Prevalence and Characteristics of Accidental Ingestions in a Prospective Cohort

Despite a known diagnosis of food allergy, accidental ingestions occur at high rates. We sought to characterize accidental ingestions, including prevalence, risk factors, food allergen triggers, and severity of reactions. A prospective monthly survey developed by the Food Allergy Consortium (FARC) was administered to parents of food allergic children between April 2015 and April 2017. The monthly survey included questions on any allergic reactions experienced in the previous month. Additionally, chart review of 100 pediatric participants from Lurie Children’s Hospital of Chicago allergy clinics (typical clinical encounters) were compared to the prospective survey results. 196 FARC survey participants and 100 retrospective review subjects were analyzed. 30% of participants from the surveyed cohort and 19% of participants from the retrospective review reported at least 1 accidental ingestion over one year. The rate of accidental ingestions reported in the prospective survey was higher than expected, 10-25% of participants each month, and multiple ingestions were common. Common triggers were milk, wheat, and tree nuts. In the retrospective cohort, the highest rate of accidental ingestion (25.0%) occurred to milk, followed by sesame (20.0%) and egg (18.8%). Rates of anaphylaxis after exposure were high among both the prospective and retrospective cohorts (33.1% and 16.7% respectively). Accidental ingestion rates were high among food allergic patients. Multiple exposures, especially to milk, were common. Incidence of anaphylaxis was also high, suggesting that ongoing patient education around allergen avoidance and accidental exposure is imperative.