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Is the prevalence of peanut allergy increasing? A 5-year follow-up study in children in Montreal - 15/08/11

Doi : 10.1016/j.jaci.2009.02.004 
Moshe Ben-Shoshan, MD a, Rhoda S. Kagan, MD b, Reza Alizadehfar, MD a, Lawrence Joseph, PhD c, d, Elizabeth Turnbull, RN c, Yvan St Pierre, MA c, Ann E. Clarke, MD, MSc d,
a Department of Pediatrics, Division of Clinical Immunology/Allergy and Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada 
b Department of Pediatrics, North York General Hospital, University of Toronto, Toronto, Ontario, Canada 
c Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada 
d Departments of Epidemiology and Biostatistics, McGill University, Montreal; and the Department of Medicine, Divisions of Clinical Epidemiology and Clinical Immunology/Allergy, McGill University Health Centre, Montreal, Quebec, Canada 

Reprint requests: Ann E. Clarke, MD, MSc, McGill University Health Centre, 687 Pine Ave West, V Building, Room V2.05, Montreal, Quebec H3A 1A1, Canada.

Abstract

Background

Studies suggest that peanut allergy prevalence might be increasing, but these results have not yet been substantiated.

Objective

We conducted a follow-up study to determine whether peanut allergy prevalence in Montreal is increasing.

Methods

Questionnaires regarding peanut ingestion were administered to parents of children in randomly selected kindergarten through grade 3 classrooms between December 2000 and September 2002 and between October 2005 and December 2007. Respondents were stratified as (1) peanut tolerant, (2) never/rarely ingest peanut, (3) convincing history of peanut allergy, or (4) uncertain history of peanut allergy. Children in group 3 with positive skin prick test responses were considered to have peanut allergy. Children in groups 2 and 4 with positive skin prick test responses had peanut-specific IgE levels measured, and if the value was less than 15 kU/L, an oral peanut challenge was performed. Multiple imputation was used to generate prevalence estimates that incorporated respondents providing incomplete data and nonrespondents.

Results

Of 8,039 children surveyed in 2005-2007, 64.2% of parents responded. Among those providing complete data, the prevalence was 1.63% (95% CI, 1.30% to 2.02%) in 2005-2007 versus 1.50% (95% CI, 1.16% to 1.92%) in 2000-2002. After adjustment for missing data, the prevalence was 1.62% (95% credible interval, 1.31% to 1.98%) versus 1.34% (95% credible interval, 1.08% to 1.64%), respectively. The differences between the prevalences in 2005-2007 and 2000-2002 were 0.13% (95% credible interval, −0.38% to 0.63%) among those providing complete data and 0.28% (95% credible interval, −0.15% to 0.70%) after adjustment for missing data.

Conclusions

This is the first North American study to document temporal trends in peanut allergy prevalence by corroborating history with confirmatory tests. The results suggest a stable prevalence, but wide CIs preclude definitive conclusions.

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Key words : Peanut allergy, prevalence, skin prick test, peanut-specific IgE, food challenge, epidemiology

Abbreviations used : CrI, DBPCFC, SPT


Plan


 Supported by the Canadian Institutes of Health Research (MOP-77584); the Allergy, Genes and Environment Network Centres of Excellence (AllerGen NCE); Anaphylaxis Canada; the Canadian Allergy, Asthma and Immunology Foundation; and Novartis Pharmaceuticals. Dr Clarke received a $2500 unrestricted grant from Novartis Pharmaceuticals. Drs Joseph and Clarke are National Scholars of Fonds de la recherche en santé du Québec.
 Disclosure of potential conflict of interest: M. Ben-Shoshan receives grant support from AllerGen. R. S. Kagan is on the Board of Directors for the Canadian Society of Allergy and Clinical Immunology (CSACI) and receives honoraria for speaking for King Pharmaceuticals and Merck Frosst. R. Alizadehfar is on the speakers’ bureau for Paladian Pharma and receives research support from Allergen. A. E. Clarke receives grant support from AllerGen; Anaphylaxis Canada; and the Canadian Allergy, Asthma and Immunology Foundation. The rest of the authors have declared that they have no conflict of interest.


© 2009  American Academy of Allergy, Asthma & Immunology. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 123 - N° 4

P. 783-788 - avril 2009 Retour au numéro
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