies in a population-based sample of 12-month-old infants by using predetermined food challenge criteria to measure outcomes.

Methods

A sampling frame was used to select recruitment areas to attain a representative population base. Recruitment occurred at childhood immunization sessions in Melbourne, Australia. Infants underwent skin prick testing, and those with any sensitization (wheal size ≥1 mm) to 1 or more foods (raw egg, peanut, sesame, shellfish, or cow's milk) were invited to attend an allergy research clinic. Those who registered a wheal size ≥1 mm to raw egg, peanut, or sesame underwent oral food challenge.

Results

Amongst 2848 infants (73% participation rate), the prevalence of any sensitization to peanut was 8.9% (95% CI, 7.9-10.0); raw egg white, 16.5% (95% CI, 15.1-17.9); sesame, 2.5% (95% CI, 2.0-3.1); cow's milk, 5.6% (95% CI, 3.2-8.0); and shellfish, 0.9% (95% CI, 0.6-1.5). The prevalence of challenge-proven peanut allergy was 3.0% (95% CI, 2.4-3.8); raw egg allergy, 8.9% (95% CI, 7.8-10.0); and sesame allergy, 0.8% (95% CI, 0.5-1.1). Oral food challenges to cow's milk and shellfish were not performed. Of those with raw egg allergy, 80.3% could tolerate baked egg.

Conclusion

More than 10% of 1-year-old infants had challenge-proven IgE-mediated food allergy to one of the common allergenic foods of infancy. The high prevalence of allergic disease in Australia requires further investigation and may be related to modifiable environmental factors.

Section snippets

Population-based recruitment

Melbourne is the second largest city in Australia with a population of almost 4 million5 and is located on the coast of southeastern Australia. The HealthNuts study methods have been previously described elsewhere.6 Briefly, parents of infants aged between 11 and 15 months (inclusive) attending childhood immunization (recommended to take place at 12 months) at over 120 locations across Melbourne were approached to take part in the HealthNuts study. Parents were not informed before attending the

Results

Between September 28, 2007, and January 18, 2010, a total of 3898 parents/guardians were approached, and 2848 agreed to participate (73.1%). The average age of participating infants was 12.7 months (SD, 0.8). Of those who decided not to participate, 99.1% (1041/1050) completed the nonparticipant interview. Of those agreeing to participate, 1.6% (45) were not skin prick–tested at the immunization session because they had recently had a SPT performed by their own doctor.

Discussion

We have demonstrated that in a study representative of the Melbourne population, IgE-mediated food allergy is higher than expected, with over 10% of 1-year-old infants having challenge-proven food allergy to 1 of the most common 3 IgE-mediated allergies: peanut, egg, and sesame. This is in the context of unexpectedly high sensitization rates to these foods and high rates of infant-onset eczema in Australia. By contrast, the cumulative incidence of parent-reported IgE-mediated cow's milk allergy

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    Supported by the National Health and Medical Research Council of Australia, the Ilhan Food Allergy Foundation, AnaphylaxiStop, the Charles and Sylvia Viertel Medical Research Foundation, and the Australian Egg Corp Ltd.

    Disclosure of potential conflict of interest: K. J. Allen receives honoraria for speakers' fees from Wyeth and receives research support from the Australian Egg Corp. N. J. Osborne receives research support from the Australian Egg Corp. A. J. Lowe receives research support from the National Health and Medical Research Council. A.-L. Ponsonby receives research support from the National Health and Medical Research Council. M. Wake receives research support from the National Health and Medical Research Council. M. L. K. Tang is an advisory board member for the Nestlé Nutrition Institute. The rest of the authors have declared that they have no conflict of interest.

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