Received: 5 January 2017 | Revised: 6 December 2017 | Accepted: 15 December 2017

DOI: 10.1111/cea.13088

ORIGINAL ARTICLE
Epidemiology of Allergic Disease

Prevalence and longitudinal trends of food allergy during

childhood and adolescence: Results of the Isle of Wight Birth
Cohort study

D. Venkataraman1 | M. Erlewyn-Lajeunesse1,2 | R. J. Kurukulaaratchy1,2,3 |

S. Potter3 | G. Roberts1,2,3 | S. Matthews3 | S. H. Arshad1,2,3

1
University Hospitals Southampton NHS
Foundation Trust, Southampton, UK Summary
2
Clinical and Experimental Sciences Background: The prevalence and time trends of food allergy change during child-
Academic Unit, Faculty of Medicine,
hood depending on the age of the child and the type of food.
University of Southampton, Southampton,
UK Objective: To study prevalence and longitudinal trends in food allergy from birth to
3
The David Hide Asthma and Allergy 18 years in an unselected birth cohort in the Isle of Wight.
Research Centre, Isle of Wight, UK
Method: Information on food allergy was collected at ages 1, 2, 4, 10 and 18 years
Correspondence from the Isle of Wight Birth Cohort (n = 1456). Skin prick testing (SPT) was per-
S Hasan Arshad, Southampton General
Hospital, Southampton, UK. formed at the age of 1 and 2 years in symptomatic children. At 4, 10 and 18 years
Email: [email protected] of age, participants were tested to a panel of food and aeroallergens. Food allergy
Funding information was diagnosed based on the criteria: symptoms suggestive of a typical IgE-mediated
National Heart, Lung, and Blood Institute, reaction and reaction <4 hours following exposure to a known food allergen. McNe-
Grant/Award Number: R01 HL082925;
Asthma UK, Grant/Award Number: 364 mar’s test was used to determine significance of changes in prevalence over time.
Results: The prevalence of food allergy remained relatively constant in early child-
hood (5.3%, 4.4% and 5.0% at 1, 2 and 4 years, respectively), with significant
decline at 10 years (2.3%, P < .001 vs 4 years) followed by significant rise at
18 years (4%, P = .02 vs 10 years). Cow’s milk (1.6%-3.5%) and egg (1.1%-1.4%)
were the most common allergens in the first 10 years with peanut (1%) and tree
nuts (0.5%) becoming more prevalent beyond 10 years. Fruit and wheat allergy
were less common at 10 years, and shellfish and kiwi emerged during adolescence.
The prevalence of food allergy plus positive SPT was 1.3%, 0.8%, 0.8%, 0.9% and
2.2% at 1, 2, 4, 10 and 18 years, respectively.
Conclusion: Food allergy is highly prevalent in infancy with partial resolution during
late childhood. However, a number of children acquire new food allergy during ado-
lescence resulting in a relatively higher prevalence at 18 years.

KEYWORDS
epidemiology, food allergy, IgE, paediatrics

1 | INTRODUCTION chronic morbidity in the developed world. FA is defined as an

immunologically mediated adverse reaction to food, which can be
Food allergy (FA) is increasingly recognized as a public health prob- both immunoglobulin E (IgE) and non-IgE-mediated. Allergic sensiti-
lem, and along with other atopic conditions is a major cause of zation is the development of specific IgE to food or aeroallergens

Clin Exp Allergy. 2018;1–9. wileyonlinelibrary.com/journal/cea © 2018 John Wiley & Sons Ltd | 1
2 | VENKATARAMAN ET AL.

and can occur in the absence of food allergy symptoms. FA is diag-

2.1 | Definition of FA
nosed based on an allergy-focussed history and/or oral challenges.
Allergic sensitization to the suspected food confirms the presence of The diagnostic criteria used for food allergy have been published
IgE-mediated FA. previously.13,14 In summary, we collected detailed information on
There is huge variability in the prevalence of FA world-wide; food-related allergic reactions and applied an a priori definition of
however, a meta-analysis in 2014 showed overall prevalence rates food allergy based on the following criteria:
of 17% for self-reported FA and 0.9% for challenge-proven FA.
Clinically defined FA prevalence varies widely (1%-13%) depending 1. A report involving a recognized food allergen as defined by the
on the specific criteria used.1,2 Food allergy in infancy can be a Committee on Toxicity of Chemicals in Foods, Consumer Prod-
transient phenomenon or may persist into adulthood. The preva- ucts and the Environment.15
lence and trends in food allergy and sensitization patterns in child- 2. Recognized IgE-mediated symptoms16 such as:
hood have been previously explored in birth cohorts.2-5 However,
there is limited knowledge about prevalence, time trends and a. localized symptoms: itching, sting/burning of the lips/mouth
overall transitions, that is change in status from food allergic to or throat, urticaria/hives, angioedema
non-food allergic (acquired tolerance) and from non-food allergic b. abdominal: nausea, vomiting, crampy/colicky abdominal pain,
to food allergic (acquired food allergy) from one assessment to diarrhoea
the next. The Isle of Wight Birth Cohort was followed up from c. respiratory: wheeze, stridor, watery rhinitis, redness of eyes/
early childhood, into later childhood and on into young adult life, nose
providing a life course perspective between childhood and adult- d. skin: urticaria, itching, flushed skin, worsening eczema
hood. e. systemic reaction: anaphylaxis
There is evidence of rising prevalence and severity of FA and 3. Temporal relationship of a reaction with symptoms developing
anaphylaxis in several studies.6-9 The reasons for reported variation within 4 hours of food ingestion.
in prevalence include differences in study methodology, the diagnos-
tic criteria used for defining FA (eg self-reported food allergy, skin Only if all 3 criteria were fulfilled, were children designated as
prick testing, open [OFC] or double-blind, placebo-controlled food having FA.
challenges [DBPCFC]), geography and local dietary habits.10 We
were in the unique position of being able to analyse 18 years of lon-
2.2 | Skin prick test
gitudinal prevalence data on FA which was collected using similar
methodology from the same, relatively static, population in the Isle Skin prick test (SPT) results were available for a subgroup of the data-
of Wight (IOW), UK. Our study aimed to determine the prevalence set. SPT was performed, using a standardized method, at 1 and 2 years
and longitudinal trends of FA and sensitization to food allergens over in symptomatic children only and at 4, 10 and 18 years in all consent-
the first 18 years of life. This will add valuable information to the ing participants attending the Centre.12,13 The SPT panel included
current knowledge of the natural history of food sensitization and common aero- and food allergens: house dust mite, grass pollen mix,
allergy. tree pollen mix, cat and dog epithelia, Alternaria alternata, Cladosporium
herbarum (aeroallergen panel) plus cow’s milk, hen’s egg, wheat, soya,
cod fish and peanut (food panel). Further SPT was also performed if
2 | METHODS symptoms were reported to other allergens. Histamine and physiologi-
cal saline acted as positive and negative control (Alk-Abello, Horsholm,
The IOW birth cohort was established in 1989 and has been fol- Denmark). A positive skin prick test was defined as a mean weal diam-
lowed up prospectively for 18 years.11,12 This unselected birth eter ≥ 3 mm larger than the negative control at 15 minutes.
cohort was established with the aim of studying the natural history
of allergic diseases and the influence of genetic and environmental
2.3 | Statistical analysis
factors on the development and progression of allergy. The study
was approved by the Isle of Wight research ethics committee (06/ SPSS statistical package Version 17 was used to analyse data (IBM
Q1701/34). All children born on the IOW between 1 January 1989 SPSS Statistics, Version 17, USA). Frequency tables of FA, sensitiza-
and 28 February 1990 (n = 1536) were enrolled in the study, and tion and combined FA and sensitization at each time-point (1, 2, 4,
1456 were available for further follow-up.13 Detailed questionnaires 10 and 18 years) were used to determine prevalence of FA and sen-
were completed at each follow-up. Allergic symptoms of FA, sitization pattern for allergens over time. Cross-tab analysis was used
eczema, asthma and rhinitis, atopic family history and home and for paired data in FA over time. Significance of changes in FA preva-
environmental factors were explored. Prospectively collected food lence rates over time (1, 4, 10 and 18 years) was tested using
reaction and sensitization data were analysed to study food allergy McNemar’s test for paired data and chi-squared/Fisher’s exact test
trends. for independent data.
VENKATARAMAN ET AL. | 3

3 | RESULTS to 0.3% (Figure 2). FA to peanuts, fruits, tree nuts and wheat were
most prevalent at 18 years (Figure 3). Vegetables, mushrooms and
Of the 1536 children enrolled at birth in 1989, 1456 were available mustard were new emerging allergies at 10 and 18 years. Allergies
for further follow-up. Most children had more than one assessment to fruits range from 0.3% to 0.9% at different ages (Figure 3) and
but not all were seen at every time-point. Figure 1 graphically included reports of a variety of fruits (eg strawberry, kiwi, orange,
depicts the availability of information regarding FA and SPT data at bananas and apples Table S3).
various stages of the study. Demographic information and allergic The prevalence of multiple food allergy (ie 2 or more food
comorbidity in the cohort participants at each assessment, stratified groups) remained in the range of 0.7% to 1.3% over 18 years, with
for sex, are provided in the Table S1 and S2. no significant increase in prevalence over time. The majority of chil-
dren with multiple allergies were allergic to 2 food groups and
rarely to 3 food groups. Therefore, the subtotal of individual FA
3.1 | Prevalence of food allergy
percentages exceeds the overall prevalence at 1, 2, 4, 10 and
The prevalence of FA by self-report and FA diagnosed based on 18 years. Cow’s milk and egg were the most common multiple food
study criteria at ages 1, 2, 4, 10 and 18 years are reported in allergies at 1, 2 and 4 years (4 cases each), while at 10 years, these
Table 1. The rates based on study criteria are significantly lower were peanut and egg (n = 3) and at 18 years, multiple nuts
(P < .05) as compared to the self-reported rates. The longitudinal (4 cases).
trend suggests FA rates remain relatively constant in early childhood,
at 5.3%, 4.4% and 5.0% at ages 1, 2 and 4 years, respectively. There
3.3 | Sensitization to food and aeroallergens
is a significant decline at 10 years (2.3%, P < .001 vs 4 years) associ-
ated with the resolution of pre-existing childhood allergies, followed The sensitization rates to food and aeroallergens increased with age.
by a significant rise at 18 years (4%, P = .02 vs 10 years) due to an For aeroallergens, the sensitization rates were 17.3%, 26.7% and
increase in the prevalence of new food allergies between 10 and 40.3% at 4, 10 and 18 years, respectively, compared to sensitization
18 years. FA data were further stratified based on SPT results rates to food allergens of 3.4%, 4.4% and 21.4% at the same time-
(Table S1). Among children with reported food allergic symptoms, points (Table 1). The majority of food allergen sensitized children
SPT information was available in 32.7% to 85.1% of the allergic pop- were also sensitized to aeroallergens (Figure 4).
ulation at 5 time-points. The prevalence of those with defined FA Milk, peanut, wheat and cod were the most common food aller-
plus skin prick test ranged from 0.8% to 2.2%, which equated to gens causing sensitization. Cow’s milk sensitization rates remained
16%-54% of those diagnosed with FA. similar at 4 (1.1%) and 18 years (1.0%) with a dip to 0.3% at
10 years (Figure 2). Peanut sensitization rates were higher than pea-
nut FA rates and increased between 4, 10 and 18 years from 1.0%,
3.2 | Rates of individual food allergies
to 1.7%, to 6.3%, respectively (Figure 3). Peanut allergy rates did not
The FA rates of individual food groups are provided in Table 2. mirror this trend and remained at 0.5%, 0.4% and 1%, respectively.
Cow’s milk and egg allergy were most prevalent at ages 1, 2, 4 and Wheat sensitization rates also did not reflect observed food allergy
10 years. Their prevalence declined with time and by 18 years, and rates. They gradually increased from 0.1% to 6.3%, while wheat
the prevalence of both milk and egg allergy had significantly dropped allergy rates remained <0.5% at all time-points. Similarly, cod

1456
Children 1 YEAR 2Y 4Y 10 Y 18 Y
Enrolled

Food N=1290
N=1268 N=1159 N=1217 N=1368
Allergy 88.6%
87.1% 79.6% 83.6% 94%
information

N= (181) Only N=(181) Only

SPT N=980 N=1035 N=851
symptomatic symptomatic
Information 67.3% 71.1% 58.5%
children tested children tested

FIGURE 1 Participation data/availability of information at ages 1, 2, 4, 10 and 18 y in the Isle of Wight birth cohort (Consort diagram)
 4
|

T A B L E 1 Prevalence of food allergy, based on self-report and study criteria and food allergen sensitization at varying ages
1y 2y 4y 10 y 18 y

FA Status No % 95% CI No % 95% CI No % 95% CI No % 95% CI No % 95% CI

Reported food allergy 108 8.5% 7-10% 106 9.1% 7.4-10.8% 111 9.1% 7.5-10.7 117 8.6% 7.1-10.1% 103 8.0% 6.5-9.5%
Food allergy (study criteria) 67 5.3% 4.2-6.7% 51 4.4% 3.4-5.7% 61 5.0% 3.9-6.4% 35 2.3% 1.7-3.3% 52 4.1% 3.2-5.4%
Availability of food allergy information 1268 (87.1%) 1159 (79.6%) 1217 (83.6%) 1368 (94%) 1290 (88.6%)
Food sensitizationa - - - - - - 31 3.4% 2.2-4.4% 46 4.4% 3.4-5.9% 182 21.4% 18.8-24.3%
b
FA and SPT positive 16 1.3% 0.8-2.1% 9 0.8% 0.4-1.5% 8 0.8% 0.4-1.6% 9 0.9% 0.4-1.6% 19 2.2% 1.4-3.4%
Availability of food sensitization information - - 980 (67.3%) 1035 (71.1%) 851 (58.5%)
a
Skin prick tests at 1 and 2 y were carried out in only symptomatic children, and hence, it was not possible to calculate cohort prevalence.
b
Total number of children with “food allergy information” was used as denominator as skin tests were carried out in only symptomatic children.

T A B L E 2 Prevalence of food allergies based on food groups and age

1y 2y 4y 10 y 18 y
Food group N = 1268 N = 1159 N = 1217 N = 1368 N = 1290
All FA 67 (5.3%) 51 (4.4%) 61 (5.0%) 32 (2.3%) 52 (4.0%)
Cow’s milk 44 (3.5%) 19 (1.6%) 32 (2.6%) 7 (0.5%) 4 (0.3%)
Hen’s egg 14 (1.1%) 15 (1.3%) 17 (1.4%) 8 (0.6%) 4 (0.3%)
Wheat 6 (0.5%) 5 (0.4%) 3 (0.3%) 1 (0.1%) 6 (0.5%)
Soya - - 4 (0.3%) - -
Fish 2 (0.2%) - 2 (0.2%) 2 (0.2%) 2 (0.2%)
Shellfish - - - 2 (0.2%) 3 (0.2%)
Peanut 1 (0.1%) 2 (0.2%) 6 (0.5%) 6 (0.4%) 12 (1.0%)
Tree nuts - 1 (0.1%) 2 (0.2%) 2 (0.2%) 7 (0.5%)
Fruits 10 (0.8%) 11 (0.9%) 9 (0.7%) 4 (0.3%) 11 (0.9%)
Kiwi - - - 1 (0.1%) 3 (0.2%)
Vegetables 2 (tomatoes) (0.2%) 3 (tomatoes) (0.3%) 4 (tomatoes/brussel sprouts) (0.3%) 4 (tomatoes) (0.3%) 5 (tomatoes/leek/cucumber (0.4%)
Miscellaneous - 2 (0.2%) 2 (0.2%) 2 (0.2%) 3 (0.3%)
VENKATARAMAN

FA based on study criteria: reaction to known food allergen, typical IgE reaction symptoms and reaction timing < 4 h.
Miscellaneous included corn, chocolate (1 y), red meat and chocolate (2 y), chocolate and oats (10 y), cinnamon, mustard and linseed (18 y).
ET AL.
VENKATARAMAN ET AL. | 5

4.0%
Cow's milk

3.50% Hen's Egg

3.5%

3.0%

2.60%
2.5%

2.0%

1.60% 1.40%
1.5%
1.30%
1.10%

1.0%

0.60%
F I G U R E 2 Prevalence of cow’s milk
0.5%
and hen’s egg allergy based on study 0.50%
0.30%
criteria (known food allergen, typical
immediate allergy symptoms and timing 0.0%
<4 h) at 1, 2, 4, 10 and 18 y 1Y 2Y 4Y 10 Y 18 Y

1.2%

1.0% 1.0%

0.9% 0.9%

0.8%
0.8%
Wheat
Peanut
0.7%
Tree nuts
0.6% Fish
0.5% 0.5% Shell fish
0.5%
Fruits
0.4%
0.4% 0.4% Vegetables
0.4%
0.3% 0.3%
0.3%
0.3%
0.2%
0.2% 0.2% 0.2%
F I G U R E 3 Prevalence of other food 0.2% 0.2%

allergies (wheat, peanut, tree nuts, fish, 0.1%

0.1% 0.1%
0.0% 0.0% 0.0%
shellfish, fruits and vegetables) at different 0.0%
ages in the Isle of Wight Birth Cohort 1Y 2Y 4Y 10 Y 18 Y

sensitization remained low at 4 and 10 years but increased at during teenage years, which was more prominent for food allergen
18 years to 1.8% with no corresponding increase in prevalence of sensitization than for FA.
cod allergy. The prevalence of FA in childhood has been previously reported
using methods which ranged from self-reported questionnaire sur-
veys to double-blind, placebo-controlled food challenges
4 | DISCUSSION (DBPCFC). 17
DBPCFC is considered the “gold standard” but has only
been used in a minority of research studies, often with biased popu-
This is the first study reporting prevalence and natural history of lations due to difficulties in administration. In our study, FA was
both food allergy (FA) and sensitization from birth to 18 years in an diagnosed using symptom-based criteria, reflecting clinical practice,
unselected population, using strict criteria and capturing time trends and included the characteristics of the reaction, timing from expo-
in individual food allergies. As the IOW cohort is an unselected and sure and exposure to common food allergens. The results have been
longitudinal birth cohort which has been followed up to the age of published previously.13 We did not use reproducibility of allergic
18 years, it was possible to follow trends of FA throughout child- reaction as a diagnostic criterion. Although useful when present, it
hood. We showed an expected decline in FA prevalence after early may not be present in individuals who have had a severe or anaphy-
childhood which we associate with the resolution of transient food lactic reaction and would not be further exposed. Other studies have
allergies, but there was an unexpected rise in overall prevalence used similar criteria to define food allergy.18-20 We also did not use
6 | VENKATARAMAN ET AL.

45.0%

40.0%

35.0%

30.0% F I G U R E 4 Sensitization patterns to

aeroallergens and food allergens at 4, 10
25.0%
FA Sensitization Only and 18 y, based on SPT results.
AA and FA Sensitization Aeroallergen sensitization increases with
20.0%
AA Sensitization Only age and reaches a maximum of 40.2% by
18 y and food allergen sensitization
15.0%
reaches a maximum of 21.4% by 18 y of
age. The majority of the food allergen
10.0%
sensitized population are also sensitized to
5.0%
aeroallergens, while there were few who
were sensitized only to food allergens. FA,
0.0%
food allergens; AA, aeroallergens; AA+FA:
4Y 10 Y 18 Y aero- plus food allergens

allergic sensitization as a criterion as we had incomplete information between 2001 and 2002), the prevalence in our study is slightly
for allergic sensitization at 1 and 2 years and no information on food higher.5,25 The variance may be attributable to the use of DBPCFC
allergen-specific IgE. Hence, we cannot reliably comment on the in the FAIR cohort. Similarly, Osterballe et al23 reported a lower
prevalence of whether these were IgE or non-IgE-mediated food prevalence of 2.3% in children under the age of 3 years old when
allergy. However, we have reported IgE-mediated allergy as a subset using food challenges. A recent population-based study from Aus-
of those with food allergy if they had a positive skin prick test to tralia, where participants were recruited at a year of age, found an
food allergens. The prevalence of FA in our cohort varied between oral challenges defined FA prevalence of 10% in 2848 1-year-olds
2.3% and 5.3%, in children between 1 and 18 years, while IgE- (egg allergy 8.9%, peanut allergy 3% and sesame allergy 0.8%).32
mediated food allergy varied between 0.8% and 2.2%. Similar preva- There were no significant overall changes during the prevalence
lence has been reported in other birth cohort studies which have of food allergy during the 1-2 year and 2-4 year transition windows;
used open and DBPCFC for diagnosis of FA.4,18,21-25 however, there was a significant reduction in FA between 4 and
Self-reported FA rates were lower compared to other studies; 10 years (5.3%-2.3%) followed by significant increase between 10
both cross-sectional and birth cohort.5,18 This could be explained by and 18 years (2.3%-4.1%). This negative transition at 10 years may
the fact that targeted FA symptom-specific questionnaires were used represent the gradual acquisition of natural tolerance of childhood
to collect data in person (where possible) at every assessment, rather FAs by 10 years of age. The subsequent positive transition at
than from an anonymous FA questionnaire survey. Similar preva- 18 years suggests the resurgence of new and possibly persistent
lence rates for FA in children and adolescents have been reported in forms of FA. These transitions were similar in the stable subgroup
other studies that have used symptom-based surveys like our (n = 843) of the cohort, where FA information was available
20,26-28
study. In the food allergic subgroup, SPT availability rates var- throughout the 5 points of assessment.
ied between 37.2% and 85.5%, which may explain the low SPT posi- Cow’s milk and eggs were the most common allergens at 1, 2, 4
tivity in our food allergic population. However, similar low SPT and 10 years, and peanut, tree nuts and shellfish became more
positivity has been found in other studies.5 prevalent at 18 years. Fruit, kiwi, mushrooms and mustard were gen-
FA prevalence according to our study criteria was in line with erally new allergies at 10 and 18 years.
other studies and suggests that our symptom-based criteria were The rate of cow’s milk allergy varied between 1.6% and 3.5%
reasonably robust. The FA prevalence at 10 years (2.3%) was the between 1 and 4 years, 0.5% at 10 and 0.3% at 18 years. Other
same as previously reported in a cross-sectional study in the IOW studies have shown a similar milk allergy prevalence of 2%-3% based
29
for 11-year-old children which used DBPCFC. The 18-year preva- on OFC/DBPCFC in the first 3 years of life,2,21,33,34 although a
lence of 4% is similar to that shown in previous cross-sectional stud- study by Gerrard et al35 reported a much higher milk allergy preva-
30
ies in adult populations, that is 3.2% and 3.6%. In a large Swedish lence of 7.4% on the basis of OFC. A large cross-sectional survey of
birth cohort, the prevalence of FA and food-related symptoms in 38,380 children36 showed a self-reported milk allergy prevalence of
early childhood was slightly higher (6.8% and 12.2%, respectively) 1.5% between 6 and 10 years, 1.4% between 11 and 13 years, and
compared to this study where FA in early childhood ranged from 1.6% in children over 14 years, which is significantly higher than our
4.4% to 5.3% and reported FA was ~9%.31 However, when com- study (0.5% at 10 years and 0.3% at 18 years).
pared to the Food Allergy and Intolerance Research (FAIR) cohort, Egg allergy rates varied from 1.1% to 1.4% between the ages of
which was also recruited on the IOW, but a decade later (born 1 and 4 years, similar to that reported by other population studies at
VENKATARAMAN ET AL. | 7

1-3 years (1%-1.6%) using OFC/DBPCFC.2,25 Prevalence at 10 years unselected nature of the cohort, the high retention rate (84%-94.3%)
(0.6%) and 18 years (0.3%) was also similar to that reported in the and prospective and repeated collection of food allergy information
cross-sectional survey by Gupta et al36 for children over 6 years. (5 specific time-points) are strengths of this study.
Peanut allergy data from this cohort have been published previ- The study has a few limitations. There was a significant gap in
ously.7,9,14,24,37 However, using a different case ascertainment crite- terms of number of years between 4th (10 years) and 5th
ria in this study (ie not using allergen sensitization as a requirement), (18 years) study assessments. However, different individuals pro-
peanut allergy was 0.08%-1% between the ages of 1 and 18 years. gress through puberty at different times, and so by assessing at 10
This is similar to previous reports up to the age of 10 years but and 18 years, we have been able to compare the population when
higher at 18 years (1% compared to 0.5% reported previously).14 most were pre- and post-pubertal. Clinical studies show that milk
Other studies have reported a similar prevalence (0.2% to and egg allergy continue to decline during teenage years with the
1.6%).23,38,39 trajectories following a straight line, and thus, we have likely cap-
Fish allergy was 0.2% at all ages, while shellfish allergy started to tured transition changes before and after puberty.43,44 A birth
1
emerge at 10 and 18 years (0.2%). A recent meta-analysis reported cohort study, where participants were assessed during adolescence,
an overall prevalence of fish allergy of <0.5% and shellfish allergy shows similar FA prevalence.31 The birth cohort was dynamic, and
between 0.0% and 1.4% (based on symptoms and specific IgE). Our some children did not participate at one time-point, but rejoined at
study reports lower rates for shellfish allergy at 10 and 18 years, another, which made it somewhat difficult to interpret transitions
which probably captures a period of gradual emergence of shellfish (emergence of new allergies and the resolution of existing allergies)
allergy in its natural history where it is more often associated with in the whole population, but this is unavoidable in a study spanning
adult FA. over 18 years. Although lack of oral challenge remains a limitation,
Wheat allergy prevalence in our study varied between 0.1 and we have used previously published robust clinical criteria,13 which
36
0.5% between 1 and 18 years. Gupta et al , in their US cross-sec- have provided results comparable to studies using the “gold stan-
tional survey, reported higher prevalence (0.3%-0.7%), with a peak at dard.” Although our definition included reactions up to 4 hours after
11-13 years whereas our study shows the lowest prevalence at exposure, this is unlikely to have resulted in much misclassification
10 years (0.1%). Allergy to fruits varied between 0.3% and 0.9%. as other adverse reactions to food would have not presented with
Kiwi allergy was mainly reported at 10 and 18 years (0.1%-0.2%). the IgE-mediated symptoms in our definition. With lack of SPT data
Other studies have reported fruit allergy between 0.1% and 4.3%.40 on all children at 1 and 2 years and of specific IgE, we were unable
Among miscellaneous food allergy, chocolate was commonly sus- to assess the proportion of IgE-mediated allergy in this report or
pected. This may be due to undiagnosed nut allergy or cross-con- patterns of sensitization in the whole cohort in the first 2 years of
tamination with nuts. life.
Focusing on sensitization, we showed a rise in overall prevalence, In conclusion, our study provides valuable information on the
more prominent for food allergen sensitization than for FA. Kulig prevalence and longitudinal patterns of FA and food sensitization
et al41 report diminishing sensitization rates to food allergens (from not only in childhood but also during adolescence. There is little
10% at 1 year to 3% at 6 years), but this study did not look at sensi- available data on this age group even though the adolescent popula-
tization rates beyond 6 years. Pereira et al29 reported food allergen tion are at the highest risk of severe allergic reactions and death as
sensitization rates of 5.1% and 4.9% in 11- and 15-year-old children a consequence of FA.45 The prevalence of FAs was high in early
in cross-sectional studies conducted on the IOW (independent of childhood with a significant decrease in prevalence at 10 years, sug-
the IOW cohort). This is similar to our findings at 10 years (4.5%), gesting resolution of early childhood allergies followed by onset of
but we found a higher prevalence at 18 years (21.4%), which may new food allergies, resulting in higher prevalence at 18 years.
indicate that the rise in food allergic sensitization occurs in later ado-
lescence.
ACKNOWLEDGEMENTS
Wheat, peanut and milk were the most common sensitizing
foods. The high rates of wheat sensitization could be due to cross- We would like to acknowledge the help of the staff at The David
reactivity with grass pollen, as increasing wheat sensitization (1%, Hide Asthma and Allergy Research Centre in undertaking the assess-
2.3% and 19.3% at 4, 10 and 18 years) did not mirror our wheat ments of the Isle of Wight Birth Cohort. We would also like to
allergy rates (which instead remained static) but did mirror grass pol- acknowledge the participants and their families who helped us with
len sensitization. Using the FAIR cohort, we have recently shown this project over the last two decades. The Isle of Wight Birth
the significance of cross-reactivity between grass and wheat pol- Cohort assessments have been supported by the National Institutes
len.42 Similarly, the increase in peanut sensitization between 10 and of Health USA (Grant no. R01 HL082925) and Asthma UK (Grant
18 years was likely to be due to cross-reactivity between peanut no. 364).
14
and grass or birch pollen.
Our study has a number of strengths. It is the first to investigate
CONFLICT OF INTEREST
the longitudinal trends in prevalence and the dynamics of change in
FA and sensitization patterns in childhood and adolescence. The The authors declare no conflict of interests.
8 | VENKATARAMAN ET AL.

ORCID 20. Ostblom E, Wickman M, van Hage M, Lilja G. Reported symptoms

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