AAAAI 2022 Highlights: Research Based on FARE Patient Registry Data

The annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) was held in Phoenix, Feb. 25-28. The hybrid in-person and virtual event included more than 150 talks and posters from FARE-supported researchers and FARE Clinical Network institutions.

Among the posters presented at AAAAI 2022, FARE was excited to find four research projects that used data from the FARE Patient Registry. These projects are summarized below.

Food allergy in adults is associated with more systemic and non-IgE mediated symptoms compared to children

An estimated 26 million American adults have one or more food allergies, but this population is not well studied. Researchers from the University of Wisconsin, a FARE Clinical Network Center of Distinction, used 2017-2021 FARE Patient Registry data to compare the reaction symptoms reported for 2,450 adults aged 18 and older and 4,500 children under age 18.

• The team first observed that adults reported different sets of symptoms than children.
• Digging deeper, the researchers compared self-reported symptoms in both adults and children to parent-reported symptoms in children. They discovered that some symptoms were more likely to be reported by the person experiencing a reaction than by a person describing someone else’s reaction.
• Notably, fatigue, sweating, chest pain and bloating were reported two to four times more often by the reacting individual than by a parent or guardian.

These finding are open to interpretation. It is possible that children and adults are experiencing distinct sets of symptoms, but it is also possible that children lack the language to describe all their symptoms to their caregivers. More research is needed to tease out the underlying reasons that children’s and adults’ reaction symptoms were reported differently.

Reactions from single and multiple food allergies: Participant experiences from the FARE (Food Allergy Research) Patient Registry

Researchers with Genentech and Northwestern University used 2017-2020 data from the FARE Patient Registry to compare individuals with multiple food allergies to those with single food allergies.

• Multiple allergies were more common among Registry participants than among U.S. residents with food allergy. An estimated 40 percent of food-allergic children and 45 percent of food-allergic adults in the U.S. are allergic to more than one food. By comparison, over 80 percent of 5,600 Registry participants reported multiple food allergies.
• Registry participants with multiple food allergies reported allergies to an average of four different foods.
• Roughly half of all Registry participants reported at least one reaction per year.
• Those with multiple food allergies reacted more frequently than those with a single allergy.

Participants with single or multiple food allergies were equally likely to report a recent severe or very severe reactions, but the foods that triggered those reactions differed among the two groups. In participants with a single food allergy, the three foods most likely to have recently caused a severe or very severe reaction were tree nuts, peanut and milk. Peanut and tree nuts were also the most reported allergens eliciting recent severe or very severe reactions in participants with multiple allergies, but their third most reported trigger was “other” foods, which accounted for more of their recent serious reactions than milk, egg or shellfish. 

Food allergic reactions In U.S. schools

At the Elliot and Roslyn Jaffe Food Allergy Institute of the Icahn School of Medicine at Mount Sinai, a FARE Clinical Network Center of Distinction, researchers studied 2017-2020 FARE Patient Registry data to learn more about allergic reactions to food in school settings.

Schools, including preschools, accounted for 7 percent of the self-reported reactions. One hundred sixty-eight (168) children aged 1 to 18 experienced 173 school-located reactions in 35 U.S. states. Half of the children ranged in age from 4 to 10, and 61 percent were male. Most reactions were to peanut (25 percent), milk (19 percent) or tree nuts (16 percent).

Findings from the Registry shed light on the need for stock epinephrine autoinjectors in schools and anaphylaxis recognition and response training for school staff. Among the 41 percent of school-located reactions described as severe or very severe, not all were treated with epinephrine, which was given in only 35 percent of reactions. Less than a third of the reactions (29 percent) resulted in an emergency room visit, and 8 percent resulted in hospitalization.

FARE offers training programs to improve school safety and support for food-allergic children. The Recognizing and Responding to Anaphylaxis and Keeping Students Safe and Included training modules are available free on demand through FARE Food Allergy Academy, FARE’s online learning platform. Offered periodically throughout the year, FARECheck Instructor Training is a cost-effective way to certify food service professionals in educational settings to train their staff in safe food handling practices that protect those with food allergies. Scholarship funding is available to cover the cost of FARECheck Instructor Training for schools with underserved student populations.

Comparison of food allergy in participants with and without comorbid eosinophilic esophagitis from the Food Allergy Research & Education (FARE) Patient Registry

Researchers at Cincinnati Children’s Hospital Medical Center, a FARE Clinical Network Center of Distinction, used FARE Patient Registry data to explore the relationship between IgE-mediated food allergies and eosinophilic esophagitis (EoE), an allergic inflammation of the lining of the esophagus, which is the muscular tube that connects the mouth to the stomach. Survey responses from 309 Registry participants with self-reported EoE were compared to those from 5,776 participants who did not report EoE. The two groups, with and without EoE, were demographically similar and did not differ by age at diagnosis.

• Participants with EoE reported allergies to more foods.
• The two groups were equally likely to report peanut allergy, but those with EoE were more likely to report allergies to other Top 8 food allergens, seeds, other grains, and other legumes.
• Participants reporting EoE were significantly more likely to also report allergic rhinitis (hay fever) and asthma, but both groups reported similar rates of atopic dermatitis (eczema).
• Anaphylaxis and hospitalization were more common in the group reporting EoE.

Given the number and severity of food allergies reported by Registry participants who have both food allergy and EoE, the research team concluded that clinicians may want to consider “a more systemic management strategy” in addressing these patients’ needs.

We thank the researchers, patients and parents who have expanded our understanding of food allergy reactions, symptoms and related conditions by collaborating together through the FARE Patient Registry.

The food-allergic population in the U.S. is demographically diverse, encompassing all ages, races, ethnicities and communities. FARE is working to diversify the Registry through partnerships with community organizations and FARE Clinical Network Centers of Distinction. To learn more about sharing your food allergy story with researchers through the FARE Patient Registry, visit foodallergy.org/registry.