All Publications

  • Emotional stress and reproduction: what do fertility patients believe? Journal of assisted reproduction and genetics Negris, O., Lawson, A., Brown, D., Warren, C., Galic, I., Bozen, A., Swanson, A., Jain, T. 2021


    PURPOSE: To better understand the beliefs about a causal role of emotional stress maintained by women seeking fertility care.METHODS: A cross-sectional, self-administered survey was distributed to fertility care patients at an academic fertility center in Illinois. Of 5000 consecutive patients, 1460 completed the survey and were included in the study sample.RESULTS: Members of our sample (N = 1460) were between 20 and 58 years (mean = 36.2, SD = 4.4). Most respondents were White (72.2%), were in a heterosexual relationship (86.8%), and felt that their physician understood their cultural background (79.4%). Of the sample, 28.9% believed emotional stress could cause infertility, 69.0% believed emotional stress could reduce success with fertility treatment, and 31.3% believed that emotional stress could cause a miscarriage, with evidence of significant racial differences. Less than a quarter (23.8%) of the sample believed emotional stress had no impact on fertility. Lower household income and educational attainment were associated with a greater belief in emotional stress as a causative factor in reproduction with regard to infertility, fertility treatment, and miscarriage.CONCLUSION: The majority of women seeking fertility care believe emotional stress could reduce the success of fertility treatment. Furthermore, beliefs about emotional stress and reproduction significantly differ based on race/ethnicity, income, and education. Particular attention should be paid to specific groups of women who may more likely not be aware of the lack of a proven biological relationship between emotional stress and reproduction.

    View details for DOI 10.1007/s10815-021-02079-3

    View details for PubMedID 33548005

  • Prevalence and characteristics of peanut allergy in US adults. The Journal of allergy and clinical immunology Warren, C., Lei, D., Sicherer, S., Schleimer, R., Gupta, R. 2021


    BACKGROUND: Peanut allergy (PA) is the leading pediatric food allergy and a common cause of anaphylaxis. Little is known, however, on the prevalence and characteristics of PA in the adult population and whether phenotypic differences exist between adult-onset and childhood-onset PA.OBJECTIVES: This study describes the current US population-level burden of adult PA.METHODS: A cross-sectional food allergy survey was administered via phone and web in 2015 and 2016, resulting in nationally representative complex-survey weighted data for 40,443 adults. Reported food allergies were considered "convincing" if symptoms to specific allergens were consistent with an IgE-mediated reaction.RESULTS: The prevalence of current self-reported PA was 2.9% among US adults, with 1.8% having convincing PA. Over 17% of adults with peanut allergy reported onset of their PA in adulthood. In adults with childhood-onset PA, 75.4% reported physician-diagnosed PA, compared with only 58.9% of adult-onset PA. Despite a similar frequency of food allergy-related emergency department visits within the past year (approximately 1 in 5 adults with PA allergy), adults with childhood-onset PA were significantly more likely to have a current epinephrine prescription compared with those with adult-onset PA (56% vs 44% respectively; P= .02) and were more likely to use an epinephrine autoinjector (48% vs 35%, P= .01).CONCLUSIONS: Approximately 4.6 million US adults have PA-over 800,000 of whom appear to have developed their PAafter age 18 years. Further examination of phenotypic differences between childhood-onset and adult-onset PA may improve understanding and management of adult PA.

    View details for DOI 10.1016/j.jaci.2020.11.046

    View details for PubMedID 33579526

  • Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial. Pediatrics Gupta, R. S., Fierstein, J. L., Boon, K. L., Kanaley, M. K., Bozen, A., Kan, K., Vojta, D., Warren, C. M. 2021; 147 (1)


    Although sensor-based monitoring of daily inhaled corticosteroids (ICSs) and short-acting ?-agonist medications may improve asthma outcomes, the effectiveness of these interventions in diverse pediatric populations remains unclear.Caregiver and child dyads were randomly assigned to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. End points included Asthma Control Test scores (?19 indicated asthma control) and asthma health care use. Caregiver quality of life (QoL) and child ICS adherence were also assessed. Multilevel models were used to estimate adjusted changes from baseline.Dyads were assigned to the control (n = 127) or intervention (n = 125) arms. At the end line, the mean Asthma Control Test score increased from 19.1 (SE = 0.3) to 21.8 (SE = 0.4) among the intervention and from 19.4 (SE = 0.3) to 19.9 (SE = 0.4) among the control (?intervention-control = 2.2; SE = 0.6; P < .01). Adjusted rates of emergency department visits and hospitalizations among the intervention were significantly greater (incidence rate ratioemergency department = 2.2; SE = 0.5; P < .01; incidence rate ratiohospital = 3.4; SE = 1.4; P < .01) at endline than the control. Caregiver QoL was greater among the intervention at the endline (?intervention-control = 0.3; SE = 0.2; P = .1) than the control.Findings suggest that sensor-based inhaler monitoring with clinical feedback may improve asthma control and caregiver QoL within diverse populations. Higher health care use was observed among the intervention participants relative to the control, indicating further refinement is warranted.

    View details for DOI 10.1542/peds.2020-1330

    View details for PubMedID 33386336

  • Food Allergy-Related Bullying and Associated Peer Dynamics Among Black and White Children in FORWARD Study. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Brown, D., Negris, O., Gupta, R., Herbert, L., Lombard, L., Bozen, A., Assa'ad, A., Chura, A., Andy-Nweye, A. B., Fox, S., Mahdavinia, M., Tobin, M., Robinson, A., Sharma, H., Coleman, A., Jiang, J., Bilaver, L., Fierstein, J. L., Galic, I., Newmark, P., Pongracic, J. A., Pappalardo, A. A., Warren, C. 2020


    BACKGROUND: The experiences of Black children with food allergy (FA) are not well characterized, particularly with respect to bullying victimization and other psychosocial outcomes.OBJECTIVE: To examine bullying experiences of Black and White children with FA, as well as associations with peer relationships, anxiety and school policies.METHODS: Surveys were administered to parents of 252 children with physician- diagnosed FA enrolled in the multi-site FORWARD cohort. Surveys assessed demographics, atopic disease, bullying victimization, and school FA management practices and policies. Descriptive statistics of bullying by race were compared via chi- squared tests. Multiple logistic regression analyses adjusting for race, age, parental education, household income, child gender and multi-FA compared adjusted probabilities of bullying victimization by school policies.RESULTS: Nearly 20% of school-aged children were bullied for FA with no significant racial differences overall, though for children ages 11 and up, Whites reported higher rates of bullying. However, Black children experienced non FA-related bullying twice as frequently as White children (38.6% vs. 17.7%; p=.002). The majority (85.7%) of caregivers who intervened in their child's bullying reported it was helpful. Among parents, 17.3% reported they were teased/bullied due to their child's FA. Over half of respondents (54.8%) reported that some allergens are banned from their child's school, most commonly peanut. In schools banning peanuts, FA-related bullying was less-frequently reported by all food-allergic students.CONCLUSION: Bullying due to FA is common and caregivers, medical professionals and school administrators can help reduce bullying by screening for bullying and supporting and educating school policies.

    View details for DOI 10.1016/j.anai.2020.10.013

    View details for PubMedID 33157272

  • Parent report of physician diagnosis in pediatric food allergy: An update. The journal of allergy and clinical immunology. In practice Galic, I., Warren, C. M., Jiang, J., Tobin, M. C., Gupta, R. S. 2020

    View details for DOI 10.1016/j.jaip.2020.09.033

    View details for PubMedID 33010522

  • Food Allergy from Infancy Through Adulthood. The journal of allergy and clinical immunology. In practice Sicherer, S. H., Warren, C. M., Dant, C., Gupta, R. S., Nadeau, K. C. 2020; 8 (6): 1854?64


    Food allergies are the result of immune responses that cause adverse reactions to foods. Immune responses to foods may produce a spectrum of symptoms and disorders, including acute allergic reactions and anaphylaxis, food protein-induced allergic proctocolitis, food protein-induced enterocolitis syndrome, food-dependent, exercise-induced anaphylaxis, and oral allergy syndrome (pollen-food allergy syndrome). Food-allergic responses also contribute to chronic inflammatory disorders such as eosinophilic esophagitis and atopic dermatitis. Although food allergy affects people from infancy through adulthood, there are allergic features that differ according to age (ie, presentation, triggers, and natural course) and have important implications for diagnosis, prognosis, and management. New food allergies can develop at any age, and we propose similarities in the etiology of de novo food allergy whether in infancy or adulthood. The approach to managing food allergy changes dramatically over the life course, and physicians and patients must respond accordingly to optimize care. Food allergy therapies are emerging, and the efficacy and safety of these interventions could differ by age group of those treated. In this review, we highlight interesting observations on the etiology and characteristics of food allergy presenting at different ages and discuss clinical management as it relates to life stage.

    View details for DOI 10.1016/j.jaip.2020.02.010

    View details for PubMedID 32499034

  • Egg Allergy in US Children. The journal of allergy and clinical immunology. In practice Samady, W., Warren, C., Wang, J., Das, R., Gupta, R. 2020


    BACKGROUND: Egg allergy is common in young children (<5 years) and has significant negative impacts on quality of life.OBJECTIVE: The objective of this study was to characterize egg allergy prevalence, severity, baked egg tolerance, and other associated factors in a large US cohort.METHODS: A national cross-sectional survey was administered from October 2015-September 2016, resulting in complete parent-proxy responses for 38,408 children. Weighted proportions were estimated to compare egg allergy prevalence and characteristics between key subpopulations.RESULTS: Overall prevalence of current, convincingly egg allergy was 0.9% among all children and 1.3% among children <5 years. Black children were over-represented among children with egg allergy, accounting for 23.4% (95% CI: 13.1-38.4) of egg-allergic children despite comprising 13.2% (12.3-14-2) of the US pediatric population. Among children with egg allergy, 64.2% reported baked egg tolerance and 60.2% had allergy to other foods, with 29.3% having peanut allergy. Asthma was more prevalent in children with an egg allergy than children with other top 8 food allergies (46.5%, (35.8-57.4) vs 33.2% (29.6-37.0), p<0.05). Among children with current egg allergy, those with baked egg tolerance reported that their food allergy resulted in significantly reduced psychosocial burden, relative to their baked egg-allergic counterparts (M=3.1 (2.9-3.3) vs M=3.7 (3.5-3.9).CONCLUSION: Egg allergy is common amongst young children. Nearly two-thirds of children with egg allergy reported baked egg tolerance. Increased efforts are needed to ensure children with egg allergy are appropriately evaluated as many have comorbid allergic disease and determination of baked egg tolerance may improve QoL.

    View details for DOI 10.1016/j.jaip.2020.04.058

    View details for PubMedID 32376485

  • Self-reported Food Allergy and Intolerance among College Undergraduates: Associations with Anxiety and Depressive Symptoms JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY Chen, J., Spleen, A., Adkins, A. E., Dick, D. M., Warren, C. M., Mountcastle, S. B., Spit Sci Working Grp 2020
  • Psychosocial factors and multiple health risk behaviors among early adolescents: a latent profile analysis. Journal of behavioral medicine Warren, C. M., Kechter, A., Christodoulou, G., Cappelli, C., Pentz, M. A. 2020


    Early adolescence is a pivotal developmental period when multiple health risk behaviors, such as obesity and substance use, are often established. Several psychosocial factors, often considered traits, have been independently associated with these increases, including executive function (EF), mindfulness disposition (MD), perceived stress, distress tolerance (DT), and anhedonia. However, these factors have not been evaluated for their conjoint relationships to determine whether different patterns may signal greater or lesser risk for obesity and substance use, and whether the same patterns relate to obesity and substance use in the same ways (same magnitude of risk). To evaluate these patterns, a latent profile analysis was conducted, resulting in a three-profile model. Profile 1 (8% of sample) was characterized by the lowest levels of EF, MD, DT and highest levels of stress and anhedonia, profile 2 (44%) intermediate levels, and profile 3 (48%) the highest levels of EF, MD, DT and lowest levels of stress and anhedonia. Youth classified to profile 1 reported significantly greater levels of both obesogenic and substance use behaviors relative to other profiles. Findings suggest that adolescents engaging in obesogenic and substance use behaviors may share common profiles of psychosocial risk.

    View details for DOI 10.1007/s10865-020-00154-1

    View details for PubMedID 32323118

  • Epidemiology and Burden of Food Allergy. Current allergy and asthma reports Warren, C. M., Jiang, J., Gupta, R. S. 2020; 20 (2): 6


    PURPOSE OF REVIEW: In recent decades, food allergy has become an increasing concern for families, clinicians, and policymakers. This review aims to summarize what is currently known about the epidemiology and population-level burden of IgE-mediated food allergy, including its effects on quality of life.RECENT FINDINGS: Prevalence surveys, healthcare utilization data, and findings from longitudinal cohort studies across the globe indicate that food allergy imposes a growing societal burden. Worryingly, recent data indicate that food allergies may be more prevalent among adult populations than previously acknowledged, with many reported cases of adult-onset allergies. While it remains unclear how much of the current population-level burden of disease results from true, IgE-mediated allergy, as much epidemiological data does not incorporate clinical confirmation of disease prevalence-it is clear that affected individuals suffer impairments in their quality of life and incur substantial economic costs-beyond the physical health burden imposed by anaphylaxis.

    View details for DOI 10.1007/s11882-020-0898-7

    View details for PubMedID 32067114

  • Advancing Food Allergy Through Epidemiology: Understanding and Addressing Disparities in Food Allergy Management and Outcomes. The journal of allergy and clinical immunology. In practice Warren, C. M., Turner, P. J., Chinthrajah, R. S., Gupta, R. S. 2020


    Epidemiological studies have been pivotal in advancing understanding of the etiology of food allergy and in guiding the development of evidence-based guidelines for food allergy prevention and clinical management. In recent years, as research into the population-level distribution and determinants of food allergy has accumulated, data indicate that substantial differences in food allergy outcomes and management exist across racial/ethnic and other socioeconomic strata. This clinical commentary aims to provide a review of existing epidemiological studies and shed valuable light on the disparate burden of food allergy. Emerging methods to quantify environmental exposure and food allergy outcomes are detailed, as are specific areas in which future research is warranted. We also highlight the role that epidemiology plays in advancing health equity and provide a framework as to how it can effectively inform health policy at all phases of the policy cycle-from initial population health assessment to the evaluation and refinement of specific health policies (ie, national guidelines to promote earlier introduction of peanut-containing foods for allergy prevention).

    View details for DOI 10.1016/j.jaip.2020.09.064

    View details for PubMedID 33065370

  • Barriers to Food Allergy Management Among Low-Income Americans. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Bozen, A., Zaslavsky, J. M., Cohn, D., Samady, W., Lombard, L., Nadeau, K., Tobin, M., Warren, C. M., Gupta, R. S. 2020

    View details for DOI 10.1016/j.anai.2020.05.007

    View details for PubMedID 32437837

  • Prevalence and Characteristics of Shellfish Allergy in the Pediatric Population of the United States. The journal of allergy and clinical immunology. In practice Wang, H. T., Warren, C. M., Gupta, R. S., Davis, C. M. 2020


    Shellfish allergy (SA) is one of the most common food allergies causing anaphylaxis in adults and children. There are limited data showing the prevalence of SA in US children.To determine the prevalence and reaction characteristics of SA in the US pediatric population.A cross-sectional food allergy prevalence survey was administered via phone and the Web by the National Opinion Research Center at the University of Chicago from 2015 to 2016. Point prevalence SA estimates, complex survey weighted proportions, and 95% CIs were determined. Relative proportions of demographic characteristics were compared using weighted Pearson ?2 statistics.The prevalence of SA was 1.3% (95% CI, 1.1-1.5), with more children allergic to crustaceans (1.2%; 95% CI, 1.0-1.3) than to mollusks (0.5%; 95% CI, 0.4-0.6). Mean ages of shellfish, crustacean, and mollusk allergy diagnoses were 5.0 (95% CI, 4.4-5.6), 5.1 (95% CI, 4.6-5.6), and 7.7 (95% CI, 5.7-9.7) years, respectively. More than half (54.9%; 95% CI, 48.1-61.4) of pediatric patients with SA had more than 1 lifetime food allergy-related emergency room visit, but only 45.7% (95% CI, 39.2-52.4) carried an epinephrine autoinjector. Children with SA were more likely to be black/Hispanic/Latino and have comorbid asthma, allergic rhinitis, or a parental history of asthma, environmental, or other food allergies (P < .001).The epidemiology of SA in the US pediatric population shows that crustacean allergy is more common than mollusk allergy. A disparity in SA children and epinephrine autoinjector carriage exists. Results from this study will lead to increased awareness of the need for detailed histories, specific diagnostic tests, and rescue epinephrine for anaphylaxis in US children with SA.

    View details for DOI 10.1016/j.jaip.2019.12.027

    View details for PubMedID 31917365

  • Prevalence and Severity of Food Allergies Among US Adults. JAMA network open Gupta, R. S., Warren, C. M., Smith, B. M., Jiang, J., Blumenstock, J. A., Davis, M. M., Schleimer, R. P., Nadeau, K. C. 2019; 2 (1): e185630


    Importance: Food allergy is a costly, potentially life-threatening condition. Although studies have examined the prevalence of childhood food allergy, little is known about prevalence, severity, or health care utilization related to food allergies among US adults.Objective: To provide nationally representative estimates of the distribution, severity, and factors associated with adult food allergies.Design, Setting, and Participants: In this cross-sectional survey study of US adults, surveys were administered via the internet and telephone from October 9, 2015, to September 18, 2016. Participants were first recruited from NORC at the University of Chicago's probability-based AmeriSpeak panel, and additional participants were recruited from the non-probability-based Survey Sampling International (SSI) panel.Exposures: Demographic and allergic participant characteristics.Main Outcomes and Measures: Self-reported food allergies were the main outcome and were considered convincing if reported symptoms to specific allergens were consistent with IgE-mediated reactions. Diagnosis history to specific allergens and food allergy-related health care use were also primary outcomes. Estimates were based on this nationally representative sample using small-area estimation and iterative proportional fitting methods. To increase precision, AmeriSpeak data were augmented by calibration-weighted, non-probability-based responses from SSI.Results: Surveys were completed by 40?443 adults (mean [SD] age, 46.6 [20.2] years), with a survey completion rate of 51.2% observed among AmeriSpeak panelists (n=7210) and 5.5% among SSI panelists (n=33?233). Estimated convincing food allergy prevalence among US adults was 10.8% (95% CI, 10.4%-11.1%), although 19.0% (95% CI, 18.5%-19.5%) of adults self-reported a food allergy. The most common allergies were shellfish (2.9%; 95% CI, 2.7%-3.1%), milk (1.9%; 95% CI, 1.8%-2.1%), peanut (1.8%; 95% CI, 1.7%-1.9%), tree nut (1.2%; 95% CI, 1.1%-1.3%), and fin fish (0.9%; 95% CI, 0.8%-1.0%). Among food-allergic adults, 51.1% (95% CI, 49.3%-52.9%) experienced a severe food allergy reaction, 45.3% (95% CI, 43.6%-47.1%) were allergic to multiple foods, and 48.0% (95% CI, 46.2%-49.7%) developed food allergies as an adult. Regarding health care utilization, 24.0% (95% CI, 22.6%-25.4%) reported a current epinephrine prescription, and 38.3% (95% CI, 36.7%-40.0%) reported at least 1 food allergy-related lifetime emergency department visit.Conclusions and Relevance: These data suggest that at least 10.8% (>26 million) of US adults are food allergic, whereas nearly 19% of adults believe that they have a food allergy. Consequently, these findings suggest that it is crucial that adults with suspected food allergy receive appropriate confirmatory testing and counseling to ensure food is not unnecessarily avoided and quality of life is not unduly impaired.

    View details for PubMedID 30646188

  • Prevalence and Severity of Sesame Allergy in the United States. JAMA network open Warren, C. M., Chadha, A. S., Sicherer, S. H., Jiang, J., Gupta, R. S. 2019; 2 (8): e199144


    Sesame allergy is of growing concern in the United States. The US Food and Drug Administration recently issued a request for epidemiological data on the prevalence and severity of sesame allergies in the United States to inform possible regulatory action requiring sesame to be labeled as an allergen on packaged foods.To provide current estimates of the prevalence, severity, distribution, and clinical characteristics of sesame allergy in the United States.This cross-sectional study assessed findings of web- and telephone-based food allergy questionnaires. Study participants were first recruited from NORC (National Opinion Research Center) at the University of Chicago's probability-based AmeriSpeak panel, and additional participants were recruited through Survey Sampling International. Surveys were administered to a nationally representative sample of 51?819 US households from October 1, 2015, through September 31, 2016. Responses for 40?453 adults and 38?408 children were included in the analysis. Data were analyzed from January 1, 2017, through May 1, 2019.Demographic and allergic characteristics of participants.Self-reported sesame allergy was the main outcome and was considered convincing if reported symptoms to sesame-allergic reactions were consistent with an IgE-mediated reaction. Diagnostic history of specific allergens and use of food allergy-related health care services were also primary outcomes.Using survey responses from 78 851 individuals, an estimated 0.49% (95% CI, 0.40%-0.58%) of the US population reported a current sesame allergy, whereas 0.23% (95% CI, 0.19%-0.28%) met symptom-report criteria for convincing IgE-mediated allergy. An additional 0.11% (95% CI, 0.08%-0.16%) had a sesame allergy reported as physician diagnosed but did not report reactions fulfilling survey-specified convincing reaction symptoms. Among individuals with convincing IgE-mediated sesame allergy, an estimated 23.6% (95% CI, 16.9%-32.0%) to 37.2% (95% CI, 29.2%-45.9%) had previously experienced a severe sesame-allergic reaction, depending on the definition used, and 81.6% (95% CI, 71.0%-88.9%) of patients with convincing sesame allergy had at least 1 additional convincing food allergy. Roughly one-third of patients with convincing sesame allergy (33.7%; 95% CI, 26.3%-42.0%) reported previous epinephrine use for sesame allergy treatment.These data indicate a substantial burden of sesame allergy and provide valuable context to physicians and policy makers in their efforts to evaluate and reduce the public health burden of sesame allergy. Moreover, the relatively low rates of physician diagnosis observed among individuals with convincing IgE-mediated sesame allergy seem to indicate the need for clear diagnosis and appropriate management.

    View details for DOI 10.1001/jamanetworkopen.2019.9144

    View details for PubMedID 31373655

    View details for PubMedCentralID PMC6681546

  • Prevalence and characteristics of adult shellfish allergy in the United States. The Journal of allergy and clinical immunology Warren, C. M., Aktas, O. N., Gupta, R. S., Davis, C. M. 2019; 144 (5): 1435?38.e5

    View details for DOI 10.1016/j.jaci.2019.07.031

    View details for PubMedID 31401288

    View details for PubMedCentralID PMC6842441

  • The prevalence of atopic dermatitis in children with food allergy. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Samady, W., Warren, C., Kohli, S., Jain, R., Bilaver, L., Mancini, A. J., Gupta, R. 2019; 122 (6): 656?57.e1

    View details for DOI 10.1016/j.anai.2019.03.019

    View details for PubMedID 30922954

  • Food protein-induced enterocolitis syndrome in the US population-based study. The Journal of allergy and clinical immunology Nowak-Wegrzyn, A., Warren, C. M., Brown-Whitehorn, T., Cianferoni, A., Schultz-Matney, F., Gupta, R. S. 2019; 144 (4): 1128?30

    View details for DOI 10.1016/j.jaci.2019.06.032

    View details for PubMedID 31288044

  • Eosinophilic esophagitis and allergic comorbidities in a US population-based study. Allergy Cianferoni, A., Warren, C. M., Brown-Whitehorn, T., Schultz-Matney, F., Nowak-Wegrzyn, A., Gupta, R. S. 2019

    View details for DOI 10.1111/all.14148

    View details for PubMedID 31846078

  • The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States PEDIATRICS Gupta, R. S., Warren, C. M., Smith, B. M., Blumenstock, J. A., Jiang, J., Davis, M. M., Nadeau, K. C. 2018; 142 (6)
  • The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States. Pediatrics Gupta, R. S., Warren, C. M., Smith, B. M., Blumenstock, J. A., Jiang, J., Davis, M. M., Nadeau, K. C. 2018


    : media-1vid110.1542/5840360268001PEDS-VA_2018-1235Video Abstract BACKGROUND: Childhood food allergy (FA) is a life-threatening chronic condition that substantially impairs quality of life. This large, population-based survey estimates childhood FA prevalence and severity of all major allergenic foods. Detailed allergen-specific information was also collected regarding FA management and health care use.METHODS: A survey was administered to US households between 2015 and 2016, obtaining parent-proxy responses for 38408 children. Prevalence estimates were based on responses from NORC at the University of Chicago's nationally representative, probability-based AmeriSpeak Panel (51% completion rate), which were augmented by nonprobability-based responses via calibration weighting to increase precision. Prevalence was estimated via weighted proportions. Multiple logistic regression models were used to evaluate FA predictors.RESULTS: Overall, estimated current FA prevalence was 7.6% (95% confidence interval: 7.1%-8.1%) after excluding 4% of children whose parent-reported FA reaction history was inconsistent with immunoglobulin E-mediated FA. The most prevalent allergens were peanut (2.2%), milk (1.9%), shellfish (1.3%), and tree nut (1.2%). Among food-allergic children, 42.3% reported ?1 severe FA and 39.9% reported multiple FA. Furthermore, 19.0% reported ?1 FA-related emergency department visit in the previous year and 42.0% reported ?1 lifetime FA-related emergency department visit, whereas 40.7% had a current epinephrine autoinjector prescription. Prevalence rates were higher among African American children and children with atopic comorbidities.CONCLUSIONS: FA is a major public health concern, affecting 8% of US children. However, >11% of children were perceived as food-allergic, suggesting that the perceived disease burden may be greater than previously acknowledged.

    View details for PubMedID 30455345

  • Parental and parent-perceived child interest in clinical trials for food allergen immunotherapy. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Kao, L. M., Greenhawt, M. J., Warren, C. M., Siracusa, M., Smith, B. M., Gupta, R. S. 2018; 120 (3): 331?33.e1

    View details for DOI 10.1016/j.anai.2017.12.012

    View details for PubMedID 29508722

  • Food Allergy-Related Risk-Taking and Management Behaviors Among Adolescents and Young Adults. journal of allergy and clinical immunology. In practice Warren, C. M., Dyer, A. A., Otto, A. K., Smith, B. M., Kauke, K., Dinakar, C., Gupta, R. S. 2017


    Food allergy (FA) affects 8% of children and adolescents in the United States. Nearly 40% of those affected have experienced severe reactions. Fatal food-induced anaphylaxis is most common among adolescents and young adults (AYA); however, FA-related risk behaviors persist in this population and factors associated with these behaviors remain unclear.To characterize FA-related risk-taking and self-management behaviors of AYA with FA.A cross-sectional survey was administered to 200 AYA with FA. Latent class analysis was used to identify distinct behavioral risk classes and predictors of risk class membership.Two distinct FA behavioral risk classes were identified, representing less (N = 120) and more (N = 80) risky subpopulations. After adjusting for age, sex, and anaphylaxis history, odds of more risky class membership were significantly reduced for AYA with peanut allergy (odds ratio [OR], 0.27; 95% CI, 0.11-0.65), supportive female friends (OR, 0.27; 95% CI, 0.07-0.99), overprotective mothers (OR, 0.42; 95% CI, 0.18-0.97), teachers who are aware of their FA (OR, 0.39; 95% CI, 0.17-0.91), a history of being bullied (OR, 0.22; 95% CI, 0.09-0.51), and an established 504 education plan (OR, 0.35; 95% CI, 0.15-0.81). AYA also reported numerous positive outcomes of their FA, such as greater responsibility, empathy, and improved diet, which was significantly associated with reduced odds of risky class membership (OR, 0.38; 95% CI, 0.18-0.80).Among AYA, increased FA-related risk-taking was associated with clinical, demographic, and social factors, including peanut allergy, greater age, as well as absence of social support and specific school FA policies. These associations may be used to inform future interventions designed to address FA-related risk and management behaviors.

    View details for DOI 10.1016/j.jaip.2016.12.012

    View details for PubMedID 28132799

  • The Development of a Clinical Decision Support System for the Management of Pediatric Food Allergy. Clinical pediatrics Otto, A. K., Dyer, A. A., Warren, C. M., Walkner, M., Smith, B. M., Gupta, R. S. 2017; 56 (6): 571?78


    Pediatricians are often first-line providers for children with food allergy. Food allergy management guidelines have been developed but are cumbersome and confusing, and significant variation exists in pediatricians' management practices. We therefore consolidated the guidelines into 5 key steps for pediatricians caring for patients with food allergy and used rapid-cycle improvement methods to create a clinical decision support system to facilitate the management of food allergy in the primary care setting. This report details the development of the Food Allergy Support Tool (FAST), its pilot testing in 4 primary care pediatric practices, and our ongoing efforts to improve its utility and ease of use. Key themes identified during these processes include the importance of both initial and ongoing provider education as well as the limitations of a tool that must be actively initiated by providers.

    View details for DOI 10.1177/0009922816669097

    View details for PubMedID 27798385

  • Quality of Life Among Food Allergic Patients and Their Caregivers. Current allergy and asthma reports Warren, C. M., Otto, A. K., Walkner, M. M., Gupta, R. S. 2016; 16 (5): 38


    Food allergy is increasing in prevalence worldwide. This review summarizes progress made studying relationships between food allergy and quality of life (QOL), with an emphasis on recent work in the field. Early work examining QOL among food allergy patients established that stress and anxiety associated with continuous allergen avoidance and the looming threat of anaphylaxis were associated with significantly impaired food allergy quality of life (FAQOL) for children with food allergy and their caregivers. Recent clinical studies suggest that undergoing oral food challenge to confirm food allergy and oral immunotherapy to treat food allergy may each improve FAQOL among both patients and their caregivers. Other intervention modalities, such as nurse-facilitated counseling and educational workshops, also hold promise, but additional work is needed. Future work must strive to recruit more representative, population-based samples, including adult patients, in order to improve the generalizability and clinical relevance of findings.

    View details for DOI 10.1007/s11882-016-0614-9

    View details for PubMedID 27048239

  • Differences in empowerment and quality of life among parents of children with food allergy. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Warren, C. M., Gupta, R. S., Sohn, M. W., Oh, E. H., Lal, N., Garfield, C. F., Caruso, D., Wang, X., Pongracic, J. A. 2015; 114 (2): 117?25


    Living with food allergy has been found to adversely affect quality of life. Previous studies of the psychosocial impact of food allergy on caregivers have focused on mothers.To describe differences in food allergy-related quality of life (FAQOL) and empowerment of mothers and fathers of a large cohort of children with food allergy.Eight hundred seventy-six families of children with food allergy were studied. Food allergy was defined by stringent criteria, including reaction history, skin prick testing, and specific IgE. Parental empowerment and FAQOL were assessed by the adapted Family Empowerment and FAQOL-Parental Burden scales. Parental scores were compared by Wilcoxon signed rank test. Multiple regression models examined the association of parental empowerment with FAQOL.Mothers reported greater empowerment (P < .001) and lower FAQOL (P < .001) compared with fathers, regardless of allergen severity, type, or comorbidities. However, parental empowerment was not significantly associated with FAQOL for mothers or fathers. Although parents of children with peanut, cow milk, egg, and tree nut allergies were similarly empowered, milk and egg allergies were associated with lower FAQOL (P < .01). Parental concern in the QOL assessment was greatest for items involving fear of allergen exposure outside the home.Parental empowerment and FAQOL vary significantly among mothers and fathers of children with food allergy. Greater effects on FAQOL were seen for milk and egg compared with other food allergies. Although parents of children with food allergy might be empowered to care for their child, they continue to experience impaired FAQOL owing to fears of allergen exposure beyond their control.

    View details for DOI 10.1016/j.anai.2014.10.025

    View details for PubMedID 25492096

  • Quality of Life in Food Allergy Patients and Their Families. Pediatric clinics of North America Walkner, M., Warren, C., Gupta, R. S. 2015; 62 (6): 1453?61


    Pediatric food allergy is a growing health problem in the United States that has been found to adversely impact the quality of life of both affected children and their caregivers. This article provides a review of how food allergy affects the quality of life of patients and their families within the domains of school, social activities, relationships, and daily life. Efforts to improve food allergy-related quality of life among caregivers are also discussed.

    View details for DOI 10.1016/j.pcl.2015.07.003

    View details for PubMedID 26456443

  • The epidemiology of milk allergy in US children. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Warren, C. M., Jhaveri, S., Warrier, M. R., Smith, B., Gupta, R. S. 2013; 110 (5): 370?74


    Milk is one of the most common food allergies in US children, yet little is known about its distribution and diagnosis.To better understand current pediatric milk allergy distribution and diagnosis trends in the United States.A randomized, cross-sectional survey was administered to parents belonging to a representative sample of US households with children from June 2009 to February 2010. Data from 38,480 parents regarding demographic characteristics, allergic symptoms associated with food ingestion, and methods used to diagnose food allergy were collected and analyzed as weighted proportions. Adjusted models were estimated to examine association of these aspects with odds of milk allergy.Of the 3,218 children identified with food allergy, 657 (19.9%) were reported to have milk allergy. Asian (odds ratio [OR], 0.5) and black (OR, 0.4) children were half as likely as white children to develop milk allergy. The highest percentage of milk-allergic children (23.8%) were aged 6 to 10 years, and the lowest percentage of milk-allergic children (15.0%) were aged 11 to 15 years. Nearly one-third (31.4%) of children with milk allergy had a history of severe reactions. Compared with children with other food allergies, children with milk allergy had a higher odds of having physician-diagnosed allergy (OR, 1.7) and were twice as likely (OR, 2.1) to outgrow their milk allergy.Childhood milk allergy, which accounts for one-fifth of US food allergies, is less prevalent among Asian and black children than white children. Although less than half of children with milk allergy received confirmatory testing, it is the most commonly diagnosed food allergy.

    View details for DOI 10.1016/j.anai.2013.02.016

    View details for PubMedID 23622009

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