Abstract
OBJECTIVE:
To determine the incidence and temporal trends of food allergies.
PATIENTS AND METHODS:
We performed a historical cohort study to describe the epidemiology of food allergies among residents of all ages in Olmsted County, Minnesota, during a 10-year period from January 2, 2002, through December 31, 2011, using the Rochester Epidemiology Project. Overall incidence and trends in biannual incidence rates over time were evaluated.
RESULTS:
During the 10-year study period, 578 new cases of food allergies were diagnosed. The average annual incidence rate was significantly higher among males compared to females (4.1 [95% CI 3.6, 4.5] versus 3.0 [95% CI 2.7, 3.4] per 10,000 person-years; 3.6 overall). The pediatric incidence rate of food allergy increased from 7.0 (95% CI 6.2, 8.9) to 13.3 (95% CI 10.9, 15.7) per 10,000 between the 2002-2003 and 2006-2007 calendar periods and then stabilized at 12.5 and 12.1 in the last two calendar periods. Milk, peanut and seafood were the most common allergen in infancy, in children between ages 1-<5 years, and in the adult population, respectively.
CONCLUSION:
This is one of the first population-based studies to examine the temporal trends of food allergies. The incidence of food allergies increased markedly between 2002 and 2009, with stabilization afterwards. Additional longitudinal studies are warranted to assess for epidemiologic evidence of changes in food allergy incidence with changing recommendations for allergenic food introduction.
Keywords: Food allergy, Epidemiology
Introduction:
Food allergy is a growing public health concern, which has received increased attention in recent years 1. Food allergy is a significant social stressor for families and causes a significant impairment in quality of life for families of children with food allergies2. There is also a significant economic burden on affected families with increased health care cost, averaging to nearly $4,184 per year per child with food allergy, with expenses incurred during doctor’s visits, emergency medical treatment, hospitalizations, and loss of productivity3.
Estimates of food allergy indicate that more than 2%, but less than 10% of the population have a food allergy4, and rates tend to be higher in children (3-4% vs 1-2% adults) and are presumed to be increasing over the last few decades. A large telephone based survey found increasing rates of peanut or tree nut allergy in children from 0.6% in 1997, to 1.2% in 2002, and finally 2.1% in 20075. However, self-reporting or parental reporting of food allergy likely overestimates the prevalence of disease. Other studies have focused on one or a few food allergies, and longitudinal studies are also lacking. Despite these attempts to better understand and define food allergy epidemiology, the difficulties in performing quality studies have led some to question whether food allergy prevalence is truly increasing.
Additionally, the underlying cause of this potential increase in food allergy prevalence remains unclear. There are numerous hypotheses to explain this trend and include an increase in associated atopic conditions (such as atopic dermatitis which is thought to be a risk factor for developing food allergy)6, and previous recommendations to delay introduction of allergenic foods.
In 2000, the American Academy of Pediatrics (AAP) committee on nutrition published guidelines recommending delay in introduction of allergenic foods including milk (until 12 months), egg ( until 24 months), peanut, and shellfish7. In the years following these recommendations, food allergy experts became concerned about rising trends in food allergy among young children. In 2008, the AAP updated the recommendation citing inadequate evidence to support delayed introduction of allergenic foods8. By 2013, the concept of primary prevention and using early introduction to help prevent food allergy came to the forefront9, and with publication of the Learning Early about Peanut Allergy10 (LEAP study) two years later, the protective effects of early introduction of certain allergenic foods were further appreciated. Since publication of the LEAP and LEAP-On trials11, addendum guidelines for the early introduction of peanut have been published which reverse the previous recommendation to delay introduction of allergenic foods12. Whether or not these changing recommendations have contributed to changes in food allergy incidence are yet unknown.
Using the unique record linkage system of the Rochester Epidemiology Project,13 we examined temporal trends in the incidence of all types of food allergy in Olmsted County, Minnesota residents over a 10 year time period from January 2, 2002 - December 31, 2011.
Materials and Methods
We performed a retrospective chart review of food allergies in Olmsted County utilizing the data resources of the Rochester Epidemiology Project (REP). REP provides the infrastructure for medical research of the approximately 148,000 citizens of Olmsted County as the result of unique record linkage system in Rochester, Minnesota14. Census information indicates that the age, sex, and ethnic characteristics of people living in Olmsted County are comparable to the rest of the state of Minnesota, and to the Midwestern United States, but overall, the population is less ethnically diverse than the rest of the United States15.
All Olmsted County residents with an incident diagnosis of a food allergy by a REP-affiliated provider during January 2, 2002 – December 31, 2011, and who had not denied access to their medical records for research purposes, were identified using REP resources. The following diagnosis codes were used to identify the patients (Supplemental Table). The medical records of all 2,734 patients with a potential food allergy were reviewed by the first author (EW) to confirm accurate diagnosis of food allergy. Patients were included in the study only if they met the following criteria: 1) clinical history consistent with food allergy and 2) confirmatory IgE specific blood testing (>0.35 kU/l) or positive skin prick testing (>3 mm), or positive open food challenge. Demographic data, specific food allergen, type of reaction, and other comorbid atopic conditions were recorded. When available, data on type of birth (vaginal vs Cesarean section), and comorbid atopic conditions was also collected.
The data was analyzed using the SAS version 9.4 software package (SAS Institute, Inc.; Cary, NC). Age- and sex-specific incidence rates in Olmsted County during 2002-2011 were calculated; the numerator was the number of persons with a food allergy and the denominator was obtained from the REP census13. Rates were age- and sex-adjusted to the total population structure of the U.S. in 2010. The 95% confidence intervals (CIs) for the rates were calculated assuming a Poisson error distribution. Incidence rates were compared between males and females or between biannual calendar periods by fitting generalized linear regression models assuming a Poisson error structure. The observations used for the regression analysis were the crude incidence counts for the subgroups which were offset by the natural logarithm of the number of person years.
Results
A total of 578 incident cases of food allergy were identified with 242 (41.9%) females and 336 (58.1%) males. Patient characteristics are summarized in Table 1; nearly three-fourths of the cases were white. The median age at the time of the diagnosis was 2.1 years (IQR, 1.2, 9.2). Other conditions present at the time of the abstraction were recorded; 56% of the patients had coexistent atopic dermatitis, 38% asthma, and 5% each with penicillin or other drug allergy. The incidence rates are summarized in Table 2. Overall, the average annual age- and sex-adjusted incidence was 3.6 [95% CI 3.3, 3.9] per 10,000 person-years and the age-adjusted incidence was significantly higher among males compared to females (4.1 (95% CI 3.6-4.5) versus 3.0 (2.7, 3.4) per 10,000 person-years, P<.001). Among females, the incidence was highest among children under the age of 5 years, with an incidence of 26.9 (95% CI 18.3, 38.1) per 10,000 person-years among females under 1 year of age and 25.8 (95% CI 21.3, 31.1) per 10,000 person-years among females between 1 and <5 years of age. Among males, the incidence rate was highest at 44.6(95% CI 38.7, 51.1) per 10,000 among children between the ages of 1 and <5 followed by an incidence rate of 31.3(95% CI 22.1, 42.9) per 10,000 among children under the age of 1 year .The incidence rate in the 1 to <5 year age group was significantly higher among males compared to females (P<.001), however none of the other age-specific incidence rates were significantly different between males and females.
Table 1:
Characteristics of Food Allergy Incident Cases, by Gender
| Characteristic | Females (N=242) |
Males (N=336) |
Total (N=578) |
|---|---|---|---|
| Race, N (%) | |||
| White | 184 (76.0%) | 246 (73.2%) | 430 (74.4%) |
| Black | 13 (5.4%) | 15 (4.5%) | 28 (4.8%) |
| Asian | 23 (9.5%) | 31 (9.2%) | 54 (9.3%) |
| Hawaiian/Pacific Islander | 1 (0.4%) | 1 (0.3%) | 2 (0.3%) |
| American Indian | 0 (0.0%) | 1 (0.3%) | 1 (0.2%) |
| Other/Mixed | 17 (7.0%) | 32 (9.5%) | 49 (8.5%) |
| Not disclosed | 4 (1.7%) | 10 (3.0%) | 14 (2.4%) |
| Hispanic ethnicity, N (%) | |||
| No | 226 (93.4%) | 315 (93.7%) | 541 (93.6%) |
| Yes | 12 (5.0%) | 11 (3.3%) | 23 (4.0%) |
| Not disclosed | 4 (1.6%) | 10 3.0%) | 14 (2.4%) |
| Age at diagnosis (years) | |||
| Median (IQR) | 2.9 (1.2, 17.0) | 2.0 (1.1, 5.6) | 2.1 (1.2, 9.2) |
| Range | 0.4-89.6 | 0.3-76.0 | 0.3-89.6 |
| Family history, N (%) | |||
| Sibling with Food Allergy | |||
| None | 189 (78.1%) | 284 (84.5%) | 473 (81.8%) |
| Yes | 13 (5.4%) | 24 (7.1%) | 37 (6.4%) |
| Unknown | 40 (16.5%) | 28 (8.3%) | 68 (11.8%) |
| Parent with Food Allergy | |||
| No | 183 (75.6%) | 274 (81.5%) | 457 (79.1%) |
| Yes | 20 (8.3%) | 34 (10.1%) | 54 (9.3%) |
| Unknown | 39 (16.1%) | 28 (8.3%) | 67 (11.6%) |
| Other conditions (ever), N (%) | |||
| Asthma | 82 (33.9%) | 136 (40.5%) | 218 (37.7%) |
| Atopic Dermatitis | 119 (49.2%) | 205 (61.0%) | 324 (56.1%) |
| Penicillin Amoxicillin Allergy | 15 (6.2%) | 15 (4.5%) | 30 (5.2%) |
| Other drug allergy | 16 (6.6%) | 12 (3.6%) | 28 (4.8%) |
Table 2:
Incidence of a Food Allergy per 10,000 Person-Years by Age and Sex in Olmsted County, Minnesota, 2002-2011
| Age Group, years |
Female |
Male |
Total |
|||
|---|---|---|---|---|---|---|
| No. | Rate (95% CI) | No. | Rate (95% CI) | No. | Rate (95% CI) | |
| <1 | 31 | 26.9 (18.3, 38.1) | 38 | 31.3 (22.1, 42.9) | 69 | 29.1 (22.7, 36.9) |
| 1-4 | 113 | 25.8 (21.3, 31.1) | 206 | 44.6 (38.7, 51.1) | 319 | 35.5 (31.7, 39.6) |
| 5-9 | 21 | 4.3 (2.7, 6.6) | 32 | 6.3 (4.3, 8.9) | 53 | 5.3 (4.0, 7.0) |
| 10-18 | 20 | 2.1 (1.4, 3.6) | 20 | 2.2 (1.4, 3.4) | 40 | 2.3 (1.6, 3.1) |
| 19-90 | 57 | 1.1 (0.8, 1.3) | 40 | 0.8 (0.6, 1.1) | 97 | 0.9 (0.8, 1.1) |
| Overall, age-and sex-adjusted † | ||||||
| 0-18 | 185 | 8.9 (7.6,10.2) | 296 | 13.5 (11.9,15.0) | 481 | 11.3 (10.2,12.3) |
| 0-90 | 242 | 3.0 (2.7, 3.4) | 336 | 4.1 (3.6, 4.5) | 578 | 3.6 (3.3, 3.9) |
Abbreviations: CI, confidence interval
† Adjusted to the population structure of the U.S. total population in 2010.
Table 3 summarizes the type of food allergies. Overall, the most common food allergy was a peanut allergy (46.4%), followed by a tree nut allergy (33.7%) and an egg allergy (24.0%). A third of the patients were allergic to more than one food category. Among patients first diagnosed prior to 1 year of age, the three most common food allergies were milk (50.7%), egg (44.9%), and peanut (37.7%), while among patients first diagnosed in the 1 to <5 year age group, the most common allergy was peanut (61.1%). Among children first diagnosed between 5 and <18 years of age, the most common allergy was tree nut (59.1%) followed by peanut (39.8%). The most common allergy among patients first diagnosed in adulthood was seafood (48.5%).
Table 3:
Type of Food Allergies, Stratified by Age at Diagnosis
| Age at diagnosis(years) |
||||||
|---|---|---|---|---|---|---|
| Characteristic | <1 (N=69) |
1-4 (N=319) |
5-9 (n=53) |
10-18 (N=40) |
19-90 (N=97) |
Total (N=578) |
| Food category | ||||||
| Milk | 35 (50.7%) | 45 (14.1%) | 1 (1.9%) | 0 (0.0%) | 1 (1.0%) | 82 (14.2%) |
| Egg | 31 (44.9%) | 98 (30.7%) | 6 (11.3%) | 1 (2.5%) | 3 (3.1%) | 139 (24.0%) |
| Soy | 4 (5.8%) | 6 (1.9%) | 1 (1.9%) | 2 (5.0%) | 4 (4.1%) | 17 (2.9%) |
| Peanut | 26 (37.7%) | 195 (61.1%) | 25 (47.2%) | 12 (30.0%) | 10 (10.3%) | 268 (46.4%) |
| Tree Nut | 14 (20.3%) | 93 (29.2%) | 30 (56.6%) | 25 (62.5%) | 33 (34.0%) | 195 (33.7%) |
| Seafood | 3 (4.3%) | 18 (5.6%) | 9 (17.0%) | 8 (20.0%) | 47 (48.5%) | 85 (14.7%) |
| Other | 6 (8.7%) | 23 (7.2%) | 8 (15.1%) | 4 (10.0%) | 19 (19.6%) | 60 (10.4%) |
| Number of categories | ||||||
| Only one food | 35 (50.7%) | 210 (65.8%) | 34 (64.2%) | 31 (77.5%) | 80 (82.5%) | 390 (67.5%) |
| >1 food | 34 (49.3%) | 109 (34.2%) | 19 (35.8%) | 9 (22.5%) | 17 (17.5%) | 188 (32.5%) |
Among the 388 patients first diagnosed under the age of five, the mode of delivery was available for 363 patients. The types of food allergies were similar between those delivered by cesarean section versus vaginally (Table 4).
Table 4:
Food Allergies by Mode of Delivery, Among Patients First Diagnosed With a Food Allergy Under 5 Years of Age.
| Mode of Delivery |
|||
|---|---|---|---|
| Cesarean Section (N=111) |
Vaginal (N=253) |
Not Documented (N=24) |
|
| Food category | |||
| Milk | 22 (19.8%) | 49 (19.4%) | 9 (37.5%) |
| Egg | 44 (39.6%) | 80 (31.6%) | 5 (20.8%) |
| Soy | 3 (2.7%) | 5 (2.0%) | 2 (8.3%) |
| Peanut | 60 (54.1%) | 146 (57.7%) | 15 (62.5%) |
| Tree Nut | 27 (24.3%) | 73 (28.9%) | 7 (29.2%) |
| Seafood | 4 (3.6%) | 15 (5.9%) | 2 (8.3%) |
| Other | 8 (7.2%) | 19 (7.5%) | 2 (8.3%) |
| Number of categories | |||
| Only 1 category | 72 (64.9%) | 158 (62.5%) | 15 (62.5%) |
| >1 category | 39 (35.1%) | 95 (37.5%) | 9 (37.5%) |
Temporal Trends in the Incidence of Any Food Allergy and Peanut Allergy
Figure 1 shows the age- and sex-adjusted biannual incidence of any food allergy and specifically peanut allergy for all ages combined. Figure 2 shows the annual incidence rate in children 0-4 yrs age in A panel and 0-18 yrs age in the B panel. Although there has been a statistically significant increase in the incidence during the first three calendar periods (P<.001), the overall incidence in the most recent calendar period remains low at 4.1 (95% CI 3.4, 4.8) per 100,000 person-years for any food allergy. The incidence of any food allergy has stabilized after 2007 and the incidence of peanut allergy has attenuated after 2007. The age- and sex-adjusted biannual incidence rates among pediatrics are depicted in Figure 3. Similar to the trend observed for all ages, the incidence of any food allergy, as well as peanut allergy, has increased among pediatrics during first three calendar periods (P<.05). Among children first diagnosed prior to 1 year of age, the differences in the incidence rates across the time periods were not significantly different for either any food allergy or peanut allergy. However, among children in the 1 to <5 age group, the incidence in the last two calendar periods appears to be on the decline compared to the peak in 2006-2007.
Figure 1:
Age- and Sex-adjusted Biannual Incidence of (A) Any Food Allergy and (B) Peanut Allergy Per 10,000 Person-Years For All Ages (0–90 years) in Olmsted County, Minnesota, 2002–2011.
Figure 2:
Overall Annual Incidence rate of food allergies in 0–4 age group (A) and 0–18 age group (B)
Figure 3.
Age- and Sex-adjusted Biannual Incidence of (A) Any Food Allergy and (B) Peanut Allergy per 10,000 Person-Years by Age Group For Ages 0–19 years in Olmsted County, Minnesota, 2002–2011
Discussion
This is the first comprehensive population-based study on food allergies in United States. Such data provide a more accurate estimate of the temporal trends in the incidence of food allergy at a population level (outpatients and inpatients combined) as compared to hospital based case series or patient self-reported surveys , which are distorted by referral bias and ascertainment bias16.Consistent with one previous study of this population17, this retrospective review found an increase in incident cases of all food allergies in Olmsted County, Minnesota, over a 10 year time period from 2002-2011. Males had higher incidence of food allergy and co-existent other atopic diseases were common. In particular, 56% of patients with food allergy also had atopic dermatitis, consistent with findings of previous studies. The types of food allergies were similar between those delivered by cesarean section versus vaginally. Five percent of the cohort had associated medication allergy. This is an area which is often overlooked and under-addressed by providers and may need further attention to address the potential role of antibiotic allergies in this population 18,19 and vice versa.
Our population-based study is unique because it was not based on registry data, which may under or over-estimate the true incidence of food allergies based on reporting bias. In addition, the availability of 10 years of data has made it possible for us to examine changes in the incidence of food allergies over time with changing recommendations from AAP.
Interestingly, despite changes in AAP recommendations regarding the uncertainty surrounding the introduction of allergenic foods in 2008, food allergy incidence remained high in the subsequent years. This maybe speculated to the delay in overall implementation of new recommendations by primary care practices, difficulties in changing establish practices, especially when concrete evidence was lacking. Our study is strengthened by the unique record linkage system20,which allowed for accurate ascertainment of cases. This helped minimize ascertainment and misclassification bias.
Our study has several limitations. Our study only included cases that were clinically diagnosed as food allergy as we were reliant on diagnosed cases. The number of undiagnosed cases is not known because no population-based screen is available.
With the severe, usually life threatening clinical manifestations of food allergies, it is unlikely that these cases would not have come to medical attention; hence the possibility of missing cases was relatively low.
In addition, the generalizability of the study findings is limited largely to white people because the Olmsted County population is mainly white (∼90%-95% during the study period). However, studies comparing various chronic diseases in Olmsted County with those in other communities in the United States indicate that data from this population can be extrapolated to a large part of the population of the country.14
Finally, the use of a retrospective study design is subject to several biases, including reviewer bias. A reliability study was conducted in a smaller sample (25 patients) of the study patients by an independent physician (AYJ). There was complete agreement between the two investigators.
The incidence and prevalence of food allergy will remain a topic of interest as recommendations for the introduction of allergenic foods evolves. While current recommendations for early introduction include only peanut, this may change in the future as we learn more about the etiology of milk and egg sensitization. We hope that, with this population based study, our understanding of food allergies will improve, which in turn will help guide avenues for primary and secondary prevention of food allergies.
Conclusion:
With the first-ever population-based study on the incidence of food allergies, we have found that the incidence of food allergies peaked in 2006-2008 and has stabilized since 2009.
We also found that there is a higher incidence in males and milk is the most common allergen in infancy, while peanuts is more common in children between ages 1-5 yrs. Seafood allergy is the most common allergy in the adult population.
Such epidemiological data are crucial if we are to raise the awareness of the medical community about food allergies. With changing guidelines about introduction of allergenic food, we need epidemiological data to support the cost effectiveness and the public health benefits of early introduction to prevent the occurrence and persistence of food allergies.
Supplementary Material
Acknowledgement:
“This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.”
Footnotes
Future direction: We plan to undertake future studies to assess for changes in incidence after 2011, which may help better understand if the changing dietary recommendations have impacted incidence rates.
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Financial support and Conflict of Interest
The authors declare no financial support or conflict of interest related to this work
References
- 1.Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J Am Acad Dermatol 2011;64:175–92. [DOI] [PubMed] [Google Scholar]
- 2.Greenhawt M Food allergy quality of life. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2014;113:506–12. [DOI] [PubMed] [Google Scholar]
- 3.Gupta R, Holdford D, Bilaver L, Dyer A, Holl JL, Meltzer D. The economic impact of childhood food allergy in the United States. JAMA pediatrics 2013;167:1026–31. [DOI] [PubMed] [Google Scholar]
- 4.Sicherer SH, Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. The Journal of allergy and clinical immunology 2014;133:291–307; quiz 8. [DOI] [PubMed] [Google Scholar]
- 5.Sicherer SH, Munoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. The Journal of allergy and clinical immunology 2010;125:1322–6. [DOI] [PubMed] [Google Scholar]
- 6.Tsakok T, Marrs T, Mohsin M, et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol 2016;137:1071–8. [DOI] [PubMed] [Google Scholar]
- 7.American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000;106:346–9. [PubMed] [Google Scholar]
- 8.Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008;121:183–91. [DOI] [PubMed] [Google Scholar]
- 9.Fleischer DM, Spergel JM, Assa’ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. The journal of allergy and clinical immunology In practice 2013;1:29–36. [DOI] [PubMed] [Google Scholar]
- 10.Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. N Engl J Med 2016;375:398. [DOI] [PubMed] [Google Scholar]
- 11.Du Toit G, Sayre PH, Roberts G, et al. Effect of Avoidance on Peanut Allergy after Early Peanut Consumption. N Engl J Med 2016;374:1435–43. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Togias A, Cooper SF, Acebal ML, et al. Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-Sponsored Expert Panel. Pediatric dermatology 2017;34:e1–e21. [DOI] [PubMed] [Google Scholar]
- 13.St Sauver JL, Grossardt BR, Yawn BP, Melton LJ 3rd, Rocca WA. Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester epidemiology project. Am J Epidemiol 2011;173:1059–68. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Rocca WA, Yawn BP, St Sauver JL, Grossardt BR, Melton LJ 3rd. History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population. Mayo Clinic proceedings 2012;87:1202–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.St Sauver JL, Grossardt BR, Leibson CL, Yawn BP, Melton LJ 3rd, Rocca WA. Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project. Mayo Clinic proceedings 2012;87:151–60. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Muggah E, Graves E, Bennett C, Manuel DG. Ascertainment of chronic diseases using population health data: a comparison of health administrative data and patient self-report. BMC Public Health 2013;13:16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Rinaldi M, Harnack L, Oberg C, Schreiner P, St Sauver J, Travis LL. Peanut allergy diagnoses among children residing in Olmsted County, Minnesota. The Journal of allergy and clinical immunology 2012;130:945–50. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.May SM, Hartz MF, Joshi AY, Park MA. Intrapartum antibiotic exposure for group B Streptococcus treatment did not increase penicillin allergy in children. Ann Allergy Asthma Immunol 2016;116:134–8. [DOI] [PubMed] [Google Scholar]
- 19.Hirsch AG, Pollak J, Glass TA, et al. Early-life antibiotic use and subsequent diagnosis of food allergy and allergic diseases. Clin Exp Allergy 2017;47:236–44. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Melton LJ 3rd. History of the Rochester Epidemiology Project. Mayo Clin Proc 1996;71:266–74. [DOI] [PubMed] [Google Scholar]
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