Prevalence of Food Allergy and Access to Epinephrine for Children in the US


December 12, 2018

Article Citation

Gupta RS, Warren CM, Smith BM, et al. The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States. Pediatrics. 2018;142:e20181235.

First Dose

Childhood food allergy (FA) is potentially life-threatening, and the prevalence may be growing. In this nationally representative household survey, parents were asked about their children’s food allergies, health care, and possession of an epinephrine auto-injector. In a sample of 38,408 children, the estimated population prevalence of “convincing” FA (ie, not oral allergy syndrome or food intolerance) among children in the US was 7.6% (95% CI: 7.1-8.1), with 40% of children with any FA reporting 2 or more FAs. Peanut (2.2%) and milk (1.9%) allergies were the most common food-specific FAs.

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Key Points to Remember

Among children with FAs, the 10 most common food-specific allergies were to:

  • peanut (29.0%)
  • milk (25.4%)
  • shrimp (12.6%)
  • egg (11.9%)
  • almond (8.7%)
  • cashew (8.6%)
  • mollusk (8.3%)
  • walnut (8.3%)
  • crab (8.2%)
  • pecan (7.9%)


Among children with convincing FA, 42.3% were estimated to have symptoms indicating severe FA, which was more common among children allergic to peanut, tree nut, and shellfish.

Among children with FA, 42.0% had been treated in the ED for a severe FA reaction sometime in their lives, but only 40.7% of children with FA reported having a current prescription for an epinephrine auto-injector.
In regression models adjusted for children’s sociodemographic variables, non-Hispanic African American children had significantly higher adjusted odds of FA than non-Hispanic white children (odds ratio=1.4; 95% CI 1.1-1.7).

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Children who had physician-diagnosed conditions including asthma, atopic dermatitis/eczema, allergic rhinitis, insect sting allergy, or medication allergy also had significantly higher odds of having a convincing FA.
Possessing a current epinephrine auto-injector prescription was associated with having 1 or more physician-diagnosed FAs, having had 1 more lifetime ED visits for FA reaction, having 1 or more severe FAs, living in the Northeast (versus Midwest), and having a FA to peanut or pistachio.

Link to Research Article

Summary Author

Matthew M. Davis, MD, MAPP

Source: Prevalence of Food Allergy and Access to Epinephrine for Children in the U.S. – Lurie Children’s Hospital of Chicago Press Release
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