Food allergy is a costly,¹ potentially life-threatening² health condition that can adversely affect patients’ well-being.^3,4 Although population-based studies^5,6 have examined the prevalence of food allergy among children, less is known about the population-level burden of food allergy among adults in the United States. The few population-based studies^7,8 to date that examined adult food allergy have focused on a limited number of specific allergens (eg, peanut) or allergen groups (eg, tree nut, seafood) or have been secondary analyses of federal health surveys, which were not designed to comprehensively characterize food allergy prevalence and severity among US adults. For example, neither the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey⁹ nor the US Food and Drug Administration’s (FDA’s) Food Safety Survey¹⁰ collects information about specific allergic reaction symptoms critical for differential diagnosis of food allergy (eg, food intolerances, oral allergy syndrome). Nevertheless, food allergy prevalence estimates from these recent national surveys exceed 9% of US adults, suggesting that food allergy may affect more US adults than previously acknowledged.

BACKGROUND: Childhood food allergy (FA) is a life-threatening chronic condition that substantially impairs quality of life. This large, population-based survey estimates childhood FA prevalence and severity of all major allergenic foods. Detailed allergen-specific information was also collected regarding FA management and health care use. METHODS: A survey was administered to US households between 2015 and 2016, obtaining parent-proxy responses for 38 408 children. Prevalence estimates were based on responses from NORC at the University of Chicago’s nationally representative, probability-based AmeriSpeak Panel (51% completion rate), which were augmented by nonprobability-based responses via calibration weighting to increase precision. Prevalence was estimated via weighted proportions. Multiple logistic regression models were used to evaluate FA predictors. RESULTS: Overall, estimated current FA prevalence was 7.6% (95% confidence interval: 7.1%–8.1%) after excluding 4% of children whose parent-reported FA reaction history was inconsistent with immunoglobulin E–mediated FA. The most prevalent allergens were peanut (2.2%), milk (1.9%), shellfish (1.3%), and tree nut (1.2%). Among food-allergic children, 42.3% reported ≥1 severe FA and 39.9% reported multiple FA. Furthermore, 19.0% reported ≥1 FA-related emergency department visit in the previous year and 42.0% reported ≥1 lifetime FA-related emergency department visit, whereas 40.7% had a current epinephrine autoinjector prescription. Prevalence rates were higher among African American children and children with atopic comorbidities. CONCLUSIONS: FA is a major public health concern, affecting ∼8% of US children. However, >11% of children were perceived as food-allergic, suggesting that the perceived disease burden may be greater than previously acknowledged.

Food allergy is a growing public health concern in the United States that affects 8% of children.¹ Childhood food allergy results in significant direct medical costs to the health care system and imposes substantial costs on families. Direct medical costs to the health care system stem from office visits, rescue medications, emergency department (ED) visits, and hospitalizations. Costs borne by families include medical and nonmedical expenses, specifically out-of-pocket, lost productivity, and opportunity costs.