Food and Drug Reactions and Anaphylaxis
Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: A 5-year follow-up study

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Abstract

Background

Allergy to peanuts and tree nuts (TNs) is the leading cause of fatal and near-fatal food allergic reactions. Peanut allergy appears to be increasing in prevalence.

Objectives

We sought to determine the prevalence of self-reported peanut and TN allergy among the general population of the United States in 2002 by sex and age and to compare the results with prevalence estimates obtained 5 years earlier.

Methods

We performed a nationwide, cross-sectional, random telephone survey by using a standardized questionnaire.

Results

A total of 4855 households participated (53% participation rate), representing a census of 13,493 individuals. Peanut allergy, TN allergy, or both was self-reported in 166 (1.2%; 95% CI, 1.0%-1.4%) individuals in 155 (3.2%; 95% CI, 2.7%-3.7%) households, overall prevalence rates similar to those reported in 1997. Also similar to the 1997 survey, the severity level was high, with 79% reporting respiratory or multiple organ system reactions and 66% experiencing more than 5 lifetime reactions. Despite the severity and reaction frequency, only 74% of the children and 44% of the adults sought evaluation for the allergy, and fewer than half who did were prescribed self-injectable epinephrine. Applying conservative rules to adjust for persons with unconvincing reactions and a false-positive rate of the survey instrument (7%), a final prevalence estimate of 1.04% (95% CI, 0.9%-1.24%) was obtained. A male predominance of peanut-TN allergy was reported in children younger than 18 years (1.7% vs 0.7%, P = .02), and a female predominance was reported among adults (1.7% vs 0.9%, P = .0008). Although the rate of peanut allergy, TN allergy, or both was not significantly different from 1997 to 2002 among adults, the rate increased from 0.6% to 1.2% among children, primarily as a result of an increase in reported allergy to peanut (0.4% in 1997 to 0.8% in 2002, P = .05).

Conclusions

Self-reported peanut allergy has doubled among children from 1997 to 2002, and peanut allergies, TN allergies, or both continue to be reported by more than 3 million Americans. Considering that reactions are severe and the allergy is persistent, these allergies represent an increasing health concern.

Section snippets

Survey methods

The survey was a nationwide, cross-sectional, computer-assisted telephone interview of households performed by the same agency that conducted the study between April and June 1997 (IMR, Inc, an AdvancePCS Company, Hunt Valley, Md).1 A random sampling of telephone numbers was generated by the Genesys Sampling System (Fort Washington, Pa). Nonresidential calls were excluded from analysis. Interviews were conducted from June 24, 2002, to August 7, 2002, by trained telephone medical interviewers. A

Participation rate

A total of 9252 households were contacted: 3503 (37.9%) refused to participate, and an additional 894 (9.7%) were ineligible (age <18 years, 57; language barrier, 524; confusion or hearing problems, 248; and willing but ultimately unable to schedule interview, 65). The total of 4855 participating households represented a census of 13,493 individuals. The overall participation rate of 4855 (52%) households was lower than that of the 1997 survey (67%).

Demographic characteristics of participants and reported rates of peanut and TN allergy

A total of 155 (3.2%; 95% CI, 2.7%-3.7%)

Discussion

Peanut and TN allergies are particularly severe, common, and rarely outgrown.1, 3, 8, 9 Previous anecdotal reports from the United States10 and the United Kingdom4 have described an increase in sensitization and prevalence, respectively. Recently, Grundy et al5 reported peanut sensitization and reactivity in a birth cohort of 3- and 4-year-old children on the Isle of Wight, United Kingdom, born between 1994 and 1996 and compared the results with those of a cohort born in 1989. They documented a

Acknowledgments

We thank Joshua Liberman, PhD, and Christina Davis of IMR, Inc (an AdvancePCS Company, Hunt Valley, Md), for assistance with data management and analysis.

References (26)

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    In the North American context, there have been numerous surveys conducted over the past 25 years that have assessed the prevalence of IgE-mediated FA among US adults. Sicherer et al,5,6 in 19995 and 2002,6 reported the prevalence of peanut allergy (PA) to be 0.7% and 0.6% among US adults aged 18 and above, whereas tree nut allergy was estimated to affect 0.7% and 0.5% of US adults, respectively. The 2002 survey reported that around half of respondents with peanut or tree nut allergy reported allergies to additional (unspecified) foods, suggesting that more than 1 FA (or multi-FA) is common among US adults with FA.

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Supported by the Food Allergy Initiative, New York, the Jaffe Family Foundation, and the Food Allergy and Anaphylaxis Network.

1

SHS is supported by K23 AI 01709 from the National Institute of Allergy and Infections Disease

2

HAS is supported by AI 44236 and AI 43668.

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