PURPOSE OF THE STUDY.
The goal of this study was to investigate the relation between food allergy and asthma morbidity in inner-city students with asthma.
A total of 300 elementary school students with physician-diagnosed asthma were enrolled over a period of 6 years in the School Inner-City Asthma Study in the northeastern United States. Subjects were eligible if they had wheezing, used controller medications, or had unscheduled health care visits for asthma in the previous 12 months. This population was primarily a nonwhite (>95%), impoverished cohort with 47% of caregivers reporting an annual income of <$25 000.
An extensive baseline survey was administered to the child' caregiver. Asthma morbidity outcomes included clinical symptoms, the effect on activities of daily living, resource utilization, and lung function measurements. Food allergy history included symptoms experienced within 1 hour of ingestion of reported allergenic foods. Pulmonary function testing was performed according to American Thoracic Society guidelines.
Twenty-four percent of the study population had physician-diagnosed food allergy, with peanut and then tree nuts being the most prevalent foods involved. Multiple food allergies were present in 49% of the subjects with food allergy. Subjects with any food allergy had almost double the increased risk of daytime symptoms and more than twice the risk of lifetime hospitalization but no increase in missed school days due to asthma or unscheduled asthma visits to a health care provider. The percent predicted forced expiratory volume in 1 second (FEV1) scores were significantly lower in the food allergy group. Subjects with multiple food allergies had >3 times the increased risk of daytime asthma symptoms and >5 times the risk of lifetime hospitalization, as well as significantly higher number of unscheduled health care visits. Lung function was also lower, including percent predicted FEV1 and FEV1/forced vital capacity scores.
This study found an increased risk of asthma morbidity in children with any food allergy and even more so in children with multiple food allergies. There was also an increased prevalence of food allergy in children with asthma compared with the national prevalence rates, consistent with previous findings.
The association between food allergy and several measures of asthma morbidity was clearly demonstrated in the current study population. Whether these same findings would apply to a population with different demographic characteristics remains to be studied. It is also not clear whether asthma exacerbations were triggered by exposure to the food allergen. Nonetheless, increased monitoring of children with concomitant asthma and food allergy seems appropriate.
- Copyright © 2014 by the American Academy of Pediatrics