- In the largest-ever study of
pediatric allergies, researchers from the Children’s Hospital of
Philadelphia analyzed electronic health records from more than 200,000
children.
- The researchers reported
that eosinophilic esophagitis (EoE), a rare food allergy previously
associated with white males, is more common among non-white people than
previously believed.
- They say this research
underscores the significant impact of allergic conditions on children’s
well-being and emphasizes the need for a precise understanding of their
prevalence and risk factors, while also highlighting the importance of
collaborative diagnoses between healthcare providers and families.
In new research, published in the journal Pediatrics,
scientists are reporting on how allergic conditions can significantly impact
the quality of life of children and are among the leading factors affecting
their well-being.
They say their findings confirm a widespread phenomenon known
as the “allergic march,” where allergies initially manifest as eczema, followed
by food allergies, asthma, and environmental allergies.
The study also revealed that the rare food allergy known
as eosinophilic
esophagitis (EoE), thought to predominantly affect white males,
is more prevalent among the non-white population
than previously understood.
Previous investigations into the prevalence and
trends of allergies have relied on surveys filled out by families.
However, the approach taken in this study
involved accessing and reviewing electronic health records, providing the
researchers with data directly from healthcare providers.
The researchers say this method enabled them to
analyze patterns at a population level, track changes over time, and reduce the
potential for reporting bias.
Using
electronic health records from a large sample of children
Researchers utilized a vast database known as the Comparative Effectiveness Research through Collaborative Electronic
Reporting (CER2) Consortium.
This database contains information from more
than 1 million children from various primary care practices and healthcare
systems across the United States.
The researchers focused their investigation on five specific
allergic conditions: eczema (also called
atopic dermatitis), anaphylactic food
allergies (severe allergic reactions to certain foods), asthma,
allergic rhinitis (commonly known as hay fever) and
EoE (the less-known food allergy that affects the esophagus).
For each of these conditions, the researchers
analyzed data to determine the age at which children were diagnosed and whether
they developed other allergic conditions over time.
In total, they identified 218,485 children who
had allergies and were observed for more than 5 years between 1999 and 2020.
They found that:
- Eczema
typically started around 4 months of age.
- Both
anaphylactic food allergies and asthma commonly began at approximately 13
months old.
- Allergic
rhinitis usually started around 26 months of age.
- EoE typically
appeared around 35 months of age.
Among the anaphylactic food allergies, the most
frequently diagnosed ones were peanut allergies (1.9%), followed by egg (0.8%)
and shellfish (0.6%).
About 13% of the children had two different
allergic conditions simultaneously.
Children with respiratory allergies such as
asthma and allergic rhinitis were more likely to have both of these conditions
and sometimes other allergic conditions as well.
The researchers also made a discovery regarding
anaphylactic food allergies when diagnosed by healthcare providers.
They found that the prevalence of these
allergies, as determined by healthcare professionals, was 4%. This is about
half the prevalence compared to studies that relied on surveys filled out by
families.
The researchers said this suggests that
previous studies might have mistakenly included non-anaphylactic food
intolerances in their findings.
Important
for healthcare providers and families to work together
The researchers said the study highlights how
it’s crucial for doctors and families to collaborate to correctly identify food
allergies.
The scientists also checked data about people’s
backgrounds to see if factors such as the home region or the culture of the
children might affect their chances of having allergies.
They discovered some trends related to a
person’s race and ethnic background.
Black children were more commonly represented
among those with eczema and asthma while white children had a higher
representation in cases of EoE.
Conversely, there was a lower representation of
Hispanic children in cases of anaphylactic food allergies.
However, it’s worth noting that even though
most children with EoE in their study were white males, approximately 40% of
EoE patients in the cohort were non-white, which is a much higher percentage
than previously reported.
EoE may
affect a more diverse population than previously known
The scientists said their research offers a
significant insight into the occurrence and trends of allergic diseases in
children, finding that EoE may affect a more diverse population than previously
believed.
This understanding is vital because families
and pediatricians often observe symptoms that might signal the development of
allergies in children.
They said future research should try to identify
groups of people who are more likely to have allergies and may benefit from
early testing.
They recommended scientists also look into any
differences in how the disease affects different communities.
“I really like this study because it involves a
lot of patients – close to a quarter of a million children – using some sophisticated electronic health
records,” said Dr. Daniel Ganjian, FAAP, a pediatrician at Providence Saint
John’s Health Center in California who was not involved in this research.
“It also sheds some more light about the characteristics of
the allergic march that we see in some children,” Ganjian told Medical
News Today.
Dr. Stephanie Leeds, a pediatric allergist and immunologist at Yale New Haven Children’s Hospital
in Connecticut who also was not involved in the study, agreed.
She told Medical News Today that
“it is heartening that researchers continue to look at patterns in the
development of pediatric allergy, particularly as there are now evidence-based
guidelines for prevention of certain allergic disease, such as peanut allergy.”
As with many diseases,
prevention is preferable to treatment. Perhaps increasing research into
patterns of disease development will help us determine those at highest risk of
developing disease (and therefore those who might benefit the most from
prevention efforts).
Dr. Stephanie Leeds
Potential
implications for the future treatment of children with allergies
Ganjian noted that “this research could have
several implications for patients and the public.”
For example, he said “understanding the
patterns of allergy development could help doctors diagnose allergies earlier
and identify children at risk for developing multiple allergies.”
The research could also allow a more
personalized treatment approach, as “knowing the common combinations of
allergies could help doctors develop more personalized treatment plans for each
child.”
Finally, “raising awareness about the
prevalence and patterns of allergies could help families understand and manage
these conditions better.”
“However,” Ganjian concluded, “it is important
to note that this is just one study, and more research is needed to confirm
these findings and to understand the underlying causes of allergic diseases.”
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