Prospective Appraisal of Complaints of Adverse Reactions to Foods in Children During the First 3 Years of Life

Abstract

To examine the natural history of adverse reactions to foods, 480 children were followed prospectively from birth to their third birthdays. Foods thought to be causing symptoms were evaluated by elimination of suspected foods, open challenges, and double-blind food challenges. Foods producing symptoms were reintroduced into the diet at 1- to 3-month intervals until the symptoms no longer occurred. Of the 480 children completing the study, 28% were thought to have symptoms produced during food ingestion, but in only 8% were these reactions reproduced (excluding fruit and fruit juices). During the first year of life 80% of the initial complaints occurred. The most striking finding was the brief duration during which reactions could be reproduced. The majority of foods were replaced in the diet within 9 months of their incrimination. A long list of foods was reported to produce many symptoms, but only a few foods reproducibly evoked gastrointestinal and skin symptoms, with respiratory symptoms being infrequent. Of great interest was that 75 children were reported to react to fruit or fruit juice, and 56 of these children had reproducible symptoms. This study has found that most food reactions occur during the first year of life, but rechallenge at regular intervals has shown that the food can be reintroduced into the diet by the third year without risk. Almost all reactions that were reproduced appear to be nonimmunoglobulin E mediated.

The Natural History of Food Allergy

“…Bock 1 prospectively followed 480 children, recruited from a single pediatric practice, for the development of food allergy from birth through the age of 3 years. Foods that were suspected of causing adverse reactions were eliminated from the diet and then reintroduced in either open or blinded challenges at regular intervals.…”

“…As was noted above in a number of studies, adverse reactions to fruits, vegetables, and other cereal grains are typically very short-lived. 1,2,13 Although some children do have severe, IgE-mediated allergies to these foods that may persist over time, for most children they can be successfully reintroduced into the diet within a period of 6 to 12 months. Many of these may in fact represent more intolerances or irritant reactions than true allergy as well.…”

TGFβ Receptor Mutations Impose a Strong Predisposition for Human Allergic Disease

“…allergens (median, 2; IQR, 0 to 5). Eighteen of 58 had a convincing history of an immediate reaction to a food (14 had a positive allergenspecific test to the same food; the other 4 never had testing to the suspect food), providing a conservative estimate of 31% for the prevalence of food allergy in LDS patients, compared to 6% of children and 2 to 4% of adults in the general population (Table 1 and table S2) (14,15). The remaining 13 LDS patients who reported adverse food reactions did not meet our strict criteria for diagnosing food allergy.…”

Food Allergy: An Overview

“…The prevalence of food hypersensitivities is greatest in the first few years of life, affecting about 6% of infants less than 3 years of age 14 and decreasing over the first decade. Virtually all infants who have cow's milk allergy have it in the first year of life, with clinical tolerance developing in about 80% by their fifth birthday.1 About 60% of infants with cow's milk allergy experience IgE-mediated reactions, and about 25% of these infants retain their sensitivity into the second decade of life, with 35% going on to have other food allergies.…”