Risk factors predisposing children to food allergies

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Ecem Firtin
Isılay Turan
Deniz Ozceker
Betul Buyuktiryaki
Gonca Hancioglu
Selami Ulas
Sezin Naiboglu
Ciğdem Aydogmus
Recep Sancak
Mehmet Halil Celiksoy


Food allergy, risk factors, children, childhood, anaphylaxis


Background: Food allergies are the most common cause of anaphylaxis in children, and their incidence is increasing globally. The aim of this study was to determine the risk factors leading to food allergies in childhood.

Methods: Children with food allergies and non-atopic healthy children were compared using a questionnaire that included prenatal, neonatal, and postnatal risk factors.

Results: A total of 314 subjects, 155 patients and 159 healthy children for the control group, were enrolled in the study. The median age of patients with a food allergy at diagnosis was 6 months (1–156 months), and 71 patients (45.8%) were males. The median age of the control group was 12 months (1–61 months), and 67.0% were males. Older maternal age (P = 0.023), birth by caesarean section (P = 0.001), birth in the summer or autumn (P = 0.011), crowded housing (P = 0.001), damp houses (P = 0.001), being fed with breast milk and complementary food (P = 0.001), use of synthetic bedding (P = 0.024), and being the oldest child in the family (P = 0.001) were the considered risk factors for an immunoglobulin-E (IgE)-mediated food allergy. A low frequency of yoghurt consumption by mother (P = 0.001) and use of wool bedding (P = 0.018) were identified as risk factors for non-IgE-mediated food allergies. Low socioeconomic status (P = 0.001) played a protective role against both IgE- and non-IgE-mediated food allergies whereas breastfeeding played a protective role against IgE-mediated food allergies (P = 0.030).

Conclusion: The most important aspect of this study was that it separately identified prenatal, neonatal, and postnatal risk factors for IgE- and non-IgE-mediated food allergies.

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1. NIAID-Sponsored Expert Panel: Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1–58. 10.1016/j.jaci.2010.10.007

2. Cianferoni A, Muraro A. Food-induced anaphylaxis. Immunol Allergy Clin N Am. 2012;32:165–95. 10.1016/j.iac.2011.10.002

3. Lack G. Update on risk factors for food allergy. J Allergy Clin Immunol. 2012;129(5):1187–97. 10.1016/j.jaci.2012.02.036

4. Atkins D, Leung DYM. Diagnosis of allergic disease. In: Kliegman RM, Stanton BF, Schor NF, St Geme JW and Behrman RE, editors. Nelson textbook of pediatrics. Philadelphia PA: Saunders Elsevier; 2011, pp. 764–8.

5. Siles RI,Hsieh FH. Allergy blood testing: A practical guide for clinicians. Cleve Clin J Med. 2011;78(9):585–92. 10.3949/ccjm.78a.11023

6. Tezcan I, Berkel AI, Ersoy F, Sanal O. Sağlıklı Türk Çocukları ve erişkinlerde türbidimetrik yöntemle bakılan serum immunoglobulin düzeyleri. Çocuk Sağlığı ve Hastalıkları Dergisi. 1996;39:649–56.

7. Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test–European standards. Clin Transl Allergy. 2013;3(1):3. 10.1186/2045-7022-3-3

8. American College of Allergy, Asthma and Immunology. Food allergy: A practice parameter. Ann Allergy Asthma Immunol. 2006;96(3 Suppl 2):S1–68.

9. Vitaliti G, Cimino C, Coco A, Praticò AD, Lionetti E. The immunopathogenesis of cow’s milk protein allergy (CMPA). Ital J Pediatr. 2012;38:35–9. 10.1186/1824-7288-38-35

10. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113:832–6. 10.1016/j.jaci.2003.12.591

11. Kıslak Turan E. Prevalence of food allergy, risk factors and relationshıp to asthma in children from kindergartens in Edirne [Internet]. [cited 2012]. Avaliable at: http://dspace.trakya.edu.tr:8080/xmlui/bitstream/handle/trakya/2070/92.pdf?sequence=1&isAllowed=y. Accessed July 22, 2023.

12. Barlık F, Guner SN, Barlık M, Sogut A, Sancak R. Prevalence of food allergy in nursery and kindergarten children in Samsun. Turk Arch Ped. 2013;48(4):288–93. 10.4274/tpa.235

13. Zeyrek D, Koruk I, Kara B, Demir C, Cakmak A. Prevalence of IgE-mediated cow’s milk and egg allergy in children under 2 years of age in Sanliurfa, Turkey: The city that isn’t almost allergic to cow’s milk. Minerva Pediatr. 2014;67:465–72.

14. Karpa KD, Paul IM, Leckie JA, Shung S, Carkaci-Salli N, Vrana KE. A retrospective chart review to identify perinatal factors associated with food allergy. Nutr J. 2012;11:87. 10.1186/1475-2891-11-87

15. Papathoma E, Triga M, Fouzas S, Dimitriou G. Cesarean section delivery and development of food allergy and atopic dermatitis in early childhood. Pediatr Allergy Immunol. 2016;27:419–24. 10.1111/pai.12552

16. Koplin J, Allen K, Gurrin L, Osborne N, Tang ML, Dharmage S. Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: A systematic review. Pediatr Allergy Immunol. 2008;19:682–7. 10.1111/j.1399-3038.2008.00731.x

17. Laubereau B, Filipiak-Pittroff B, von Berg A, Grübl A, Reinhardt D, Wichmann HE. Caesarean section and gastrointestinal symptoms, atopic dermatitis, and sensitisation during the first year of life. Arch Dis Child. 2004;89:993–7. 10.1136/adc.2003.043265

18. Gu L, Zhang W, Yang W, Liu H. Systematic review and meta-analysis of whether cesarean section contributes to the incidence of allergic diseases in children: A protocol for systematic review and meta analysis. Medicine (Baltimore). 2019;98(52):e18394. 10.1097/MD.0000000000018394

19. Falth-Magnusson K, Kjelman N-IM. Development of atopic disease in babies whose mothers were on exclusion diet during pregnancy–A randomized study. J Allergy Clin Immunol. 1987;80:869–75. 10.1016/s0091-6749(87)80279-8

20. Matsui T, Tanaka K, Yamashita H, Saneyasu KI, Tanaka H, Takasato Y, et al. Food allergy is linked to season of birth, sun exposure, and vitamin D deficiency. Allergol Int. 2019;68(2):172–7. 10.1016/j.alit.2018

21. Kamphorst K, Vlieger AM, Oosterloo BC, Garssen J, van Elburg RM. Neonatal antibiotics and food allergy are associated with FGIDs at 4–6 years of age. J Pediatr Gastroenterol Nutr. 2022;74:770–5. 10.1097/MPG.0000000000003428

22. Love BL, Mann JR, Hardin JW, Lu ZK, Cox C, Amrol DJ. Antibiotic prescription and food allergy in young children. Allergy Asthma Clin Immunol. 2016;12:41. 10.1186/s13223-016-0148-7

23. Forastiere F, Agabiti N, Corbo GM, Dell’Orco V, Porta D, Pistelli R. Socioeconomic status, number of siblings, and respiratory infections in early life as determinants of atopy in children. Epidemiology. 1997;8:566–70. 10.1097/00001648-199709000-00015

24. Almqvist C, Pershagen G, Wickman M. Low socioeconomic status as a risk factor for asthma, rhinitis and sensitization at 4 years in a birth cohort. Clin Exp Allergy. 2005;35:612–8. 10.1111/j.1365-2222.2005.02243.x

25. Tepler E, Wong KH, Soffer GK. Health disparities in pediatric food allergy. Ann Allergy Asthma Immunol. 2022;129:417–23. 10.1016/j.anai.2022.04.022

26. Gustafsson D, Sjoberg O, Foucard T. Development of allergy and asthma in infants and young children with atopic dermatitis–A prospective follow-up to 7 years of age. Allergy. 2000;55:240–5. 10.1034/j.1398-9995.2000.00391.x

27. Järvinen KM, Martin H, Oyoshi MK. Immunomodulatory effects of breast milk on food allergy. Ann Allergy Asthma Immunol. 2019;123:133–43. 10.1016/j.anai.2019.04.022

28. Baker SS, Cochran WJ, Greer FR, Heyman MB. American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000;106:346–9.

29. Hadjimbei E, Botsaris G, Chrysostomou S. Beneficial effects of yoghurts and probiotic fermented milks and their functional food potential. Foods. 2022;11:2691. 10.3390/foods11172691

30. Qamer S, Deshmukh M, Patole S. Probiotics for cow’s milk protein allergy: A systematic review of randomized controlled trials. Eur J Pediatr. 2019;178:1139–49. 10.1007/s00431-019-03397-6

31. Zhang S, Sicherer S, Berin MC, Agyemang A. Pathophysiology of non-IgE-mediated food allergy. Immunotargets Ther. 2021;10:431–46. 10.2147/ITT.S284821

32. Illikoud N, Mantel M, Rolli-Derkinderen M, Gagnaire V, Jan G. Dairy starters and fermented dairy products modulate gut mucosal immunity. Immunol Lett. 2022;251–252:91–102. 10.1016/j.imlet.2022.11.002

33. Koplin JJ, Dharmage SC, Ponsonby AL, Tang ML, Lowe AJ, Gurrin LC. Environmental and demographic risk factors for egg allergy in a population-based study of infants. Allergy. 2012;67:1415–22. 10.1111/all.12015

34. Dogan M. Industrialization process in Istanbul from past to present and ıts development over the last decade. Marmara Coğrafya Dergisi (Marmara Geogr Rev). 2013;0(27):511–50.

35. Katelaris CH, Beggs PJ. Climate change: Allergens and allergic diseases. Intern Med J. 2018;48(2):129–34. 10.1111/imj.13699

36. Zhang X, Lu C, Li Y, Norbäck D, Murthy P, Sram RJ, et al. Early-life exposure to air pollution associated with food allergy in children: Implications for “one allergy” concept. Environ Res. 2023;216(Pt 3):114713. 10.1016/j.envres.2022.114713

37. Ozturk MZ, Cetinkaya G, Aydın S. Climate Types of Turkey According to Köppen-Geiger Climate Classification. Journal of Geography. 2017, 35: 17-27. 10.26650/JGEOG295515

38. Anto JM, Bousquet J, Akdis M, Auffray C, Keil T, Momas I, et al. Mechanisms of the development of allergy (MeDALL): Introducing novel concepts in allergy phenotypes. J Allergy Clin Immunol. 2017;139(2):388–99. 10.1016/j.jaci.2016.12.940