Anaphylaxis to foods in a population of adolescents: incidence, characteristics and associated risks

Background Information about severe reactions to foods in adolescence is limited. Objective: To describe reactions to foods, including anaphylaxis, with regard to incidence, characteristics and associated risks, among 16-year-olds (adolescents) in a large, population-based birth cohort. Methods Parent-reported questionnaire data from ages 2-3 months, and 1, 2 and 16 years were used (N=3153). Anaphylaxis at age 16 years was defined per NIAID-FAAN criteria. Immunoglobulin E (IgE) antibodies to 14 common food and inhalant allergens were analyzed at ages 4 (n=2283) and 16 years (n=2510). Among adolescents with food-related symptoms and for whom blood was available (n=221), 25 additional food allergen extracts or allergen components were analyzed. Associations between reactions to foods, and sensitization and allergic multimorbidity were investigated. Results In the 12 months prior to the 16-year assessment, 8.5% of adolescents had food-related symptoms. This included 0.8% (n=24) adolescents who were classified as having anaphylaxis, yielding an incidence rate of 761/100,000 person-years. One-third of adolescents accessed healthcare during anaphylaxis. Allergic multimorbidity in infancy, as well as sensitization to foods and airborne allergens at age 4 years were associated with an increased risk for food-related symptoms in adolescence. Peanuts and tree nuts were the most common culprit foods for anaphylaxis, and fruits and vegetables for non-anaphylactic reactions. Adolescents with anaphylaxis were significantly more likely to be sensitized to storage proteins (Ara h 2, Cor a 9, Cor a 14) and to be polysensitized to foods (p<0.001 vs. non-anaphylactic reactions). Conclusions & Clinical Relevance The incidence of food-induced anaphylaxis during adolescence in our population-based birth cohort is higher than previously reported. Adolescents with anaphylaxis differ from adolescents with non-anaphylactic food-related symptoms with regard to culprit foods and sensitization. Adolescents with previous anaphylaxis are likely to be polysensitized to foods, particularly tree nut and peanut storage proteins, and which warrants consideration at follow-up. This article is protected by copyright. All rights reserved.