June 25, 2012 -- Severe allergic reactions are common among young children with food allergies, but nearly two-thirds do not get the emergency treatment they need, a new study shows.
To find out how food allergy exposures happen and how often, researchers followed more than 500 kids with allergies to milk, eggs, or peanuts from the time they were diagnosed in infancy.
During the three-year study, close to 3 out of 4 children experienced a reaction caused by exposure to the food they were allergic to, and around half had more than one such exposure.
Around 1 in 10 reactions was severe, but just 30% of these dangerous allergic events involved treatment with epinephrine, an injection that can mean the difference between life and death for severely allergic children and adults.
Nearly 6 million children in the U.S. have food allergies, with most cases occurring among preschool-age children.
The new study, which appears in the June 25 issue of the journal Pediatrics, is the first large-scale investigation of the frequency and circumstances surrounding food allergy exposures in preschool-aged children.
"This study really highlights a number of ways in which things go wrong," says researcher Scott H. Sicherer, MD, of the Jaffe Food Allergy Institute at New York City's Mount Sinai School of Medicine. "The good news is that these are addressable issues."
Among the key findings:
The most common food involved in allergic reactions was milk (42% of reactions), followed by eggs (21%), and peanuts (8%).
Caregiver vigilance issues, such as failure to check ingredients, cross-contamination, forgetfulness, and misreading labels, were involved in most exposures.
About half of the exposures involved non-parent caregivers.
Intentional Exposure Not Uncommon
One of the most surprising and disturbing revelations, Sicherer says, was the finding that around 1 in 10 exposures was not accidental, with parents or other caregivers intentionally feeding the problem food to the child.
It was not clear if this was done as a test to determine if the child was still allergic.
While many children do outgrow food allergies -- especially those to eggs and milk -- food challenges should never be done outside of medical settings, says pediatric allergy specialist James Fagin, MD, of Cohen Children's Medical Center of New York.
"Food allergies are unpredictable," he says. "You can't predict what a reaction will be based on past reactions. If peanut exposures have resulted in little more than hives in the past, that doesn't mean that the next exposure won't be life threatening."
Also of concern, he says, was the under-use of epinephrine during severe allergic reactions.
He says doctors need to do a better job of teaching parents and other caregivers how and when to use EpiPen autoinjectors.