PREVALENCE OF PEANUT AND TREE NUT ALLERGY IN THE US IS DETERMINED BY A RANDOM DIGIT DIAL TELEPHONE SURVEY

Purpose of the Study. To determine the prevalence of peanut and tree nut allergy among the general population in the United States. Study Population. A total of 7036 US households were contacted by telephone. Respondents were eligible if they were over 17 years of age, were living in the household, understood questions in English, and could provide informed consent. Methods. This was a nationwide, cross-sectional random digit dial telephone survey of households in the United States. The questionnaire used included primarily "yes/no" responses to questions developed by the investigators and administered by using a computer-assisted system. Demographic information was obtained from all households. Adults with tree nut or peanut allergy identified by a surrogate were included in the prevalence estimate but details of the reactions were only included when the affected adult was personally interviewed. For individuals reporting reactions, further questions were administered to obtain detailed information. Reactions were considered "convincing" if the organ system affected and symptoms were typical of allergic reactions and occurred within 1 hour of ingestion. Results. A total of 12 032 individuals participated from 4374 households (67% participation rate). Peanut and tree nut allergy was reported in 164 individuals (1.4%) in 151 households. The prevalence of reported allergy in adults (1.6%) was higher than the prevalence reported in children (.6%). The overall "corrected" prevalence was estimated at 1.1% for the entire population surveyed. A total of 118 individuals fulfilled criteria established for a "convincing" allergic reaction and provided detailed history of those accounts. The allergic reactions involved 1 organ system (skin, respiratory, and gastrointestinal) in 50 individuals, 2 in 45 individuals, and all 3 in 23 individuals. Only 53% of those subjects had ever seen a doctor for the allergic reaction while 45% of those reported more than 5 lifetime reactions. Only 7% had self-injectable epinephrine available at the time of the interview. Conclusions. Peanut and/or tree nut allergy affects approximately 1.1% or about 3 million Americans. Only half of those interviewed had established medical care for their allergy and few had epinephrine readily available for emergency use. Reviewer's Comments. This is a very enlightening study that emphasizes several important points. First, peanut and tree nut allergy affect a large portion of the US population and represent a major health care concern. Second, most affected individuals do not seek health care for their allergy. Third, the vast majority do not have appropriate life-sustaining devices (ie, injectable epinephrine) readily available. The authors very aptly emphasize the importance of appropriate diagnosis and management of these typically lifelong, life-threatening food allergies. This study further serves to challenge all of us as health care providers to better educate and manage our food-allergic patients.
Sicherer SH, Munoz-Furlong A, Burks AW, Sampson HA. J Allergy Clin Immunol. 1999;103:559-562 STACIE M. JONES, MD Little Rock, [...]