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Kim, Lee, Lee, Cho, Kim, Kwon, Yang, Kim, Lee, and Hong: The change in food allergy prevalence of elementary school children in Seoul since the last 20 years and the risk factor analysis
Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(4): 276-283.

Published online: 31 July 2016

DOI: https://doi.org/10.4168/aard.2016.4.4.276

The change in food allergy prevalence of elementary school children in Seoul since the last 20 years and the risk factor analysis

Yeong-Ho Kim1, So-Yeon Lee2, Eun Lee3, Hyun-Ju Cho1, Hyo-Bin Kim4, Ji-Won Kwon5, Song-I Yang2, Eun-Jin Kim6, Jeom-Kyu Lee6, Soo-Jong Hong1

1Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea.

3Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea.

4Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea.

5Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.

6Division of Allergy and Respiratory Diseases, National Institute of Health, Korea Center for Disease Control and Prevention, Cheongju, Korea.

Correspondence to: Soo-Jong Hong. Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3379, Fax: +82-2-473-3725, sjhong@amc.seoul.kr

Received 7 January 2016       Revised 20 April 2016       Accepted 27 April 2016

© 2016 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Purpose

There are many reports that the prevalence of food allergy (FA) is globally increasing. We investigated the change in FA prevalence since the last 20 years in elementary school children, in Seoul, Korea.

Methods

A modified International Study of Asthma and Allergies in Childhood questionnaire survey was done to elementary school children in Seoul, Korea in 1995, 2000, 2005, 2008, and 2012. The numbers of subjects included in the analysis were 7,963, 7,971, 7,131, 3,975, and 3,307, respectively. Blood and skin prick tests were done in 2008 and 2012.

Results

The prevalence rates of FA diagnosis ever were 4.6% (95% confidence interval [CI], 4.1–5.1), 5.2% (95% CI, 4.7–5.7), 6.4% (95% CI, 5.9–7.0), 5.5% (95% CI, 4.8–6.3), and 6.6% (95% CI, 5.8–7.6) in 1995, 2000, 2005, 2008, and 2012, respectively (P-value for trend <0.001). Asthma (adjusted odds ratio [aOR], 2.209; 95% CI, 1.589–3.072), allergic rhinitis (aOR, 1.874; 95% CI, 1.473–2.384), and atopic dermatitis (aOR, 4.288; 95% CI, 3.340–5.506) were associated with FA diagnosis. Parental allergic disease history (aOR, 2.191; 95% CI, 1.666–2.881), antibiotics use in infancy (aOR, 1.484; 95% CI, 1.170–1.883), and house mold exposure in infancy (aOR, 1.540; 95% CI, 1.172–2.024) were risk factors for FA diagnosis. Sensitization to inhalant allergens (aOR, 1.867; 95% CI, 1.091–3.194) and increased serum total IgE (aOR, 2.014; 95% CI, 1.081–3.752) were associated with FA diagnosis.

Conclusion

The prevalence of FA diagnosis is likely to be increasing since the last 20 years in Seoul. Antibiotics use in infancy and house mold exposure in infancy were risk factors for FA diagnosis.

Keywords: Food allergy, Prevalence, Child, Risk factor

Figures and Tables

Fig. 1

The change of food allergy prevalence by year. FA, food allergy.

aard-4-276-g001
Table 1

Characteristics of the subjects

aard-4-276-i001
Characteristic 1995 (n = 7,963) 2000 (n = 7,971) 2005 (n = 7,131) 2008 (n = 3,975) 2012 (n = 3,307)
Age (yr) 9.08 ± 1.77 9.16 ± 1.78 9.34 ± 1.73 8.94 ± 1.74 8.95 ± 1.78
Male sex 4,072 (51.1) 4,109 (51.6) 3,692 (51.8) 2,109 (53.1) 1,702 (51.5)
Body mass index (kg/m2) 17.47 ± 2.89 17.89 ± 2.92 18.05 ± 3.04 17.86 ± 3.05 18.00 ± 3.20
Education level of mother
 Below elementary school graduation NA 103/7,883 (1.3) 54/6,937 (0.8) 13/3,402 (0.4) 5/3,215 (0.2)
 Below high school graduation NA 3,963/7,883 (50.3) 2,709/6,937 (39.1) 1,408/3,402 (41.4) 1,132/3,215 (35.2)
 Over university graduation NA 3,817/7,883 (48.4) 4,174/6,937 (60.2) 1,981/3,402 (58.2) 2,078/3,215 (64.6)
Environmental tobacco smoke 3,349/7,914 (42.3) 5,145/7,845 (65.6) 2,969/5,922 (49.9) 1,475/3,823 (38.6) 1,071/3,228 (33.2)
Asthma diagnosis 680/7,843 (8.7) 741/7,109 (9.4) 537/7,041 (7.6) 313/3,753 (8.3) 268/3,279 (8.2)
Allergic rhinitis diagnosis 1,298/7,781 (16.7) 1,730/7,860 (22.0) 1,869/7,032 (26.6) 1,298/3,639 (35.7) 1,475/3,256 (45.3)
Atopic dermatitis diagnosis 1,546/7,841 (19.7) 2,160/7,851 (27.5) 2,091/7,039 (29.7) 1,226/3,823 (32.1) 1,098/3,277 (33.5)
Parental allergic disease NA 2,757/7,460 (37.0) NA 360/2,453 (14.7) 1,463/2,896 (50.5)
Inhalant allergen sensitization NA NA NA 473/3,975 (11.9) 464/3,307 (14.0)
Food allergen sensitization NA NA NA 11/3,975 (0.3) 7/3,307 (0.2)
Serum eosinophil (%) NA NA NA 3.60 ± 2.57 3.22 ± 2.35
Total IgE (IU/L) NA NA NA 148.85 ± 298.77 194.90 ± 328.00

Values are presented as mean±standard deviation or number (%).

NA, not available.

Table 2

Prevalence of food allergy by year with 95% confidence interval

aard-4-276-i002
Food allergy 1995 (n = 7,963) 2000 (n = 7,971) 2005 (n = 7,131) 2008 (n = 3,975) 2012 (n = 3,307) P-value for trend
FA symptom ever 13.1 (12.3–13.9) 9.5 (8.8–10.2) 12.0 (11.2–12.8) 11.2 (10.2–12.3) 14.4 (13.2–15.7) 0.143
FA 12 months symptom 7.7 (7.1–8.3) 5.9 (5.4–6.4) 7.6 (7.0–8.2) 7.4 (6.6–8.3) 5.7 (4.9–6.5) 0.115
FA diagnosis ever 4.6 (4.1–5.1) 5.2 (4.7–5.7) 6.4 (5.9–7.0) 5.5 (4.8–6.3) 6.6 (5.8–7.6) < 0.001
FA 12 months treatment 2.9 (2.5–3.3) 2.7 (2.3–3.0) 2.8 (2.4–3.2) 2.4 (2.0–3.0) NA 0.297

Values are presented as percent (95% confidence interval).

FA, food allergy; NA, not available.

Table 3

Prevalence of FA diagnosis ever by age

aard-4-276-i003
Age (yr) 1995 (n = 7,963) 2000 (n = 7,971) 2005 (n = 7,131) 2008 (n = 3,975) 2012 (n = 3,307) P-value for trend
6 3.4 (2.1–5.2) 3.8 (2.2–6.0) 6.6 (3.8–10.7) 6.7 (4.3–9.9) 8.2 (5.4–11.7) < 0.001
7 5.6 (4.4–7.1) 3.8 (2.8–5.0) 7.0 (5.5–8.7) 7.1 (5.3–9.4) 7.4 (5.2–10.0) 0.008
8 4.8 (3.7–6.1) 5.2 (4.1–6.5) 6.4 (5.1–8.0) 4.6 (3.1–6.6) 6.6 (4.6–9.1) 0.153
9 4.5 (3.4–5.7) 6.4 (5.1–7.9) 6.9 (5.5–8.4) 5.8 (4.2–7.9) 5.9 (4.1–8.3) 0.086
10 4.2 (3.1–5.4) 5.7 (4.7–7.1) 5.9 (4.6–7.4) 4.7 (3.2–6.5) 7.4 (5.3–9.9) 0.027
11 4.0 (3.0–5.2) 4.7 (3.6–6.1) 6.4 (5.1–7.9) 4.8 (3.3–6.8) 4.9 (3.3–7.0) 0.116
12 5.7 (4.1–7.6) 5.9 (4.5–7.6) 5.7 (4.3–7.4) 5.7 (2.6–8.6) 7.2 (4.1–11.6) 0.762

Values are presented as percent (95% confidence interval).

FA, food allergy.

Table 4

The risk factors for food allergy

aard-4-276-i004
Variable aOR* (95% CI)
FA diagnosis ever FA symptom within 12 months
Age 0.949 (0.884–1.019) 0.933 (0.870–1.001)
Sex 0.833 (0.656–1.058) 0.909 (0.719–1.151)
Body mass index 0.989 (0.949–1.032) 1.002 (0.962–1.044)
Education level of mother 1.218 (0.950–1.561) 1.490 (1.155–1.921)
Prematurity 1.196 (0.746–1.918) 0.767 (0.442–1.331)
Environmental tobacco smoke 1.121 (0.879–1.431) 1.143 (0.899–1.454)
Asthma diagnosis ever 2.209 (1.589–3.072) 1.590 (1.111–2.276)
AR diagnosis ever 1.874 (1.473–2.384) 1.615 (1.274–2.048)
AD diagnosis ever 4.288 (3.340–5.506) 2.708 (2.139–3.428)
Parental allergic disease 2.191 (1.666–2.881) 1.527 (1.165–2.002)
Parental asthma history 1.735 (1.324–2.273) 1.155 (0.874–1.527)
Parental AR history 1.713 (1.313–2.236) 1.403 (1.075–1.833)
Parental AD history 1.715 (1.124–2.618) 1.286 (0.813–2.035)
Cesarean section 0.992 (0.758–1.298) 0.703 (0.528-0.937)
Breast milk feeding 1.219 (0.951–1.563) 1.010 (0.794–1.285)
Antibiotics use in infancy 1.484 (1.170–1.883) 1.290 (1.020–1.632)
Moving to new house 0.975 (0.762–1.247) 1.470 (1.162–1.860)
House fungus in infancy 1.540 (1.172–2.024) 1.539 (1.175–2.015)
Pet within 12 months 0.860 (0.582–1.270) 1.133 (0.795–1.616)

2008 and 2012 data were merged.

aOR, adjusted odds ratio; CI, confidence interval; FA, food allergy; AR, allergic rhinitis; AD, atopic dermatitis.

*Adjusted for age, sex, body mass index, education level of mother, prematurity, and environmental tobacco smoke.

Table 5

Adjusted odds ratio of specific allergen sensitization for food allergy

aard-4-276-i005
Variable aOR* (95% CI)
FA diagnosis ever FA symptom within 12 months
Inhalant allergen
 Dp 1.221 (0.884–1.766) 1.211 (0.841–1.743)
 Df 1.355 (0.948–1.937) 1.413 (1.000–1.997)
 Cat 1.805 (0.813–4.005) 1.278 (0.507–3.222)
 Dog 1.931 (0.575–6.485) 2.807 (0.952–8.278)
 Cockroach 3.901 (1.068–14.248) 1.505 (0.191–11.841)
 Alternaria 0.725 (0.174–3.016) 0.690 (0.166–2.872)
 Aspergillus 5.326 (0.547–51.889) 18.866 (2.563–138.846)
 Birch 0.957 (0.293–3.123) 0.352 (0.048–2.574)
 Oak 1.294 (0.163–10.261) 2.591 (0.542–12.387)
 Alder 4.672 (0.946–23.088) 6.882 (1.638–28.903)
 Grasses 2.718 (0.603–12.257) 3.248 (0.702–15.029)
 Ragweed NA 3.681 (0.771–17.580)
 Mugwort 1.383 (0.323–5.919) 2.189 (0.646–7.418)
 Japanese hop 0.811 (0.193–3.411) 0.465 (0.063–3.427)
Food allergen
Egg white NA 2.683 (0.311–23.164)
Milk 7.369 (0.661–82.151) 6.655 (0.597–74.205)
Soy 15.370 (0.954–247.596) 13.689 (0.844–221.968)
Peanut 17.324 (1.071–280.161) NA
Inhalant allergen sensitization 1.867 (1.091–3.194) 1.300 (0.943–1.792)
Food allergen sensitization 3.090 (0.662–14.424) 3.033 (0.650–14.153)
log total IgE (IU/L) 2.014 (1.081–3.752) 1.652 (1.144–2.386)

2008 and 2012 data were merged.

aOR, adjusted odds ratio; CI, confidence interval; FA, food allergy; Dp, Dermatophagoides pteronyssinus; Df, Dermatophagoides farina; NA, not available.

*Adjusted for age, sex, body mass index, education level of mother, prematurity, and environmental tobacco smoke.

Notes

This study was supported by a grant (2014-ER5602-00) from the Research of Korea Centers for Disease Control and Prevention.

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ORCID iDs

Soo-Jong Hong
https://orcid.org/http://orcid.org/0000-0003-1409-2113

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