Abstract
BACKGROUND: Although fatal food-induced anaphylaxis is rare, adolescence is the period of highest risk. However, we lack strong estimates of the incidence of food allergic reactions among adolescents. OBJECTIVE: To estimate the incidence of food allergic and anaphylactic reactions among adolescents with food allergy who have a prescription for epinephrine. METHODS: As part of a cohort study that was embedded in a randomized trial to promote safe food allergy management, we followed adolescents aged 15 to 19 years with food allergy and a current prescription for epinephrine for a period of 15 months in 2019 to 2020. At monthly intervals, participants were asked, through text message check-ins, whether they had experienced a food allergic reaction due to accidental exposure to food allergens in the past month. RESULTS: Among the cohort of 131 adolescents, 112 answered at least 1 of the 15 monthly check-ins. Together, these respondents contributed 742 person-months of follow-up data of a total possible 1680 person-months. In the 15-month study period, the incidence of food allergic reactions among adolescents with food allergy was 34.0 events per 100 person-years (95% CI: 21.0-51.9). The incidence of food allergic reactions meeting the criteria for anaphylaxis was 16.2 events per 100 person-years (95% CI: 7.8-29.7). CONCLUSION: Data on the incidence of food allergic reactions can help set expectations for safe food allergy management for adolescents and their families, and can help inform discussions between patients, families, and physicians regarding different treatment options available and their associated risks and benefits. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03284372.