Patterns in the Development of Pediatric Allergy

• Published in: Pediatrics (Evanston) 2023-08, Vol.152 (2), p.1
• Main Authors: Gabryszewski, Stanislaw J, Dudley, Jesse, Shu, Di, Faerber, Jennifer A, Grundmeier, Robert W, Fiks, Alexander G, Hill, David A
• Format: Article
• Language: English
• Subjects: Allergic rhinitis; Asthma; Asthma - diagnosis; Asthma - drug therapy; Asthma - epidemiology; Atopic dermatitis; Child; Children; Comorbidity; Dermatitis, Atopic - diagnosis; Dermatitis, Atopic - epidemiology; Diagnosis; Electronic health records; Electronic medical records; Eosinophilic Esophagitis - diagnosis; Eosinophilic Esophagitis - epidemiology; Epidemiology; Esophagitis; Food allergies; Food Hypersensitivity - diagnosis; Humans; Immunoglobulin E; Infant; Leukocytes (eosinophilic); Pediatrics; Rhinitis, Allergic - epidemiology
• ISSN: 0031-4005; 1098-4275; 1098-4275
• DOI: 10.1542/peds.2022-060531

Describe clinical and epidemiologic patterns of pediatric allergy using longitudinal electronic health records (EHRs) from a multistate consortium of US practices. Using the multistate Comparative Effectiveness Research through Collaborative Electronic Reporting EHR database, we defined a cohort of 218 485 children (0-18 years) who were observed for ≥5 years between 1999 and 2020. Children with atopic dermatitis (AD), immunoglobulin E-mediated food allergy (IgE-FA), asthma, allergic rhinitis (AR), and eosinophilic esophagitis (EoE) were identified using a combination of diagnosis codes and medication prescriptions. We determined age at diagnosis, cumulative incidence, and allergic comorbidity. Allergic disease cumulative (and peak age of) incidence was 10.3% (4 months) for AD, 4.0% (13 months) for IgE-FA, 20.1% (13 months) for asthma, 19.7% (26 months) for AR, and 0.11% (35 months) for EoE. The most diagnosed IgE-FAs were peanut (1.9%), egg (0.8%), and shellfish (0.6%). A total of 13.4% of children had ≥2 allergic conditions, and respiratory allergies (ie, asthma, AR) were commonly comorbid with each other, and with other allergic conditions. We detail pediatric allergy patterns using longitudinal, health care provider-based data from EHR systems across multiple US states and varied pediatric practice types. Our results support the population-level allergic march progression and indicate high rates of comorbidity among children with food and respiratory allergies.