Food Allergy in At-Risk Adolescents With Asthma: A Key Area for Focus

Abstract

To determine the prevalence of food allergies (FAs) in adolescents with persistent asthma and see whether concurrent FAs contributed to asthma morbidity.In the study, the researchers included 342 adolescents (12–16 years) with severe asthma who attended the Rochester City School District and participated in the School-Based Asthma Care for Teens (SB-ACT) trial from 2014 to 2018.The parent trial, SB-ACT, aimed to decrease asthma morbidity by directly observing asthma medication administration in the Rochester City School District to high-risk adolescents identified as having persistent symptoms or poor control. Additionally, an 18-item FA questionnaire was also administered to the participants and caregivers that assessed a history of physician-diagnosed FAs versus self-reported FAs, foods in question, status of allergy (current or previous), and whether diagnostic testing of FA (skin test, blood tests, or food challenges) was performed.A total of 101 (29%) respondents reported FAs, with shellfish being the most common (38%), followed by peanut (34%) and tree nut (30%). A total of 58% of the adolescents did not have an epinephrine autoinjector (EAI), and only 13% reported carrying their EAI daily. There was no statistically significant difference in the mean asthma symptom-free days in patients with and without FA, but those patients with FA had a higher fractional excretion of nitric oxide. In a linear regression analysis, adolescents with FAs had more days of activity limitation in a 2-week period because of asthma and a higher odds of missing school attributed to asthma than those without a FA did.FAs are commonly found in adolescents with severe asthma and can lead to negative impacts on their quality of life, including increased activity limitations as well as missed days of school. Less than one-half of this cohort with FA had access to an EAI, which may increase near fatal outcomes.In this study, the authors highlight the need to screen adolescents with severe asthma for other atopic diseases, including FAs, to minimize adverse outcomes. Adolescents are at higher risk for fatal food-induced anaphylaxis when they have asthma and if epinephrine administration is delayed. Therefore, it is of utmost importance to not only screen for FAs in this population but ensure both prescriptions for and counseling of proper use of an EAI to avoid adverse outcomes.