Pediatric Allergic March Supported by Nationwide EHR Data

A typical allergic march started with atopic dermatitis during infancy and progressed to other allergies later in life, a multi-state study found.

In total, 13.4% of pediatric study participants had two or more allergic conditions based on electronic health record (EHR) information, reported David A. Hill, MD, PhD, of Children’s Hospital of Philadelphia, and coauthors.

The most common condition was asthma, in 20.1% of the children, followed by allergic rhinitis in 19.7%, atopic dermatitis in 10.3%, immunoglobulin E (IgE)-mediated food allergy in 4%, and eosinophilic esophagitis in under 1%, according to the retrospective cohort study published in Pediatrics.

“To our knowledge, our study is the first to determine pediatric allergic disease patterns across multiple U.S. pediatric practices and health systems,” the authors wrote.

“Although direct comparisons with nationally representative surveys cannot be performed, we note that allergic disease prevalence rates in our cohort were within previously reported ranges, with notably lower rates of [IgE-mediated food allergy] and higher rates of asthma and allergic rhinitis,” they reported.

Conditions like allergic rhinitis, atopic dermatitis, IgE-mediated food allergy, eosinophilic esophagitis, and asthma are among the most common chronic diseases affecting this population.

Incidence of atopic dermatitis peaked at the youngest patient age of 4 months, the group reported. This was followed by both asthma and IgE-mediated food allergy incidence at 13 months, allergic rhinitis at 26 months, and eosinophilic esophagitis at 35 months. The most common food allergies were peanut allergies at 1.9%, then egg at 0.8%, and shellfish at 0.6%.

Hill and colleagues noted that concurrent allergies were seen among many of the children, with asthma and allergic rhinitis often clustering with other conditions. For example, 43.9% of asthma patients also experienced allergic rhinitis, 44.8% of allergic rhinitis patients also had asthma, 33.1% of IgE-mediated food allergy patients also experienced allergic rhinitis, and 40.6% of eosinophilic esophagitis patients also had a food allergy diagnosis.

The researchers noted that current methods of understanding and identifying allergy patterns fall short.

“Allergic diseases are one of the most common causes of impaired quality of life in children, so to improve the diagnosis and care of children with these diseases, it is important that we have an accurate understanding of how widespread they are, and the risk factors that are associated with them,” said co-author Stanislaw Gabryszewski, MD, PhD, also of Children’s Hospital of Philadelphia, in a press release.

“Prior studies have gauged the prevalence and patterns of allergies based on surveys completed by families. By using data from electronic health records, we were able to analyze data from medical providers, which allowed us to examine population-level patterns over time and in a way that minimizes reporting bias,” he said.

Study participants were part of the American Academy of Pediatrics CER² EHR database that spans multiple independent primary care practices and health systems, with 218,485 children included in the present analysis.

Of those participants, 49% were girls. The cohort was 48% white, 32% Black, 4% Asian or Pacific Islander, 7% of an unknown race, and 11% were listed as another race. The majority, 76%, were non-Hispanic and 90% lived in metropolitan areas.

Researchers noted that one large limitation of the study is that it cannot account for preexisting health disparities such as difficulties accessing care. Other limitations include the fact that the diagnosis codes used may actually represent clinical suspicion and a potential loss of participants to follow-up, among others.

Nevertheless, Hill and colleagues argued that EHRs have the potential to provide essential clarity on allergic patterns, which may help patients in a more efficient manner.