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An analysis of 190 studies including 2.8 million children published in JAMA Pediatrics found that approximately 4.7% of children develop food allergy by age 6. The strongest risk factors for food allergy include several prior allergic conditions: atopic dermatitis in the first year of life (odds ratio [OR] 3.88, risk difference [RD] 12%); allergic rhinitis (OR 3.39, RD 10%); and wheeze (OR 2.11, RD 5%). Markers of skin barrier dysfunction, including elevated transepidermal water loss, also increase risk, according to the authors. Introduction of peanut products after 12 months showed a risk difference of 6.8%. Early-life antibiotic exposure also had an effect, especially when exposure occurs in the first month (OR, 4.11, RD 12.8%) or the first year of life (OR, 1.39, RD, 1.8%). Low birth weight, postterm birth, maternal age, breastfeeding, and maternal stress during pregnancy showed no important risk difference for kids developing food allergies.
The way forward: The authors recommend that clinicians use combined risk factors to identify high-risk infants and develop prevention strategies. About 33 million Americans have food allergies, yet there are few food allergy prevention plans. In recent years, more evidence has shown that exposing kids to peanut products early can help prevent future allergies, which is now reflected in updated guidelines from the National Institute of Allergy and Infectious Diseases.