Thread by @ATLergist

I'm just getting caught up after the break, & still not done. There's been a ton going on recently in the food allergy space, and in particular I want to comment on the recent work by @ruchisgupta that's gotten a lot of press.

(long thread)

jamanetwork.com/journals/jaman…

1. The reporting on the study has frustrated me quite a bit. The headlines have generally delivered clickbait conclusions, with some variation on "only half of people that claim food allergy really have one," suggesting very unhelpfully that many/most food allergies aren't real.

2. It has long been known that food allergy prevalence is overestimated, but very little population-based work has been done in adults prior to this, and none with this amount of rigor. This kind of work is hard to do, & the definitions and expert panel in use here are strengths.

3. Some key findings:

4. Historically the adult prevalence of food allergy was considered to be < 5%. Here the authors estimate that it is roughly twice that, with a whopping 48% reporting onset during adulthood. If this is true, we have no idea why mechanistically adults lose tolerance.

5. Food allergy is nearly twice as common in adult women compared to men. There may be an important clue there (e.g. endocrine?). Interestingly, gender distribution in children is generally boys > girls.

6. Food allergy prevalence in adults is no different across all ranges of household income, from < 25K/yr to >150K/yr. This is not upper middle class or rich people popularizing some sort of fad or preference.

7. Relatedly, prevalence was significantly higher for non-white adults vs. white adults, even after adjusting for covariates like income, educational level, physician diagnosis, etc.

8. Only 24% of adults with 1 or more convincing food allergies reported a current epinephrine prescription. I personally know many well-educated adults with bona fide food allergy who do not have & therefore do not carry autoinjectors despite a risk of anaphylaxis.

9. Some of these folks have had pretty scary near-misses. Almost none of the food-allergic adults I know even have a relationship with an allergist, presumably because they feel we have nothing to offer them.

10. Ultimately, although this work has important limitations, there are several important findings that should spur additional research. It is safe to say that we don't understand adult food allergy very well and that it is likely a much larger problem than we appreciate.

11. This all seems to get lost in the popular coverage, which tends to focus on the real but distracting message of the unreliability of self-report - a shame. Kudos to Ruchi & her team for uncovering some important findings that should help to set an adult research agenda.