Presumed Food Allergy Common in Children With Asthma, Affects Symptom Control

Presumed food allergy is a relatively common occurrence among children with asthma and can impact symptom control, according to a study published in the journal Health Science Reports.

Researchers conducted a cross-sectional study among children with asthma who attended a childhood asthma clinic in a tertiary care hospital in southern India between July 2017 and July 2019. The primary study objective was to estimate the percentage of children with asthma who have food-induced respiratory allergy symptoms and to correlate it with skin prick test (SPT) results and level of asthma control. The secondary study objective was to describe the factors that are linked to food allergy in children with asthma. Basic demographic features and clinical details of all participants were recorded. SPT was performed with the use of AllergoSPT, based on guidelines recommended by the British Society of Allergy and Clinical Immunology. Researchers also evaluated asthma control with an asthma control test (ACT) and childhood ACT questionnaires.

A total of 305 children aged 6 years or older were included in the study. The median patient age was 10 years (IQR, 8-12). The median age at asthma diagnosis was 7 years (IQR, 5-9). Overall, 67% of the participants were boys, 60% resided in rural areas, and 52% belonged to the class 4 socioeconomic status. Among 73.1% of the children, breastfeeding alone was continued until 6 months of age, which was followed by the addition of complementary feeding after 6 months; in 26.9% of the children, complementary feeding was initiated prior to 6 months of age. Overall, 48.5% of the children had mild persistent asthma, 89% were using rotahalers, 96% were using the device correctly, and 98% were compliant with therapy.

Among the 305 enrollees, 167 reported symptoms of food allergy and 76 of them exhibited SPT positivity. The most commonly reported allergen was banana—found in 45% (137 of 305) of the participants. The most prevalent symptom reported among the children was wheezing—found in 54% of the participants. SPT was positive in 24.9% (76 of 305) of the enrollees. Level of asthma control, age at introduction of complementary foods, and family history of atopy were all significantly associated with food allergy (P <.01 for all).

The researchers concluded that the findings from the current study should be interpreted with caution for a number of reasons. Although spirometry was not performed as part of this analysis, most of the children being followed had undergone the procedure in the past. Further, a double-blind, placebo-controlled trial is the gold standard for the diagnosis of food allergy, but time and resource constraints did not permit this. Community-based studies might be warranted to learn the true prevalence of food allergy in children with asthma in the community being evaluated.

“…[W]e find presumed food allergy to be relatively common in children with asthma, quite contrary to popular belief,” the study authors noted. “Perceived food allergy shows only a moderate correlation with SPT and cannot be relied upon in isolation to diagnose food allergy. Food allergy affects symptom control significantly and is associated with a family history of atopy and timing of complementary food introduction.”

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  

Reference  

Cherian AA, Lakshminarasappa DS, Chandrasekaran V, Chinnakali P. Food allergy in children with asthma and its correlation with level of asthma control. Health Sci Rep. Published online January 6, 2022. doi:10.1002/hsr2.475