unpredictable in later childhood and adulthood. This may be due to the fact that these children tend to develop asthma later in life (Sampson, 2005). Also, a recent review of anaphylactic fatalities in the United Kingdom showed that in 85% of fatal food reactions the patient had previously experienced a non-severe reaction (Pumphrey, 2004). Pumphrey (2004) stated that the severity of previous reactions is not a risk factor for fatal reactions in nut allergic patients. These data imply that any individual with a clinical history of IgE-specific food allergy may be predisposed to anaphylaxis or severe reaction.
D. Prevalence Information on the prevalence of food allergies in the U.S. suggests that up to 6% of children and 4% of the total population have IgE-mediated food allergies (Sampson, 1997; Sampson, 2004; Sicherer et al., 2003; Sicherer et al., 2004). The estimated prevalence in the U.S. population of allergies to each of the food allergens identified by the FALCPA is given in Table II-2. Severe food-related allergic reactions result in an estimated 30,000 emergency room visits, 2,000 hospitalizations, and 150 deaths per year (Sampson, 2004). Clinical data and surveys indicate that the prevalence of allergy, including food allergy, has been rising in recent years, though there are limited historical data to compare to more recent estimates (Sicherer et al., 2003; Grundy et al., 2002). Peanut allergy has received the most attention in the U.S., and data indicate an apparent doubling of peanut allergy in children under 5 years old from 1997 to 2002 (Sicherer et al., 2003). An increase in peanut allergy has also been seen in the United Kingdom (Ewan, 1996; Grundy et al., 2002). Peanuts and tree nuts are the most common cause for fatal reactions in the US, although seafood allergy is increasingly being recognized in adults (Yunginger et al., 1988; Sampson et al., 1992b; Bock et al., 2001, Sicherer et al., 2004, Ross et al., 2006).
Table II-2. Allergy Prevalence in the United States Percentage of the Population
aShellfish includes both crustaceans and mollusks. bUNK = unknown. Sources: Cordle, 2004; Sampson, 1997; Sampson, 2004; Sampson, 2005; Sicherer et al., 2003; Sicherer et al., 2004.
Allergenic Foods of Concern
The FALCPA identifies eight major foods or food groups: milk, eggs, fish (e.g., bass, flounder, cod), crustacean shellfish (e.g., shrimp, crab, lobster), tree nuts (e.g., almonds, walnuts, pecans), peanuts, wheat, and soybeans. These eight foods are believed to account for 90 percent of food allergies and most serious reactions to foods (FALCPA section 202(2)(A); Bousquet et al., 1998; Hefle et al., 1996). More than 160 other foods are known to cause food allergies; however, these allergies are relatively rare with
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