Considerable concern has been voiced in recent years about the role of food allergies. Risk factors for potentially fatal childhood asthma are incompletely understood. A study by Vogel and coworkers sought to determine whether self-reported food allergy is significantly associated with potentially fatal childhood asthma. Medical records from 72 patients admitted to a pediatric intensive care unit (PICU) for asthmatic exacerbation were reviewed and compared in a case-control design with two randomly selected groups of 108 patients admitted to a regular nursing floor for asthma and 108 ambulatory patients with asthma. Factors evaluated included self-reported food allergy, gender, age, poverty area residence, race/ethnicity, inhaled steroid exposure, tobacco exposure, length of hospital stay, psychological comorbidity, and season of admission. At least one food allergy was documented for 13% (38/288) of the patients. Egg, peanut, fish/shellfish, milk, and tree nut accounted for 78.6% of all food allergies. Children admitted to the PICU were significantly more likely to report food allergy, and 3.3 times more likely to report at least one food allergy compared with children admitted to a regular nursing floor, and significantly more likely to report food allergy and 7.4 times more likely to report at least one food allergy compared with children seen in the ambulatory setting. Children admitted to either the PICU or the regular nursing floor were significantly more likely be African-American and to be younger compared with children seen in the ambulatory setting.

WHAT THIS STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that self-reported food allergy is an independent risk factor for potentially fatal childhood asthma. Asthmatic children or adolescents with food allergy are a target population for more aggressive asthma management.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The only way to sharply reduce food allergies is to teach patients with the symptoms to self-manage their food intake. After all, the patients are ones to ingest the food, not medical personnel. For this reason, patients, particularly children with food allergies, should be enrolled into self-management programs in order to learn and perform self-management skills.

NM Vogel et al. Food allergy is associated with potentially fatal childhood asthma. Journal of Asthma, 2008;45:862-866.