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Patterns in the Development of Pediatric Allergy
Stanislaw J Gabryszewski1, Jesse Dudley2, Di Shu2,3
1Division of Allergy and Immunology.
Insights
Pediatric allergy patterns reveal high incidence of atopic dermatitis (AD) and asthma. Many children experience multiple allergic conditions, supporting the concept of an allergic march from food to respiratory allergies.
Area of Science:
- Pediatric Allergy and Immunology
- Epidemiology
- Electronic Health Records Research
Background:
- Pediatric allergies represent a significant public health concern with complex clinical and epidemiologic patterns.
- Understanding the progression and co-occurrence of allergic diseases in children is crucial for effective management and prevention strategies.
Purpose of the Study:
- To describe the clinical and epidemiologic patterns of pediatric allergies.
- To analyze the incidence, age at diagnosis, and comorbidities of various allergic conditions in children using longitudinal data.
Main Methods:
- Utilized a multistate EHR database (Comparative Effectiveness Research through Collaborative Electronic Reporting) from 1999-2020.
- Defined a cohort of 218,485 children (0-18 years) with a minimum 5-year observation period.
- Identified atopic dermatitis (AD), immunoglobulin E-mediated food allergy (IgE-FA), asthma, allergic rhinitis (AR), and eosinophilic esophagitis (EoE) using diagnosis codes and medication data.
Main Results:
- Cumulative incidence rates were highest for asthma (20.1%) and allergic rhinitis (19.7%), with early peak ages of diagnosis (13 months for asthma, 26 months for AR).
- Atopic dermatitis showed a high cumulative incidence (10.3%) with a very early peak diagnosis at 4 months.
- Food allergies, particularly peanut (1.9%) and egg (0.8%), were diagnosed later. A significant proportion (13.4%) had multiple allergic conditions, with common comorbidities between respiratory allergies and other allergic diseases.
Conclusions:
- Longitudinal EHR data from diverse US pediatric practices provide detailed insights into pediatric allergy epidemiology.
- Findings support the 'allergic march' phenomenon, where children progress from conditions like atopic dermatitis to food and respiratory allergies.
- High rates of comorbidity among food and respiratory allergies underscore the need for integrated management approaches in pediatric allergy care.
Objectives:
Describe clinical and epidemiologic patterns of pediatric allergy using longitudinal electronic health records (EHRs) from a multistate consortium of US practices.
Methods:
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.
Results:
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.
Conclusions:
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.
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