Design, setting and participants: Retrospective analysis of the records of 1489 children aged 0–5 years referred to a community-based specialist allergy practice in the Australian Capital Territory (population, about 0.33 million).
Results: 47% (697/1489) of 0–5 year-old children seen in private practice had food allergy (175 with food-associated anaphylaxis), most commonly to peanut, egg, cows milk and cashew. Over 12 years, the number of children in this age group evaluated each year increased more than fourfold, from 55 cases in 1995 to 240 in 2006. There was no change in the proportion diagnosed with allergic rhinitis in 1995 and 2006 (14.5% and 13.3%, respectively), urticaria (14.5% and 12.9%) or atopic eczema (54.5% and 57.0%). By contrast, the proportion with asthma dropped from 33.7% in 1995 to 12.5% in 2006 and the number with food allergy increased 12-fold, from 11 to 138 patients (and from 20.0% to 57.5% of children seen) The number with food anaphylaxis increased from five to 37 children (9.0% to 15.4%) over the same period. There were similar trends in age-adjusted Australian hospital admission rates for anaphylaxis in children aged 0–4 years, which increased from 39.3 to 193.8 per million population between the financial years 1993–94 and 2004–05, a substantially greater increase than for older age groups, or for the population as a whole (36.2 to 80.3 per million population).
Conclusions: There is an urgent need for coordinated systematic studies of the epidemiology of food allergy in Australia, to ascertain risk factors and guide public health policy. An increased prevalence of food allergy has implications for public health and medical workforce planning and availability of allergy services in Australia.
- 1. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet 1998; 351: 1225-1232.
- 2. Robertson CF, Roberts MF, Kappers JH. Asthma prevalence in Melbourne schoolchildren: have we reached the peak? Med J Aust 2004; 180: 273-276. <MJA full text>
- 3. Grundy J, Matthews S, Bateman B, et al. Rising prevalence of allergy to peanut in children: data from 2 sequential cohorts. J Allergy Clin Immunol 2002; 110: 784-789.
- 4. Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol 2003; 112: 1203-1207.
- 5. Bernstein IL, Storms WW. Practice parameters for allergy diagnostic testing. Ann Allergy Asthma Immunol 1995; 75: 543-625.
- 6. Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol 2004; 114: 371-376.
- 7. Baumgart K, Brown S, Gold M, et al; Australasian Society of Clinical Immunology and Allergy Anaphylaxis Working Party. ASCIA guidelines for prevention of food anaphylactic reactions in schools, preschools and child-care centres. J Paediatr Child Health 2004; 40: 669-671.
- 8. Australian Bureau of Statistics. Australian historical population statistics, 2006. Canberra: ABS, 2006. (ABS Cat. No. 3105.0.065.001.) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3105.0.65.0012006?OpenDocument (accessed May 2007).
- 9. Australian Institute of Health and Welfare. National hospital morbidity database principal diagnosis data cubes. Principal diagnosis cubes for 1993–94 to 1997–98 and 1998–99 to 2004–05. http://www.aihw.gov.au/hospitals/datacubes/datacube_06_pdx.cfm (accessed May 2007).
- 10. Gupta R, Sheikh A, Strachan DP, Anderson HR. Time trends in allergic disorders in the UK. Thorax 2007; 62: 91-96.
- 11. Gupta R, Sheikh A, Strachan D, Anderson HR. Increasing hospital admissions for systemic allergic disorders in England: analysis of national admissions data. BMJ 2003; 327: 1142-1143.
- 12. Warner JO. Anaphylaxis; the latest allergy epidemic. Pediatr Allergy Immunol 2007; 18: 1-2.
- 13. Ewan PW, Clark AT. Efficacy of a management plan based on severity assessment in longitudinal and case-controlled studies of 747 children with nut allergy: proposal for good practice. Clin Exp Allergy 2005; 35: 751-756.
- 14. Braganza SC, Acworth JP, Mckinnon DR, et al. Paediatric emergency department anaphylaxis: different patterns from adults. Arch Dis Child 2006; 91: 159-163.
- 15. Kemp A. Hypoallergenic formula prescribing practices in Australia. J Paediatr Child Health 2006; 42: 191-195.
- 16. Kemp AS. EpiPen epidemic: suggestions for rational prescribing in childhood food allergy. J Paediatr Child Health 2003; 39: 372-375.
- 17. Gupta R, Sheikh A, Strachan DP, Anderson HR. Burden of allergic disease in the UK: secondary analyses of national databases. Clin Exp Allergy 2004; 34: 520-526.
- 18. Kemp AS. Severe peanut allergy in Australian children [letter]. Med J Aust 2005; 183: 277. <MJA full text>
- 19. Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999; 104 (3 Pt 2): S114-S122.
- 20. Lack G, Fox D, Northstone K, Golding J; Avon Longitudinal Study of Parents and Children Study Team. Factors associated with the development of peanut allergy in childhood. N Engl J Med 2003; 348: 977-985.
- 21. Scholl I, Untersmayr E, Bakos N, et al. Antiulcer drugs promote oral sensitization and hypersensitivity to hazelnut allergens in BALB/c mice and humans. Am J Clin Nutr 2005; 81: 154-160.
- 22. Dioun AF, Harris SK, Hibberd PL. Is maternal age at delivery related to childhood food allergy? Pediatr Allergy Immunol 2003; 14: 307-311.
- 23. Pesonen M, Kallio MJ, Ranki A, Siimes MA. Prolonged exclusive breastfeeding is associated with increased atopic dermatitis: a prospective follow-up study of unselected healthy newborns from birth to age 20 years. Clin Exp Allergy 2006; 36: 1011-1018.
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